Increase Medicaid Rate for Ambulance Service
By Albert B Kelly
Legislation can be many things, sometimes complicated, often redundant. Occasionally though, you come across a piece of legislation that makes a great deal of sense and you realize that it’s long overdue. That was my sentiment when a colleague shared S-2946, a bill sponsored by State Senators Troy Singleton and Jean Stanfield.
This legislation would set the minimum Medicaid reimbursement rate for basic life support emergency ambulance transport service at $200 a run. This proposed increase matters, because the rate is presently $58 per run (plus $1.50 per mile) and it has been so since Bill Clinton’s first term. That rate might have been adequate back in 1994, but the reality is that everything involved with providing this particular service has gotten so much costlier.
We’re talking about emergency transport and there is really no way of knowing what will be involved with a given call. Everything from gloves and syringes to sheets, EKG leads, medications and oxygen equipment have gotten incredibly expensive. This doesn’t even factor in the costs involved with keeping ambulances on the road.
Consider that the average cost of an ambulance is somewhere in the neighborhood of $300,000 and given the current inflationary climate, that figure may be low.
According to NJ Spotlight News and health care writer Lilo Stainton, New Jersey’s Medicaid program covers upwards of 2.1 million low-income residents and children and in 2021, the program spent some $46.1 million on 295,000 ambulance runs on behalf of 139,000 residents.
While those big picture numbers are staggering, my focus tends to be at the local level where our ambulance squad logs approximately 5,500 calls per year, covering five jurisdictions, spread out over 70 square miles, providing services to roughly 50,000 people.
The increased reimbursement is also of great significance because not everyone can pay and this reality is perhaps the hardest part of making the service work. I say that because when it comes to emergency ambulance service, money is not the first thing we think about. Everyone involved will attest to the fact that you provide the best service you can regardless of someone’s ability to pay because we’re talking about people’s health and well-being. What price do you put on that?
While the discussion about money stands in contrast to the righteous motivations of first responders, without money these services will disappear or would otherwise be greatly compromised. Emergency transport itself is only going to get more technical and complicated in the future. Gone forever are the days when an ambulance was a station wagon that doubled as hearse.
Considering that Medicare reimburses at $450 a pop, it is not at all clear that $200 a run is enough but it is surely a step in the right direction because something has to help offset the number of calls where the patient has no insurance or the patient has to pay a portion of the costs not covered by insurance but is simply unable or unwilling to do so.
Still, we hesitate to treat someone’s unpaid emergency ambulance charges as we would any other unpaid bills since it smacks of adding insult to injury. You also don’t want to discourage someone from calling who really needs help, so you try to collect, but there is a limit.
There is within that category of nonpayers those who use ambulance services and emergency rooms for frivolous, meaning non-medical reasons. These frequent flyers are often homeless and whether they are seeking a few hours out of the cold or a hot meal or just a little attention, it is not uncommon for them to fake a medical emergency to get a “hot and a cot” for a few hours.
Compassion aside, locally these non-medical ambulance runs average several hundred per year. When we factor in personnel, gas, and use of equipment costs run in the tens of thousands of dollars per year for non-medical ambulance calls. Yet, because we cannot know which calls for help are legitimate and which are frivolous, we treat them all with the same level of care and professionalism.
Finally, there is an entire segment of society that treats the emergency room in the same way you or I might utilize our family doctor and because ambulances are an extension of emergency rooms, this too has impacted the cost of providing emergency ambulance service.
For all these reasons and more, S2946 needs to become law.