By Anne Halliwell
Post-Bulletin
ROCHESTER, Minn. — One-time grants will not save local emergency medical services, area leaders say.
John Fox, director of Dodge Center Ambulance Services, has worked on several EMS and ambulance commissions that have petitioned the state of Minnesota for emergency funding and volunteer subsidies.
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Grants have been slow to arrive, smaller than needed to stem the monetary bleed, and rarely repeated. In 2024, Gov. Tim Walz signed a bill to send $30 million to rural emergency medical services; $24 million of that went to short-term emergency aid for EMS in the state. The dollars helped, but long-term changes are still needed.
“Everybody’s looking for a silver bullet, and there’s no silver bullet, so it’s going to require a lot of a variety of solutions,” Fox said. “I’m not saying the state isn’t doing their part. They just need to do better.”
Across Southeast Minnesota, there are 50 ambulance services. Some cover small areas, like Adams and Spring Grove’s EMS. Others hold down parts of multiple counties, like Rushford’s ambulance in Winona, Houston and Fillmore counties.
Most of these services are hemorrhaging money. And every director who spoke with the Post Bulletin said the financial situation is precarious.
Across the board, Minnesota’s ambulance services struggle with job competition, increasing costs and insufficient reimbursement by Medicare and Medicaid.
A recent Austin roundtable touched on many of the funding issues EMS providers deal with every day — including failure to compensate services for non-transport visits, problems with insurance reimbursement, and retaining trained volunteers.
Local ambulance directors see large-scale ways to help, which boil down to three main points: making all ambulance services taxpayer-funded, increasing Medicare/Medicaid reimbursement, and letting EMS bill for primary and preventative care.
Plenty of people assume a portion of their taxes goes toward emergency healthcare.
But that’s not the case in many cities and counties.
“Traditionally, the only funding source ambulance got was billing for patients,” Fox said. “Very rarely is there a tax subsidy to support ambulance service. There is no requirement for a local unit of government to pay for the ambulance service.”
Some places with high call volumes — the metro, Rochester — can survive off the margins from multiple calls per hour or day.
Dodge Center, Fox’s service area, is estimated to respond to about 1,400 emergencies this year.
A smaller area, like Hayfield, will have fewer than 400 calls in 2026.
“We’re still not quite enough to be able to sustain ourselves on billing alone,” Fox said.
Vicki Arendt, the bookkeeper for Eyota Volunteer Ambulance, said the city stopped paying for the ambulance service in the 1990s.
Nowadays, the funding comes from several streams — but tax dollars aren’t one of them. Instead, the service sometimes requests supplemental funding from the many townships it serves.
“A lot of people, when they call me, they’re like, ‘Well, I’m paying tax dollars,’” Vicki Arendt said. “I’m like, ‘Yeah, none of that’s coming to us because we’re not ‘essential.’ And they don’t understand that we are based on the goodwill of the townships.”
Eyota Volunteer Ambulance has the ability to ask its city and townships to vote on tax levies, but tries to “hold the line” — which director Chris Arendt says is difficult with rising fuel prices and medical equipment costs.
“We don’t want to always ask for more and more,” he said. “I’m sure if we needed to, we could probably find a source for a one-time partial lift that might be enough, but that’s not a business model.”
Wabasha’s ambulance is partially subsidized by the city, which helps cover operating losses, director Ryan Marking said.
“Hopefully, at some point here in the future, we can be self-sustaining,” he said. “But that’s not going to happen without the state or the federal government increasing our reimbursement rates or the state government providing us with yearly funding, like they do with fire departments and law enforcement.”
Just about every ambulance director in Southeast Minnesota bemoans the fact that Medicare and Medicaid pay “30 cents on the dollar” for services.
Marking said an increase from 30 cents to 35 cents simply won’t cut it.
“We need a significant increase in our reimbursement from Medicare and Medicaid,” he said. “For us, 70% of our patient mix is on Medicare and Medicaid. So when 70% of our bills are only paying us 30 cents on the dollar, we’re really — that’s a lot to make up.”
