Cuts in governor’s budget would hurt local ambulance services

March 07-- Mar. 7--MOHAWK -- Board President Greg Eisenhut, of the Mohawk Valley Ambulance Corps, warned of a crisis in emergency transport services in rural areas during a symposium MOVAC hosted last March at Herkimer College.

And based on Gov. Andrew Cuomo's proposed cuts to Medicaid Crossover and Supplemental funding, things could be getting even worse for MOVAC and other rural ambulance services.

The United New York Ambulance Network issued a news release last week warning of "the impending collapse of the statewide ambulance industry if Medicaid Crossover and Supplemental funding are not reinstated in the 2019-20 State Budget. At a time when the statewide ambulance industry struggles to survive, the Executive's budget proposal has slashed critical funding and put the statewide ambulance industry in peril."

The statement points out state and federal reimbursements for Medicare and Medicaid calls are already far below the cost of the emergency and non-emergency services ambulances provide.

The state Department of Health's Medicaid Rate Adequacy Study Report found ambulances across the state are underpaid $31 million annually for Medicaid transports.

"In other words, every time an ambulance service answers a call for a Medicaid patient -- whether it's an emergency call or a hospital to hospital transfer -- they lose money," according to the release.

Ambulance personnel were in Albany Tuesday to protest the cuts.

Eisenhut echoed their concerns.

"Our state has lost at least 20 to 30 ambulances that have gone out of business or gobbled up by larger ones in many in rural areas," he said during a telephone interview this week.

One, in neighboring Fulton County, ceased operations just last month. That service had the same corporate structure as MOVAC, but was a larger operation, he said.

After reviewing last year's records, Eisenhut found MOVAC had been reimbursed $1.9 million for more than $6 million in services.

"That's 29 cents on the dollar and that's not sustainable," he said.

"The governor's budget plan, which is entailed in two bills, includes two very disastrous cuts to Medicaid," said Eisenhut. "The more rural you are in New York state, the more people are covered by Medicare and Medicaid."

Reimbursement for Medicaid transports amounts to only 10 cents on the dollar.

He cited the high cost of ambulances -- a Type 1 ambulance costs $135,000 to $140,000 -- along with the cost of workers' compensation, which he said is the highest in the nation, among the factors that put more pressure on ambulance services. And those factors affect what MOVAC can offer its employees.

"These are highly trained people operating in pre-hospital care without a doctor looking over their shoulders," said Eisenhut. "I just respect these young men and women who want to make a career out of this, but how can you have a career when you can't even have health insurance?"

When MOVAC seeks to collect some of the more than $200,000 in unpaid bills it is owed, "we're the enemy," he said. "But the alternative is to go out of business. We have no reserve funds left at MOVAC. There's nothing to fall back on."

Eisenhut said he has been writing letters to the governor and other state officials about his concerns.

"It certainly hurts," Ilion Fire Chief Robert Paddock said of the proposed cuts.

He heads a career fire department with an ambulance service.

"I think the most devastating impact will be on the private ambulance companies. It's hard to say what the impact on our revenue will be," Paddock said.

He said a certain portion of the people transported by Ilion ambulance have Medicaid as their sole insurance while some have Medicare with a Medicaid supplement.

"It's a little bit different for a career fire department anyway. I think the biggest impact will be on the ambulance services that rely solely on billing patients for their source of revenue," Paddock said.

There are few volunteer ambulance companies any more, he said.

"And even with a volunteer ambulance company, you still have to have a facility, lights, heat and ambulances," Paddock said.

State legislators are also concerned about the cuts.

"I'm very concerned about the way governor proposes to treat our ambulance providers," said state Sen. James Seward, R-Oneonta. "There's a direct $3 million cut in extra reimbursement for ambulance services for Medicaid and basically $3 million at the state level translates to a $6 million cut."

He explained after a study showed Medicaid reimbursement rates to ambulance services were "woefully inadequate," the state began providing a $3 million supplement, which is matched by federal funds.

The governor's budget plan would also eliminate crossover funding that allows additional reimbursement for people who are eligible for both Medicare and Medicaid.

"That's an estimated $14 million cut," said Seward. "This is particularly difficult in our area."

He pointed out MOVAC has a unit in Dolgeville and questioned whether these cuts would make it even more difficult for the ambulance service to cover the calls in a less busy area.

"To me it's so important to have ambulance service available in rural areas," he said. "I will work very hard to have restoration of those funds."

"This is just a terrible situation we're in," said Assemblyman Robert Smullen, R-Gloversville, whose district includes Fulton and Hamilton counties and parts of Herkimer, Oneida and St. Lawrence counties. "What the governor has done is take money designated for ambulance companies and sweep it in the general fund simply to patch the massive hole in this year's budget. Ambulance services across the state are already operating at a loss of millions servicing Medicaid patients. Why are we taking more money from these vital services? Unfortunately, in a lot of rural areas, the number of Medicaid patients tends to be higher, so the impact would be much more severe upstate, and we're already seeing the consequences. I'm all for a balanced budget, but doing it on the backs of ambulance services is not the place to start."

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