Albert Einstein College of Medicine, NY (Guaranteed by Montefiore Medical Center, NY) Surveillance Report

Rating Summary

The Outlook revision reflects Montefiore Medical Center’s (MMC’s or the “Medical Center’s”) materially weakened operating performance in CY 2025, resulting in a pronounced decline in maximum annual debt service coverage (MADS) to 1.29x from 3.4x and days cash on hand to 58 from 80. Q1 2026 results highlight continued operating pressure, partially attributable to severe winter weather and a costly nursing strike, with further erosion in unrestricted cash & investments.

Management expects operations generate another deficit in CY 2026, albeit somewhat smaller than CY 2025, with a goal of returning to structural balance in CY 2027. In KBRA’s view, this goal may be challenged by reimbursement pressures, particularly among managed care organizations that have increased claim denials, and a persistent inflationary environment. An additional layer of uncertainty stems from MMC’s proposed acquisitions of Garnet Health and St. John's Riverside Hospital, which are expected to…