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Ambulance Reimbursement: A MediCal Crisis

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Hello, and thanks for joining us for sustaining us here on KLCS PBS, I'm David Nazar.

Many people assume that when you have a health emergency and dial 911, your city fire departments and their paramedics are going to race to your house and take you to the hospital if necessary.

Well, that's partly true, except for the fact that three out of every four ambulances in California are private.

These private ambulance companies often respond in collaboration with Fire Department Rescue.

And these private companies and their EMTs are often the ones, too.

Let's say, for example, check your vitals, administer CPR, give you insulin, transport you to the hospital.

Well, what if, just for argument's sake, many of the private ambulance companies were to go out of business?

The question is, who's going to be there to help?

Well, that's the claim of some private ambulance companies and their ambulance workers here in California.

And that's where we begin our broadcast with a special report as we investigate the ambulance reimbursement medical crisis.

Will, the wages are just not sustainable?

They're at poverty level.

There is an ambulance emergency of sorts looming in California this emergency involves private ambulance companies, Medi-Cal, and what some claim is state bureaucracy and mismanagement.

These ambulance companies and some of their EMTs, emergency medical technicians are now in a battle with Medi-Cal.

Medi-Cal is California's state version of the federal Medicaid health care program.

Medical insurance is designed for low income folks.

If you can't afford insurance here in California, the state gives you Medi-Cal.

So how does this all relate to ambulance service?

Well, critics argue that collateral damage of this poor reimbursement is the ambulance worker's paycheck, the low wages, in many cases anywhere from 15 to $17 an hour.

To give some context, an entry level worker at a restaurant or retail store can make more money than an EMT.

The people who save lives.

These same critics of Medi-Cal in the state of California argue this is causing a public health care crisis in the Golden State.

Many private companies now say they can't recruit emergency medical technicians or keep them.

And that's going to have a ripple effect within the health care industry.

We have not had an increase since 1999.

If you think about the wages in 1999, they were somewhere in the $6 range.

We are paying at least 400% more in wages and it's been extremely terrible because the medical.

California has the highest medical population.

And so every time we are transporting a medical patient, we do it at a loss.

Melissa Harris serves on the board of directors of the California Ambulance Association.

CAA is comprised of ambulance companies all throughout the state, both 911 and enter facility transport.

The organization is designed to provide a unified voice when dealing with things like legislation, policy, really anything related to EMS, emergency medical services.

Harris is also the owner of Ambush Serve in Gardena, California.

Her ambulance company serves several different communities all throughout Los Angeles and Orange County.

Ambush Serve operates 50 ambulances, and the company has about 300 employees.

250 of those are EMS care providers.

$111 port per transport.

Most states pay five times more than what California pays 75% of ambulances.

Overall expenses are wages since we are on call 24 hours a day.

And so when we have these large populations where we're taking losses 30 to 40% of our transports, it affects our ability of income and how much we can make to support paying a living, thriving wage.

It has never been more difficult to retain employees as it is today.

I've never seen shortages all across California of EMT just leaving the workforce because the wages are too low.

They're burnt out, they're working a lot of overtime and so we really need to have an increase so we could pay our employees what they're worth.

You know, every day they're there risking their lives.

We have EMTs that work, you know, 24 hour, 48, 72 hours.

They miss all types of family commitments.

They can't be home.

They're trying to do whatever they can because they love what they do.

And it saddens me to see people leave this career.

Medi-Cal now represents over 40% of ambulance service dealings in just the Southern California area alone.

Ambulance providers like Melissa Harris are required to contract with Medi-Cal despite the reimbursement schedule.

The intention of Medi-Cal is honorable.

The state program was designed as a safety net years ago here in California to make sure low income folks had access to health care.

Today, Harris Graves the state of California a for effort f for execution where private ambulance companies are concerned.

She explains that whether a patient has Medi-Cal or they have the premium plan of health insurance or they pay out of pocket California ambulance companies obvious you have to serve everyone, whether patients have money or not.

And the companies basically have to take what they get, so to speak.

In this case, the $111 from the state Medi-Cal reimbursement.

Harris says this financial formula causes problems.

We don't get to pick and choose which patients we transport.

We arrive on scene and we're here to serve and take care of the community.

And so when you're getting such a low reimbursement, other payers like commercial insurance and private pay, we have to charge them so much more than what we should be charging them to offset all the losses.

Every time we're taking a medical patient, it's extremely difficult.

I mean, it's not just EMT.

We provide paramedics so advanced life support.

We also employ nurses and respiratory therapists.

And you can we compete with hospital staffing for nurses?

