The State of California is considering a budget proposal that would disrupt access to healthcare for tens of thousands of local Medi-Cal members with unsatisfactory immigration status. As CEO of CenCal Health, the local Medi-Cal managed care plan serving Santa Barbara and San Luis Obispo counties, I see firsthand how health coverage and local access to care supports the well-being of our community.
I wanted to share personally why I am so deeply committed to an alternative model that would preserve comprehensive managed care for all members while addressing a federal compliance issue. My compassion for this beautiful community began as a child, watching my mother dedicate her life to migrant education as a teacher for 40 years at the Santa Maria-Bonita School District. Her love for community began in her early years teaching in East Los Angeles, where she advocated for bilingual education and for children whose dignity, potential, and needs were too often overlooked. I inherited from her a passion for service and equity, and it has shaped the work I have chosen throughout my career.
Nearly 20 years ago, I worked on the development and expansion of Healthy Kids programs for vulnerable children in San Luis Obispo and Santa Barbara counties, alongside leaders like Joel Diringer, Dr. Rene Bravo, Tara Dooley, and MaryEllen Rehse. My role then was to help build the provider network for children regardless of immigration status. I went one by one, doctor to doctor, specialist to specialist — asking, explaining, sometimes begging, and always trying to build trust. That work took years. In truth, the network we rely on today took two decades to build, and it rests on hundreds of conversations, local relationships, and a shared belief that everyone in our communities deserves access to care.
That’s why I am so concerned about the proposal to move some members out of managed care and into a yet-to-be-developed state fee-for-service program. On the Central Coast, CenCal Health serves approximately 38,000 impacted members, including children, older adults, workers, parents, grandparents, and people with serious and ongoing health needs. This population receives approximately 18,000 mild-to-moderate behavioral health visits each year from therapists who serve under contract with CenCal Health. These are not services that can simply be assumed into existence under fee-for-service. They depend on contracts, relationships, navigation, referral pathways, case management, and a local managed care infrastructure that helps people actually access care.
I also know how strained our providers already are. HR-1 and state budget pressures are landing on physicians, clinics, hospitals, counties, and community partners who are doing everything they can to remain available to Medi-Cal members. Many simply cannot see patients at 100 percent of Medi-Cal fee-for-service rates and survive financially — not because of greed, but because of sustainability, workforce shortages, and the cost of living and practicing on the Central Coast. I have had recent area conversations that make me believe this transition will not work here. The worst-case scenario is not that providers reluctantly work for less. It is that all patients lose access, conditions worsen, and providers reduce services, leave the state, or close.
I am asking legislators to reconsider the state’s proposal and for their support of an alternative endorsed by a broad coalition of physicians, hospitals, advocates, clinics, and health plans. The state has acknowledged that a compliant path exists. The alternative proposal carves out federally sensitive services while preserving comprehensive, local managed care for all. It protects provider relationships, preserves continuity of care for members, supports local access, and maintains infrastructure our community has spent 20 years building. The alternative proposal does not ask the state to ignore compliance or savings. I am asking for a solution that meets the constraints without dismantling access to care for people whose lives depend on it. My community relies on this local managed care infrastructure, and I believe this is the better, safer, and more humane path forward.