The costs of medication, fuel, and even ambulances skyrocketed in the past 10 to 15 years as well.
“In 2012 ... I bought two brand new ambulances, a new power load cocking system, and a new stair chair for about $253,000,” Marking said. “In 2025, our new ambulance — not only did it take us 30 months to get, but it also cost $340,000 and change, and that’s including reusing some of our big-ticket equipment. ... If we would have replaced everything and made everything brand new, we were probably looking closer to ($400,000), maybe $425,000.”
In the early 2000s, Fox remembers, about 70% of his patients were on commercial insurance, which reimbursed far more of the ambulance services’ costs.
Today, with an aging population and higher healthcare costs, about 70% of his patients are on government insurance.
The state mandates that EMS providers are ready to respond 24/7, Marking pointed out, but providers aren’t reimbursed or subsidized that way.
Instead of billing for transport, some services are looking for ways to bill insurance for other activities.
After COVID-19 dropped out of “pandemic” status, patients found it harder to access primary care. Marking’s Wabasha patients are staying in their homes longer without in-home care, meaning lift assists are more common.
Anecdotally, Marking also thinks individuals without out-of-pocket copay costs don’t have a reason not to call an ambulance after letting a minor health issue snowball.
“In the last six months, I’ve responded to a call for somebody that had a tooth abscess for multiple weeks, had not sought dental care, and called in the middle of the night,” he said. “We now need to service that call and take them to the hospital.”
Wabasha saw a 9% increase in call volume from 2024 to 2025, and if current rates hold, will see another 3% increase between 2025 and 2026.
Eyota Ambulance’s “WeCare” program is in its infancy, the Arendts say, but they hope to quantify its benefits enough to bill for it in the future — or to ask insurance to fund preventative care.
“WeCare” allows staffers without active emergency calls to do minor wound care, visit seniors to help with medication, and treat serious issues like diabetic reactions which, once managed, don’t necessarily require a hospital trip.
But first, they have to prove the program keeps patients out of hospitals and saves Medicare and Medicaid money.
“If the payers paid us to keep them out of the emergency department when it’s appropriate, this whole system wins,” Fox said. “It’s just changing that model and changing that mindset.”
At the beginning of 2025, the City of West Concord considered closing its EMS service because of staffing issues, which would have left residents relying on Dodge Center or Hayfield for emergency transport.
City administrator Paula Even Trenda said Dodge Center provided free mutual aid for a time, then contracted with the city until a new ambulance director could be trained in.
In 2026, West Concord’s ambulance service is still running — but faces the same problems with cost/reimbursement that other services have.
Rushford Ambulance covers three towns and eight townships across 177 square miles.
Their ambulance is off-road capable, director Joey Busse said, can “slam fences open if we have to,” and can generally get places another team could not.
Fortunately, Rushford’s ambulance is healthily in the black this year, because replacing it with a “street ambulance” from a neighboring city would not work for the area.
Some cities are finding success by pooling resources, however.
Lewiston and St. Charles Ambulances began partnering in October 2022, according to director Matt Essig, and now staff one truck 24/7 for both cities.
If the truck is called to an emergency, a second can provide backup or mutual aid. But mostly, the partnership lets both cities share employees, resources, and training.
The two services combined have 69 total staffers — 65 of which are volunteers.
“Financials remain difficult,” Essig wrote. “The cost of ‘readiness’ is the most expensive. To have all the equipment, facility, paid staff and volunteers is expensive. ... We are blessed that in both the St. Charles & Lewiston communities they do levy tax dollars to help supplement the service. Without this money, it would be nearly impossible to operate.”
Consolidation is likely to become the future of EMS, especially if big funding changes aren’t around the corner, Marking said.
“Just in the long run, it’s not going to be feasible,” he said. “These small towns can’t support the ambulance at a loss every year. ... I don’t think that privatizing all of EMS is good for us either, because when that happens, you know they look more at the bottom line.”
Ultimately, it’ll probably take multiple changes to bring all local EMS providers into the black. Before that happens, there are likely to be more ambulance services that have to share resources and staff or pray for more state funding, Marking said.
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