So you could imagine just in wages alone how expensive it is to transport a patient in an ambulance.

And also we provide medicine and we stabilize the patient during the transport.

And beyond that, often EMTs have to spend hours at the hospital with the patient until there's a doctor or a room available so the patient can be processed and medically evaluated.

You can't just drop off a patient and then leave them alone at the hospital.

So this adds extra hours to the frenzied pace.

This labor intensive work schedule, coupled with the low pay, now has some ambulance workers fleeing this industry.

We asked some local Southern California ambulance company, EMT, is it their opinion of the Medi-Cal reimbursement, given their hectic EMT schedule each and every day?

All the people they take care of, the lives they save, the miles they travel?

Is this Medi-Cal reimbursement fair?

As an EMT, we want to help people.

We want to serve the community, but we might not be able to stay in that profession because we're not making enough to support ourselves and family.

I do have such a great passion for the field and my job has been so fulfilling in so many ways.

But the reality is being an EMT is not financially, financially sustainable.

So as much as I would want me to EMT, it's not enough for me to support myself on my own.

So the reality is, as much as I have a passion for it, it's not a sustainable option to make a living here, Obviously.

I think it's pretty unfair.

I feel like EMS is a super important part of any community, so knowing the that rate hasn't changed at all for like 22 years is it's kind of sad to see because it's such an important part of the part of like everything.

Shelly Huddleston represents thousands of EMT workers in California, Nevada, Arizona and Hawaii.

Huddleston is the national labor representative for the International Association of EMTs and Paramedics.

She's not just your average union rep, so to speak.

She's been in the trenches.

Got my first EMT certificate in.

I'm going to age myself.

1990.

From there, I went overseas as a military wife and I worked in the emergency room.

And then I came back in 1993 and I got a job as an EMT in San Bernardino.

And then I went to paramedic school in I believe, 95, and I'm still a licensed paramedic.

Huddleston knows all too well what many EMT are dealing with.

A lot of work and not much pay.

Safe to say Huddleston is qualified to fight for the rights of her fellow emergency medical technicians.

She says she's outraged over the fact that California now has a massive money surplus.

These days after the Biden covered bailouts.

And yet the state can't take some of that newfound money and give private ambulance companies and their respective workers better reimbursed meant.

To do such a risky, high liability job.

They could go to Starbucks or to Target and make more money.

And so we're fighting for them to be paid correctly, to be paid for what they do for the professionals that they are.

We are fighting to get the Medi-Cal rates raised so that the companies will get a higher rate increase and hence it would trickle down to the employees who are the ones out there actually running the calls.

I believe we're asking for $350 for a total.

That's nothing compared to what some of the other states are getting that are getting 500 and $600.

So I think it's a fair ask.

We have never seen as low recruitment as we see now.

And what happened is you have tons of employees that are working tremendous amount of overtime and they're just burnt out.

They're just exhausted.

And so we really need the state to step up and give us an increase and show us that we are your heroes and you're worth what you do, too.

Now, I contacted the state of California requesting an on camera interview for their take on all of this.

I emailed DHS.

That's the California Department of Health Care Services.

They declined an on camera interview saying they did not have a representative in L.A.

So I offered a Zoom interview, which they also declined.

However, Anthony Cava, who's the spokesperson for the Department of Health Care Services, did send me a written statement to answer some of my questions.

The written statement says in part, and I'm quoting here, DHS reimburses Medi-Cal providers of ground medical transportation services in accordance with state and federal law and must adhere to federal requirements in implementing any changes to the California Medicaid state plan.

Additionally, DHS evaluates and continually monitors provider payments to ensure compliance with federal access requirements and maintains that California Medicaid State plan is approved by the Centers for Medicare and Medicaid Services.

Seems, end quote.

The statement goes on to say in part, DHS is authorized to establish reimbursement rates for ground medical transportation services in accordance with applicable state and federal laws.

The add on and supplemental payment programs described above increase total reimbursement to providers and total reimbursement as a more accurate representation and only evaluating base rates.

The regulations for medical transport reimbursement do not include requirements or limitations on ambulance companies related to salaries and wages for their employees.

End quote.

Wow.

For the record, I appreciate that DHS sent a statement.

Thanks for that.

Although I was just hoping for an interview with state officials so we could have a common sense conversation and they could answer some questions and talk about a possible solution.

What they said, to be honest, was basically state of California mumbo jumbo legalese, legal jargon, which takes a medical expert and a Harvard lawyer to decipher.

Certainly, which I'm not, unfortunately.

And I'm going to be honest.

California state officials have a bad habit of not going on camera and answering tough questions.

