Community presentations have generated an overwhelmingly favorable response as residents learn more about the hospital’s modernization project, financing plan and the stakes of the November 3rd election.

 

With Election Day approaching, Residents for Measure Q is addressing common questions about the proposed bond measure, the hospital’s $72 million seismic improvement and modernization project, and why the hospital is asking voters for support.

 

Over the past couple months, Residents for Measure Q has been meeting with groups throughout the mountain communities, presenting the facts, answering questions and helping people to better understand the project and its financial realities. The community’s response has been overwhelmingly favorable, reflecting the importance residents place on preserving access to hospital care close to home.

 

The following Q&A addresses the issues community members are asking about most.

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Why is the hospital asking voters to approve Measure Q?

Mountains Community Hospital is in the middle of a $72 million seismic improvement and modernization project. Built largely in the 1950s, the hospital must meet the State’s seismic requirements by the 2030 deadline to remain open. The project will also modernize facilities that no longer adequately support today’s patient care needs.

 

When the project moved forward in 2024, the hospital secured a $48.5 million low-interest USDA loan, with a 35-year repayment term at approximately 3.5% interest and annual payments of about $2.4 million. The financing plan also included hospital savings, grants and philanthropic support, allowing the hospital to proceed without asking local taxpayers to fund construction.

 

Since then, the hospital’s financial outlook has changed significantly. Federal Medicaid (Medi-Cal in California) funding reductions enacted through the One Big Beautiful Bill Act in July 2025 are projected to reduce the hospital’s annual revenue by approximately $4 million. Nearly half of the hospital’s patients rely on Medi-Cal, making these changes particularly consequential.

 

The original financing plan depended on the hospital having sufficient operating cash flow to make its loan payments. With the projected revenue losses, that assumption has changed. Measure Q would help the hospital manage these financial challenges, continue critical modernization and expansion work, and address unexpected construction costs.

 

 

Did the hospital have financing in place before construction began?

Yes. The hospital secured a $48.5 million USDA loan in 2024, before construction began. The loan offered very favorable terms (3.5% interest over 35 years), but the repayment plan depended on the hospital maintaining sufficient operating revenue to cover its annual payments. Federal Medi-Cal funding reductions enacted through the One Big Beautiful Bill Act are projected to reduce the hospital’s annual revenue by approximately $4 million, significantly changing that financial outlook. Measure Q would help the hospital repay the USDA loan and cover unexpected construction cost overruns.

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Is Measure Q just another way to cover the hospital’s operating losses?

No. Measure Q restricts bond proceeds to the hospital’s construction and modernization project. Measure Q provides that bond funds cannot not be used to pay employee salaries or routine hospital operating expenses. An independent citizens’ oversight committee established under Measure Q would monitor bond expenditures to help ensure that the money is spent only for the purposes authorized by Measure Q. Under Measure Q, bond funds can only be used to pay for the construction project.

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How much would Measure Q cost property owners, and when would the tax begin?

Measure Q will cost no more than $25 per $100,000 of assessed property value within the Hospital District. The bond term is 30 years. The calculation is based on assessed value, not current market value. For example, a property with an assessed value of $400,000 would have an estimated annual tax of approximately $100 in the first year.

 

Importantly, the tax would not begin immediately. Under Measure Q, tax collections would begin when repayment of the USDA loan begins, anticipated in late 2028 or 2029. The actual timing and amount of the tax would depend on the financing schedule and the hospital’s borrowing needs. Measure Q would authorize up to $61 million in general obligation bonds, but the hospital would not automatically have to issue the full amount. If less financing is needed, less debt would be issued, reducing the associated tax burden.

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Doesn’t the hospital already have a bond measure?

No. Mountains Community Hospital has never had a voter-approved general obligation bond measure. The hospital does have a parcel tax that was approved in 1989. It’s a flat annual tax of $40 for a vacant parcel, $80 for a residential parcel, and $200 for a commercial parcel.

 

While healthcare costs have increased dramatically since 1989, these tax amounts have remained unchanged. Measure Q would be the first bond measure for the hospital, providing a dedicated funding source to help pay for the construction project.

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What will the community get for this investment?

The project is focused on essential seismic improvements and practical upgrades that support safer, more effective patient care.

 

Planned improvements include:

• Major seismic upgrades designed to help the hospital remain fully operational following a major disaster and meet the State’s strict seismic requirements by the 2030 deadline.

• A larger Emergency Department with improved patient privacy and patient care.

• A modern Acute Care Wing with larger rooms, air conditioning, isolation facilities for patients with contagious diseases, private bathrooms and an updated nurse call system.

• Expanded Skilled Nursing capacity, adding 13 beds (increasing capacity from 20 to 33 beds).

 

The existing hospital was built for a different era of healthcare. The project is designed to bring the facility closer to current requirements and patient-care needs while making responsible use of available resources. The goal is not to build an extravagant hospital. It is to create a safer, more functional facility that can serve the mountain community for decades to come.

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What happens if Measure Q does not pass?

The mandatory seismic work would still need to be completed to meet state requirements. However, without the financing provided by Measure Q, the hospital would need to reconsider the remaining work, which would most likely be halted. We would likely have to make do with our existing 75-year-old facilities and limitations: no air conditioning in the inpatient wing, inadequate storage, fewer Skilled Nursing Facility beds than our community needs, and no dedicated isolation rooms, among many other challenges.

 

This is the community’s opportunity to complete the work our hospital needs for the long term. The hospital has already made a significant investment and secured very favorable USDA financing. When will we have another opportunity to finance a project like this on such favorable terms? Meanwhile, construction costs will continue to rise, making it even more expensive to complete the work in the future.

 

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Why is keeping Mountains Community Hospital so important?

For mountain residents, access to emergency and hospital care close to home is more than a convenience. It can be critical during a medical emergency, severe winter weather or a disaster that makes traveling down the mountain difficult. The hospital also provides care across multiple stages of life, including emergency services, inpatient care, skilled nursing, rehabilitation and outpatient services.

 

A hospital is an essential part of a community’s infrastructure. It supports local jobs, contributes to the community’s quality of life and helps make the mountain communities viable places to live.

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How can I learn more about Measure Q?

Measure Q will appear on the November 3, 2026, ballot. Approval requires a two-thirds vote of voters within the Hospital District, which serves communities from Twin Peaks through Green Valley Lake.

 

Residents can learn more about the proposed financing, project improvements and estimated property tax at www.residentsforq.com. We are also on Facebook and Instagram @residents4q. Residents for Measure Q is an independent community campaign separate from the hospital.

 

Vote Yes on Measure Q. Invest in the Hospital Our Mountain Community Can’t Afford to Lose.