EMS providers struggle in rural Idaho, OPE reports

An image used in the OPE report (Source: Caribou County EMS)

Ruth Brown, Idaho Reports 

Depending on where Idahoans live, access to emergency medical services is not a guarantee, according to a new report from the Office of Performance Evaluations

In a letter to the Joint Legislative Oversight Committee on Nov. 16, OPE Director Rakesh Mohan explained “insufficient staffing means patients in these areas face longer wait times and receive a lower standard of care. The COVID-19 pandemic has worsened these concerns, according to several EMS agency officials. Agencies must submit patient care reports to the Department of Health and Welfare’s Bureau of EMS and Preparedness, but several factors lead this data to be inaccurate and incomplete.”

The report notes that Idaho is one of only three states without performance data available through the National EMS Information System, a collaboration between the National Highway Traffic Safety Administration and the University of Utah.

Report findings

Idaho law does not designate EMS as an essential service and therefore the state is not required to provide funding. Many EMS crews are volunteer-only and the struggle for funding is a constant battle. 

In 2020 alone, EMS reported responding to 146,000 emergency calls in Idaho.

Idaho has nearly 2,000 EMS volunteers, making up more than 40% of EMS providers statewide, according to OPE. In rural Idaho, 69% of EMS are volunteers.

Some volunteers receive minimal compensation, but about 45% of volunteers do not receive any payment for their work regardless of whether they’re called out.

OPE performed a similar report on EMS in 2010, but several of that report’s recommendations made to the legislature were not adopted. That included a recommendation to create regional or county-level EMS systems.

Some local tax districts, such as ambulance districts or fire districts, fund EMS, but the data is not uniform. Counties, cities, and hospital districts may also put general fund revenue from property taxes toward EMS. 

Only 22% of EMS agency directors in Idaho say they are sufficiently funded, according to the report.

Several agencies reported problems recuperating costs through billing, in part due to low staffing and complicated medical billing. Reimbursement rates are also lower for patients not on private insurance.

Larger agencies offered OPE some context.  “For example, Ada County Paramedics reported that it lost $520 per Medicare patient and $550 per Medicaid patient treated and transported to a hospital in county fiscal year 2020,” the report stated.

The report also found that EMS use is higher among lower-income and uninsured people because they have difficulty accessing routine medical care. 

Paid vs volunteer EMS

One major issue with paid EMS workers versus volunteer EMS workers revolves around licensing and training. 

Volunteers are licensed at a lower level than paid workers. A higher level of licensing means the provider can administer certain types of care and medication that lower level licenses are not legally allowed to administer.

Paid providers are 3.6 times more likely to be licensed to provide intermediate or advanced life support when treating a patient, according to OPE. 

That also means largely volunteer EMS in rural counties are about half as likely as providers in urban counties to be licensed for intermediate or advanced life support.

OPE recommended the legislature consider paying full-time EMS in rural counties and offering benefits such as health insurance and retirement to incentivize staff retention.

The report also recommended ongoing training and licensure to support retention efforts. The state does not fund volunteer EMS training, which has a financial expense and can be time consuming. 

OPE did provide a study on how much it would cost to offer volunteer EMS retirement benefits, including a cost/analysis report.

House Bill 389

The OPE report released in November found that agencies expect to receive less revenue than they otherwise would have because during the 2021 session the Legislature passed HB 389, pitched by Rep. Mike Moyle, R-Star, with intent of providing tax relief to Idahoans.  The budget caps under the bill no longer fully account for growth in service usage due to new construction and annexation. 

Funding was already a problem before HB 389 passed. OPE found that in 2019 the budget cap constrained 14 out of 28 ambulance service districts and 90 out of 158 fire protection districts.

Moving forward

OPE submitted copies of the report to Gov. Brad Little and Idaho Department of Health and Welfare Director Dave Jeppesen. 

The report was submitted to the Joint Legislative Oversight Committee and it’s up to the committee members to decide whether to act on recommendations from OPE. 


<strong>Ruth Brown</strong> | Producer
Ruth Brown | Producer

Ruth Brown grew up in South Dakota and her first job out of college was covering the South Dakota Legislature. She’s since moved on to Idaho lawmakers. Brown spent 10 years working in print journalism, including newspapers such as the Idaho Statesman and Idaho Press, as well as a paper in southern California. She’s covered everything from the correctional system to health care issues. She joined Idaho Reports in 2021 and looks forward to telling stories about how state policy can impact the lives of regular Idahoans.

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