A group of Montana lawmakers met with ambulance service providers last week to see if there's a way to fix what many say is a financial crisis hitting the emergency services industry in the state.
Sen. Shane Morigeau, a Democrat from Missoula, is a member of the 2023-2024 Economic Affairs Interim Committee at the Montana Legislature. The committee held a hearing to discuss the failure of a bill in the last session, HB 828, that would have established an ambulance provider assessment fee in order to leverage federal dollars.
Morigeau told his fellow committee members that a constituent once complained to him that two girls, who were in critical condition following a highway car crash, had to wait over an hour for an ambulance.
"And that was because we have an ambulance desert problem," Morigeau said. "It's a problem that needs to be fixed."
By "ambulance desert," Morigeau was referring to places in rural Montana that are far away from the nearest ambulance provider.
Many ambulance providers around the state say that the reimbursement rates from Medicare and Medicaid, along with trouble recruiting and retaining paramedics, is hurting their financial stability.
Earlier this year, Granite County lost its only ambulance provider, prompting the local sheriff to say he was concerned that people suffering medical emergencies might have to find their own ride to a hospital.
Erin Sullivan, a legislative research analyst with the state, told the committee that a recent national study found that Montana has fewer than three ambulances covering every 1,000 square miles of land.
"According to the Montana Ambulance Association, the industry is experiencing funding gaps and workforce shortages, leading to ambulance service closures across the state," she told the committee.
According to Sullivan, during the House Human Services hearing on HB 828, Justin Grohs with Great Falls Emergency Services stated that Medicaid reimbursement rates are about 40% below cost.
At the same hearing, Ryan Pitts with Logan Health EMS (in Kalispell) explained that the reimbursement model is call-based, and "with the vast geography in Montana and lower call volume, it is difficult to sustain services with low reimbursement rates," according to Sullivan.
Sullivan told the committee that HB 828 would have levied an assessment on ambulance providers in the state, and those funds would be used to leverage federal funds that would then be re-distributed to providers to enhance ambulance provider rates and improve the quality of services.
Sullivan told the committee that HB 828 passed the House and Senate in the last session but was sent back by Gov. Greg Gianforte with some minor amendments he wanted, one of which was to strike the implementation date from the language of the bill to give state agencies more time to work out the details. The House passed the changes, but the Legislature adjourned for the session before the Senate could vote on the changes. Therefore, the original bill was vetoed by the governor.
Don Whalen, the manager of Missoula Emergency Services Inc., is also the president of the Montana Ambulance Association. He said the association didn't have a problem with Gianforte's amendments.
Justin Grohs, with Great Falls Emergency Services, said the bill would not have put any additional burden on Montana taxpayers. He said the bill would help service providers increase wages and therefore recruit and retain paramedics.
Sen. Mark Noland, a Republican from Bigfork, said he's generally in support of the bill. He noted that if Montana leverages federal dollars, that increases the federal budget deficit.
"When we ask the feds for money and take the money, we're adding to the problem," Noland said. "Debt is a big problem. The feds are so out of control, we're bustin' at the seams."
Noland noted that the state of Montana doesn't have a budget deficit problem right now.
The committee took no action on the bill, but they all agreed that the issue is worth a closer look during the 2025 session of the Montana Legislature.