County EMS officials warn of mounting reimbursement gaps and recommend options including JPAs or an exclusive operating area

Tammy Bartleme, acting program administrator for Public Health emergency preparedness and EMS, and Jen Banks, Emergency Medical Services Coordinator for Coastal Valleys EMS Agency, presented a systematic review of emergency medical services in Mendocino County and cautioned about looming financial pressures.

Banks told the board there currently is no single contracted 9‑1‑1 ambulance provider to guarantee a dedicated resource; services are provided by a patchwork of ALS and BLS providers, fire departments and one private ambulance (MedStar). She said 2024 saw about 17,000 EMS calls countywide and highlighted long transport times in remote areas where alternate receiving authorizations (Round Valley, Redwood Coast Medical Services) have been used to reduce out‑of‑county transports.

Presenters flagged state and federal policy changes—described in the presentation as impacts from a recently referenced reimbursement bill—as creating potential 10–15% reductions in ambulance revenue based on modeling performed by national consulting groups. Banks explained how Medi‑Cal eligibility changes for undocumented adults (effective 01/01/2026 per the presentation) and an anticipated tax cap reduction affecting GEMT (ground emergency medical transport) reimbursement could shift payer mixes and create substantial reimbursement gaps for local providers: "This could be a 15% reduction," she said, attributing the figure to industry analyses.

The presenters reviewed local funding sources: service billings, one‑time PG&E disaster settlement funds, and Measure P distribution (Resolution 22‑159). They said Measure P was intended to support fire protection and prevention with 90% direct aid to agencies and 10% for prevention and resilience, but debate among supervisors and providers continues about how much Measure P supports EMS operations versus fire functions.

To shore up stability, presenters proposed several options for board consideration: pursue an exclusive operating area (EOA) contract (a prior RFP had been rejected by the board), pursue joint powers agreements (JPAs) among rural fire districts to coordinate and share resources, pursue federal and state grants, and consider local tax measures—though staff emphasized the difficulty of passing a new tax measure in a community already experiencing tax fatigue. Banks asked the board for an audit of Measure P usage to clarify how much funding currently supports EMS versus fire operations.

Supervisors discussed next steps including a request for staff to map service coverage by parcel and transport destination, to calculate the fiscal gap required to raise service levels and to come back with polling options and cost estimates by May or June.