Newsom’s California faces scrutiny over costly ambulance billing

An ambulance ride is raising bigger questions

California is facing scrutiny over a sharp increase in Medi-Cal reimbursement for eligible public ambulance providers. Under the state’s Public Provider Ground Emergency Medical Transport program, qualifying public agencies can receive supplemental payments far above the standard reimbursement available through the separate ambulance quality-assurance program.

The controversy centers on how those public-provider payments are financed, how they compare with payments to private providers, and whether pending increases meet federal requirements for efficient and economical Medicaid spending. State and federal reviews are still shaping the final payment picture.

The numbers drew attention

For several common emergency transport codes, Medi-Cal’s resulting payment under the ambulance quality-assurance program was $339 in 2022. After eligible public providers moved into a separate reimbursement program, their payment for those codes reached $1,168.18 in 2024.

California has proposed raising the public-provider payment to $1,596.88 for 2025 and $1,636.81 for 2026. Those increases are not final: the corresponding state plan amendments remain pending federal approval.

Why Newsom is part of the story

Gov. Gavin Newsom became part of the debate because California’s Medi-Cal system operates under his administration, while state agencies manage reimbursement policies and seek federal approval. The scrutiny reaches beyond ambulance companies to public healthcare spending.

California’s Department of Health Care Services administers Medi-Cal and oversees ground emergency transport programs. Current records show the administration is working through reimbursement rules, supplemental payments, and federal approvals.

Medi-Cal does not work like a normal bill

Medi-Cal is California’s Medicaid program, so ambulance payments can involve state and federal funding rather than a simple patient-provider transaction. That makes reimbursement rates important because changes can affect public spending even when patients do not pay the full amount.

California uses mechanisms to supplement ambulance payments, including the Ground Emergency Medical Transport Quality Assurance Fee program. DHCS says the program generates additional reimbursement for qualifying providers.

Fun fact: The program pays for nearly 39% of all babies born in California.

A key distinction matters

The controversy over Medi-Cal reimbursement is different from the separate problem of surprise ambulance bills. For many Californians with state-regulated commercial health coverage, AB 716 generally limits what a patient owes for services from a noncontracted ground ambulance provider to the applicable in-network cost-sharing amount.

Newsom signed AB 716 in October 2023, with the new protections applying beginning January 1, 2024. The law does not apply to Medi-Cal managed care plans, whose beneficiaries are covered by separate balance-billing protections.

What AB 716 changed

Under AB 716, people covered by applicable state-regulated health plans or insurance policies generally owe no more than their in-network cost-sharing amount when they receive covered services from a noncontracted ground ambulance provider. Plans and insurers must directly reimburse the provider, generally using an applicable locally established rate or other payment rules when no local rate exists.

The law also restricts collection actions and prevents noncontracted providers from billing protected patients for the difference between their permitted cost sharing and the provider’s reimbursement. Medi-Cal beneficiaries remain subject to separate balance-billing protections.

Why reimbursement can still look high

Ambulance reimbursement is shaped by more than one statewide price. California’s system can involve local rates, Medi-Cal fee schedules, supplemental payments, quality-assurance fees, and federal matching funds.

That layered structure helps explain why a reported reimbursement figure should not automatically be treated as the price every patient pays. It also makes comparisons harder because providers can operate under different payment arrangements.

Private providers face a different problem

California lawmakers have also heard concerns that Medi-Cal payments can be too low for private ambulance providers. During a 2025 legislative hearing, testimony said the basic Medi-Cal payment for certain transports remained around $110 since 1999.

Supporters of higher reimbursement argue that outdated rates can weaken ambulance services and make transportation harder to maintain. That adds another side to the debate over whether public payments are excessive or necessary.

The funding model is complicated

California’s public-provider Ground Emergency Medical Transport program uses intergovernmental transfers, allowing eligible public providers to participate in supplemental Medicaid financing. DHCS says the program operates through contributions, certifications, invoices, and reconciliation processes.

For taxpayers, the key question is how much each transport ultimately costs across state and federal funding streams. For policymakers, the challenge is balancing adequate funding with controls that show payments are reasonable.

Federal approval remains important

California cannot simply change every Medi-Cal reimbursement rule on its own. State plan amendments can require review and approval from the Centers for Medicare and Medicaid Services before certain payment changes take effect.

DHCS records show California submitted a 2026 proposal to renew the Ground Emergency Medical Transport Quality Assurance Fee program and its reimbursement add-on. The proposal covers July 2026 through June 2027.

The 2026 rate picture is evolving

DHCS currently lists a $35.56 Ground Emergency Medical Transport Quality Assurance Fee rate for fiscal year 2026-27. The agency says the assessment applies to qualifying ground emergency transports regardless of payer type.

DHCS also says it submitted a related state plan amendment for federal approval in August 2026. That means ambulance financing is still being shaped, rather than representing one final statewide payment figure.

Local governments still matter

California’s ambulance system remains partly local because jurisdictions can establish or approve reimbursement rates. Under AB 716, those local rates can determine what health plans pay noncontracted ground ambulance providers.

That local role creates variation across counties and service areas, making a single statewide number potentially misleading. Providers can face different payment conditions based on jurisdiction, contracts, payer mix, and eligibility.

Curious about a controversial policy Newsom is opposing? Check out how the California wealth tax proposal faces opposition from Newsom.

The bigger question for California

California’s ambulance debate comes down to who should bear emergency transportation costs and how much that service should be worth. Newsom’s administration has expanded consumer protections while maintaining a Medi-Cal reimbursement structure that attracts scrutiny.

The next stage will depend on approvals, state payment decisions, local rates, and evidence about provider costs. A protected patient bill does not mean ambulance service is inexpensive for taxpayers.

Want to know what has people questioning the governor’s judgment? Check out how Newsom’s charity reporting fine raises new questions about trust.

Do you think California needs stronger oversight of ambulance billing practices? Share your thoughts.

This slideshow was made with AI assistance and human editing.

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