So I emailed them again, asking if they could send another statement.

Just simplifying everything for me and our viewers.

I never heard back from them.

Well, joining me now to discuss a possible solution and explore this further is Democrat California State Assemblyman Freddy Rodriguez, representing Pomona, Ontario and other parts of San Bernardino County.

Assemblyman Rodriguez, who is the chairman of the Assembly Emergency Management Committee, worked for over 30 years as an EMT.

He was awarded the California Star of Life recognition for his volunteer contributions and life saving rescues.

Assemblyman Rodriguez was elected to the state assembly in 2013, and now he's leading the way to pass the legislation to increase Medi-Cal reimbursements to ambulance companies throughout the state.

Assemblyman Freddy Rodriguez, the perfect person to talk to you.

Thank you so much for being here.

Thank you.

It's a pleasure.

Listen, Assemblyman Rodriguez, I have to be honest and I apologize.

These folks were running from the camera.

What they sent me was crazy.

Your opinion?

It might be too harsh or you get what I'm saying.

Assemblyman Rodriguez.

I get what you get.

100%.

I mean, shame on them for not coming to you to meet you regarding some of these questions.

I think you had some good questions there.

And it's shame on them for not giving you just a plain, basic investor answer to the question.

Right.

Being from my point of view, I mean, over 30 years in the industry, I can tell you a lot about some simple fixes as this bill I'm trying to do right now, AB 55.

We're going to get to that in a moment.

The Assembly bill first, though, Assemblyman Rodriguez, ironically, correct me if I'm wrong, the state of California now has a surplus, a surplus of money thanks to the Biden blue state bailout, as I term it, during the height of COVID.

We all know that any fair and objective observer must admit the state of California.

Look, over the years they've squandered so much money, billions of dollars.

There's been I've reported on it, misappropriation of funds from state lawmakers.

Not you, sir.

But let's be honest, California certainly likes to spend money.

President Biden, well, he erased all that.

The red ink that was here in the Golden State with a bailout.

So, look, California has money, Assemblyman, With that extra money, why not just give a bit more to the ambulance companies?

Am I oversimplifying it or is there something to be said there?

No, you're absolutely right.

I mean, just think what's a small portion that money could do to these men and women out there running these calls day in and day out, make maintain a sustainable living wage and really be able to recruit more people to the industry.

As we all know, they're they're suffering from shortages as well.

But if you pay people right, take care of them, I think you'll be able to retain more and get more folks coming and working for your industry.

You know, it's also kind of ironic, a somewhat frustrated, frustrated.

And given the fact that California has, I want to say, the highest property tax, sales tax, the gas tax, the business tax, I mean, really the most insane taxes anywhere here in California, should the state be able to send some extra money to the ambulance companies, not with the bailout money, but just with all the taxes that the state collects?

You're right.

And I think it's one industry that's overlooked in many times, just as we're talking about right now, we're looking for a small investment that could really help this industry that once again operates 24, seven, day in and day out.

I don't think people really realize how important this industry does as a provide service and care to many folks across the state.

Speaking of that, can you give our audience an idea?

I mean, I tried to explain it somewhat in my field report earlier, but the reimbursement rate as far as California, let's say, versus other states, do you have some data for that comparison?

For example, I believe in my report I was talking about the fact that isn't the reimbursement rate, something like 400 some dollars per ambulance trip in Arizona as opposed to what is it, the 1100, $111 for Medi-Cal here in California?

Because California, what, it's 46, lowest of the 50 states for private ambulance reimbursement.

Freddie, you're absolutely right.

Once again, shame on folks.

Think about California.

We're always the leader in many industries, right.

Moving California forward in this case, we're not.

How can Arizona State like Arizona pay over $400 for the reimbursement rate?

And here in California, a little over $100.

That's obviously upside down.

Definitely.

We're not the leaders in this industry, as we are talking about now.

And that's why introduce HB 55, hopefully close that gap.

Once again, California be the leader, especially when it comes to these reimbursement rates here for ambulance providers.

So with that said, Assemblyman, you're leading the charge to try and effect change.

Can you talk about that in some detail for our viewers?

Yes, we just recently implemented AB 55 AB 55 will increase the rate to $350.

It's still short term in Arizona, but it's a huge increase from where it currently getting.

Now.

Currently, like I said, it's a little over $100, but my budget request to be looking at increasing it to $350 and hopefully we can get more, but at least that's the start.

The obvious question Are ambulance companies able to even keep these EMS workers, these great brave EMT?

I mean, it seems like it's an impossible chore that's being asked of them given what they're paid, although I guess to defend the state of California is upping overstated or embellished or in fact, is that the case?

