Although the process seems to be dragging out for much longer than anyone expected, the merger of the nonprofit Anderson Valley Ambulance Service with the Anderson Valley Fire Department is close to being a done deal.
Last week the Community Service District's budget committee got their first look at a draft budget based on what the merger might look like. There are still several unanswered questions relating to the County's pending "Exclusive Operating Area" plans for ambulance services in inland Mendocino County. The CSD’s draft budget assumes that our ambulance service would operate more or less as-is after the merger.
Given that assumption, it looks like a merged Fire-Ambulance department would be revenue neutral, even though a significant number of ambulance responses go unreimbursed every year.
Medi-Cal reimbursements are so niggardly for Medi-Cal patients that ambulance rides are effectively free to those patients. Several dozen private responses also go unpaid every year. However, Medicare and private insurance provide a substantial revenue source on top of donations and memberships. According to Ambulance Service Manager Clay Eubank, memberships would be allowed even if our ambulance becomes part of the Community Services District "government agency."
At the moment there is some possibility that if the ambulance becomes part of a government organization such as the Community Service District it would qualify for "InterGovernmental Transfer" (IGT) funds, which have some connection with the Obamacare providing partial reimbursements to rural medical services. However, Eubank and Avila did not include that possible revenue source in their draft budget because they doubt that it will continue to exist when Trump takes office.
If the merger goes through, the existing ambulance service would remain as a nonprofit fundraising arm independent of the fire department but without their operational role, similar to the way the Volunteer Firefighters Association now operates.
After much discussion a couple of years ago about the need for setting up an Exclusive Operating Area in inland Mendocino so that ambulances in the Ukiah area do not compete for patients, the process of preparing a Request for Proposals (RFP) and setting up the authority for the request has dragged out indefinitely since the County turned over the process to an arm of the Sonoma County Health & Human Services Department known as "Coastal Valley EMS."
There is still no date set for the release of the RFP and concerned locals are worried that if Anderson Valley Ambulance were to become a subcontractor to a Ukiah-based operation, the private organization might either require more professionalized services than Anderson Valley can afford, or could sidestep the local ambulance service altogether and provide ambulance service via a dispatch out of Ukiah — with much longer response times.
The Community Services District board recently sent a letter to the County Board of Supervisors (which still retains theoretical authority over the Exclusive Operating Area RFP process), asking them to look into it and provide some clarity so that the merger budget and staffing questions can be answered. The Board of Supervisors so far has not responded to the letter and Fifth District Supervisor Dan Hamburg has been entirely invisible on the question.
The full Community Services District board will get their first look at the draft budget tonight, Wednesday, November 16, at their 5:30pm meeting.
The current Ambulance Service Board initiated the merger idea last year in hopes of providing more stable management, closer working relationships with volunteer emergency responders, and improved local control in the event that a corporate ambulance operation tries to extend its privatized reach from Ukiah to Anderson Valley.