MEXICO — Wednesday night’s informational meeting by Med-Care Ambulance Service’s Board of Directors to explain the reasoning behind its recent subsidy hike only attracted four people from two of its 11 member towns.

Board President Steve Brown gave an overview of the ambulance service itself that was formed by Andover, Byron, Canton, Carthage, Dixfield, Hanover, Mexico, Newry, Peru, Roxbury and Rumford. The nonprofit corporation is run by a board comprised of representatives from each town, while Dean Milligan, the operations chief, runs the ambulance service itself.

Because of several unforeseen changes at the state and federal levels, and a dwindling overall population of its member towns, the Med-Care board had to increase its subsidy rate from $18 per capita to $24 per capita, Brown said.

That $6 per capita subsidy rate hike and budget of about $1.8 million starts July 1. Subsidies from the towns represent about 16 to 18 percent of the budget. Med-Care also reduced about $90,000 in expenses during 2014 against what was spent in 2013, he said.

“We do try to run a pretty efficient ship here,” he said. “We’ve fine-tuned this over the years and we’ve got a lot of things pretty under control here, but we ran into this thing with the Affordable Care Act that we couldn’t predict — and we still can’t — what’s going to happen.

“The whole idea of this is for everyone to get some type of coverage and get away from the problems where you have people with no insurance, no Medicare, no nothing,” Brown said.

So people are getting high deductible insurance through the ACA and many cannot afford to pay 100 percent of the costs out of pocket until that deductible is met and the insurance kicks in, he said.

“Of course, we want to send our bills out promptly and so we do, and we end up eating the deductible,” Brown said.

He said he talked with a pharmacy employee on Wednesday and learned that people don’t even have money to pay some of these co-pays for medications that are required by insurances.

“In the case of our service, it’s not, ‘Well, we’re not coming next time,’ we’ve got to go,” Brown said. “That’s the service we provide to our community.”

Medicare and Medicaid don’t pay as much as they used to for mileage reimbursement and for ambulance crews with advanced life support skills that are sent on every call, because Med-Care’s communities asked the service to send paramedics.

Brown said Med-Care is dispatched in about 4,000 calls a year, but not all of the calls are billable.

Calls are only billable if the ambulance service takes people to a hospital. Brown said they aren’t reimbursed if someone calls for assistance or it’s something their crews can handle without taking the person to a hospital.

Additionally in 2014, there were more than 50 patients who previously had MaineCare/Medicaid insurance who were no longer covered. Maine also cut and tightened eligibility requirements for MaineCare, dropping thousands of people from the program.

Brown said these patients couldn’t afford health insurance to begin with, which is why they were enrolled in MaineCare. So now they’re falling into a gap where they’re no longer eligible and still can’t pay for ambulance service.

“The problem we ran into was cash flow,” he said of 2013 and 2014. So they moved $40,000 each year from the reserve fund into the checking account to cover operational costs and also cut expenses to a bare-bones budget.

“If we got the money we bill for, we could probably run this without a subsidy,” Brown said.

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