Central Maine Medical Center in Lewiston must get its trauma license back, the state says, or it won’t be able to move forward with its anticipated acquisition by a California nonprofit.

CMMC let its trauma status lapse this month, leaving just two hospitals statewide to provide 24/7 trauma surgery. Hospital leaders say it’s a cost-saving measure and there will be no real impact on its services.

State officials, however, say it is a necessary part of its future operation.

Central Maine Healthcare, which owns the hospital, is in the midst of being taken over by Prime Healthcare Foundation, which operates more than 50 hospitals across 14 states. The state approved the acquisition in late November but included a condition that CMMC must remain a certified trauma center for at least one year.

Trauma centers offer around-the-clock trauma services, including immediate access to emergency surgery, diagnostic imaging and intensive care. Those services are crucial for victims of serious injury and accidents — the third-leading cause of death in Androscoggin County, according to the Maine Department of Health and Human Services.

“CMMC will need to maintain their trauma hospital designation,” said Lindsay Hammes, the department’s spokesperson. “Should the certification lapse, the buyer will need to reestablish the designation.”

It might not be that simple.

Trauma centers are certified by the American College of Surgeons and assessed on quality every three years. Erin Clark, director of CMMC’s emergency department, said the hospital discontinued its designation to cut $500,000 in certification costs, with no plans to reduce actual trauma resources.

But some say Prime, which has vowed to invest $150 million in the Maine health system, has a different motive. The nonprofit withdrew trauma center designation from multiple Illinois hospitals earlier this year, inciting backlash from the state’s senators, and has not yet agreed to Maine’s trauma center condition.

“If they can’t make it profitable, they don’t want to pay for it,” said Richard King, former trauma medical director at CMMC. “Because they know that, no matter what the quality issues would be that the American College of Surgeons would oversee, the patients will come anyway through the door, shot or stabbed.”

A spokesperson did not answer questions about why Prime Healthcare Foundation has moved away from trauma center certification, but said they will make “significant capital investments in Central Maine Healthcare’s facilities, technology, and clinical capabilities.”

The foundation has until Dec. 21 to request that the state reconsiders its trauma center condition.

Until an agreement is reached, CMMC remains a trauma system hospital — one of about 30 in the state that can provide trauma care without the promise of surgical readiness. Maine EMS says patients with serious injuries should be brought to a trauma system hospital unless a trauma center is within 45 minutes.

Maine Medical Center in Portland and Eastern Maine Medical Center in Bangor are the only two trauma centers left in the state.

Wil O’Neal, executive director of Maine EMS, said that losing Lewiston’s trauma center leaves more patients in limbo across the state.

“My concern is that this could generate more inter-facility patient movements, moving from one hospital to another,” O’Neal said. “If I’m the patient, any longer that it took me to get in front of a doctor or definitive care: That’s a bad thing.”