In Jay, paramedics Amanda Ellis, left, and Cassandra Clark work on a patient reporting weakness and dizziness before transporting her to Franklin Memorial Hospital in 2021. Ben McCanna/Staff Photographer

Lawmakers approved more than $30 million last year to prevent struggling ambulance service providers from going out of business, especially in rural areas where hospitals and walk-in clinics are scarce.

They wanted to distribute $12 million of that funding as quickly as possibly given the urgent need. But so far, none of the money has been delivered to providers, largely because of bureaucratic hurdles associated with rulemaking.

“I’m happy that we were able to get some money funded for EMS services, but I agree the bureaucracy is probably what will be the downfall unfortunately of some services receiving funding,” said Rep. Suzanne Salisbury, D-Westbrook, who chairs the Criminal Justice and Public Safety Committee. “Our initial intention was to give that original funding … out immediately.”

Lawmakers who served on the second Blue Ribbon Commission to Study Emergency Medical Services Funding expressed their disappointment about the delay Monday as they considered other ways to shore-up the state’s dwindling fleet of emergency medical service providers. Although they expected the emergency funding to be available at the end of October, the state is still accepting applications through the end of the week.

Sen. Chip Curry, D-Belfast, said unexpected delays with rulemaking also have held up a relatively modest program aimed at encouraging regionalization among ambulance providers and municipalities. About $200,000 in community planning grants approved by the previous Legislature still hasn’t been distributed, he said.

“That added to our great frustration that we have this vulnerable sector and the stewards of that sector are not delivering in a way that we need them to deliver,” said Curry, who co-chaired the commission. “And that’s not disparaging of the volunteer board members that sacrifice and serve on that, but new structures, new organizations and supports are needed.”

EMS services are overseen by the Maine EMS bureau in the Department of Public Safety. The bureau is overseen by a volunteer board of directors appointed to three-year terms by the governor.

A spokesperson for the Office of the Maine Attorney General said that the required rulemaking was necessary and expedited. A spokesperson for the Department of Public Safety did not respond to questions about the delay.

Ambulance services have been struggling to support their operations for years, said Butch Russell, president of the Maine Ambulance Association and the director of finance for North East Mobile Health Services.

“We’re all hurting right now financially,” Russell said in an interview after the committee meeting.

Russell said previous legislative efforts that increased reimbursement rates through MaineCare and from private insurance companies were once considered a panacea for EMS providers. But like in so many other sectors, the pandemic created more challenges, including workforce shortages, he said.

Maine’s EMS providers now have a $70 million a year structural funding gap, as they have had to increase wages to hire and retain workers. Service providers often turn to municipalities for additional revenue, which comes from property taxes.

Russell said that over the last five years North East has increased its starting wage from $18 an hour to $30 an hour.

“They deserve every bit of it,” Russell said, noting paramedics and emergency medical technicians often provide the same level of care as nurses and other medical professionals.

More needs to be done to make EMS a career, rather than a stepping stone to other medical professions, Russell said.

The disclosure comes as lawmakers consider systemic reforms to make EMS more sustainable, including regionalization.

The Mills administration initially resisted the one-time funding proposal last session, urging lawmakers to force a conversation among providers about regionalization. But lawmakers added the funding to the final budget, which Gov. Janet Mills then signed.

House Speaker Rachel Talbot Ross, D-Portland, who co-chaired the commission, was asked what role county governments would play in a regional ambulance service. She said county governments were represented on the commission and their role is “still an outlying question.”

CURRENT BILL POSTPONED

The Criminal Justice and Public Safety Committee postponed action Monday on a bill Talbot Ross sponsored to increase annual funding and make structural changes to EMS services.

The bill, L.D. 1515, was carried over from the first session and proposed increasing EMS funding by $45 million in the current budget and $70 million in the fiscal 2025 budget.

Talbot Ross told the committee that she planned to amend her bill to include some of the structural reforms proposed by the blue ribbon commission, including funding a “needs analysis” for communities looking to form a regional ambulance service.

Republican lawmakers balked at the breadth of the bill and worried about spending additional money without considering whether a service is viable.

“This is an absolutely enormous bill,” said Sen. Matthew Harrington, R-Sanford, suggesting the bill be reopened for a public hearing.

Rep. Donald Ardell, R-Monticello, said the bill should have a provision to allow “market forces” to “right-size” unsustainable services.

“My deep concern is merely having the state of Maine make it rain for EMS with Mainers’ tax dollars merely buoying unsustainable services,” Ardell said.

Talbot Ross conceded that given the delays in dispersing the $31 million already approved for EMS services, the additional funding originally proposed may not be in the final version of the bill. But she said she hopes to find a consensus on the committee.

“This is a system that is looking for our help now,” Talbot Ross said. “Otherwise we’re looking at another two years or so before some simple changes can be made that would have a really large impact in fact on our delivery of services in EMS.”