In a bid to make ambulance service quicker, Johnson County commissioners this month agreed to hire nine emergency medical technicians and reallocate $1.2 million in general fund reserves to pay for them in 2026.
The move is intended to help MED-ACT, the only ambulance service in the county, cope with a 67% increase in call volume since 2010, while bringing down response times that have begun to fall short of the county’s goals.
But it comes at a price. To raise the $1.2 million, the county will have to increase user fees for ambulance calls — a decision that has the potential to hit uninsured and underinsured patients who are paying out of pocket the hardest.
At their meeting on Nov. 13, commissioners unanimously approved the measure, but will monitor its effect on payers as the new year begins.
Chair Mike Kelly said he expects the topic to come up again as budget discussions begin in January, and the county learns whether it can put a separate extension of a public safety sales tax up for a countywide vote next year.
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Open in new tab 911 call volumes are rising in Johnson County
A continuing increase in calls has stressed the ambulance service for the past several years. The request for additional staff was made during budget talks as next year’s budget was being developed.
The average daily call volume in 2025 is 156, with peaks as high as 236 in a single day, said Paul Davis, chief of county MED-ACT.
Meanwhile, response time has begun to lag behind the county’s goal of 90% of emergency ambulance calls answered within 10 minutes.
Response times met that target in 2021, with just over 92% of calls answered that quickly. But this year, the response time has been about 87.6% in 10 minutes.
Med-Act is targeting peak demand time
The additional staff will expand the number of hours county ambulances will run.
Currently, Med-Act keeps three ambulances with six staff running during peak demand time, which is 8 a.m. to 4 p.m. Monday through Friday.
The additional staff will mean increased use to 12 hours a day, seven days a week. Local fire departments also provide first responses in medical calls.
Emergency service officials say the additional employees will more than double the number of hours the county is covered each year, going from 6,240 to 13,104 hours and potentially reducing staff burnout.
The decision also targets peak demand, according to staff documents presented to the commission. But commissioners were told that it might only improve the percentage of on-time responses by a percentage point, depending on how many calls are received.
Ambulance fees are going up to help pay for added staff
The commission voted to raise the funds for the hires by increasing the rate it charges for ambulance services for the first time since 2020.
Ambulance fees vary widely depending on what type of service the patient receives. The fees set for ambulance care in 2026 range from $488 for basic life support, non-emergency service to $1,586 for specialty care transport between facilities.
The fees are currently set at 1.8 times the Medicare reimbursement rate. That is a level that is 39% below the Midwest regional average, Davis said.
Changing the fees to 2.0 times the Medicare reimbursement rate would raise money to be used for the personnel costs and expanded operations.
The fee increase would bring the basic life support, non-emergency service to $532 and the specialty care transport service to $1,728.
Who will pay for the increased fees?
The majority of the cost will be paid by private insurance, Medicare and Medicaid, Davis said. Around 90% of county ambulance patients are covered by a third-party payer.
But around 3,000 to 3,300 patients the ambulance service typically cares for in a year are either uninsured or underinsured, he said.
“That doesn’t necessarily mean they can’t pay. Some are financially capable,” he said, adding that MED-ACT officials can work out something for the people who can’t afford it. Usually, that means a payment plan, or the fee is written off.
“There’s not a particular hardship fund. I have the authority to write off those accounts if people meet the criteria,” he said.
Last year, fewer than five people claimed hardship for their ambulance service.
Federal budget action this year has also left some uncertainties about health insurance coverage. Changes in Medicaid and the Affordable Care Act marketplaces and other policies may increase the number of people without health insurance by 10 million to 14 million nationwide by 2034.
Davis said the county does not have projections of the impact of the federal changes on ambulance service payers, since it does not keep a breakdown of how many using commercial insurance get it through the Affordable Care Act.
A “stopgap” measure
Commissioners supported the increased staffing and fees as a way to improve a service that typically ranks as a high priority on citizen surveys. But they also cautioned that the impact on lower-income payers needs to be studied as the budget is drawn up for 2027.
Commissioner Michael Ashcraft said the county needs to do more to bring the response time down. An improvement of one percentage point still leaves the service behind its performance standard, he said.
“I know that will put pressure on users, but we also have a system in place to help those who have financial and monetary concerns to make sure they are not unduly penalized,” he said.
Commissioner Julie Brewer also said the impact on uninsured and underinsured users needs to be watched.
“I appreciate we do have a fund to support individuals who are in that position, but it’s not an inexhaustible fund,” she said.
Commissioner Janeé Hanzlick said the county should look at how to offset the potential negative impact on payers without adequate resources. She called it a “sticky situation,” adding that, “we do need to pursue that to accurately know what the impact will be on our ability to provide the best services possible.”
Kelly said the fee increase is “a measured approach in increasing those fees to balance the need that we see with having proper ambulance service and a highly trained and rested staff.”
But he also called it a “stopgap” measure to strengthen the service until officials know whether a public safety sales tax extension is a possibility in future budgets.
The commission voted to put an extension of the public safety sales tax on the November ballot, but withdrew it under a challenge from Kansas Attorney General Kris Kobach. The question of whether the commission exceeded its authority is still in court. Officials hope to put it on a March special election ballot, if a judge’s ruling is favorable.
The sales tax was originally approved in 2016 to build a new courthouse and medical examiner’s office. It will expire in March 2027.
