Cities, fire departments back bill to let Nebraska draw federal GEMT funds for ambulance costs

Members of the Health and Human Services Committee heard bipartisan support for LB610, legislation that would adjust Nebraska's Medicaid state plan language to permit supplemental federal reimbursement for ground emergency medical transport (GEMT).

Sponsor Sen. Eliot Bostar said the change would allow Nebraska to claim federal Medicaid matching funds for the reasonable cost differential between Medicaid reimbursements and the actual costs of ambulance transports. He and witnesses said the program is voluntary for local governmental providers and has been adopted by many neighboring states.

Fire chiefs, municipal leaders and hospital representatives told the committee the federal supplement would help address shortfalls in payment for ambulance transports and reduce pressure on local property-tax budgets. Lincoln Fire Chief Dave Engler and Papillion Fire Chief Rob Gottsch described high call volumes, rising equipment costs and the difficulty of maintaining staffed ambulances in a tight labor market. Chief Engler said roughly 70% of his departments transports are Medicaid or Medicare and that GEMT funds would support fleet, staffing and training improvements.

DHHS Deputy Director Jeremy Brunson testified on implementation details and said participation would be voluntary for governmental providers. He outlined the primary mechanics: participating providers would file cost reports, the state would calculate the allowable cost differential, and providers would transfer the non-federal share via an intergovernmental transfer (IGT); federal matching dollars would then be claimed and passed back as supplemental payments. Brunson said the state would not expect general-fund costs and would retain a small administration portion from the supplemental payment to cover operational costs.

Supporters also included the Nebraska Professional Firefighters Association, the Nebraska Hospital Association and volunteer firefighter groups. Some witnesses cited the 2019 collapse of a for-profit ambulance operator in rural Nebraska as an example of how fragile transport networks can become without adequate reimbursement.

The committee did not take a vote at the hearing. DHHS indicated it had worked with the sponsor on draft permissive language and a schedule for prospective implementation to meet federal rules. Proponents said the program will not be mandatory for local agencies but would provide an option to recover reasonable costs for public ambulance operations.