County hears detailed briefing on ambulance funding as services face reimbursement gaps

Consultants and local EMS directors presented a sustained briefing on ambulance sustainability at the Lincoln County Commission meeting, describing a widening gap between service costs and reimbursement and offering funding options for the commission and local governments to consider.

Sharon Shantel of Sage Project Consultants described staffing and pay issues facing rural EMS: on‑call paid volunteers receive $3.25 per hour while paid EMTs average $15 per hour and paramedics $23 per hour. She emphasized that those pay levels make recruitment and retention difficult and increase reliance on mutual aid across jurisdictions.

Sharon outlined two primary funding approaches used in South Dakota: (1) equitable funding within an ambulance jurisdiction—sharing the shortfall between revenue (billed charges and reimbursements) and costs across municipalities and counties based on call volume or population; and (2) forming an ambulance district (a special purpose taxing entity) that can levy property taxes or special assessments within a defined geographic area to sustain operations. She explained statutory mechanics, including formation by petition or resolution and board governance, and cited statutory levy caps discussed by the group.

Presenters gave anonymized billing examples showing typical insurance and patient payments cover a minority of billed ambulance charges; Medicaid and Medicare reimbursements in examples covered roughly 19–34% in sample cases shared during the briefing. Alan Perry, director of EMS for Lennox, said roughly 60–70% of call volume in his service area is limited by Medicare/Medicaid reimbursement constraints, which restricts revenue recovery and increases reliance on non‑patient funding.

Commissioners and attendees asked detailed questions about collection practices, whether ambulance services can pursue small‑claims or judgment collections for remaining balances, and how hospitals handle similar gaps. Presenters said unpaid patient responsibility can be sent to collections but insurer contractual rules and federal law limit recovery from Medicare/Medicaid patients; collection practices vary across providers.

Speakers also reviewed legislative activity: Senate Bill 211 (proposals to change minimum standards for insurer payments to EMS) failed on a narrow Senate vote this year; Senate Bill 89 (initially proposing to designate EMS as an essential service) has been amended into a study/task force during the session. Presenters encouraged local jurisdictions to explore equitable funding or ambulance districts proactively rather than waiting for state mandates.

Public comment included municipal officials urging county leadership to consider targeted county funding support and to study successful regional approaches (the presenter cited Moody County as a case where city, tribe, hospital and county contributions closed the gap). The briefing did not conclude with a motion; commissioners were urged to consider next steps, including a county funding application process and coordination with neighboring jurisdictions.