L.A. Care CEO: 650K Member Loss by 2028 from H.R. 1 + State Cuts — Statewide Projection 3M Californians Could Lose Coverage

At the recent CCALAC Symposium, L.A. Care CEO Martha Santana-Chin projected the nation's largest publicly operated health plan will lose up to 650,000 members by 2028 due to H.R. 1 enrollment freezes, work requirements, and state Medi-Cal cuts. Statewide projection: 3 million Californians could lose coverage. Direct revenue impact: every LA County FQHC contracting with L.A. Care as a Medi-Cal MCO partner faces capitation/PMPM revenue compression in the FQHC APM (Alternative Payment Methodology) and per-visit PPS revenue loss as enrollees disenroll. This is the most specific quantification yet of the H.R. 1 + state cuts combined impact for the largest Medi-Cal plan in California. Strategic implication: (1) FQHCs in LA County should immediately model capitation revenue scenarios assuming 15-20% L.A. Care member loss; (2) strengthens case for LA Measure ER (June 2 ballot); (3) APM-participating FQHCs need to revisit risk-share, downside protection, and stop-loss provisions; (4) PPS-billing FQHCs should accelerate enrollment retention investments (eligibility specialists, redetermination outreach). Pairs with the LA DHS $743.6M reserve drawdown — the LA safety-net is now operating under twin contraction pressures.