COLUSA, CA (MPG) – The Colusa County Board of Supervisors approved a $500,000 increase to its annual subsidy for emergency ground ambulance services on March 10, advancing a plan county officials say will stabilize service but raise concerns about contract scope and future costs.
The 4-1 vote authorizes additional funding for American Medical Response (AMR), the county’s contracted ambulance provider, under the existing Exclusive Operating Area agreement. The increase takes effect Jan. 1, and will be funded through Measure A revenues, with no impact on the county’s general fund.
County Administrative Officer Joshua Pack said the current agreement, which runs from April 2024 through March 2027, allows for adjustments when costs rise beyond the contractor’s control. AMR requested an increase citing higher-than-expected staffing costs, a request reviewed and supported by the Sierra-Sacramento Valley Emergency Medical Services Agency and a county advisory committee.
“SSVEMS has reviewed the request, determined it to be justified,” Pack told the board.
Documents included in the agenda packet show AMR’s permanent staffing costs reached about $1.4 million annually, above the $1.2 million originally projected due to labor market conditions and union wage increases. The company projected an 11.4% increase in compensation costs from 2025 to 2026 and a potential operating loss of about $164,000 without additional funding.
Financial projections show total operating expenses of about $2.87 million in 2026. Without the increase, AMR projected a net loss of about $164,000. With the added subsidy, the company projected a net income of about $190,000, reflecting a modest margin tied largely to rising labor costs.
Supervisor Daurice Kalfsbeek-Smith cast the lone dissenting vote, questioning whether the increase effectively changes the scope of the original contract.
Kalfsbeek-Smith said while she supports AMR’s performance, the county should consider whether additional funding would have attracted more bidders during the original procurement process.
Supervisor Merced Corona acknowledged the concern but pointed to the advisory process established to evaluate such requests.
“We put together this committee to look at these things,” Corona said. “They recommended the funds be added. I’m good with that.”
Board members also reviewed the county’s Measure A fund balance, which stood at about $6.2 million at the end of 2025. Officials said the increased subsidy would not create a structural deficit, as annual sales tax revenues exceed current subsidy levels.
Supervisor Kent Boes emphasized that point, noting the funding mechanism was designed to support ambulance services.
“This money can only be spent for things that are ambulance-related,” Boes said. “Otherwise we’re just going to build a reserve in the tens of millions of dollars.”
Boes also cited improvements in response times since AMR took over operations, describing system performance as consistently strong.
AMR representatives said the request is driven by workforce realities rather than profit.
Regional Director Gabriel Cruz said AMR was unable to recruit enough local personnel and instead relied on a unionized workforce from outside the region, which increased wages and overall staffing costs. He said the shift was necessary to maintain full coverage and meet response time standards.
“The ask isn’t for us to be able to be profitable,” Cruz said. “It’s to be able to sustain the level of service to this community.”
Cruz said AMR staffs two stations with a total of 12 paramedics and 12 EMTs, operating on rotating schedules. Because local recruitment has been limited, the company relies on personnel from larger regional systems, including Sacramento and surrounding counties.
Officials said that model provides access to a broader network of ambulances, though it also increases labor costs.
John Poland, executive director of the Sierra-Sacramento Valley EMS Agency, cautioned the board about the risks of reopening the contract process.
He cited recent examples in other counties where ambulance providers declined to sign contracts after bidding, leaving gaps in service.
“Just because you do an RFP doesn’t mean that you end up with a bidder,” Poland said.
Poland also noted that rural ambulance systems face structural challenges, including low reimbursement rates. He said AMR collects about 17% of billed charges on average, with most revenue coming from public payers that do not adjust rates.
“You’re paying for availability,” Poland said. “That costs money.”
Supervisors agreed the issue will likely resurface as the current contract approaches expiration in 2027. Several members said broader discussions about service levels, funding and potential expansion should take place during the next procurement cycle.
Despite the debate, the majority of the board framed the decision as necessary to preserve a system that has shown measurable improvements.
“We used to hear about response times constantly,” Corona said. “We haven’t heard those complaints.”