Did low reimbursement or abortion rules kill Madera’s hospital lifeline?

Sifting through the financial rubble of Madera Community Hospital has created more questions than answers.

Madera Community Hospital shuttered two months ago in large part due to the low Medi-Cal reimbursement rates provided to the hospital. 

But as Madera residents remain without a hospital, new information has been revealed surrounding the failure of Trinity Health and the state to come to a deal for the Roman Catholic healthcare provider to merge with Madera Community Hospital. 


The backstory: Trinity Health, which operates Fresno’s Saint Agnes Medical Center, initially had a deal in place to take over Madera Community Hospital last year as the region’s lone hospital drew closer to bankruptcy. 

  • But Attorney General Rob Bonta placed a certain set of conditions on the deal, including price rate caps on all hospital services for five years. Trinity Health backed out, and Madera Community Hospital was left without a buyer. 

The big picture: Trinity Health sent an email to Bonta’s office last June discussing the parameters of the deal revealed that low reimbursements from private insurance health plans also played a major factor in Madera Community Hospital’s dire financial situation, according to a report from Fresnoland.

  • Per the email, over 70 percent of all privately insured patients in Madera County traveled elsewhere for hospital. The numbers for City of Madera residents came in even higher at 80 percent. 
  • “For these reasons, managed care plans do not face significant risks of MCH is not in their networks,” Trinity Health wrote. “They can therefore refuse to pay MCH rates which would allow its viability.” 
  • Trinity Health also took issue with the proposed cap of 150 percent of Medicare for out-of-network emergency services and the proposed cap of 110 percent of Medi-Cal fee-for-service for Medi-Cal managed care organization business. Trinity Health sought out caps at 275 percent and 150 percent, respectively. 

State of play: Another possible factor in the hospital’s closure is Trinity Health’s refusal to perform or provide formal referrals for abortions or certain contraceptive services given its state as a Roman Catholic health care provider. 

  • John Gerardi, the executive director of Right to Life Central California, raised the point in an op-ed with GV Wire, wondering if part of the conditions that caused Trinity Health to walk included abortion and contraceptive services. 
  • “It would be a disgrace if Mr. Bonta (a fierce proponent of legal abortion) were so obstinate as to insist that Saint Agnes abandon its moral principles as a term of the merger,” Gerardi wrote. “The people of Madera County deserve to know if Attorney General Bonta preferred that there be no general hospital in Madera, rather than a Catholic one.”
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