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Select Board hears ambulance billing shortfalls, reviews $317,614 DES grant for a replacement engine
Summary
The board was told Candia billed $236,932 for ambulance runs in 2024 but collected about 57.7% under fee schedules; unpaid balances totaled roughly $18,896. The fire chief also described a $317,614 NH DES reimbursement award for a replacement engine and asked whether the town would pursue the purchase given upfront costs and timing.
The Select Board on Feb. 9 reviewed ambulance billing performance for 2024 and a partial state grant to replace an aging fire engine.
Fire Department leaders told the board the town billed $236,932 for ambulance services in 2024 and collected roughly 57.7% of that amount under prevailing fee schedules; about 34% was reduced by government fee-schedule rules (Medicare, Medicaid and similar), roughly 5% represented patient bad debt after insurance paid and about 3% was uninsured nonpayment. The chief said unpaid ambulance balances totaled about $18,896.
"We lost, as the billing company explains, a little over 34% due to government fee scheduling," the Fire Chief said, adding that roughly 5% of patients left an unpaid balance after insurance. He told the board the billing vendor typically makes six bill attempts before classifying a balance as bad debt and recommended a hardship-review process for residents who cannot pay.
Board members discussed two options: refer unpaid accounts to collections (where the town would receive a portion of any recovery) or write off bad debt to clear the town’s reports. Several members expressed concern about referring residents to collections for relatively small sums and asked staff to provide examples from comparable towns. The chief said he would draft a hardship-policy template and circulate it for board review.
On apparatus funding, the chief said the town had been offered a $317,614 reimbursement award through the New Hampshire Department of Environmental Services (funds originating from the Volkswagen settlement) toward a replacement diesel fire engine. The grant is reimbursement-based: the town must purchase and put the engine in service before submitting for reimbursement, and work must be completed by Sept. 30, 2027.
The chief described three procurement options: custom-built engines (multi-year lead times and higher cost), dealer-select units (shorter lead times with some customization) and stock units (fastest delivery but least customization). He said custom options can cost $1.1M–$1.2M; dealer-select or stock units were being quoted in the $750,000–$950,000 range in recent estimates. The grant amount covers only part of the likely price, and the chief and board noted the town would need to front the remaining balance and later receive reimbursement.
Members flagged timing and budgeting concerns and asked the chief to pursue other grants and vendor options. One board member suggested waiting until after an upcoming warrant vote affects the capital fund balance before committing to a purchase. The chief said he would continue vendor outreach and present funding scenarios and any additional grant opportunities to the board.
The chief's presentation concluded with the board asking staff to draft a written ambulance hardship policy and return with more detailed cost and financing options for the engine, including whether capital-reserve funds could be used with subsequent reimbursement.
