Title
Emergency Medical Services, a division of the Chief Administrative Office, recommending the Board adopt and authorize the Chair to sign Resolution 128-2026 which finds that the repayment of the Fiscal Year 2025-26 General Fund contribution of $750,000 to County Service Area 3 (CSA 3) for ambulance services would create an economic hardship for the residents of CSA 3 and waives the repayment in whole. (4/5 vote required)
FUNDING: General Fund.
Body
DISCUSSION / BACKGROUND
County Service Area No. 3 was established on January 21, 1963, for the purpose of providing extended services, namely mosquito abatement, via Resolution No. 9-63. On August 10, 1982, the Board of Supervisors amended the authority of CSA 3, through Resolution No. 210-82, to include extended ambulance services to be provided within the unincorporated area of CSA 3. On April 28, 1987, the Board of Supervisors approved Resolution 132-87, extending ambulance services to the incorporated area of CSA 3.
CSA 3 provides ambulance services to South Lake Tahoe and the Tahoe West Shore. Transport and dispatch services for CSA 3 South Shore area are contracted to the California Tahoe Emergency Services Operations Authority (Cal Tahoe JPA). Cal Tahoe JPA has been under contract to provide transport operational services since 2001, and their current contract expires August 31, 2031. Transport and dispatch operational services for the area of Meeks Bay in CSA 3 are contracted to the North Tahoe Fire Protection District. North Tahoe has a current contract that expires June 30, 2029.
CSA 3 ambulance services are funded by a special tax, benefit assessment, and ambulance fees; however, the CSA is currently operating at a deficit and requires additional funding to support ambulance services. The ambulance rate schedule for CSA 3 was last reviewed and updated in 2022, increasing ambulance fees to within the 75th percentile of comparison agencies, including base rates for residents and non-residents (Legistar file 22-0380). In addition, the rates have been increased each fiscal year by the increase in the Consumer Price Index (CPI). To address the ongoing deficit, County staff are currently reviewing the possibility of an additional increase to ambulance fees and continue to assess the ambulance billing system to find process improvements and increase revenue. The process to update the ambulance schedule has been delayed by various State bills that impact how fees can be collected. For example, AB716, which took effect in 2024, amended Health and Safety Code 1797.233 to prevent the County from billing uninsured patients more than the Medi-Cal or Medicare fee-for-service amount. The ambulance system in CSA 3 is remote and impacted by weather, wildfires, and tourism. These factors increase the cost of providing this service. Increasing fees does not proportionally increase revenue due to rates of collection, including the amount that can be collected, like with Medi-Cal or Medicare enrollees. Staff continue to evaluate fee increases, but it will not address the need for a General Fund contribution in FY 2025-26.
On June 10, 2025, as part of the Fiscal Year (FY) 2025-26 Budget, the Board approved a General Fund Contribution of $750,000 to CSA 3 to support ambulance services, which are impacted by tourism in the Tahoe Basin (Legistar file 25-0948). California Government Code is very specific and limits how California counties can fund CSAs with discretionary resources. California Government Code Section 25214.4 authorizes the County’s Board of Supervisors to authorize a loan of funds to a county service area (CSA) for any lawful expenses of the CSA. This Government code authorizes the Board of Supervisors, by a four-fifths vote, to waive the repayment of a loan to a CSA, in whole or in part, if the Board of Supervisors finds that the repayment of the loan may result in an economic or fiscal hardship to the property owners or residents of the CSA.
While the Board approved the $750,000 General Fund contribution to CSA 3 without expectation of repayment, to comply with Government Code Section 25214.4, the County is proposing the Board approve the attached Resolution which treats the contribution as a loan to the CSA. To repay the General Fund contribution, CSA 3 will require additional revenue to be raised from its residents, constituting a fiscal hardship.
If the Board of Supervisors approve the Resolution, the repayment of the FY 2025-26 $750,000 General Fund contribution to CSA 3 will be waived in full.
ALTERNATIVES
If the Board of Supervisors does not waive the repayment of the General Fund contribution, CSA 3 does not have sufficient funding to repay the $750,000 within FY 2025-26. Any repayment of the funds would result in an economic or fiscal hardship for CSA 3 as there would not be sufficient revenue to cover contracted expenses. Failure to approve the waiver of repayment may result in the County being out of compliance with Government Code Section 25214.4.
PRIOR BOARD ACTION
Legistar file 22-0380, June 21, 2022 - Resolution 089-2022 approved, increasing CSA 3 ambulance rates
Legistar file 24-0997, June 11, 2024 - FY24-25 Recommended Budget approved.
Legistar File 25-0948, June 10, 2025 - FY25-26 Recommended Budget approved.
Legistar File 25-0642, June 17, 2025 - The Board of Supervisors approved Resolution 081-2025 and waived the repayment of the FY24-25 General Fund contribution to CSA 3.
OTHER DEPARTMENT / AGENCY INVOLVEMENT
County Counsel review of Resolution
CAO RECOMMENDATION / COMMENTS
[This section is completed by the CAO's Office. This section is required]
FINANCIAL IMPACT
The $750,000 General Fund contribution to CSA 3 was budgeted as a General Fund expense and transferred to CSA 3 in the FY 2025-26 Budget.
CLERK OF THE BOARD FOLLOW UP ACTIONS
Clerk of the Board to obtain the signature of the Chair on the attached Resolution and provide a certified copy to CAO - Central Fiscal, Attention: Serena Lemmons.
STRATEGIC PLAN COMPONENT
N/A
CONTACT
Emma Owens, Chief Budget Officer