San Juan County officials say EMS faces $510,000 shortfall; consider TRT grant, special district, hospital partnership

San Juan County commissioners, city representatives and EMS staff met May 6 to review ambulance operations and finances and to discuss ways to cover a projected 2025 budget gap of about $510,000 for county-run emergency medical services.

The county’s EMS presenter, Jeremy (EMS staff), said the department expects to collect $503,000 in transport revenue in 2025 but still faces a deficit once personnel and other operating costs are counted. “It does leave us a deficit this year of $510,000,” Jeremy said. He told commissioners staff had cleaned up patient care reports (PCRs) and that transport billing and collections have improved, but industrywide payment rates and insurer denials limit revenue.

The shortfall and its implications

Jeremy’s presentation included staffing and workload details: the county staffs two full ambulances continuously and two additional units as staffing allows, and annual call volume puts the county’s per-call cost at roughly $1,800 when the approved budget is divided by the number of runs. Jeremy described Medicare and Medicaid payment limits and insurer denials as constraints on revenue: “Ambulance rates are set by the state of Utah,” he said, adding that collection rates on billed transport revenue have been near industry norms (about 30–35 percent of billed charges).

Why this matters

Commissioners and city officials framed the shortfall as a shared service issue involving county, cities and the hospital district. The county’s budget shortfall, if unaddressed, could force reductions in ambulance coverage or require new local funding. Jeremy and other officials emphasized that EMS was designated an essential service in state law in 2022 and that keeping 24/7 ambulance coverage is a public-safety priority: “We can’t not fund it. It can’t fail,” Jeremy said.

Options officials discussed

- TRT resolution and grant application: Staff described a new state-level program tied to transient room tax revenue. A county staff member (Staff member, county) said counties can pass a local resolution to adopt a portion of TRT revenue and become eligible to apply for a competitive grant pool the staff member estimated at about $8,500,000 statewide. Staff said the county must pass its resolution and notify the Utah State Tax Commission; the earliest collections from an adopted increase would arrive in the second quarter after implementation.

- Special service district or shifting EMS to the hospital district: Commissioners and staff discussed whether turning EMS over to San Juan Health Services (the hospital district) or creating a dedicated ambulance service district would help; participants disagreed about likely benefits. Some officials worried hospital control could favor one facility’s transfers and could leave other areas underserved. Others noted a hospital-run billing operation could reduce outside billing fees.

- Cost-sharing with cities and neighboring providers: City representatives said they are sensitive to increasing local taxes and to the perception of double taxation where city residents already pay a health-services levy. Commissioners suggested meeting with city leaders, the hospital district and legislators to pursue joint solutions and possible legislative changes to better reflect rural needs.

Billing, transfers and payer mix

Jeremy and other staff detailed operational and billing realities that affect revenue. The county uses an ambulance-billing vendor (JCI); Jeremy reported the county paid about $17,400 last year to JCI to collect roughly $500,000 in transport revenue. Officials said a large share of calls involve Medicaid or Medicare patients—one staff member summarized the payer mix as roughly 60 percent Medicare/Medicaid, about 20 percent private or self-pay and the remainder commercial—limiting high-margin collections. Officials also said hospital-to-hospital transfers and long-distance transfers create high operational costs with little corresponding reimbursement; one example showed 13 long transfers produced only about $1,000 in collections after costs.

Local partnerships and next steps

Commissioner Mann urged lawmakers and local officials to take a broader view of rural needs and suggested meeting with the county’s legislative representatives. Officials agreed next steps should include continued work with the Utah Association of Counties on a model TRT resolution, outreach to San Juan Health Services to explore partnership or transfer options, and further data collection on payer mix and transfer costs. Jeremy said staff would continue refining PCR-based run-location data to better show the impact of tourism and nonresident patients on call volume.

Formal action

No funding action was taken at the meeting; the commission adjourned after the discussion. Commissioners and staff said they will continue conversations with city officials, the hospital district and legislators and expect to return with follow-up information and possible draft resolutions or proposals.

Ending

County officials described the session as the start of continued outreach and analysis rather than a final plan. They urged cooperation among the county, cities and hospital district to avoid weakening 9-1-1 ambulance coverage in San Juan County.