Keeping Emergency Medical Care Available, Reliable, and Sustainable

When someone calls 911 for a medical emergency, Sacramento Metropolitan Fire District responds with highly trained firefighters, paramedics, emergency medical equipment, ambulances, medical supplies, and the resources needed to provide lifesaving care.

To ensure these services remain available, reliable, and sustainable for our community, Metro Fire periodically reviews the actual cost of providing emergency medical services (EMS). These reviews help ensure that fees remain fair, transparent, and aligned with the true cost of service while preserving the high-quality emergency response residents expect. The goal is to maintain a strong EMS system that continues to deliver lifesaving care whenever and wherever it is needed.

In 2025, the district completed a comprehensive Ambulance and First Responder Fee Study, which analyzed the costs of staffing, equipment, medical supplies, training, readiness, transportation, and regulatory requirements associated with providing EMS throughout the District. The study helps ensure that fees are fair, transparent, legally compliant, and do not exceed the reasonable cost of providing service.

The Metro Fire Board of Directors reviewed the study through a public process and adopted an updated EMS Fee Ordinance and Fee Schedule, which will take effect on July 1, 2026.

What Is Changing?

Metro Fire has adopted an EMS Fee Study, EMS Fee Ordinance, and EMS Fee Schedule. Together, these documents establish the actual cost of service, patient protections, billing practices, and the fees associated with emergency medical treatment and ambulance transportation services.

Why Is Metro Fire Doing This?

Emergency medical response is one of the most critical public safety services Metro Fire provides. Every day, firefighters and paramedics respond to medical emergencies with highly trained personnel, specialized equipment, advanced life support capabilities, and around-the-clock readiness.

As call volumes, equipment costs, training requirements, and medical care standards continue to increase, it is important that EMS fees accurately reflect the actual cost of providing service. Updating fees helps ensure the long-term sustainability of the EMS system while maintaining accountability to taxpayers and service users.
Costs include firefighter-paramedic staffing, ambulances and medical equipment, medical supplies and medications, training and certification, dispatch and communications systems, 

emergency readiness and response capabilities, and state and federal regulatory requirements.
The goal is simple: preserve high-quality emergency medical care for our community while ensuring fees remain fair, transparent, and legally defensible.

What EMS Fees Support

• 24/7 firefighter-paramedic staffing
• Ambulances and emergency response vehicles
• Advanced life support equipment and technology
• Medical supplies, medications, and protective equipment
• Emergency dispatch and communications systems
• Ongoing training, certification, and continuing education
• Equipment maintenance and replacement
• Mobile Integrated Health programs
• Readiness to respond at a moment’s notice, every day of the year
EMS fees help recover a portion of these costs from service users rather than relying solely on taxpayers.

How Does This Affect Me?

Most residents will only encounter EMS fees if they receive emergency medical services. Examples include receiving treatment from firefighters or paramedics, being transported by ambulance, or receiving certain specialized EMS services. If you never use EMS services, these fees generally do not apply to you.

When Are EMS Fees Charged?

Ambulance Transport, Treatment on Scene, Automatic Aid with Transport, Mobile Integrated Health (MIH), and related medically necessary add-on services such as mileage, oxygen administration, and cardiac monitoring.

What Are the New EMS Fees?

Effective July 1, 2026:
Ambulance Transport: $3,495
Automatic Aid with Transport: $2,963
Treatment on Scene: $532
Mobile Integrated Health Service: $3,388
MIH Supplemental Service: $1,165
Mileage: $53
Oxygen: $194
Cardiac Monitor: $148

Actual patient responsibility may vary based on insurance coverage, Medicare, Medi-Cal, contractual billing limitations, and applicable laws.

Patient Protections

Metro Fire recognizes that emergency medical situations are often stressful and unexpected.
• No prohibited balance billing where restricted by law or insurance contracts.
• Low-Income Assistance Program for qualifying individuals.
• Financial Hardship Waiver available through the Fire Chief or designee.
• Billing transparency based on documented patient care and adopted fees.
Metro Fire is committed to ensuring emergency medical care remains available to everyone who needs it. No one should hesitate to call 911 during an emergency because of concerns about receiving care.

Frequently Asked Questions

Are these new taxes?
No. EMS fees are service-related user fees and apply only to emergency medical services provided to a patient.

Why are fees increasing?
The cost of staffing, equipment, training, supplies, and readiness has increased.

Does this affect property taxes?
No.

What if I cannot afford my bill?
Low-income assistance and hardship review programs are available.

Will insurance still be billed?
Yes, in accordance with applicable laws and contractual requirements.

Why is treatment on scene billable?
Resources, personnel, equipment, and readiness are required whether or not a patient is transported.

How are fees determined?
Fees are based on the Ambulance and First Responder Fee Study.

Why doesn't Metro Fire simply pay for EMS services through taxes?
User fees help recover a portion of service costs from those who receive services rather than placing the entire burden on taxpayers.
 

Transparency Center 

EMS Fee Study PowerPoint
EMS Fee Ordinance
EMS Fee Schedule
Previous Ordinance Rescission
Public Hearing Notices
Board Agendas and Staff Reports

Timeline

November 2025 – Fee Study Completed
May 14, 2026 – Board Accepts EMS Fee Study
May 28, 2026 – Board Adopts EMS Fee Ordinance and Fee Schedule
July 1, 2026 – New EMS Fee Schedule Takes Effect

Our Commitment to the Community

Metro Fire is committed to transparency, accountability, fiscal responsibility, and exceptional emergency medical care.

The EMS Fee Study was conducted to ensure fees are based on documented costs, comply with California law, and support the long-term sustainability of emergency medical services.

Emergency medical response requires significant investment in personnel, training, ambulances, medical equipment, communications systems, and readiness resources. By periodically reviewing fees and aligning them with the actual cost of service, Metro Fire can continue providing reliable, high-quality emergency medical care to the communities it serves.

We encourage community members to review the study, ask questions, and participate in the public process. Together, we can ensure emergency medical services remain available when they are needed most.

Questions?

EMS Division
Sacramento Metropolitan Fire District
10545 Armstrong Avenue, Suite 200
Mather, CA 95655
(916) 859-4300