Fixing Medi-Cal Ambulance Reimbursement: Why AB 1328 Matters for California

California's inter-facility ambulance system is at a breaking point. A bill in the legislature could change that.

Assembly Bill 1328, from Assemblymember Michelle Rodriguez, is moving through the legislature now. If it passes, it will be the first real update to Medi-Cal rates for non-emergency ambulance transport in almost 30 years. For private ambulance companies moving California's most vulnerable patients, this bill could mean the difference between staying open and closing their doors.

AB 1328 would raise Medi-Cal reimbursements for non-emergency ambulance transport to 80–100% of the federal Medicare rate, an increase of approximately $200 per transport and the first meaningful update in nearly 30 years. The bill also modernizes mileage documentation and strengthens payment oversight to ensure new funding actually reaches frontline providers. 

At Royal Ambulance, we strongly support AB 1328. Here is why it matters, and why it should matter to you.

The Work Nobody Sees

Most people picture a 911 call when they think of an ambulance. Lights, sirens, a critical patient on the way to the ER. But that is only half the story.

The other half is quieter and just as important: the inter-facility transfer, or IFT. Moving a patient from a hospital to a skilled nursing facility. Taking a cardiac patient to a specialty center. Opening up a hospital bed so the next emergency patient has a place to go. IFTs make up about half of all ambulance calls in California. Private companies handle almost all of them. The funding for this work has not changed since 1999.

IFT is the core of what we do at Royal Ambulance. Our EMTs, paramedics, and critical care nurses move patients across the Bay Area every day–between hospitals, between facilities, between moments in a patient's care journey. We see firsthand how fragile this part of the healthcare system has become.

Living on 1999 Rates in a 2026 Economy

The base Medi-Cal reimbursement for a non-emergency ambulance transport is approximately $111. That rate has not changed in nearly 30 years. It is among the lowest in the nation.

The California Ambulance Association estimates private ambulance companies lose $165 million each year because Medi-Cal pays below cost. This is not a future risk. It is the reality for companies serving patients with no other options.

We are already seeing the consequences. In 2022, one of the largest private ambulance companies stopped all IFT operations in Los Angeles County. That meant about 28,000 fewer non-emergency transports each year. The patients most affected were in underserved, lower-income, and rural communities who rely on Medi-Cal and often have no other options.

For the providers who remain, the math forces hard choices. They can cut service areas, reduce staff, or take on losses they cannot carry forever. Our clinicians show up every shift because they care about patients. They deserve to work in a well-funded system that can provide them with the wages, resources, and opportunities needed to thrive in their EMS career.

How Prop 35 Made Things Worse

In late 2024, California voters passed Proposition 35 with broad bipartisan support. The measure made the Managed Care Organization tax permanent, securing billions for Medi-Cal. It was rightly celebrated as a major win for California's healthcare system.

But for IFT providers, Prop 35 created a new problem.

The measure directed dedicated funding to many healthcare provider groups, including 911 emergency ambulance services. Non-emergency IFT ambulances were left out. And crucially, the passage of Prop 35 wiped out a prior agreement under SB 159 that had allocated $25 million annually to raise IFT reimbursement rates.

Now we have a two-tiered system. Ambulances answering 911 calls have a permanent increased funding stream. Ambulances doing inter-facility transfers, serving patients who are just as vulnerable, are stuck accepting 1999 reimbursement rates. AB 1328 is meant to close this reimbursement gap.

Why This Affects Every Californian

Nearly 15 million Californians (one third of the state's population) are enrolled in Medi-Cal. These are the patients who depend most on IFT services and who have the fewest alternatives if those services disappear.

But this problem affects more than just Medi-Cal patients.

If a stable patient cannot be transferred out of a hospital because no IFT ambulance is available, that bed stays full. When a 911 ambulance brings in a critical patient and there are no open beds, the ER has to divert. The whole system backs up.

IFT is the bridge that keeps hospitals running. If we take away that bridge, it does not just hurt patients waiting for transfers. It affects every patient who might need emergency care.

What You Can Do

California's EMS system is only as strong as its weakest link. AB 1328 is a real, bipartisan chance to fix a 30-year funding failure and protect one of the most critical and most overlooked parts of our healthcare system.

We are asking two things:

1. Share this article. The more people who know what is at stake, the stronger the case for AB 1328. Forward it to a colleague, post it to your network, or send it to your state representative. 

2. Consider a $50 contribution to the California Ambulance Association's Political Action Committee. The CAA PAC is the advocacy engine fighting to keep this issue in front of lawmakers. A $50 contribution is a direct investment in that work.

Supporting AB 1328 is not about helping private companies. It is about making sure that when a patient needs to move through California's healthcare system, the ambulance is there and the crew is paid fairly for their work.

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Royal Ambulance is a leading medical transportation provider headquartered in San Leandro, California, serving the greater San Francisco Bay Area and Northern Nevada. Learn more at royalambulance.com.