photo by: Chad Lawhorn/Journal-World

A Lawrence-Douglas County Fire & Medical ambulance is pictured on July 5, 2023 and Station No. 2 in eastern Lawrence.

Lawrence-Douglas County Fire Medical has some new financial estimates to share with the County Commission this week. One is a proposal to increase ambulance fees; the other is a 2026 budget scenario that commissioners asked about in May — one that the department now says would cut more LDCFM staff positions than “the previous ‘worst-case’ scenario.”

At the commission’s meeting on Wednesday, LDCFM will provide a briefing about its revenue projections and the proposed increase in ambulance fees. The department says the fees need to increase to keep up with inflation and match nearby agencies.

There are two main components to the fees that patients are billed for ambulance services. One of them is a flat fee, which in the county code is called the “base rate,” and it varies based on whether the situation is an emergency and the complexity of the care that the ambulance crew provides the patient. The other is a per-mile rate that is always the same regardless of the care the patient needs.

In the new rate proposal, outlined in a presentation attached to the commission’s meeting agenda, the base rates for non-emergency service would stay where they are. The less complex tier of non-emergency service would stay at $595, and the more complex one would stay at $699. However, all of the emergency rates would rise by 28%. The least complex emergency service level would rise from $595 to $762; the next most complex would go from $699 to $895; and the most specialized and complex level of care would rise from $774 to $991.

The mileage rate, meanwhile, would rise for all ambulance rides. It would go from the current $9.23 per mile to $15.24 per mile.

The department is also proposing a new fee for what’s called “specialty care transport services.” These involve moving a critically ill or injured patient from one hospital to another while offering care that’s beyond the scope of what a normal paramedic would provide. This service would have a fee of $1,210, the presentation said.

“While these situations are rare, they do happen, and are eligible for reimbursement at a higher rate” than the rates that LDCFM currently bills for the most complex care, said McKenzi Ezell, chief of staff at LDCFM, in an email to the Journal-World. “Establishing a separate fee for (specialty care transport services) allows LDCFM to collect more revenue for these higher-acuity services when we provide them.”

The presentation about the fees is for informational purposes only, and commissioners will not take any action afterward.

photo by: Screenshot

Lawrence-Douglas County Fire Medical’s updated fee schedule for ambulance fees with a market comparison.

An alternative Fire Medical budget scenario

Over the past few months, LDCFM has been presenting the commission with scenarios that would reduce the impact of City of Lawrence budget cuts, but would also require the county to contribute more funding. The commission had a question last month about one of these scenarios: Could this idea be done while keeping the funding split between the city and county at its current level?

This week, the department has an answer — one that might be worse than the previous “worst-case scenario.”

Currently, the city funds about 64% of LDCFM’s operations, and the county is responsible for about 36%. But the city is also trying to close a budget hole for 2026 and has asked LDCFM to find more than $1.5 million in cuts.

If the county provides no additional funding to make up the difference, LDCFM has said the cuts would require 18 full-time-equivalent positions to be eliminated. It would reduce the number of battalion chiefs from six to three, shut down a fire truck at Station 5 and reduce one existing ambulance from operating 24/7 to just 40 hours a week, among other changes. The department is calling this option the “green option,” after the color of a table outlining it in a previous report to the commission.

The County Commission had a problem with the “green option,” especially with the idea of cutting emergency medical services. So, last month, LDCFM presented the County Commission with several options that would change the funding split so that more of the burden rested on the county and more services and staff could be maintained.

One of the options is the so-called “gray option,” which is described by LDCFM as a plan to “minimize reduction of current EMS resources.” It would change the funding split to 61.75% from the city and 38.25% from the county, which would be about $183,000 extra in county funding, and it would still cut 10 positions. But it would keep all six battalion chiefs and maintain all ambulances at 24/7 service levels.

The commission asked for a version of this scenario that would minimize the impact on EMS while also keeping the funding split the same as it is now — 64% city and 36% county. In a memo to the County Commission attached to this week’s meeting agenda, LDCFM describes this scenario and says it would look much more dire than the original “gray option.”

In this new scenario, the memo says, “LDCFM would need to shut down a second fire apparatus (in addition to Engine 5) and reduce our workforce by another 10 employees” for a total of 20 positions eliminated. “This would meet the City’s target for reduction without changing the Shared Expense ratio from the current EMS agreement.”

The memo said that such a plan would eliminate a third of the city’s staffed fire engines, or “apparatus” in firefighting jargon, and that this wouldn’t just have an impact on fire calls, but also on the EMS services that the county wants to preserve. “[M]ost of [the fire engines’] call volume is medical incidents,” the memo said, “so reducing the number of staffed fire apparatus will reduce EMS service levels to a majority of Douglas County residents.”

The staff reductions in this option would be “more than the previous ‘worst-case’ scenario,” the “green option,” which would eliminate 18 positions and shut down one fire engine.

It’s not clear whether the commission will be discussing this scenario in detail at Wednesday’s meeting. While it is included in the agenda materials, it is described as “information requested at the May 28th work session on LDCFM 2026 Budget alternatives.” It is not mentioned in the subject of that agenda item, which simply refers to discussing the ambulance fee structure proposals.

photo by: Screenshot

A new budget alternative for the city and county from Lawrence-Douglas County Fire Medical.

In other business, county commissioners will:

• Preview the 2026 budget during a work session. The presentation will cover budget themes and emerging pressures, the county’s fund structure, assessed valuation and sales tax trends, revenue and expenses in the Behavioral Health Fund, planned transfers for 2026, a summary of supplemental requests and the budget timeline, according to a memo in the agenda.

No additional materials were provided to commissioners, and no action will be taken, as the work session is for informational purposes only.

• Receive an overview of the behavioral health objectives and strategies adopted in the 2024-2029 Community Health Improvement Plan – a strategic plan that addresses health issues in Douglas County – and review the funding priorities that were identified and supported with budget allocations in 2025.

The presentation comes amid concerns about the financial status of Bert Nash Community Mental Health Center, which recently announced staffing reductions and temporary pay cuts for some employees. One county commissioner, Gene Dorsey, has suggested using the county’s mental health sales tax fund — which has typically been used for building expenses for mental health projects — to provide emergency assistance to Bert Nash, as the Journal-World reported.

• Consider authorizing Chief Judge James McCabria and the Citizen Review Board director to accept the Permanent Families Fund grant award in the amount of $60,103. The grant is for the Citizen Review Board, a volunteer program of the Douglas County District Court.

• Consider authorizing the county administrator to purchase excess workers’ compensation insurance coverage from Midwest Employers Casualty. The premium is $162,250 for June 15, 2025, through June 14, 2026.

• Consider replacing the bridge on North 1400 Road, Route 442, over a tributary of Captain Creek, east of Eudora. The commission is being asked for a determination that the project is necessary, as well as to approve the project plans and specifications prepared by the county engineer and to authorize the county engineer to solicit construction bids for the project.

• Hold an executive session “for the purpose of consultation with legal counsel for the County regarding potential litigation, which would be deemed privileged under the attorney client relationship.”

The County Commission’s work session will begin at 4 p.m. Wednesday in the Douglas County Commission meeting room at 1100 Massachusetts St. The business meeting will follow at 5:30 p.m. The meeting will also be available via Zoom.