The Brief

When the head of the nation’s largest publicly operated health plan worries about the looming federal cuts to Medicaid, it’s not just her job. It’s personal.

Martha Santana-Chin, the daughter of Mexican immigrants, 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 L.A. Care, which runs by far the biggest Medi-Cal health plan with more than 2.2 million enrollees, exceeding the Medicaid and Children’s Health Insurance Program enrollments in 41 states.

“If it weren’t for safety nets like the Medi-Cal program, I think, many people would be stuck in poverty without an 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 steering L.A. Care, Santana-Chin is grappling with federal and state spending cuts that complicate her task of providing health care to the poor and medically vulnerable enrollees in Medicaid. The insurer also provides Affordable Care Act marketplace plans through Covered California.

Santana-Chin warns that the GOP’s One Big Beautiful Bill Act, enacted last year and also known as HR 1, could result in 650,000 enrollees falling off L.A. Care’s Medi-Cal rolls by the end of 2028. This will strain the plan’s finances as revenues decline. The insurer had revenues of $11.7 billion in the last fiscal year.

HR 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 runs Medi-Cal.

Like other states facing big deficits, California has reduced its Medicaid spending through such steps as freezing new enrollments for immigrants without legal status and reintroducing an asset limit. And that’s before the state reckons with the spending cuts that likely will be required by the withdrawal of so many federal dollars under HR 1.

Santana-Chin oversaw Medi-Cal and Medicare operations for the for-profit insurer Health Net before taking the helm of L.A. Care in January 2025, nearly three years after state regulators fined L.A. Care $55 million over violations they said compromised the health and safety of its members. L.A. Care paid $27 million in penalties to the state and agreed to contribute $28 million to community health projects.

In a wide-ranging interview, Santana-Chin talked to KFF Health News senior correspondent Bernard J. Wolfson about the financial headwinds facing L.A. Care and why she believes health care shouldn’t be restricted based on a person’s immigration status. This interview has been edited for length and clarity.

Q: You 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 that we’re serving are just like my family. They’ve struggled and have had to have their own children translate things that were very difficult to translate. I remember doing that for my own mother. You know, basic human dignity requires that you have access to health care.

Martha Santana - Chin, CEO of L.A. Care, is the daughter of Mexican immigrants and was a beneficiary of Medi - Cal throughout her childhood. Because of that experience, she says, the concerns of L.A. Care members resonate with her on a personal level.

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Bernard J. Wolfson

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KFF Health News

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Q: Has anything you’ve dealt with at Health Net or L.A. Care reminded you of your childhood experiences in Medi-Cal?

Back then they didn’t cover transportation, and we didn’t have a vehicle. Today, one of the issues we’ll hear from our members is the need to make sure we have trustworthy transportation that shows up on time, where the drivers treat them with respect. Had I had that, had my mother had that, life would have been much easier.

Q: What do you think the impact of HR 1 will be?

It’s going to devastate the delivery system. The state obviously isn’t going to be able to make up for the shortfalls in federal funding, and over the course of the next several years, funding is going to be less and less, and the people we cover are going to decrease significantly. We are expecting between now and the end of 2028 that we’re going to see 650,000 people drop off the rolls. That’s just L.A. Care.

Q: That’s over a quarter of your Medi-Cal enrollment.

Yes, it’s very, very significant. The reductions in payment and the rise in uncompensated care are really going to impact our delivery system. As the delivery system gets destabilized and hospitals and other health care providers are forced to close services or reduce the number of sites they have, it’s going to impact access. And it’s not only going to impact those that lose coverage.

Q: How will L.A. Care respond?

Obviously, we’re going to see a significant drop in revenue. We’re very focused on making sure that we are operating as efficiently as we can operate. And we are looking at creative ways to use technology to empower our people to do higher-level work. Mostly supporting our call center agents with smarter technology that helps them answer questions and resolve problems more quickly. Some of it is automating processes on the claims payment side.

Q: What do you have to say to congressional Republicans who passed HR 1?

We are at a point of inflection in the health care delivery system. And we have to recognize that some of the components of HR 1 will have long-term unintended consequences — maybe they were intended; I’ve got to believe that some of these things are not. There’s probably a need to reconsider some of the things that were passed.

Q: Such as?

Work requirements are an example of something that many people did believe was the right thing to do to be good stewards of the health care dollar. It is very complex and is going to cause people to lose coverage that actually do qualify. It’s unfortunate, and that would be something that I would urge folks 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. If you are a human being and you need health care, you’re going to try to access health care wherever you can. That’s going to put a strain on the delivery system if you’re uninsured.

Q: What has L.A. Care done to address the state’s concerns in 2022 that it delayed authorizing care and addressing patient grievances?

There has been quite a bit of investment in the L.A. Care infrastructure over the last several years — our IT platforms, our data. There’s also quite a bit of investment in adding new capacity, adding bandwidth to many of the teams, more folks to help support the work.

Q: How have federal immigration raids in L.A. affected L.A. Care members and the broader community?

It absolutely has had a chilling effect. Families are afraid to come in. They’re not taking their children to get vaccinated. I’ve had numerous providers in emergency departments say that they have experienced a drop in the volume of individuals coming in. One of our case managers was really distraught because there was an individual that decided to forgo serious lifesaving treatment because of fear.

