Combating Fire & EMS Financial Constraints with Medicaid Supplemental Payment Programs

Author: Kendal August

Primary EMS Challenges

Amidst surging inflation and the rising cost of living, EMS departments find themselves in a critical condition. This article centers on the funding-related challenges faced by departments around the country and highlights the significance of obtaining adequate financial support through the Ambulance Supplemental Payment Program (ASPP).

In a previous webinar hosted by PCG, attendees from Fire & EMS departments were presented with the question “What are your top 5 biggest challenges?” This question yielded the following results: (1) Staffing, (2) Recruitment and retention, (3) Funding, (4) Reimbursement, (5) Finding/Keeping Volunteers.



Source: Today’s Biggest EMS Department Challenges – Fire and EMS Blog | Public Consulting Group (


As evident from the data, staffing and retention have become a prevalent challenge faced by Fire and EMS departments. An article from The Hill addressing the “Crippling Workforce Shortage” reveals that the American Ambulance Association and the National Association of Emergency Medical Technicians have jointly requested a congressional hearing on the matter, urging for increased funding to raise wages as a potential solution. This illustrates the need for additional funding to support departments to hire and retain workers. Although AMR raised wages over the summer, shortage of labor persists. As stated in the article, “until there’s a more consistent flow of new recruits, there will just be a never-ending revolving door.” This is further supported by the pie chart above with 21% of departments identifying recruitment and retention as one of their top challenges.

Additionally, James Pierson, the president of the California Ambulance Association, pointed out that though wages are currently at a peak, ambulance companies face a significant limitation in their ability to charge insurers higher rates. This is primarily because a considerable number of patients rely on Medicare and Medicaid, which offer fixed reimbursement rates. To compensate for this shortfall, agencies heavily depend on payments from commercial insurance and patients. To provide more insight on this topic, The National EMS Advisory Council Committee Report and Advisory (NEMSAC) states “The first challenge is that federal health care policy currently reimburses ambulance service as a transportation benefit. In general terms, the ambulance must transport the patient to a hospital emergency department (ED) to receive compensation from federal payers and most commercial insurance companies.” Consequently, there has been a rising trend where ambulance agencies are handling more cases without any reimbursement, leading to adverse consequences for all organizations involved. Departments are burdened with unreimbursed costs while providing crucial life-saving assistance on-site. Many commercial insurance agencies, Medicaid, and Medicare are not covering services provided by EMS organizations due to these services being considered as a mere “benefit.” As a result, agencies are facing severe financial strain.

In conclusion, the most pressing issue confronting EMS departments is the inadequacy of funding. Securing sufficient financial resources is essential not only for recruiting and retaining employees, but also for sustaining the department’s operations when expenses remain unreimbursed by insurance companies, Medicare, or Medicaid.


Combat funding constraints by participating in ASPP!

What is ASPP?

Ambulance Supplemental Payment Program (ASPP) is a cost reporting program that provides additional financial assistance to ambulance service providers in the United States. It was designed to address the funding challenges faced by essential emergency response organizations, especially in areas with high Medicare and Medicaid utilization. The program emphasizes the rationale behind adopting a cost-based Certified Public Expenditures/Intergovernmental Transfer (IGT) program for public Emergency Medical Services (EMS) providers, along with a provider assessment for private providers.

Publicly owned and operated ambulance providers are the frontline first responder workforce and play a vital role in supporting our local communities. Public emergency providers serve a disproportionately high share of services to the Medicaid beneficiaries and the uninsured. Regrettably, Medicaid reimbursement rates have not kept pace with the actual cost departments incur for the provision of services. Due to below market Medicaid reimbursement rates, providers continue to face colossal financial and operational pressures. The objective of ASSP is to ease some of the financial burden faced by dedicated first responders.

Notably, the ASPP aims to bridge the gap between the actual expenses incurred by fire and EMS providers and the amount reimbursed by insurance programs. By offering supplementary payments, the ASPP helps ensure that these critical first responder agencies can sustain their operations, retain skilled personnel, and continue providing life saving services to the community without facing undue financial strain.

ASPP is also known as Ground Emergency Medical Transportation (GEMT) and Public Emergency Medical Transportation (PEMT). The program name, requirements and extent of financial assistance may vary by state as it is administered at the state level.

General Program Eligibility to Participate in ASPP:

    1. Meet the definition of a government-owned ambulance provider.
    2. Have an active NPI number.
    3. Participate in CPE program and complete annual cost report.
    4. Receive authorization to IGT from governing body and set expectations.
    5. Sign a letter of Agreement (LOA) to IGT and participate program.
    6. Contract with all Medicaid MCOs within region.

For the Fiscal Year 2022 reporting period, PCG partnered with Fire & EMS departments across the country and helped providers generate over $143 million in supplemental funding!

State Programs PCG partnered with in FY22:

California Ground Emergency Medical Transport Colorado EMS Supplemental Payment Program
District of Columbia Reimbursement for Emergency Medical Ground Transport Services Florida Ground Emergency Medical Transportation
Illinois Ground Emergency Medical Transportation Iowa Ground Emergency Medical Transportation
Maryland Emergency Service Transporter Supplemental Payment Program Missouri Ground Emergency Medical Transportation
Oklahoma Certified Public Expenditure Oregon Ground Emergency Medical Transportation
Texas Ambulance Services Supplemental Payment Program Washington Ground Emergency Medical Transportation



Ground ambulance data collection (MGADC) survey

The MGADC survey is an initiative mandated by CMS to gather departmental statistics and data on the expenses incurred by ground ambulance providers and suppliers for providing EMS services. The purpose of this initiative is to evaluate the adequacy of Medicare payment rates for ground ambulance services, to inform future Medicare rate changes, and possible payment system reforms.

PCG helps navigate the data collection process and completion of the MGADC Instrument via three service levels that allows clients to get just the right amount of guidance and support based on their needs and budget.


To learn more about ASPP, MGADC or how PCG can serve your department, visit our website or book a complimentary appointment with one of our subject matter experts!


Sources Referenced:



Posted by Nora Culeton

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