The Honorable Aaron Michlewitz
Chair, House Committee on Ways and Means
State House, Boston

Dear Chairman Michlewitz,

We are writing to you asking for your consideration to expand on efforts made by Governor Healey in her recently filed fiscal 2024 state budget to address the serious staffing crisis impacting emergency medical service providers throughout the Commonwealth.

The Governor is seeking to increase the non-emergency Medicaid rate to parity with the Medicare rate to address the severe situation that currently exists in moving patients to and from mental health facilities, dialysis centers, hospitals and nursing homes. These patients often wait days to be transported for lifesaving care due to a lack of paramedics and EMTs to staff these ambulances.

The same staffing crisis exists for emergency 911 providers. Emergency providers in Massachusetts are a mix of fire-based services, private EMS providers, and services like Boston EMS and Worcester EMS. Communities rely on EMS responses to be rapid, and any delays can be life-threatening. Increasing the emergency Medicaid rate to Medicare parity would greatly help in their efforts to recruit and retain staff in order to avoid elongated response times that could result in tragedy.

Increasing the emergency rate would have a significant impact on both emergency and non-emergency access. Unfortunately, we have seen that limited fixes do not move the needle for non-emergency access. During the pandemic, EOHHS temporarily increased the non-emergency ambulance rate for dialysis patients to encourage providers to take these critically ill patients, but it had little impact on the system as 911 resources just could not be diverted. We believe strongly that if we can also stabilize the emergency staffing issues, it will greatly improve non-emergency availability as the two are so intertwined.

Below is language that we would ask you to consider. The language addresses the following:

“All Ambulance ground transportation shall be reimbursed at 100% of the Medicare Locality 99 Urban reimbursement rate at the time of service.”

• With no less than six different Medicare rate structures across Massachusetts, for parity this language matches the lowest cost.

• Provides one statewide Medicaid rate that would be easier for MassHealth to administer.

• All EMS providers would be treated the same statewide.

• Least expensive option allowing for the broadest based improvement for all EMS providers.

We believe that the cost of increasing the emergency Medicaid rate to be in line with the Medicare rate would be roughly double the cost of implementing the non-emergency rate. We appreciate all of your efforts over the years to support EMS providers. We stand ready to work with you to address this staffing crisis for these providers that will have a direct impact in every city and town in Massachusetts.


Geoffrey C. Beckwith
MMA Executive Director and CEO

Richard MacKinnon Jr.
President, Professional Fire Fighters of Massachusetts

Chief James Vuona
President, Fire Chiefs Association of Massachusetts

Dennis R. Cataldo
President and CEO, Massachusetts Ambulance Association