By Emma Murphy
The Press Democrat
SONOMA COUNTY, Calif. — The Sonoma County Board of Supervisors is poised to approve, with minimal public debate, a 9% increase in ambulance billing for the county’s largest ambulance provider.
The proposed increase marks the Sonoma County Fire District’s second attempt to secure a significant ambulance rate hike since 2024, when it took over the contract to exclusively provide ambulance services in the county’s urban core.
| READ NEXT: EMS cannot continue to be treated as a transportation service
The board is set to vote on the rate hike Tuesday, Oct. 13, as part of its consent calendar, which is typically used for procedural decisions requiring little, if any, discussion.
It will mark the board’s first public review of the 9% increase. Until now, much of the county’s discussions with the fire district have taken place behind closed doors, with little information made public.
The territory covered by the county contract includes Santa Rosa , Oakmont, Kenwood , Rohnert Park , Cotati , Sebastopol , Graton , Occidental and Freestone .
District officials say the newly proposed rate hike is necessary to cover higher than expected labor costs, the financial burden of paying for its share of emergency dispatch and a negative change in “payor mix,” which is the share of private insurance, Medicare and Medicaid patients.
Gabriel Kaplan, assistant director of the county’s Department of Health Services, said Monday that those financial hits justify the proposal going before the board Tuesday.
“We definitely recognize that the economic circumstances today are substantially different than when the district bid on the contract three or four years ago,” he said, describing healthcare’s future as murky.
The increase would apply only to privately insured residents, as the rates charged to Medicare and Medi-Cal patients are fixed by the federal government. Meanwhile, some bills never get paid at all, said Sonoma County Fire District Chief Ron Busch in a written response to Press Democrat questions.
“An increase of 16.36% in charges can be expected to result in about a 4.5% increase in revenue, well below the general inflation rate for this time,” Busch said.
When the district’s five-year contract took effect in January 2024, it was worth $30 million annually. The agreement spells out rates for various services including advanced and basic life support transport; mileage, oxygen, IV supplies and 12-lead cardiogram care.
Under the proposed 9% increase, the cost of advanced life support transport would increase from $3,174 to $3,460. The cost of basic life support transport would increase from $2,919.32 to $3,182, according to a spreadsheet detailing the impact of the proposed rate changes.
The other services would also increase by 9% across the board, that spreadsheet shows.
County Executive David Guhin said the proposed increase was placed on the consent calendar because it was a “fairly routine item.”
“If the board has any questions or wants to dive into it in any way it’s at the board discretion to pull it off the consent and have further conversation,” he said.
After failing to secure a requested 25% increase from the county in 2025 — the county ultimately granted a 2.4% cost of living increase — the fire district returned this year in July with a request for a 16.36% hike. Like in its first request, the district requested the county bifurcate the increase by granting a 9.9% increase “ASAP”, followed by the remaining 6.46% in January 2027.
Any rate increases over 10% trigger an extensive operations and financial audit of the fire district’s books — a step that has yet to occur since the 2024 takeover.
In addition to the 9% increase, county staff are also now recommending the board move forward with an audit, Kaplan said.
County health officials in August rejected the district’s request for a cumulative 16.36% increase.
“When we did our analysis we weren’t 100% on the same page with the district in terms of where they were landing financially and where we were landing financially when we were looking at the numbers,” Kaplan said. “Of course, when we’re doing our analysis we’re relying on audited financial statements from the district, but those audited financial statements are not validated in the same way they would be by the kind of analysis we’re looking to contract for.”
He added the county is working with the Auditor-Controller-Treasurer-Tax Collector’s Office to identify an audit company to analyze the district’s financials.
Busch previously told The Press Democrat that fire district welcomes an audit. He renewed that sentiment Monday.
“We welcome an outside review, and are confident that an independent reviewer with a background in EMS and out-of-hospital care will validate our operational successes and our financial reporting,” Busch said.
© 2026 The Press Democrat (Santa Rosa, Calif.).
Visit www.pressdemocrat.com.
Distributed by Tribune Content Agency, LLC.