County staff: emergency-services billing fund running a deficit; commissioners ask for options before adding recurring EMS positions

County finance staff told the Board of Commissioners on March 15 that the Emergency Services Billing enterprise fund is currently projecting a shortfall and that the draft FY23 budget includes placeholders and requests that, if adopted as recurring items, would materially increase that deficit. Commissioners paused on adding a suite of new EMS personnel and ambulances until staff returns with revenue and fund-balance options.

The numbers staff presented Chief Financial Officer Jeanette Cudmore walked the board through the packet showing the emergency-services billing fund and connected support accounts. Using the early-year billings and an annualized estimate, staff presented a working revenue estimate of roughly $1.98 million for the billing fund but identified current packet reconciliations showing the fund would be "in the red by about $1.1 million" before adding any new ECC (essential cost change) requests.

Cudmore urged caution in adding recurring costs while the fund's receivables and collections are still stabilizing under a new billing system. "This is really the best information we have right now as far as the billing system," she told commissioners, noting that the Quick Medic implementation had improved reporting but that collections remain a month behind.

EMS operations and staffing requests Emergency services leaders had requested multiple additional positions, medic staffing and vehicles in the draft package to build capacity. The packet includes a set of salary, hourly and vehicle requests that staff said would increase total enterprise costs by several million dollars if all adopted as recurring items.

Commissioner questions and board direction Commissioners asked for clear separation between one-time purchases that can be funded with fund balance or ARPA (vehicles, one-time equipment) and recurring personnel costs. Several commissioners said they were open to using fund balance for specific capital items (for example, replacement vehicles), but asked finance and emergency services to re-scope the package so the board could see: (a) what can be paid from one-time sources; (b) what would require recurring operating revenue; and (c) what additional revenue sources (including higher collections, fee changes or PAYGO transfers) might be used to cover recurring staff costs.

A single recorded motion at the session concerned pay adjustments for paramedic supervisors (a separate narrow personnel action). The board approved the requested pay adjustments for full-time paramedic supervisors by voice vote during the meeting; the transcript records the motion, a second and the presiding officer's call for the ayes, but does not list a line-by-line roll call in the minutes.

Context and next steps Finance staff will return with a focused package next week that distinguishes fund-balance-funded capital needs from recurring personnel requests and that identifies potential revenue offsets or PAYGO transfers to reduce the projected shortfall. Commissioners emphasized they want to avoid committing to large recurring EMS payroll increases without clearer revenue commitments.

Ending The budget work session closed with the commission asking staff to: (1) identify which EMS items can be funded one time (fund balance or ARPA); (2) quantify recurring personnel costs and the resulting gap; and (3) present offset options before the board adopts recurring appropriations for EMS staffing or new ambulances.