By Soumya Karlamangla
May 24, 2015

Since California’s health insurance program for the poor was expanded under the Affordable Care Act last year, enrollment has exploded, with more than 3.5 million people signing up for the first time. Almost 1 in 3 Californians — a total of 12.2 million people — now receive coverage through Medi-Cal.

But the sudden growth has raised questions about how state officials will serve millions of new beneficiaries and continue paying for the program, which currently costs the state $18 billion a year. There are also other big changes afoot as Medi-Cal switches patients into managed care — a system in which plans coordinate patients’ care to keep costs down — and tries to move beyond its reputation as a health program of last resort.

In February, Jennifer Kent became the director of the state’s Department of Health Care Services, which oversees Medi-Cal. Over the last decade, Kent, 41, has worked in a variety of roles within state government, including as associate director of the agency she now leads.

She oversees the country’s biggest Medicaid program, and a department that manages the spending of more than $90 billion annually with 3,700 employees. The Times recently caught up with her to find out how she and her agency are coping. The interview was edited for length and clarity:

Does it feel overwhelming running such a big program?

Well, it’s probably good that I’ve been inoculated from my previous work at the department. I think it can be overwhelming if you let it. You have to come to this job with a lot of flexibility.

For some people who want a very structured environment, this is maybe not the job for them. I tend to find it interesting.

I run, I go swim in the mornings before I come to work, so I get a lot of good thinking out in the hours before I actually show up in the office.

What have been the biggest challenges?

The Affordable Care Act really put a lot of focus on managed care. That is the organized delivery system of choice across both California and the country. Right now we’re kind of putting all the different pieces in place for the long haul.

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