To: Board of Supervisors
From: Lewis Broschard, Chief, Contra Costa County Fire Protection District
Report Title: PP-GEMT IGT Payment to California Department of Health Care Services for CY 2026
☒Recommendation of the County Administrator ☐ Recommendation of Board Committee
RECOMMENDATIONS:
Acting as the governing board of the Contra Costa County Fire Protection District, APPROVE and AUTHORIZE the Auditor-Controller to issue payment installments to the State of California Department of Health Care Services, totaling an amount not to exceed $13,000,000 for the Public Provider Ground Emergency Medical Transport Intergovernmental Transfer (PP-GEMT IGT) for ambulance transports anticipated to be provided by the District during January 2026 through December 2026; and AUTHORIZE the Fire Chief, or designee, to execute and submit the required IGT Certification forms.
FISCAL IMPACT:
The payments to the State of California Department of Health Care Services (DHCS) are estimated to be $13,000,000 for the calendar year and represent an increase over prior years due to an anticipated increase in supplemental program funding. The cost of the payments will be offset by the reimbursements from the supplemental Medi-Cal program for public providers. The District anticipates that for all payments and fees paid to the DHCS, the District’s EMS Transport Fund will receive a net annual increase of $15 million in additional supplemental reimbursements from this program. The fiscal impact is projected to be positive for the District's EMS Transport Fund due to the significant number of Medi-Cal transports within the District's ambulance operating area.
BACKGROUND:
In 2019, Assembly Bill 1705 (AB1705) was passed, and certain sections of the California Welfare and Institutions Code relating to Medi-Cal were amended and added. In accordance with the passage of the bill, the Department of Health Care Services (DHCS) developed the Public Provider Ground Emergency Medical Transport (PP-GEMT) Intergovernmental Transfer Program (IGT) to provide increased reimbursements by application of an add-on increase to emergency medical transports provided by eligible public GEMT providers. The non-federal share collected will be used to provide this add-on increase to the fee-for-services (FFS) fee schedule rate for the affected emergency medical transport billing codes and a rating increment that will be applied to primary capitation rates for contracted Medi-Cal plans. The new legislation requires the nonfederal share of any supplemental reimbursement provided under this program to be derived from voluntary intergovernmental transfers of local funds. Known to us as the “PP-GEMT IGT” program, this program replaced the Quality Assurance Fee (QAF) and former Ground Emergency Medical Transport (GEMT) Medi-Cal supplemental reimbursement programs. The bill requires eligible providers, including the Contra Costa County Fire Protection District, to receive an add-on increase to the associated Medi-Cal fee-for-service and managed care payments. The District has agreed to provide funding, along with all other public providers, to support the program's financial sustainability for the non-federal share of the program. The District anticipates the need to provide intergovernmental transfers to the state of approximately $13 million annually, beginning in 2026, which is currently scheduled to be paid in four installments during the calendar year 2026. The District anticipates total revenue from the program and the revised Medi-Cal reimbursements to be approximately $25 million annually, according to estimates provided by the District’s contracted medical billing firm. After accounting for intergovernmental transfers and the dissolution of the QAF and GEMT supplemental reimbursement programs, it is anticipated that the District will realize a net increase in total revenue of $15 million annually from the PP-GEMT IGT program. Contra Costa County Fire Protection District will be billed on the following schedule:
CONSEQUENCE OF NEGATIVE ACTION:
If the payments are not made, the State may withhold supplemental provider payments for ambulance services provided to Medi-Cal recipients.