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A debate over roads may cost Glenn County its only emergency room. 

Glenn Medical Center, a 25-bed hospital in the rural agricultural town of Willows, north of Sacramento, is about to lose its “critical access” title. Without it, administrators say the hospital couldn’t afford to stay open because it would lose its increased Medicare reimbursements and regulatory flexibilities.

Glenn Medical Center received a letter in April from the U.S. Centers for Medicare and Medicaid Services notifying the hospital that it was no longer in compliance with the distance requirement to qualify as “critical access.” That requirement states that hospitals must be more than a 35-mile drive on primary roads — or a 15-mile drive on mountainous or secondary roads — from the next nearest hospital.

The next closest hospital is Colusa Medical Center, which the federal Medicare and Medicaid agency places at 32 miles south of Glenn Medical Center. That makes Glenn County’s hospital three miles short of the qualifying distance for the critical access title. But local health officials and the Willows Fire Department say ambulances and most patients take the “more reliable” route of I-5 and Highway 20, which makes the distance between the hospitals 35.7 miles — far enough to qualify.

About 40% of Glenn County’s 30,000 residents rely on public health insurance programs — Medicaid and Medicare — and 12% live under the poverty line.

“We treat and see and care for a lot of people who are unseen in the community. A lot of behavioral health crises, a lot of justice-involved folks, a lot of elderly, a lot of people without transportation. And we are truly a lifeline for those folks,” said Lauren Still, chief administrative officer at Glenn Medical Center.

Closing the only hospital in this Sacramento Valley county would mean residents would have to travel farther for emergency care and ambulances would take longer responding to 911 calls.

Dr. Jared Garrison, Glenn County’s health officer, said losing the hospital would be a devastating blow to the community. Garrison worries about the elderly who may be afraid to drive at night and people who don’t have transportation to make it out of the county. Heart attacks, strokes, traumatic injuries and overdoses can become more deadly when hospital treatment is delayed.

“If Glenn Medical Center closes, it’s not just a health crisis — it’s an economic and social crisis,” Garrison said. “We’ll see longer emergency response times, job losses, declining local businesses, and worsening health outcomes for our most vulnerable neighbors.”

‘This is not the road people would take’

Both hospitals, Colusa and Glenn, have been at the same location since their construction decades ago. In 2001, Glenn Medical Center was first approved to participate in the federal Critical Access Hospital Program under the same distance rule. Hospital and county health officials say geographically nothing has changed. 

“We tried to send some emails back and forth and say, ‘Hey, this is not the road people would take. This is not the road the ambulance takes. This is just not accurate,’” Garrison said. The “shorter” route, he explained, actually takes longer because it includes a county road that often floods and is primarily used by farm equipment.

The hospital’s appeals to the federal agency have been unsuccessful. Still said she is clinging to one last hope that U.S. Rep. Doug LaMalfa, a Richvale Republican, can make the hospital’s case.

Mark Spannagel, chief of staff at LaMalfa’s office, told CalMatters that no resolution has been reached yet, but that conversations with the federal agency continue and that the hospital’s situation is under “heightened review.”

The federal Medicare and Medicaid agency is supposed to review critical access hospitals’ eligibility periodically. This review started last year and the issue seems to be a reclassification of roads, Spannagel said.

The federal agency did not respond to a CalMatters request for comment about why it changed its decision on the roads.

Peggy Wheeler, vice president of policy at the California Hospital Association, said she is aware of four critical access hospitals in California that received a similar letter. Two of them, Bear Valley Community Hospital in Big Bear Lake and George L. Mee Memorial in Monterey County, have since resolved their cases and will be allowed to keep their “critical access” designation. 

A third, Santa Ynez Valley Cottage Hospital in Solvang is also working with the federal agency and considering its options, Wheeler said. The Cottage Health system declined an interview request from CalMatters. 

Wheeler explained that hospitals that lose their “critical access” designation may have to apply for other classifications, such as a “low volume provider” or “sole community hospital,” which also provide enhanced Medicare payments. 

In its letter, the federal agency told Glenn Medical Center that it has until April 23, 2026 to reclassify as another type of hospital to continue participating in the Medicare program.

A financial buffer for ‘critical access’ hospitals

The Clinton administration created the Critical Access Program in 1997 as a way to support rural hospitals. The goal of the program is to make sure that remote areas far from cities have adequate medical care.

“Our hospital was on the brink of closure back in 2001. We got this designation and have kept our doors open for the next 24 years,” said Still at Glenn Medical Center. The hospital is owned by American Advanced Management, the same group that recently purchased and reopened Madera Community Hospital. 

The program gives the hospital a bit of a financial buffer through higher-than-average Medicare reimbursement. Medicare pays critical access hospitals 101% of costs for most inpatient and outpatient services; for comparison, Medicare reimburses most other hospitals 82% of costs, according to the American Hospital Association. 

The designation also allows rural hospitals to stay open even if they don’t meet certain standards required of most other general acute hospitals. For example, Glenn Medical Center does not have a serviceable operating room, and bringing it up to required standards is financially prohibitive, Still said. 

The financial burden of losing its critical access designation would be such that the hospital would likely have to close its inpatient services by next spring, Still said. Outpatient services, such as clinics and labs, would remain open.

Like hospitals across the country, Glenn Medical Center is also bracing for a separate financial blow in the form of potential Medicaid cuts that are currently being debated in Congress. Hospitals could see decreased federal funding and increased costs because of uncompensated care from people who lose their Medicaid coverage. The American Hospital Association has estimated that rural hospitals across the country could lose about $50 billion altogether in federal Medicaid spending by 2034, if President Donald Trump’s “One Big Beautiful Bill” were to pass as currently drafted.

Last month, all of California’s Republican House members voted in support of the budget bill, including La Malfa, who represents the area. The Senate is now deliberating on its own version of the bill. 

To raise awareness of the hospital’s looming loss of its critical access status, Glenn Medical Center recently launched a campaign urging residents to write testimonials and letters in support.

Without a local hospital, the county’s two ambulances would have to travel farther, to Enloe Medical Center in Chico, about 36 miles north. Garrison explained that ambulances would probably choose Enloe over Colusa Medical Center because it is the larger of the two and has a trauma center.

The vast central-north region between Mendocino and Plumas National Forests is already down a hospital after Adventist’s Feather River Hospital was damaged in the 2018 Camp Fire and did not reopen. 

If ambulances have to drive 45 minutes out of the county instead of the five to ten minutes to their local hospital, that will affect the ability of Emergency Medical Services to respond to 911 calls, Garrison said. 

“I was talking to an administrator at Enloe and they estimated that this could increase their wait times by up to two hours,” Garrison said. 

Supported by the California Health Care Foundation (CHCF), which works to ensure that people have access to the care they need, when they need it, at a price they can afford. Visit www.chcf.org to learn more.

CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics. ​​

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