1.
SUBJECT:
OVERVIEW
On May 5, 2026 (FP01), the Board of Directors took action to further consider and adopt the
Ordinance on May 19, 2026.
On February 27, 2024 (FP01), the San Diego County Fire Protection District (SDCFPD) Board
of Directors approved the ambulance transportation fee increase to maintain current services
within the SDCFPD Ground Ambulance Service Area (ASA) for Fiscal Year (FY) 25-26. The
ASA includes the entirety of the SDCFPD as well as the Deer Springs, Valley Center, Alpine,
and a portion of the San Miguel Fire Protection Districts. Ambulance operating areas have
historically relied upon insurance revenue from transports to hospitals to recover costs.
However, rural communities with large geographic areas and small population centers are more
costly to serve and generally are overrepresented by public insurance programs that reimburse at
lower rates than private health plans. Public plans, such as Medicare and Medi-Cal, pay a fixed
rate based upon regulation and statute that is below the actual costs for ambulance transport to
the hospital.
San Diego County Fire (County Fire), on behalf of the ASA, recently conducted a review of fees
to ensure compliance with Board of Supervisors Policy B-29, Fees, Grants, and Revenue
Contracts - Department Responsibility for Cost Recovery (Board Policy B-29), which requires
County departments to recover the costs to provide services to agencies or individuals. As a
result, County Fire is proposing actions that support the cost of providing services, while
ensuring fair and equitable fee levels for the public. After reviewing the current fees and rates,
County Fire staff is proposing to increase three fees and decrease one fee. The Auditor and
Controller reviewed and approved the supporting documentation and the methodology for
establishing the fees in this proposal for FY 2026-27.
The proposed ambulance transport user fee received support from the SDCFPD Fire Advisory
Board and would be consistent with County Service Area 17’s proposed fees, which is another
ambulance service that is managed by County Fire. In the ASA, the average collection rate on
fees assessed is about 28% due to various reimbursement rates from Medicare, Medi-Cal,
commercial insurance, and patient private pay. Since 100% of the fees assessed on ambulance
transports are not collected, full cost recovery for services will not be achieved in FY 26-27 and
a waiver of Board Policy B-29 is being requested. The proposed fees in the ASA have a 5%
escalator through FY 28-29, to align with the annual increase in contract costs that support the
operations of the ASA.