When the head of the nation’s largest state-run health plan worries about looming federal cuts to Medicaid, it’s not just her job. It’s personal.
The daughter of Mexican immigrants, Martha Santana Chen grew up on Medi-Cal, California’s version of Medicaid, the government-run health care program for people with low incomes and disabilities. Today, she is CEO of LA Care, which operates by far the largest Medi-Cal health plan, with more than 2.2 million enrollees, exceeding the number of enrollees in Medicaid and the Children’s Health Insurance Program in 41 states.
“If it weren’t for safety nets like Medi-Cal, I think a lot of people would still be stuck in poverty without the ability to get out,” she said. “For me personally, not having to worry about health care allowed me to really focus on what I needed to focus on, which was my education.”
As she begins her second year leading LA Care, Santana Chen faces difficulty cutting federal and state spending that complicates her mission of providing health care to poor and medically vulnerable Medicaid enrollees. The insurer also offers Affordable Care Act Marketplace plans through Covered California.
Santana Chen warns that the GOP’s Big Beautiful Bill, enacted last year and also known as HR 1, could see 650,000 enrollees fall off L.A. Care’s Medi-Cal rolls by the end of 2028. This would strain the plan’s finances as revenues decline. The insurance company achieved revenues of $11.7 billion in the last fiscal year.
H.R. 1 is expected to cut more than $900 billion from Medicaid over the next 10 years — including $30 billion or more In California, according to the Department of Health Care Services, which administers the Medi-Cal program.
Like other states facing large deficits, California has reduced its Medicaid spending through steps such as freezing new enrollments for immigrants without legal status and reintroducing Medicaid. Asset limit. And that’s before the state takes into account spending cuts that would likely be required by withdrawing so many federal dollars under H.R. 1.
Santana Chen oversaw Medi-Cal and Medicare operations for for-profit insurance company Health Net before taking the helm of LA Care in January 2025, nearly three years after state regulators LA Care fined $55 million Because of violations that they said put the health and safety of their members at risk. LA Care paid $27 million in fines To the state and agreed to contribute $28 million to community health projects.
In a wide-ranging interview, Santana Chen spoke with Bernard J. Wolfson, senior correspondent for KFF Health News, on the financial headwinds facing LA Care and why she believes health care should not be restricted based on a person’s immigration status. This interview has been edited for length and clarity.
Q: I grew up on Medicaid. How has that shaped your views now that you run one of the largest Medicaid plans in the country?
What really motivates me is knowing that many of the people we serve are just like my family. They struggled and had to get their children to translate things that were very difficult to translate. I remember doing it for my mother. As you know, basic human dignity requires that you have access to health care.
Q: Is there anything you dealt with at Health Net or LA Care that reminds you of your childhood Medi-Cal experiences?
At that time they didn’t cover transportation, and we didn’t have a car. Today, one of the issues we will hear from our members is the need to ensure that we have trustworthy transportation that arrives on time, and where drivers treat them with respect. If I had that, if my mother had that, life would be so much easier.
Q: What do you think is the impact of HR1?
It will destroy the delivery system. It is clear that the state will not be able to make up the shortfall in federal funding, and over the next several years, funding will be less and less, and the number of people we cover will decrease dramatically. From now until the end of 2028, we expect to see 650,000 people withdraw from the lists. That’s just LA Care.
Q: This represents more than a quarter of your Medi-Cal enrollment.
Yes, it is very, very important. Reductions in payment and increases in uncompensated care will really impact our delivery system. As the delivery system is destabilized and hospitals and other healthcare providers are forced to close services or reduce the number of sites they have available, this will impact access. This will not only affect those who lose coverage.
Q: How will LA Care respond?
Obviously we’re going to see a significant decline in revenue. We are very focused on making sure we operate as efficiently as we can. We look for innovative ways to use technology to enable our employees to do work at a higher level. We often support our call center agents with smarter technology that helps them answer questions and solve problems more quickly. Some of them automate processes on the claims payment side.
Q: What do you have to say to the Republican members of Congress who passed H.R. 1?
We are at an inflection point in the health care delivery system. We must recognize that some components of HR 1 will have unintended consequences in the long term – perhaps they were intended; I have to believe that some of these things are not so. There may be a need to reconsider some of the things that were passed.
Q: Like?
The work requirement is an example of something that many people believe is the right thing to do to be good stewards of their health care dollar. It’s very complicated and will cause people to lose coverage that already qualifies. It’s unfortunate, and it’s something I would urge people to reconsider.
Q: What impact do you expect from California’s decision to freeze Medi-Cal enrollment for immigrants without legal status?
It doesn’t matter what immigration status you are in. If you are a human being and need health care, you will try to get health care wherever you can. This will stress the delivery system if you are not insured.
Q: What has LA Care done to address the state’s concerns in 2022 that it was late in authorizing care and handling patient complaints?
There has been a significant amount of investment in LA Care’s infrastructure over the past several years – our IT platforms, our data. There is also a significant amount of investment in adding new capacity, adding bandwidth for many more teams, and more people to help support the business.
Q: How have the federal immigration raids in Los Angeles affected members of LA Care and the broader community?
It certainly had a chilling effect. Families are afraid to come. They do not take their children to receive vaccination. Many providers in emergency departments have told me that they have seen a decrease in the number of people coming in. One of our case managers was absolutely distraught because there was an individual who had decided to forego serious, life-saving treatment out of fear.