Sonoma County supervisors poised to approve 9% ambulance rate increase with little debate
The consent calendar vote on Tuesday would raise advanced life support transport from $3,174 to $3,460 for privately insured patients in the Sonoma County Fire District's territory, and county staff are recommending an audit of the district's books alongside it.
SANTA ROSA: The Sonoma County Board of Supervisors is set to vote on Tuesday on a 9% increase in ambulance billing for the Sonoma County Fire District, the county's largest ambulance provider, with the item placed on the board's consent calendar, where it is expected to pass with minimal public debate, The Press Democrat reported.
The vote will be the board's first public review of the 9% increase. Until now, much of the county's discussion with the fire district over rates has taken place behind closed doors, with little information made public, according to The Press Democrat.
What the increase would charge
Under the proposal, advanced life support transport would rise from $3,174 to $3,460, and basic life support transport from $2,919.32 to $3,182, according to a spreadsheet detailing the impact of the rate changes reported by The Press Democrat. Other services would also increase by 9% across the board. The increase would apply only to privately insured residents, because the rates charged to Medicare and Medi-Cal patients are fixed by the federal government.
The fire district holds the county contract to exclusively provide ambulance service in the urban core, a territory that includes Santa Rosa, Oakmont, Kenwood, Rohnert Park, Cotati, Sebastopol, Graton, Occidental and Freestone. Its five-year contract took effect in January 2024 and was worth $30 million annually at the time, covering advanced and basic life support transport as well as mileage, oxygen, IV supplies and 12-lead cardiogram care.
A smaller step than the district asked for
District officials say the increase is needed to cover higher than expected labor costs, the cost of paying for its share of emergency dispatch, and a negative change in payor mix, the share of patients covered by private insurance, Medicare and Medicaid. In July, the district returned with a request for a 16.36% increase, split between 9.9% right away and the remaining 6.46% in January 2027; county health officials rejected the cumulative request in August. The district's request projected about $40.2 million in ambulance revenue against $42.7 million in expenses for the 2026-27 fiscal year. In 2025, the district had sought increases totaling just under 25%, and the county ultimately granted a 2.4% cost of living increase.
Gabriel Kaplan, assistant director of the county's Department of Health Services, said Monday that the financial hits justify bringing the proposal before the board on Tuesday, while adding that the county's analysis and the district's numbers were not fully aligned, according to The Press Democrat.
An audit is part of the package
County staff are also recommending that the board move forward with an audit of the district. Rate increases above 10% trigger an extensive operations and financial audit under the contract, a step that has not yet occurred since the district took over the service in 2024. County Executive David Guhin said the item was placed on the consent calendar because it was a "fairly routine item," and that the board could pull it for a fuller discussion. Fire District Chief Ron Busch said the district welcomes an outside review and is confident an independent reviewer will validate its operational successes and its financial reporting.
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