Board orders analysis after review finds rural ambulance services running structural deficits

Coastal Valleys EMS and county staff told the Mendocino County Board of Supervisors on Oct. 7 that the county’s volunteer- and fire-based ambulance providers face persistent yearly shortfalls driven by workforce shortages, low Medi-Cal reimbursement and an unfavorable payer mix. The board unanimously voted to direct the executive office and county counsel to return with funding options — including an estimate for a 1% countywide sales tax and available PG&E-related funds — and asked Coastal Valleys to help develop spending scenarios.

The board hearing followed a fiscal assessment requested in May. Coastal Valleys EMS agency staff summarized each provider’s finances and operational risks. For Covelo, the agency identified an annual structural shortfall of about $900,000 and described a service area with nearly 40% of residents living in poverty and 10.4% uninsured, which drives low recovery rates even after billing efforts and rate adjustments. Anderson Valley’s reimbursement is constrained by payer mix (roughly 64% Medicare, 17% Medi-Cal) and a pattern of uncompensated “ALS rendezvous” transfers that account for a large portion of transports. Laytonville, the largest of the three in billing volume, still runs an estimated recurring deficit between roughly $191,000 and $216,000 annually despite stronger gross billing, the presentation said.

Coastal Valleys staff told the board county subsidy stipends and grants are currently essential to keep the three agencies operating, and warned that federal- and state-level reimbursement programs (GEMT/IGT) carry administrative burdens and uncertain futures. Presentation slides and the consultants’ review, the agency said, were vetted with each provider before the meeting.

Supervisor Ted Williams, who sponsored the motion, framed the problem as one of local funding choices and said the county should present options for voters rather than expect state or federal relief. Supervisors asked for a countywide fiscal estimate and a legal opinion on whether a sales tax could fund EMS and fire services. County staff said they would report back at a later board meeting with available PG&E-related funds that have been set aside and with revenue estimates for a countywide sales tax; county counsel agreed to advise on allowable uses of any proposed tax. The motion passed unanimously.

Public commenters included Anderson Valley EMS officer Clay Eubank, probation chief Aizen Locatelli, Teamsters representative Robert Maddock and others who urged action. Several speakers emphasized that, for rural residents, reliable ambulance response is a crucial public-safety service and said the county should lead on a community funding solution rather than wait for external aid.

Next steps: the executive office will inventory any PG&E/PG&E-set aside funds available to the county for EMS work, produce a revenue estimate for a 1% countywide sales tax, and return with county counsel’s legal analysis about permitted uses of such a tax. Coastal Valleys EMS will work with fire and EMS partners on possible allocation and program ideas to accompany the fiscal analysis.