A hike in the ambulance availability fee for Hoquiam residents has left some still feeling surprised and upset months after the vote to increase the fee from about $19 per month to about $39 a month.

The availability fee helps fund the necessaries to keep the ambulance running, such as fuel, equipment and operator salaries. It’s separate from transport fees, which a user, or their insurance, pays if they require ambulance service.

“This is to keep the ambulance, or ambulances and staffing available,” said Hoquiam Fire Chief Matt Miller. “We’re trying to stop the bleeding now rather than continue to use the reserves and play catch up.”

The increase came as a surprise to some, said Robbin Emery, Hoquiam resident and frequent voice in the discussion.

“It’s partly our fault for not paying attention,” Emery said in a phone interview. “It was a shock when they slapped that raise on the fee.”

The nearly doubling of the utility fee is a result of a number of factors, said Hoquiam Finance Director Corri Schmid. The failure of the movement to consolidate into a Regional Fire Authority, the dangerous dip in reserve funding as it was used to keep the department running, the declining amount of federal funding to help close the gap left by Medicare and Medicaid payouts, and several years of not raising the rates all came together.

“It was a long time coming. The third time, when we got the no vote for the RFA, we instantly started the process,” Schmid said in an interview. “We were like, OK, let’s look at our rate. The significant rate increase is because we didn’t do gradual rate increase because we didn’t go outside of the box.”

The department burned a sizable chunk of its reserve funds last year keeping the department running, Miller said.

“We used $300,000 in reserves in 2023. We were pushing the mark of what the state says we should have,” Miller said. “As with everybody, our costs are rising. Our cost of fuel is going up. Cost of supplies is going up. That’s a prime example in how our costs go up. Medications, medical supplies. Oxygen has gone up. Nasal cannulas. Non-rebreather masks. CPAP masks.”

Running medical calls costs money, Miller said, especially in an area like Hoquiam, where a large part of the population relies on Medicare or Medicaid, which does not fully reimburse the department for the cost of service. That’s where federal funding, under the Ground Emergency Medical Transportation program, comes in, to help fill that gap.

“A large percentage of our population is covered by Medicare and Medicaid. That’s where GEMT came in from 2018 till now,” Miller said. “The ambulance monthly utility fee helps maintain an ambulance here. The cost of doing business here isn’t being completely paid by insurance companies and by Medicare and Medicaid.”

However, the program has been reimbursing smaller and smaller amounts, Miller said, and is likely to terminate entirely in the next several years.

“It really, significantly helped us. We didn’t have to raise the rates because this helped us,” Miller said. “Since 2021, the yearly reimbursement rate has gone down. We’ve also been informed that this program is scheduled to go away in the next couple years.”

Emery said that after talking to city officials, she talked to other people and was informed the program is not ending.

“I got the run around about that, the hemming and hawing,” Emery said. “I went to the GEMT funding people.They said it is not quitting.”

While there isn’t a date set in stone yet, Miller said the city and department have heard from a number of sources that the program is winding down in the next several years.

“We’ve been informed through different avenues, through the program, through people that we communicate with, that it’s sunsetting, that it’s going away,” Miller said. “The federal government has not said, this is the date this is going to end. We’re trying to prepare for it before it hits us.”

The increased rate is going to operations and costs, Miller said, to keeping the doors open and the lights on. The department isn’t increasing size, and indeed, Miller said, has lost positions since the ‘90s.

“It’ll be more of we’re not operating at loss. Not significant enough to make us flush with funds coming in,” Miller said. “I know people are upset because of the huge increase now. We just weren’t functioning off of what we were making.”

The city as a whole has cut staffing and costs wherever it can, Schmid said, going from 115 employees in 2002 to 89 today, doing the same amount of work to provide services for the residents.

“We’ve got far less employees trying to keep up with the system. The city as a whole is running as lean as you can probably get,” Miller said. “We understand that the money is not there. We still need to provide those services for the city.”

Emery said it’s going to impact residents, particularly the elderly, harshly.

“This is literally hurting fixed income people. We get people going, ‘Hey, I’m going to have to move,’” Emery said. “There’s a lot of retired people living here, just like Aberdeen. We’re a poor area.”

It’s not something the city decided casually, Schmid said. There are some citizens who are eligible for discounts or exemptions; more information is available at the city of Hoquiam’s webpage, where eligible residents can file requests for discounted rates.

“We realize this increase is a lot for people,” Schmid said. “Unfortunately, this increases comes at a bad time when inflation is through the roof. The council did not take this increase lightly. This was not a decision easily made.”

The department isn’t making a profit off the increase, which is projected to bring in around $900,000, Schmid said. It will help the reserve fund to recover from the deficit and hopefully move the department toward leaning less on the general fund, Schmid said, which currently subsidizes 38% of the ambulance fund.

“We are not getting rich off of firefighting. We have always been on a tight budget, ever since I’ve started,” Miller said. “It’s to keep the doors open. We’re not increasing the staffing as the study from 2019 indicated we needed. We’re still operating the way we were. We’re not adding any additional programs or services. This is just to maintain what we’re already doing.”

Other solutions, including switching the department to a volunteer department, have been discarded as ineffective, Miller said. A volunteer department still costs money in training and equipment, and would mean that Hoquiam is not guaranteed to have volunteers available when residents need them, Miller said.

“Hoquiam hasn’t been a volunteer station since the 1920s or 1930s,” Miller said. “Up until the 1990s we actually had more staffing. Our call volume has gone up since then.”

Hoquiam’s high call volume set against it’s relatively low salaries, compared to many other departments, means that the department needs to stay in shouting distance just to keep the personnel it has, Miller said.

“We’re definitely doing more with less. That’s one of the reasons it’s very hard for us to retain personnel,” Miller said. “They can go work for a larger department on the I-5 corridor with more money and half as much work.”

Miller encouraged those who have concerns to communicate with them.

“We’re like an insurance policy. You hope not to use us. Some people don’t often understand how our operations work, how the fire department works, the people we have, why we have the equipment we have,” Miller said. “We encourage people to come down and talk to us.”

Contact Senior Reporter Michael S. Lockett at 757-621-1197 or mlockett@thedailyworld.com.