• Global Medevac


April 20, 2021 by Daniel Bendtsen, WyoFile

The historic revenue crisis facing Wyoming’s state, county and municipal governments is threatening to claim yet another casualty: universally available ambulance service.

The state-wide problem is perhaps most acute in Fremont County, where a five-year-old cost-saving plan has unraveled, leaving the nearly Vermont-sized region without a single outfit interested in providing service beyond June.

(Mike Vanata/WyoFile)

Amid an economic downturn and significant budget cuts, Fremont County Commissioners opted to privatize the county’s ambulance service in March 2016.

The cost of the county-run ambulance service had been rising, resulting in a $1.2 million budget request. The county’s assessed tax base dropped 27% that year.

So commissioners signed a five-year contract with Guardian Flight. The private enterprise not only took over the EMS service, but it did so without requiring a governmental subsidy and paid the sheriff’s office more than $200,000 per year for dispatch services and another $250,000 to rent the county’s ambulance equipment.

At the time, there was a hope that Guardian — now owned by AMR — would eventually buy the county’s equipment and the original contract would’ve been just the start of a long-term relationship.

Instead, the operation lost money from the get-go; in the 2020 fiscal year, AMR lost more than $1 million in Fremont County, according to Matt Strauss, who oversees the local operation as regional director for AMR.

When county commissioners decided to issue a request-for-proposals this year after failing to reach terms on a second agreement, AMR announced it wouldn’t bid.

“We can’t sustain that kind of loss long-term,” Strauss said.

When the deadline for the RFP ended Thursday, however, no other company had bid either. County commissioners are set to discuss next steps Tuesday.

Before the RFP closed, Fremont County Commissioner Larry Allen had hoped AMR’s successor wouldn’t need any governmental subsidy, but also acknowledged that might not be possible.

“We’re hopeful that, if we have to pay a subsidy, it’ll be minimal,” he said. “If they want something like $1.5 million, the county might as well run it ourselves.”

Long-term, Allen said, Fremont County will need to find a stable source of funding for EMS.

“We’re going to have to do something, maybe a mill levy,” he said. “Those are the conversations we’ve had with other commissioners. … If towns and cities want ambulances, they’re also going to have to help out a bit.”

Fremont County is just one Wyoming community where the future of EMS is uncertain. Its struggles with financing the service underscore an issue unfolding across the mostly rural state, where cash-strapped local governments are grasping to find a sustainable funding model to maintain a service most agree is essential.

The issue is now reaching a “breaking point that was easily predicted,” said Andy Gienapp, the state’s top EMS official from 2010 to 2021. “We have not gone about creating a design that works for the future or, when we see it, we’re hesitant to make the changes that need to happen to really design something.”

Without that foundation, communities across the state are having hard conversations as they try to forge solutions.

No mandate, no money

Sweetwater County Commissioners are also struggling to craft a plan to maintain EMS service amid rising costs.

In December, commissioners told their two EMS providers they’d terminate both contacts by March, saying it was “unsustainable” to continue subsidizing them. The current county-paid subsidy, $1.2 million annually, is more than double what it was just two years ago, according to the county’s budgets.

In early March, commissioners asked the cities of Rock Springs and Green River to cover half of that $1.2 million cost. The county warned the municipalities that one of the two services, Sweetwater Medics, was just weeks away from no longer responding to EMS calls. Ultimately, the commission voted to continue funding the ambulance services until at least June, while continuing negotiating with the two cities.

Contributing to the crises facing counties like Fremont and Sweetwater is a lack of a designated tax base for ambulance service and the lack of mandate to fund those services.

Wyoming counties are allowed by state law to levy a maximum of 12 mills in property taxes for their general funds — revenue that is already stretched thin funding services that state statute explicitly obligates counties to provide.

So, for example, when Fremont County’s assessed values dropped by about $250 million for the 2017 fiscal year, the county found itself scrambling to shore up a $2 million budget deficit. State law both limited what the county could cut and barred raising taxes just as the county’s EMS director was requesting $1.2 million in general funds.

Commissioners stressed the need to focus on meeting “statutory obligations” — services like sheriffs and prosecutors.

Ambulance service is not on that list. In fact, no entity — not municipalities, counties, hospitals nor the state of Wyoming itself — is required to provide EMS to Wyoming residents.

“As we talk today, literally everybody who runs an ambulance service could stop doing it tomorrow, and there’s nobody that could make them do it,” Gienapp said of the 62 ground ambulance services and 23 air medical groups currently operating in Wyoming under a variety of contracts.

As the funding crisis worsens, EMS leaders are pushing the Legislature to establish some legal obligation to prevent a worst-case scenario.

“The ultimate risk is that you might not have ambulances coming to take care of you, and if you do, you might have to wait hours before someone gets to you,” Strauss said. “I think that’s the concern that all of us have, because we’re all health care providers and we want to take care of people.”



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