With ultimatum set, decisions must be made on ambulance service’s future
Carleen Wild, Enterprise staff
Posted 1/15/25
By Carleen Wild Moody County Enterprise
The City of Flandreau and a newly formed Ambulance Task Force are scrambling to decide whether Flandreau will take over Moody County ambulance operations …
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With ultimatum set, decisions must be made on ambulance service’s future
During an emergency session Friday, the Flandreau City Council assigned a new mission to the Ambulance Task Force: assess the feasibility of the city taking over the county’s ambulance service within seven weeks. The Task Force includes city, Tribal, and county leaders, as well as other stakeholders. Meetings will be open to the public, with times and dates to be posted on the city’s website.
Facing a stalemate with the City of Flandreau over funding and a potential new home for the ambulance in the old fire hall, county commissioners voted Thursday to transfer ambulance services to the city. The city must formally respond by February 28 at 9 a.m.
The International City/County Management Association offers the following as to why ambulance services nationwide are suffering such heavy losses:
EMS agencies are typically funded through two primary sources: service fees and public funding (i.e., tax subsidies). When operating costs exceed revenue from fees, tax subsidies are usually necessary.
EMS service fees are reimbursed by Medicare, Medicaid, commercial insurance, or directly by patients. The proportion of insured patients in a community and their insurance types form the “payer mix.”
Medicare reimburses less than the cost of service, Medicaid reimburses even less, and commercial insurers generally cover about 80% of the “usual and customary rate” (UCR). However, insurers determine the UCR, often leading to underpayments.
When insurers underpay, patients often receive a “balance bill” for the remaining amount. Meanwhile, uninsured patients, who typically make up about 20% of the payer mix, often do not pay their ambulance bills at all.
Carleen Wild, Enterprise staff
By Carleen Wild
Moody County Enterprise
The City of Flandreau and a newly formed Ambulance Task Force are scrambling to decide whether Flandreau will take over Moody County ambulance operations following a surprising ultimatum last week.
County commissioners voted Tuesday to hand over the county’s two ambulances and other resources to the city, citing stalled negotiations on financial support for the service.
The city and task force have until February 28 to respond.
“If the city had reached out to us, they would have seen that working together was — and is — the best way to manage ambulance services,” said Commission Assistant Marty Skroch, expressing frustration.
“But it’s time, guys…Moody County has run this service for 36 years…I think Flandreau should take a crack at it.”
City officials, caught off guard by the proposal and its near-unanimous approval, disputed claims that talks had stalled. Instead, they said they were working to understand how best to support the service, noting no formal funding request had been filed.
All funding requests to the city require formal documentation, officials said. While county representatives attended open meetings and made verbal appeals, no paperwork was submitted.
City leaders emphasized the need for clarity before committing funds. To ensure the service’s long-term sustainability, they have questions that they feel need answers before throwing money at it and hoping it works, they said.
Financial strains and staffing challenges have plagued the county-run ambulance service, which has operated at an annual loss of nearly $70,000 since 2011 due to low reimbursement rates and rising costs. Moody County is not alone by any means in these challenges, ambulance services nationwide are ceasing operations for the same reasons.
Discussions about city support began in August 2022, with subsequent meetings addressing the possibility of using the vacant fire hall as a new ambulance base.
The city has hesitated to give away the building, initially planning to sell it to replenish its general fund and remove a deteriorating elevator downtown. However, many see the space as a logical new home for the ambulance.
The service, which is not required by law, relies on limited financial support. The Flandreau Santee Sioux Tribe contributes $10,000 annually, but no other consistent funding sources exist.
If the county exits the business, Flandreau — unlike most of the county already covered by ambulance services from Dell Rapids, Madison, or Brookings — would be left without.
Skroch reiterated his recommendation to commissioners.
“We’ve got two ambulances with power-lift systems and state-of-the-art equipment. If we’re not going to run it anymore, we should turn it over to Flandreau.”
He added that the county could contribute a $36,000 annual stipend — about half its typical loss — to support the city’s efforts.
City Administrator Cohl Turnquist responded, emphasizing collaboration. “The City Council’s goal has been to ensure reliable ambulance service. We wanted to work with the county to identify challenges and explore solutions, including a city subsidy, mutual aid, third-party operations, or city control. With the commission’s unexpected decision, I’ll recommend the task force assess the feasibility of a city-operated service.”
Both the county’s letter and the city’s response are posted on the Moody County Enterprise Facebook page.
In the meantime, Turnquist wants to assure residents the city will prioritize maintaining ambulance services.
“If it’s feasible for the city to take over, we’ll need full cooperation from the county and assurances the service will operate until a smooth transition is achieved,” he said.
The county has indicated its willingness to ensure a smooth handoff, emphasizing that the February 28 deadline is for a decision — not the end of its ambulance operations.
This is a developing story. Those interested can attend city meetings in person or watch live-streams and archives on the city’s website. County meetings, held bi-weekly, are open for in-person attendance only.