San Jose city officials have signed off on a first responder fee program, joining 23 other cities across the state as it looks to generate millions of dollars for its fire department in response to the growing number of medical calls in the community.
Through the new $427 fee that will go into effect Jan. 1, the department has estimated it could generate nearly $4 million per year, primarily through billing either medical insurance or car insurance providers, in the event of a vehicle crash.
Over the past 10 years, medical-only events have increased by 39% and made up 62% of the more than 110,000 incidents the department responded to in 2023-2024 fiscal year.
“What we’re trying to balance here is making sure that we can appropriately bill for life-saving medical care and make our department sustainable and continue to staff the services that our community needs without putting an undue burden on our residents,” Mayor Matt Mahan said. “Since the pandemic, emergency medical calls have increased by 16%, and our fire department is taking an ever-increasing role in providing advanced life support beyond fire suppression.”
Over the past 25 years, San Jose has seen an evolution of the services its fire department provides, offering more advanced care.
An analysis of the city’s responses found that fires only made up 4% of incidents in the 2023-2024 year.
Proposition 26, passed in 2010, allowed local governments to charge constituents user fees specifically for emergency medical care and ambulance transport services, adding to the number of government services where an additional charge could be assessed.
Dozens of municipalities across the state have implemented similar programs, including cities like San Francisco, Sacramento and Long Beach.
Fire Chief Robert Sapien said that for the 23 jurisdictions with existing programs, fees ranged from $225 to $753 per incident, placing San Jose’s initial charge in the 70th percentile.
Along with servicing more medical calls, the departments also responded to 4,106 motor vehicle accidents, making collision response another important aspect of the new program.
“The Department has evolved into a substantial medical care provider in the city, and in recent years, has continued to strive to meet service demand, serving effectively as a safety net for the community where other providers have reduced services,” Sapien said. “As such, the department seeks to align with medical care providers to access medical care payers as a means to recover costs for services to ensure the sustainability of emergency medical services relied upon by our community.”
As part of approving the program, District 8 Councilmember Domingo Candelas has asked the city to use the revenues to restore some of the functions of the Med 30 unit delegated throughout the fire department. Candelas said Med 30 was the busiest resource in the department, providing logistical medical support for the field firefighter EMTs and firefighter paramedics.
In its revenue calculations, the fire department has anticipated an 80% collection rate for those with commercial medical insurance or billed through auto insurance in the event of an accident. Sapien said the department expects a collection rate of 3% for those who choose private pay.
He also noted that the department would be developing a compassionate billing program to identify criteria for hardship waivers where fees may either be reduced or waived, as well as flexible payment and fee forgiveness programs.
While the fee program will not go into effect until next year, Sapien said the department would create a communications plan to address potential billing questions.
Despite concerns that a fee program could deter residents from contacting emergency services, Sapien said it did not have that effect in the other cities where a similar program exists.
“None reported a detrimental effect to 911 access,” Sapien said. “We didn’t hear anyone say that we implemented this program, and then people became fearful or leery of calling.”