Where things stand in Central California 1 month after a community hospital's closure

Officials are still weighing a number of options to revive Madera (Calif.) Community Hospital about one month after the facility, located in California's Central Valley region, shuttered its doors. 

The closure of Madera County's sole hospital has led to a domino effect around care access for its 160,000 residents and signaled much larger financial and operational issues for many of the state's hospitals. 

Madera Community officially shut its doors at midnight on Dec. 30, after Trinity Health's plan to buy the hospital fell through. Both Madera and neighboring Fresno County had declared states of emergency by Jan. 3 over care access issues stemming from the hospital closure. On Jan. 10, Madera Community's three affiliated clinics in Madera, Mendota and Chowchilla, Calif., also closed. 

Madera's 106-bed hospital and clinics ultimately closed because of the inability to keep up with the rising costs of care, and most of its patients were on Medi-Cal. Enrollment increases have come without higher rates to cover costs, leading to $2.5 million in losses every month for the hospital, Rob Poythress, county supervisor and member of the hospital's board, told KVPR in a Jan. 30 report

Challenging hospital finances are not exclusive to the Central Valley. 

"These hospitals dependent on these government programs that are paying less than cost, they are being hardest hit," Carmela Coyle, CEO of the California Hospital Association, told KVPR. The state's hospital association has asked Gov. Gavin Newsom for $1.5 billion to be distributed to the most financially burdened facilities. 

Meanwhile, Madera's city council has approved up to $60,000 to pay for consultants tasked with developing plans that could bring more healthcare access back to the community. One such solution being explored is creating a taxpayer-funded healthcare district that could operate a community hospital, according to KVPR

"The first thing we need to do is determine what kind of ongoing revenue sources Madera County has access to for any kind of healthcare provision," Jay Varney, Madera County administrative officer, said of his conversations with consultants, according to the outlet. 

Later this month, consultants are expected to present local officials with a more detailed report. Freshman U.S. Rep. John Duarte has also co-signed a letter with Rep. Jim Acosta requesting federal relief to revive the hospital. 

Another challenge for the region's healthcare system is that in-network contracts expired Dec. 31 between Fresno's largest health system, Clovis, Calif.-based Community Health, and several commercial payers, including UnitedHealthcare, Cigna and Anthem Blue Cross. As of Feb. 3, only UnitedHealthcare is back in network with the health system.

The situation has also had a major impact on vulnerable populations in the region.

Two large state prisons are located in Madera County. With no local hospital, Fresno-area hospitals are seeing an influx of inmates in their facilities, the Fresno Bee reported Jan. 30.

Danielle Campagne, MD, chief of Community Regional Medical Center's emergency department in Fresno, told the newspaper that the unexpected increase in prison patients is "really the straw that's breaking the camel's back."

For undocumented individuals, which make up nearly 10 percent of Madera County's population, the hospital's closure is leaving many with no access to a hospital due to a lack of transportation, the Fresno Bee reported Jan. 23.

"If something happens to farmworkers on the fields around here, how are they going to make it all the way to Fresno?" one woman told the newspaper.

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