Local officials continue weighing funding options for ambulance, air service, public transportation

(Lander, WY) – Local officials continue working on plans to fund commercial air service, emergency medical services, and public transportation in Fremont County after voters declined to renew the half-percent sales tax for economic development last fall.

For example, the Fremont County Commission still has about $1.9 million left in its half percent sales tax account, and Commissioners previously discussed using $500,000 of that total to support the local ambulance service this year.

They’ve held off on finalizing that decision, however, until they have a chance to ask local municipalities to contribute to the ambulance subsidy.

“We still want to have some conversations with municipalities (about) what level of service they want to pay for,” Commission Chair Larry Allen said during a meeting this week. “Because we can’t afford to pay for (all of it).”

The total ambulance subsidy currently sits at more than $1.8 million annually, county officials said – so even if the Commission were to allocate the rest of its half percent sales tax funding to support the local ambulance service, “we’re still going to need more ambulance subsidy in the future,” Commissioner Mike Jones pointed out.

To fund those future subsidies, Jones said the Commission could create an EMS district in Fremont County that would generate property tax revenues to support the local ambulance service.

An EMS district – if it’s approved by local residents – could generate up to $1.3 million a year set at two mills, Jones said.

At four mills – the maximum allowed – the district could generate more than $3.4 million, according to a ground EMS report from the Wyoming Department of Health.

Of course, Jones said, “this is like the worst possible timing in the history of Wyoming to talk about tax increases, because nobody’s in love with (taxes) – especially property tax.”

Another option is to pursue a new sales tax initiative – an effort that Jones said some local groups are already considering as a way to support commercial air service and public transportation in Fremont County.

Those groups expressed “no interest in pursuing the ambulance” as part of the potential sales tax initiative, Jones added – but Allen said the Fremont County Association of Governments was interested in having more “holistic … conversations” about ways to support the local ambulance system.

At the state level, Wyoming Department of Health Deputy Director Franz Fuchs said the state could help local ambulance systems “reduce administrative costs” by procuring a “billing contractor” to “generate healthcare claims, submit those to payers, collect the revenue and then give it back to those ambulance providers.”

“Right now, ambulance providers … have to do the bills themselves,” Fuchs explained during a Joint Labor, Health and Social Services Committee meeting last month. “This concept … would cut out that labor of billing – of actually generating those claim forms.”

The state could also use its own operations to provide local ambulance companies with billing services, he added.

Another idea Fuchs mentioned during last month’s meeting is to encourage local tax-supported fire departments and critical access hospitals to “take on more EMS” responsibilities – but he said that plan wouldn’t work in Fremont or Uinta counties, which don’t have specific tax-supported fire departments or critical access hospitals.

“So those would be (the) two areas of the state where this model would not pencil out,” Fuchs said. 

Some states fund EMS services by charging an extra fee for vehicle tags, AARP Wyoming’s Associate State Director Tom Lacock said during the same committee meeting last month, citing a survey of more than 1,000 Wyoming residents that showed 83 percent of respondents were willing to pay more money to support their community’s ambulance system.

In the same survey, more than 80 percent of respondents agreed that EMS should be considered an essential government service, like firefighting and law enforcement.

Currently, because EMS is not officially designated as an essential service, “counties and cities do not have to pay for ambulance service or ensure their residents have access to them,” Lacock explained. 

The survey also showed that 73 percent of respondents think communities should fund EMS in the same way that they pay for police and firefighting services – but later in the meeting, Wyoming Association of Municipalities Executive Director Ashley Harpstreith said local governments “lack the funding” to provide “this critical service and need to our constituents.

“There’s major funding gaps that we’re subsidizing, (and) the ability to raise revenues is getting harder and harder, especially with the reduction of property tax,” she said. “If there’s no property tax, how do we fund special districts?”

Jones also had a question for the Labor Committee during last month’s meeting: What is the role of the state in funding EMS in Wyoming?

“I am wondering if this committee could take on (that) question,” Jones said. “It seems like what we’re doing is dancing around that question a little bit. (So) I would love to see that question being thrown out, either in this committee or elsewhere.. … Is there a role to be had? And if there is a role to be had, then are there other tools that we could be looking at?”

He pointed, for example, to the capacity purchase agreement the state entered into with SkyWest Airlines several years ago to help support commercial air service in Wyoming.

“The state kicks in for air service, and then the local communities kick in as well,” Jones said. “It seems like there are models out there (that we) could take into account, and I’d love to … wrestle with more of those solutions.”

At the end of last month’s meeting, the Labor Committee approved a motion from Wyoming Sen. Charles Scott, R-Casper, to draft a bill that would increase the Medicaid reimbursement for ambulance services “to the maximum that’s allowed.”

“I think there’s no question (that) part of the solution here is … to put some money into it,” Scott said when he made the motion.

Earlier in the meeting, Fuchs had reported that Wyoming’s 44 EMS agencies respond to almost 78,000 calls in the state each year, but only 51,000 of those calls are “reimbursable.”

“The other 34 percent are not reimbursable, meaning most insurance companies will not pay for that call because it usually involves something called a lift assist … where you show up to someone’s house and maybe help them because they fell down,” he explained. “There’s no way you can even submit a bill to a payer.” 

The other issue EMS providers face in a rural state like Wyoming is the low volume of calls that ambulances receive compared to the “high fixed costs” required to maintain emergency medical services, Fuchs said. 

“The volume is not there to sustain a lot of these services on the revenue side,” he said. 

Wyoming Rep. Pepper Ottman, R-Riverton, wondered whether the state could take steps to ease some of the training requirements emergency medical technicians are required to fulfill, so Fuchs noted that Wyoming currently uses national EMT licensing standards and added that there is also “a balance” to be struck between the regulatory “burden” and the “standards of care” that EMTs offer.

“Do you want somebody who’s not trained working on your ambulance?” he asked. “That’s … the balance that we weigh. (But) we’re certainly happy to defer to you all as elected officials on how that balance should be struck.”