It's just tough to hire and retain these folks.

I think it really it's tough to hire retain them because of their wages.

Right.

They don't make good enough wages as other industries we talk about fast food workers and other industries, but yet this industry is once one industry that's always overlooked.

And really, if you pay them more, the chances are they're going to stay in, give or been working conditions as well, and able to recruit and retain more folks as well.

Despite the fact that state of California officials ran from the camera, do not interview with me.

I'm also going to defend them because what we do on this program is fair and honest.

And even if they run from the camera, I am going to defend them and try to be very balanced.

With that said, then why not just in defense of the state?

Why not have an ambulance company owners let them pay their workers more?

Maybe they can take on some of that responsibility and not rely so much on the state.

Everybody is begging the state of California, begging government for money.

Yeah, we know it's difficult in this industry that we work in and talk about the employers industry.

I mean, one thing is they're transporting a lot of patients still.

They don't have insurance, the indigent population.

So they're taking a huge loss as it is.

So why not look look at these reimbursement rates for Medi-Cal to help bump, bump up their salaries and be able to keep and retain employees?

Right.

It's a win win.

And once again, this industry operates 24 seven nonstop.

Doesn't matter what's happening in our world economy.

People are fortunate, get sick, get hurt in accidents, and we have patients that need to be transported from one hospital to another.

And there's the ambulance companies that do it no matter what.

If I'm not mistaken, there's another challenge for these private ambulance companies.

Correct me if I'm wrong, Assemblyman, aren't aren't these private analysts, companies vying for the same money as some of the city fire departments in their ambulances?

Because I know the city fire departments need money as well.

And if that is the case, how is this affecting the private companies?

In other words, are they vying for the same dollars?

And is the state possibly favoring fire departments over these private companies?

Assemblyman Rodriguez Well, when you talk about those two agencies, we got the local fire departments and then you got the private sector EMS.

So they're kind of a little bit different.

They do the same.

But you got to look at the private sector, EMS.

They rely on a lot of non-emergent transport drivers.

Those those patients are going maybe from one hospital to another, a skilled nursing facility to the hospital or dialysis centers.

Right.

Those are what you called non-emergent.

So that's not going to affect a fire city fire department that are responding to basically 911 emergency calls.

Right.

So it's a little bit of difference of type of service they're providing, but yet they're the same.

They're they're trained the same, They have the same licenses and really, some private ambulance companies are contracted with fire departments to provide the nine on one service as well, just depending on the jurisdictions.

But it is a little separate.

But they're doing the same calls.

Just once again, the private sector, EMS ers, ones that are going to be impacted the most because of the non-emergency transports they do.

And a lot of those have the Medicare and the Medi-Cal only type of insurance.

That's why you really don't want to increase these rates or be able to pay those employees a livable wage.

Final question, Assemblyman.

There's another challenge as well.

I was reading that.

Listen, in California, the cease fire season is all year round.

It's not just a season.

Struggles probably get worse for these private ambulance companies during fire season because now I'm guessing these private EMS folks, well, they have to take care of some of these massive wildfires, so to speak.

Could that be causing a problem?

Because could it be leaving, let's say, fewer ambulance workers elsewhere when people need them the most?

Yeah, well, you know, that's a mutual aid agreement we have up and down the state.

When these disasters are declared, a lot of the private sector ambulance companies are contracted with the counties to provide what they call strike teams to get dispatched to these areas of disasters.

Right.

To supplement the local fire departments and the county departments there.

So, yeah, it could have a ripple effect, especially when we're short staffed already as it is providing the care around the emergency number one calls and even those skilled nursing facility calls, or rather they referred to as non-emergent calls right there short, so as in a major disaster is declared, you got to move some of those resources to these mutual aid programs that they have dropped the state.

So it could be an impacting on some of these areas.

So just depending on the location and how severe these disasters are.

You are leading the charge to find a solution.

Thank you so much, California State Assemblyman Freddy Rodriguez for a great interview.

I really appreciate you being here.

Thank you very much for your interest.

And we'll keep our fingers crossed and get this bill signed, hopefully by the governor and be able to provide better service and salaries to our employees out there.

And keep us posted.

Now for more information about our program, just click on, tells the story, and then click Contact us to send us your questions, your comments or your story ideas so we can hear from you or contact me directly at @DavidNazarNews on Twitter or just go to DavidNazarNews on YouTube.

Contact me there.

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You know that.

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Thank you so much for joining us for this edition of Sustaining US here on KLCS PBS.

I'm Devin Nazar.

I am David is our host of Sustaining US.

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