Richmond Ambulance Authority tells committee it needs $10 million subsidy; warns leasing costs and payer mix strain finances

Chip Decker, chief executive officer of the Richmond Ambulance Authority, gave the committee an annual report and budget update, saying RAA responded to just over 61,000 calls in 2025 and transported roughly 43,000 patients. Decker said the agency bills about $88 million annually but expects to collect approximately $18.9 million due to payer mix and write-offs; he characterized the resulting shortfall as the reason RAA repeatedly seeks city subsidy.

Decker detailed the composition of revenue and expenses: personnel salaries and benefits are the largest single expense (about $21 million), the agency collects roughly 23% of what it bills, Medicaid and Medicare reimburse at low fixed rates compared with billed charges, and bad debt/write-offs are large (he cited ~$58 million as the portion classified as bad debt in conversation). Decker described recent forced leasing of ambulances and estimated that five-year principal and interest on ambulances and monitors totals about $18 million, with roughly $1 million in interest costs over five years attributable to leasing.

For FY26, Decker said his requested subsidy was $10 million (about the same request as the prior year) while noting the current proposed city budget included $7.6 million in general-fund support plus $1 million in capital to purchase two ambulances. He said the authority needs seven additional ambulances next year to replace an aging fleet and that leasing shortfalls and price increases have produced a potential $2.4 million gap between his request and the proposed subsidy.

Decker asked the committee to consider the fiscal pressures the authority faces and to evaluate options to reduce losses through billing or payer-mix changes, and the committee followed up with detailed operational and budget questions.