California Ambulance Leaders Fight to Save Local EMS

This past week the California Ambulance Association (CAA) brought EMS organizations across the state together for its annual conference and celebration of frontline heroes (Stars of Life) in Sacramento, CA. This year the hot topic was Senate Bill AB55, proposing a Medi-Cal reimbursement rate increase expected to make EMS wages higher, increasing interest in the profession.

For EMS professionals in California, this bill represents a critical opportunity to address staffing shortages, improve employee retention, and ensure local ambulance services can meet community needs.

During the annual recognition event, over 50 of the state’s EMS industry leaders, including the leadership team at Royal Ambulance, shared best practices, elevated hard-working front-line team members, and raised awareness about the challenges and opportunities that California's EMS System faces.

Events like the Stars of Life not only honor frontline responders but also serve as a platform for discussing solutions to long-term challenges in emergency medical services.

Every leader voiced challenges related to staffing deficiencies.

Last year CAA and a broad coalition of labor unions were unsuccessful in persuading the Governor's office to enact a rate increase to address staffing shortages created by uncompetitively low EMT pay rates across the state. California reimburses at the 46th lowest rate in the nation and is home to the largest population of MediCal patients.

These low Medi-Cal reimbursement rates have been a major barrier to sustaining competitive EMS wages, which directly impacts recruitment and retention of skilled EMTs and paramedics.

This year, the association is back at it, with a bigger, better-aligned, and more robust coalition to save the services that our communities rely on.

Sponsoring the bill and speaking alongside CAA President Jimmy Pierson, Assembly Member Freddy Rodriguez, former EMT of 30 years and District 53 representative said:

“Our first responders deserve a living wage for the lifesaving support they provide to our communities. They should not be forced to choose between a livable income and job they truly love”.

While the pandemic brought EMS into the spotlight, as much of life for Californians returns back to the pre-pandemic era, the challenges the State’s EMS industry faces remain. The most pressing issue the industry faces today stems back as far as 1999. Despite public recognition during COVID-19, systemic issues such as outdated reimbursement structures continue to undermine the stability of EMS in California.

Digging in further, the problem clearly becomes an issue of economics and scale with a relatively simple solution.

1999 - 24 years ago - was the last time that Califonia’s private ambulance providers received an increase in reimbursement for transporting Medi-Cal patients.

Nearly a quarter of a century later, it's safe to say a lot has changed. This rate is the reason EMTs, a respected profession, hailed as “Heroes” during the pandemic, that requires schooling, maintained credentials, hard work, and empathy, is now a minimum wage job. The inability to adjust reimbursement rates for inflation over the last two decades has placed unprecedented financial strain on EMS agencies statewide.

Let’s talk numbers.

In the State of California, private ambulance companies are reimbursed $111 for transporting a Medi-Cal patient regardless of the scope of service or time the transport required.

The problem is that the cost to run an ambulance transport has changed dramatically since 1999 when the $111 rate was established.

CAA reports that the average cost to run an ambulance transport in 2022 was $589.

If the state’s reimbursement for running Medi-Cal transport is $111, that means we lose over $480 per Medi-Cal patient we transport. In 2022, the Medi-Cal patients Royal served accounted for nearly 20% of our total transport volume - a percentage that is growing. As our population ages, more people qualify for Medi-Cal and subsequently, the state has become more dependent on local healthcare and EMS resources to care for citizens. Rising operational costs, combined with an aging population and increased demand for ambulance services, make the reimbursement gap an urgent financial crisis for EMS providers.

Let’s review some local news:

American Medical Response recently exited its IFT contract in Orange County and a number of other Southern California locations. Falck is on the rocks in San Diego and Alameda Counties, and worst of all is that many rural counties aren’t even seeing ambulance providers bid on RFP’s because finding team members to run the calls is nearly impossible. This shortage of available EMS providers has a direct impact on patient care, often leading to longer response times and reduced access to life-saving services in rural areas.

If the largest companies in EMS are struggling to staff units and foregoing major contracts as a result, how could local EMS possibly attract and retain team members with competitive wages?

We can’t speak for others, but don’t you think that if these companies had the capability to service a contract as large as Orange County’s, they would? That’s nearly 30K annual transports that they’re walking away from.

As Californians, we’re asking EMS professionals to serve and support the largest Medicaid population in the country while they struggle to support their families. We’re making heroes choose between a career they love that serves our community and a job that makes ends meet. Without decisive legislative action, more EMS agencies will be forced to reduce service areas or close entirely, leaving communities vulnerable during emergencies.

Without an increase in the reimbursement rate, EMS companies will continue to lose team members to industries that provide living wages. Reliable emergency services will become less available with longer wait times, impacting the safety of our communities. The Californian EMS System is at a breaking point and that’s why we’re rallying for change.

Increasing Medi-Cal reimbursement rates is one of the most effective ways to stabilize the EMS workforce, ensuring faster response times and better patient outcomes across California.

Please visit https://www.fundfirstresponders.org/ and sign the petition. Together we can make our voices heard at the State Capital.