At the helm of L.A. Care, the nation’s largest public health plan, Martha Santana-Chin oversees the well-being of over 2.2 million people. But for her, this work is not just professional; it is deeply personal. As a child of Mexican immigrants, she and her family relied on Medi-Cal, California’s Medicaid program, an experience that forged her perspective on the vital importance of a robust public safety net. We sat down with her to discuss how these formative years inform her leadership today, especially as L.A. Care confronts a future of severe federal budget cuts. Our conversation explores the tangible, on-the-ground impact of these financial pressures, the dual role of technology in achieving efficiency while preserving human dignity, and the profound community-wide consequences of policies that instill fear and create complex new barriers to care.
Growing up, your family relied on Medi-Cal but faced challenges like a lack of transportation to appointments. How does that personal experience shape the specific priorities you now set for L.A. Care’s members, and can you share a practical example of a service you’ve championed because of it?
That experience is what motivates me every single day, because I know that so many of the families we serve are walking the same path my family did. I vividly remember being a child and having to translate complex, often frightening, medical information for my mother. It’s a burden no child should have to carry. That sense of vulnerability informs everything we do. A very concrete example is transportation. We didn’t have a car, and the program didn’t cover transport back then, which made getting to a doctor incredibly difficult. So today, I am absolutely focused on ensuring our members have access to trustworthy transportation that arrives on time, with drivers who treat them with the respect and dignity they deserve. It’s a seemingly small thing, but for a parent trying to get a sick child to an appointment, it can make all the difference in the world.
Your organization projects a loss of 650,000 enrollees by 2028, which you warn will destabilize the delivery system. For a family that keeps its coverage, what will this destabilization look like on the ground? Describe the potential ripple effects on their wait times, provider availability, and hospital services.
This is a critical point that is often misunderstood. The destabilization won’t just impact those who lose their coverage; it will create a ripple effect that harms everyone. Imagine 650,000 people—just from our plan alone—suddenly becoming uninsured. That’s a massive increase in uncompensated care that hospitals and clinics will be forced to absorb. This financial strain is immense. For a family that keeps its Medi-Cal card, it means the local community clinic they rely on might have to reduce its hours or even close a site. The nearby hospital might be forced to shut down its pediatric or maternity ward to cut costs. This means longer wait times for a specialist, more crowded emergency rooms, and fewer providers in your neighborhood, forcing you to travel much farther for basic care. The entire system becomes weaker and less accessible for all.
With a significant drop in revenue expected, you are turning to technology to boost efficiency. What specific steps are you taking to ensure these automations improve member support rather than create new barriers or frustrations, and what metrics will you use to track the real-world impact on patient care?
Our focus with technology is not to replace people but to empower them. We’re facing a significant drop from our $11.7 billion in revenue, so we have to be smarter. Instead of routing members to frustrating automated menus, we’re investing in smarter technology that assists our human call center agents. The goal is to give them the tools to answer questions and resolve problems on the first call, without needing to transfer someone multiple times. We’re also automating back-end processes, like claims payments, which frees up our staff to focus on higher-level work and more direct member interaction. We’ll be tracking metrics like first-call resolution rates, member satisfaction scores, and the time it takes to resolve an issue. Success for us means technology makes our human support faster, more effective, and more compassionate, not more distant.
The implementation of work requirements for Medicaid is often cited as a key challenge. Could you walk through a practical, step-by-step example of how a fully eligible person might inadvertently lose their health coverage due to these complex new rules and administrative burdens?
The complexity is precisely the problem. Imagine a single mother working two part-time jobs in the gig economy. Her hours fluctuate week to week. First, she receives a thick packet of paperwork in the mail that she struggles to understand after a long day. To prove her work hours, she needs to collect pay stubs from multiple employers and submit them by a strict deadline. One month, her hours dip slightly below the requirement because her child was sick, and she had to miss a few shifts. She may not even realize this puts her coverage at risk. Or perhaps the reporting website is confusing, or she misses the deadline because she was simply overwhelmed. Suddenly, she gets a notice that her coverage is terminated, even though she is working and completely qualifies. It’s a classic case of an administrative hurdle causing a truly eligible person to fall through the cracks of a system that is too rigid to accommodate the realities of low-wage work.
Providers have reported a “chilling effect” from immigration enforcement, causing people to forgo even lifesaving care. How does this fear, combined with state-level freezes on enrollment for certain immigrants, impact broader community health? Please share an example of the consequences you are seeing in L.A. County.
The “chilling effect” is devastatingly real, and it poisons the health of the entire community. When families are afraid to interact with any official system, they avoid essential care. We hear from pediatricians that parents are not bringing their children in for routine vaccinations, which creates a very real risk of preventable outbreaks like measles that can affect everyone. The most heartbreaking stories come from our case managers. I recall one who was distraught because a patient she was working with chose to forgo a serious, lifesaving treatment due to overwhelming fear of enforcement. When you combine this terror with state-level freezes on enrollment, you create a large population of uninsured and fearful people who will only seek care when they are in a desperate crisis. This puts an enormous strain on our emergency rooms and ultimately makes the entire community less healthy and safe.
In 2022, L.A. Care was cited for delaying patient care and mishandling grievances. Beyond adding staff, what specific infrastructural or procedural changes have you implemented to rebuild trust and ensure members receive timely authorizations and have their concerns resolved effectively? Please detail the process.
Rebuilding that trust has been a top priority, and it required more than just hiring more people. We’ve undertaken a significant, multi-year investment in our core infrastructure. First, we focused on our technology. We’ve modernized our IT platforms and data systems to create a more seamless and transparent process. This ensures that when a provider submits a request for care, it’s tracked efficiently and doesn’t fall through the cracks of an outdated system. Second, while we did add more people to our teams, we also invested in their capacity and bandwidth, giving them better tools and training. This allows them to manage their caseloads more effectively and provide the thoughtful attention each member’s case deserves. It’s about building a robust, responsive system from the ground up, so that timeliness and accountability are built into the process, not just hoped for.
What is your forecast for the future of public health safety nets, like Medi-Cal, given the current financial and political pressures?
I believe we are at a critical point of inflection. My forecast is one of immense strain, but also one that demands innovation. The financial pressures from policies like HR 1 are not abstract; they represent a potential loss of coverage for hundreds of thousands of our members and a direct threat to the stability of our entire delivery system. Without a serious reconsideration of these deep cuts, the safety net will be stretched to its breaking point. However, this crisis is also forcing us to operate more efficiently and find creative solutions. My ultimate forecast is that the survival and strength of these safety nets will depend on our collective ability to recognize that their erosion doesn’t just harm the most vulnerable—it destabilizes the health and well-being of our entire community. We have to make the case that these programs are not just an expense, but an essential investment in a healthy society.
