Fire chiefs have come across a source of federal funding that could more than double the reimbursement they receive for responding to 911 calls for medical emergencies and transporting Medicaid recipients in ambulances.
Currently, Medicaid only pays $420 for ambulance rides, which emergency service providers say more typically cost $1,300. Officials at the federal program are willing to pay half the remaining difference for local governments to provide this service. The local governments would still bear some of the cost, but this new pot of money would bring up their federal reimbursement to about $1,000 a ride.
“A lot of departments across the state struggle to provide the service they’re asked to provide,” said Tualatin Valley Fire & Rescue Chief Mike Duyck, who has spearheaded the effort to tap this new source of money, which could bring in as much as $75 million to public ambulance service providers in the state.
Oregon fire chiefs learned of the potential Medicaid money from emergency service providers in California, who were able to leverage federal funding to boost their department budgets even with strained state financing. The program had existed since the 1970s but had never been utilized until recently. Since it’s structured as an entitlement, similar to the food stamps program, the states do not need to put up matching funds to draw the money.
Duyck and his counterparts have asked the House Health Care Committee to pass House Bill 4030, which would direct the Oregon Health Authority to convene a stakeholder workgroup that would figure out precisely how Oregon could participate in the program and then apply for the funding. The bill has bipartisan sponsorship from Rep. Margaret Doherty, D-Tigard, and Rep. Gene Whisnant, R-Sunriver.
The bill also directs ambulance service providers and the health authority to develop ways to better integrate efforts with coordinated care organizations so that ambulance providers can get paid without automatically sending patients to the emergency room who do not need to go.
Too often, the only way that the ambulance providers can get reimbursed is when they deliver people to the hospital for ER care, even when less costly alternatives may exist. “We don’t want to put anyone at risk, but we could find ways to save costs,” Duyck said.
A troubling question has been whether private companies that are contracted to give ambulance rides could also tap into this source of money.
In many parts of the state, ambulance services are not provided by fire departments but have long been contracted to private companies, including non-profit companies and volunteer organizations as well as businesses.
Both Duyck and Oregon State Ambulance Association lobbyist Nan Heim believe they should still be able to receive the additional Medicaid payments, since private ambulance companies are hired by county governments, and those local governments have the freedom to delegate fire departments or private companies to provide ambulance service for their constituents, a flexibility they also have with mental health or public health services.
The federal money has not been drawn for private companies in California, however, which led Heim’s organization, along with the Teamsters, who represent emergency response workers at the private American Medical Response in the Portland area, to initially oppose the legislation.
Heim told The Lund Report that compensating public fire and rescue services but not the companies she represents would put private entities at an unfair disadvantage when counties request bids for contracts, and that would eventually put the private companies out of business. Public entities would be able to underbid private competitors because they could count on these federal dollars to provide most of their needed funds.
Rep. Rob Nosse, D-Portland, drew up an amendment to HB 4030 that charged the Oregon Health Authority with including private companies in the request for increased Medicaid funding, while directing the state agency to proceed without them if the Centers for Medicare and Medicaid Services prohibits those private companies from participating.
The House Health Care Committee approved the Nosse amendment on Monday and is expected to move HB 4030 to the Committee on Ways & Means on Wednesday.
