New rates take effect July 1 and are expected to fully fund the city’s ambulance transport program while reducing pressure on the General Fund
The Folsom City Council on Tuesday approved a significant update to the city’s ambulance cost recovery program, adopting higher ambulance transportation fees and establishing an annual inflation-based adjustment intended to keep pace with rising operational costs in the years ahead.
The action approved a revised ambulance fee schedule that will take effect July 1 at the start of the 2026-27 fiscal year. The measure is projected to generate approximately $1.95 million in additional annual revenue, eliminating what city officials say is the current General Fund subsidy required to operate Folsom’s ambulance transport service.
According to the staff report prepared by Fire Chief Jason Solak, the Fire Department’s ambulance transport program currently costs an estimated $8.24 million annually to operate while generating approximately $6.29 million in annual revenue, leaving a funding gap of nearly $1.95 million that has been absorbed by the city’s General Fund.
“The Fire Department periodically reviews the fee schedule for emergency ground ambulance transportation services and recommends adjustments to ensure that fees accurately reflect the cost of providing the service,” Solak wrote in the report.
The last ambulance fee increase approved by the City Council took effect in October 2023. Since then, city officials reported that operating costs have continued to rise while ambulance fees remained unchanged.
Under the new schedule, the ambulance base rate for transports both within and outside Folsom city limits will increase from $2,158 to $3,071. Other charges, including mileage, oxygen administration, CPAP treatments and bone drill procedures, will also increase. The patient assessment and treatment fee for incidents where no transport occurs will rise from $425 to $438.
While the increases may appear substantial on paper, city officials emphasized that ambulance billing is heavily influenced by insurance reimbursement rules, particularly for Medicare and Medi-Cal patients.
According to the city’s analysis, Medicare patients account for approximately 60 percent of all ambulance transports in Folsom, yet reimburse only about 18.5 percent of billed charges. Medi-Cal patients account for another 15 percent of transports and reimburse approximately 38 percent of billed charges. Private insurance represents about 21 percent of transports and reimburses roughly 81 percent of charges, while uninsured patients account for about 4 percent of transports with collections averaging only 9 percent of charges.
The staff report notes that federal and state reimbursement caps prevent the city from collecting charges above approved Medicare and Medi-Cal reimbursement levels regardless of what the city bills. As a result, fee increases do not automatically translate into equivalent increases in revenue.
Currently, the average ambulance transport generates a billed charge of approximately $2,981, but the city collects only about $1,099 per transport after accounting for reimbursement limitations and payer mix.
To determine the appropriate fee levels, the Fire Department conducted an internal fee study and compared Folsom’s rates with neighboring agencies, including Sacramento Metropolitan Fire District, the City of Sacramento, Cosumnes Community Services District and South Placer Fire District.
According to the staff report, simply matching regional averages would not generate enough revenue to close the program’s funding gap. Staff determined that adopting regional average fees across all categories would have generated approximately $1.59 million in additional revenue, still leaving a significant shortfall.
As a result, the city selected a higher Advanced Life Support base rate of $3,071 while using regional averages for other fee categories. The resulting fee structure is expected to generate the full $1.95 million needed to eliminate the subsidy.
Revenue generated by the fee adjustments will support ongoing ambulance operations, including personnel costs, medical supplies, equipment, oxygen, fuel, vehicle maintenance and future ambulance replacement expenses. The ambulance transport program currently includes six firefighter-paramedic positions, seven single-role EMT positions and seven single-role paramedic positions.
In addition to approving the new rates, the council authorized a new annual adjustment process tied to the Ambulance Inflation Factor, or AIF, published each year by the Centers for Medicare and Medicaid Services. Under the new policy, future inflationary fee adjustments can be made administratively by the city manager or designee without requiring a separate City Council vote, unless a more substantial fee restructuring is proposed.
City officials said the annual adjustment mechanism is intended to prevent the type of revenue erosion that occurred between 2023 and 2026 as operating costs increased while rates remained unchanged.
The updated fee schedule becomes effective July 1, 2026.
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