New York State Proposed Cut of Medicaid and Medicare Crossover Payments Threatens EMS and Ambulance Viability
Thomas C. Coyle, Chairman United New York Ambulance Network
There is a looming crisis across Kathy Hochul’s New York. Imagine a loved one having a medical emergency. You call 911 for an ambulance, but you’re told there isn’t one immediately available and response delays are worsening.
A scheme coming out of Albany would result in ambulance service closures and drastic reductions in available EMS professionals. Underserved communities in urban and rural areas already struggling with accessing healthcare will face even fewer EMS options.
It would eliminate Medicaid crossover payments for dual-eligible patients, costing the industry more than $20 million annually. Simply put, crossover payments cover the 20 percent Medicare Part B coinsurance for low-income beneficiaries who also qualify for Medicaid.
Closures and slashed services won’t be limited to one segment of EMS. Private, municipal, and volunteer ambulances would all be impacted, weakening overall emergency response.
We have seen this movie before. EMS doesn’t receive meaningful Medicaid rate adjustments despite escalating costs. We lose money on all Medicaid transports. Eliminating crossover payments would not create savings in a vacuum, it would merely shift costs to local governments, weaken response systems, and jeopardize care for vulnerable New Yorkers.
Enough is enough.
We provide 24-hour-a-day, 365-days-a-year service. We respond to vulnerable populations, seniors, low-income residents, individuals with chronic illness, and those in crisis. Our crucial role in public safety has never been fully recognized in the Medicaid reimbursement structure.
EMS agencies are mandated responders. We must treat and transport every patient regardless of insurance status or ability to pay. We do not screen for coverage, shift costs to patients, or access indigent care pools to mitigate uncompensated critical care.
Roughly 70 percent of our costs are associated with labor to pay wages and benefits; wages everyone recognizes are already not sufficient for the care our EMTs and paramedics provide. We maintain trained crews, equipment, and constant readiness, even though a significant share of emergency responses generates no reimbursement.
These costs continue to rise faster than inflation. Government payment shortfalls prevent us from strengthening EMS workforce and maintaining reliable access.
There is a better path forward. EMS leaders stand ready to work with the Governor and Legislature on solutions to protect access and deliver savings. The recently approved Treatment in Place program is one example. By allowing appropriate patients to be treated on scene or navigated to more suitable care options, we can reduce unnecessary ER visits, lower overall healthcare spending, and provide more appropriate care, while preserving emergency response capacity.
EMS is not simply raising concerns; we are offering solutions. But removing crossover payments will cripple an already fragile system.
This is not a plea for profits. EMS needs fair, predictable, and sustainable reimbursement that reflects the cost of readiness, workforce, and care delivery. This proposal undoes the progress we’ve made and moves the system even closer to instability. New York State must reject the proposed cut of crossover payments and fund EMS through a Medicaid fee schedule that reflects our true value to the public.
