By KAREN VELIE

After years of taking a slice of the medical emergency revenue pie, there is a proposal for San Luis Obispo County and its cities to adopt a public private partnership known as an alliance model that would help cement government’s ability to charge for emergencies.

There are multiple models for county ambulance services including having only private ambulance providers respond to medical emergencies such as heart attacks and seizures, the cheapest for the consumer and some say the safest. Currently, in SLO County, firefighters respond to all calls while the ambulance drivers are generally dispatched a few minutes later under the first responder fee program.

First-responder fees are a relatively modern concept, coined within the last 30 years as a way for fire departments to receive compensation for assisting the private ambulance company as the first to arrive on scene in medical emergencies. With fewer building fires, it was a way to help fund fire departments.

Built into the cost of an ambulance ride locally is the fact that San Luis Ambulance Service is facing first-responder fees of about $1,059,732 for the 2026-2027 fiscal year.

In several counties, fire departments have completely taken over emergency medical services and own and operate their own ambulances. However, with large salaries, early retirements with huge packages, this model is generally the most expensive.

Meanwhile, California increased its Medicaid payments to government-run ambulance providers at a cost to federal taxpayers. The discrepancy is huge: $360 to private ambulance companies for transport and more than $700 to government run programs.

Federal watchdogs have raised alarms about the Medicaid financing. The Trump administration is planning to tighten the rules. The Center for Medicare and Medicaid services have already proposed a rule to stop extra funding to government agencies.

“These schemes distort Medicaid’s financing structure, shift costs from states to the federal government,” wrote Mark Howell and Chris Medrano from Paragon Health Institute. “They are also fundamentally unfair because they give public providers a significant advantage over private providers.”

After 80 years of contracting with San Luis Ambulance for services, the SLO County Board of Supervisor voted last year to put the contract out to bid.

Noting the higher pay for government programs, the City of Paso Robles is seeking to replace the current program with the alliance model, which they would control. Paso Robles put out a request for proposals.

However, of the 170 ambulance companies operating in California, only American Medical Response made a bid. Ambulance companies argue the alliance model is not sustainable, with an estimated startup cost of over $12,500,000 to local governments.

Of the seven cities in SLO County, Morro Bay is the only city that rejected the plan.

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