Take accountability and move forward.

Those were the two points Los Angeles Fire Chief Jaime Moore hit repeatedly when speaking with LAist’s Larry Mantle this week.

On taking accountability, Moore said hazardous conditions and decisions made before the Palisades Fire erupted a year ago meant “our firefighters never had a chance” to arrest the fire that killed 12 people and destroyed thousands of structures.

On moving forward, he emphasized that reform is already in the works.

“Things have changed since the Palisades Fire, and we're going to continue making big changes in the Los Angeles Fire Department,” said Moore, who was selected for the LAFD top job by Mayor Karen Bass in November.

Here are three takeaways from the interview, which aired on AirTalk on Tuesday.

1. Staffing decisions hampered fire response

The LAFD uses a so-called pre-deployment matrix to set firefighter staffing levels ahead of high-risk weather.

According to the department’s after-action report, however, staffing levels on the day the Palisades Fire began fell short of the LAFD standard for extreme weather conditions. The National Weather Service had warned of low humidity, high winds and dry vegetation, what it calls a “particularly dangerous situation.” It’s the highest level of alert the agency can give.

Despite the high risk, the LAFD report said the decision not to deploy more firefighters in advance was in part made to save money.

Moore said Monday that the department has updated its policies to increase staffing for especially hazardous conditions, but he said he doesn’t believe additional resources would have stopped a fire of the magnitude that leveled the Palisades.

To suppress that kind of fire, he said, the department would need to pre-deploy resources across the city’s vast geography — to places like Baldwin Hills, Franklin Canyon, the Hollywood Hills, the Palisades, Porter Ranch and Sunland-Tujunga.

Moore said the department has already made new policies to call for more resources when the Weather Service issues a “particularly dangerous situation” alert.

2. LAFD is mostly an urban firefighting department

Moore referenced a key finding of the after-action report regarding a lack of training in wildland firefighting, which contributed to confusion and struggles to effectively utilize resources during the fire.

Wildland fires pose a number of challenges that are different from what firefighters face in urban environments. Those include the need to coordinate a large number of resources over vast areas, all while dealing with fast-moving flames that can rapidly tear through dry plants and structures.

The department found in its report that fewer firefighters were trained in fighting these wildland fires in recent years and that “leaders struggled to comprehend their roles.”

Some leaders in the department had “limited or no experience in managing an incident of such complexity,” the report said. And some reverted to doing the work of lower positions, leaving high-level decision-making positions unfilled.

“What we're doing now is really furthering that training and reinforcing that education with our firefighters so that they could be better prepared,” Moore said on AirTalk.

3. Changes to the after-action report

Early versions of the after-action report differed from the version released to the public in October, a fact that was first reported by the Los Angeles Times. The Times also reported that Battalion Chief Kenneth Cook, who wrote the report, wouldn’t endorse the final version because of the changes.

Moore acknowledged to the L.A. Board of Fire Commissioners at a Jan. 6 meeting that the report had been watered down.

“It is now clear that multiple drafts were edited to soften language and reduce explicit criticism of department leadership in that final report,” Moore told the commissioners. “This editing occurred prior to my appointment as fire chief, and I can assure you that nothing of this sort will ever again happen while I am fire chief."

Some changes were small but telling. A section titled “Failures” later became “Primary Challenges.”

Moore told LAist that changes between versions “ made it easier for the public to understand,” but an LAist review found the edits weren’t all surface-level.

In the first version of the report, the department said the decision not to fully pre-deploy all available resources for the particularly dangerous wind event “did not align” with their guidelines for such extreme weather cases. The final version said that the initial response “lacked the appropriate resources,” removing the reference to department standards.

The department also removed some findings that had to do with communications.

One sentence from the initial version of the report said: “Most companies lacked a basic briefing, leader’s intent, communications plan, or updated fire information for more than 36 hours.” That language was removed from the final report.

LAist has asked the Fire Department for clarification about why these assertions were removed but did not receive a response before time of publication.

Fans who want a chance to buy tickets to the 2028 Olympic Games have until March 18 to enter the draw, which opens at 7 a.m. Wednesday.

Locals will get the first bite at the apple. A pre-sale for people in L.A., Orange, Riverside, San Bernardino, and Ventura counties will run April 2-6. Certain Oklahoma residents where some Olympic competitions are taking place also will be eligible for the pre-sale.

The first round of ticket sales for all fans will launch April 9. The first round will include tickets to the Opening and Closing ceremonies.

Those selected to buy tickets will get an email with a time slot. After the first round, LA28 says there will be rolling ticket drops. Each person who registers will be able to buy a maximum of 12 tickets.

"Fans are encouraged to register today for the best choice of tickets and events, as capacity may be filled or limited in subsequent drops," the private Olympics organizing committee said in a press release.

Registering once will enter applicants into all future draws to purchase Olympic tickets until they've maxed out ticket purchases, according to LA28.

At a press conference Tuesday outside the L.A. Memorial Coliseum, Olympics organizers also provided more details on ticket prices for the first time. One million tickets will sell for $28 a pop and around a third of tickets will be under $100, according to LA28 Chair Casey Wasserman.

That means the majority of tickets to the Olympic Games will run into triple digits. If the World Cup is any indication, some tickets could get astronomically pricey.

Tickets to the Paralympic Games will go on sale next year.