Last year marked Minnesota’s first large investment in emergency medical services statewide, but with ambulance services in the state receiving less than half of the funds billed to insurance companies in 2023, EMS providers are in need of more funds to keep running.

Last year’s $30 million investment put $24 million toward grants to various statewide EMS providers and $6 million toward a “sprint medic” pilot program, which will staff paramedics in an SUV that can provide support to multiple ambulance services. The concerns for EMS funding in Minnesota arose in part from the Office of the Legislative Auditor’s 2022 report that highlighted the continued struggles of EMS in the state.

The $24 million invested across the state varied from about 19.2% of the funds or $4.6 million going to the northeast region and about 4.5% or $1 million going to the Twin Cities metro, with a small portion of the funding going toward aiding the Department of Revenue to manage payments.

The funding, which was disbursed Dec. 26, was based on a formula of call volume, square miles and population in each region that EMS covers to ensure funding was fairly distributed, according to the Office of Emergency Medical Services.

The bill also required the creation of the Office of Emergency Medical Services. Dylan Ferguson, who directs that office, said the funding is focused on operational expenses, but the intent was to be flexible based on the needs of each region of Minnesota.

“We see a higher level of challenges in our more rural and sparsely populated areas,” he said. “They have to cover larger areas, and they have to typically drive longer to get to a hospital, and those more rural areas do rely very heavily on volunteer EMS providers.”

So far in 2024, Ferguson said, Minnesota has seen 1,388 emergency medical technician certifications expire with retention rates struggling. On top of that, he said, 1.2% more calls were received from January to November of 2024 compared to the same period in 2023.

As Minnesota’s population continues to age and things like reimbursement rates for providers decrease, their office is seeing a continued need for funding, Ferguson said.

“The investments that were made in EMS during the last legislative term, they were very much needed,” he said. “They’re going to help a lot of ambulance services that were struggling, particularly in the short term, but intermediate and long-term needs are certainly going to remain.”

Looking forward

Rep. Jeff Backer, R-Browns Valley, is a volunteer EMT and said he plans to continue pushing for more EMS support in the upcoming session. Backer said while he doesn’t expect funding for health services to increase dramatically this session with Minnesota’s tight budget, EMS funding is one of those “essentials” that will get attention.

“We’re going to be focusing on essentials, and EMS falls into that category, just like hospitals fall into that category,” with extra interest in Greater Minnesota, Backer said.

He said he wants to look at reimbursement rates, with Medical Assistance programs like MinnesotaCare increasingly struggling to refund hospitals and EMS providers.

Backer said he thinks Democrats have put more individuals into programs like MinnesotaCare than the providers can keep up with and believes the absence of additional funding from the state will keep lowering reimbursement rates and rates of the services in general.

“When you don’t add additional funding, and EMS makes a call on an ambulance run, your rates are just going to get lower and lower,” he said. “So, there’s more people who want that medical assistance, but if you have 100 people who were using that pool before, now it’s 150, and your pay rate is going to decrease even more, which puts more strains on our local ambulances.”

Backer said in his last three runs as an EMS volunteer, people have been using some form of Medical Assistance where up to only $1 is provided as a reimbursement. “You just can’t keep a service running that way,” he said.

Ferguson said about 40% of the services are paid for via Medical Assistance.

“EMS billable revenue is billed to Medicare, and the amounts reimbursed are below the cost of what it actually takes to provide the service,” he said. “We look at the policies of various payers for EMS services, those are probably some of the largest drivers to the workforce and the funding challenges that we see in not only in Minnesota EMS, but in EMS across the country.”

Backer also called attention to a lack of reimbursement for what are called “no loads.” He said that in many cases, first responders don’t get paid because a person either refuses care or doesn’t need transportation.

In 2023, ambulance services reported $1.2 billion in insurance billables in Minnesota but received approximately $450 million in insurance payments during the reporting period, and 72% of reporting ambulance services reported some level of financial loss when comparing operational expenses to insurance revenues, according to the Office of Emergency Medical Services 2023 report.

Backer said another part of addressing the problem is looking at the need for better preventative care to reduce emergency calls, as people often wait until the last minute to seek help, putting pressure on EMS. He noted that is a more long-term fix.

“It’s no different than if you walk into your bathroom and the toilet’s leaking,” Backer said. “Yes, it’s going to be nice to repair the floor, but … we got to stop the leak first before we can fix the flooring.”

Increased funding in telehealth was another solution Backer and Ferguson both pointed to, giving EMS providers an option to communicate with doctors via telehealth and treat patients on the scene versus having to drive patients to a hospital for that care.

Ferguson said their mindset is, “We’ll eat the elephant one bite at a time,” and that in the next two legislative sessions, they believe Minnesota will see multiple proposals on the bipartisan issue of EMS support.

“Did we solve all the issues last year? No, we got past the first curve,” Backer said. “We got curve two, curve three, curve four, and then we have another lap, maybe two more laps, but we are on the racetrack.”

Related Articles

Bans on ‘junk fees,’ forever chemicals and binary triggers among new Minnesota laws as of Jan. 1

Survey on isolation: Nearly half of Minnesotans report feeling left out at times

Gearing up for ice fishing can be as inexpensive – or as pricey – as anglers want it to be

For former Pioneer Press sportswriter Kelsie Snow, life exists at the junction of joy and grief

Friends, colleagues remember groundbreaking Minnesota lawmaker Mary Murphy