Commercial ambulance services — private businesses that work with health care facilities transporting patients in New York State — say they will refuse to carry anyone who is "dual eligible" for Medicaid and Medicare unless a proposed cut from the state budget is restored.
The transporters say their industry stands to lose about $8.25 million this upcoming fiscal year and $12 million the following fiscal year because Medicaid Crossover and Supplemental funding has been eliminated in Gov. Andrew M. Cuomo's proposed budget plan. The state's next fiscal year starts April 1.
The governor's budget calls for slightly more than a $20 million cut, which could automatically trigger a matched loss in federal Medicaid dollars for a total of more than $40 million, said officials for the United New York Ambulance Network, a nonprofit organization that represents the commercial ambulance industry.
Crossover and Supplemental funding, which is financed through Medicaid, primarily affects older and disabled patients who are eligible for Medicaid and Medicare. This population frequently is in need of nonemergency medical transportation services, especially from nursing homes to hospitals or vice versa, ambulance network officials said.
When a Medicare patient is transported by a commercial ambulance service, 80 percent of the cost is billed to Medicare and the additional 20 percent to the patient. For someone who is dual eligible, meaning covered by Medicaid and Medicare, the remaining 20 percent is paid by Crossover funding.
“The governor has cut 20 percent of our reimbursement,” said Michael Vatch, chief executive of SeniorCare EMS in Lynbrook, who explained his ambulance service largely transports medically fragile patients between health care facilities, often from a subacute care center to a hospital or from one hospital to another.
“Nonemergency hospital-to-hospital transport is done by commercial services. We’re taking the hit. This will result in a significant cut in services,” Vatch added. He called the transport of nonacute patients one of the most vital aspects of health care that rarely, if ever, captures a spotlight.
Commercial ambulance businesses in New York State not operating under the 911 calling system can refuse services for nonemergencies.
Nonemergency transportation of sick patients is not a trivial affair, asserted Vatch, who noted that these patients “can’t be put in a taxi” and driven to where they need to go. The patients usually are quite compromised, he said, and require special care during transportation.
Vatch’s service, along with another, Hunter EMS Inc. in Bay Shore, respond to many of the calls throughout Long Island for specialized ambulance services. In rural New York, commercial transporters provide the vast majority of emergency and nonemergency services, Vatch said.
“We move several hundred people a day,” said Daniel Leibowitz, chief executive of Hunter EMS, who estimated that his company might have to consider cutbacks if state funding is not restored. “We also would have to make tough decisions about how we deliver care. There’s no way to maintain the status quo that the health systems and patients have come to rely on. This would affect a lot of facilities."
The state contends that changes are underway regarding how money is allocated to the health care industry. Cuomo additionally wants to rein in Medicaid growth, which is estimated to be the highest in the nation at 75 percent above average.
“The state has been standardizing payment practices across the health care industry, including updates to Medicaid billing methodologies," Morris Peters, spokesman for the New York State Division of the Budget, said in an email.
"In situations where Medicare pays an appropriate amount, Medicaid should not pay more than it ordinarily would for any other patient. These changes are not anticipated to have any adverse impacts on availability of transport services," Peters added. "The Executive Budget also includes an increase in ambulance reimbursement rates and several new EMS workforce development efforts are underway.”
Despite possible cuts nonemergency providers face, emergency responders are experiencing tough times as well, said veteran first responder Anthony Guerne, who has worked throughout Long Island for nearly three decades and is a past member of the Regional Emergency Medical Advisory Committee.
“When I started 28 years ago, there was a waiting list to become a volunteer. Now, no one wants to volunteer. Volunteerism is a thing of the past. Every fire department is having problems finding volunteers, and call volume has exploded on the Island," Guerne said.
Unlike commercial ambulance services, volunteer fire department emergency response systems do not bill patients, Guerne said.
David Butler, chairman of the United New York Ambulance Network, said the need for ambulance services is increasing as the population invariably ages.
"For years, the statewide [commercial] ambulance industry has been operating at a loss of over $31 million annually when it comes to Medicaid and Medicare reimbursements from the state. The elimination of this vital Crossover funding will make it more difficult for ambulance services statewide,” Butler said.