Agenda No. 2.
CITY COUNCIL MEMORANDUM
| City Council Meeting: | August 19, 2025 |
| Department: | Emergency Medical Services |
| Subject: | Resolution 25-R-085 - Authorizing Amendment Number 1 to the EMS Interlocal Agreements with multiple governmental entities for the provision of Emergency Medical Services (S.Williams/J.Mabbitt) |
BACKGROUND
In 2023, the City of Schertz, and other entities in the region, signed a new five-year Interlocal Agreement (ILA) to utilize the EMS service. The ILA authorizes the City of Schertz to increase that base price per resident based on the most recent 12-month Consumer Price Index (CPI) for all urban consumers for medical care services to a maximum of 3 percent. In addition to the 3 percent CPI, Schertz annually adjusts for population growth for each entity.
The number of service calls for each entity in the EMS system has increased as the growth increases, yet the population in all the entities does not keep up with the pace of the demands of the service. There are other mitigating factors. The ten government entities (Schertz + nine entities) fees provide for 33% of the EMS budget. Sixty-five percent (65%) of the EMS budget is through insurance; 28% of this is written off as bad debt. The bad debt also includes uninsured persons (11%) and charity cases (6%), plus non-payment from users with Medicare, Medicaid, and private insurance companies that do not cover the full cost of their EMS services. While Schertz EMS attempts to collect from Medicare/Medicaid/private insurance users, not paying an EMS bill has no consequences. Additionally, Schertz recently did a compensation study and increased the pay for EMTs and Paramedics by an average of 26%. These positions make up 86% of the personnel for Schertz EMS. At the same time, Schertz EMS went from 24-hour work periods to 12-hour work periods. This resulted in Schertz EMS having to add additional personnel as well. Lastly, there are legislative hindrances that prevent Schertz EMS from collecting certain ambulance fees.
These increases, as well as the cost of providing service, have drained the fund balance, resulting in a negative cash balance. To continue to provide the same level of service, it was determined to increase the fees for each entity. We met with each stakeholder in April 2025 and notified them of this increase of 35% for FY26 and 5% for both FY27 and FY28.
Partner entities requested we look at some alternatives that would spread the increase out over a longer period of time. A longer period of time was not conducive, but we did provide an alternative to increase the rates by 20% for both FY26 and FY27, and then 5% for FY28.
The number of service calls for each entity in the EMS system has increased as the growth increases, yet the population in all the entities does not keep up with the pace of the demands of the service. There are other mitigating factors. The ten government entities (Schertz + nine entities) fees provide for 33% of the EMS budget. Sixty-five percent (65%) of the EMS budget is through insurance; 28% of this is written off as bad debt. The bad debt also includes uninsured persons (11%) and charity cases (6%), plus non-payment from users with Medicare, Medicaid, and private insurance companies that do not cover the full cost of their EMS services. While Schertz EMS attempts to collect from Medicare/Medicaid/private insurance users, not paying an EMS bill has no consequences. Additionally, Schertz recently did a compensation study and increased the pay for EMTs and Paramedics by an average of 26%. These positions make up 86% of the personnel for Schertz EMS. At the same time, Schertz EMS went from 24-hour work periods to 12-hour work periods. This resulted in Schertz EMS having to add additional personnel as well. Lastly, there are legislative hindrances that prevent Schertz EMS from collecting certain ambulance fees.
These increases, as well as the cost of providing service, have drained the fund balance, resulting in a negative cash balance. To continue to provide the same level of service, it was determined to increase the fees for each entity. We met with each stakeholder in April 2025 and notified them of this increase of 35% for FY26 and 5% for both FY27 and FY28.
Partner entities requested we look at some alternatives that would spread the increase out over a longer period of time. A longer period of time was not conducive, but we did provide an alternative to increase the rates by 20% for both FY26 and FY27, and then 5% for FY28.
GOAL
The goal of this resolution is to amend the existing ILA with multiple governmental entities.
COMMUNITY BENEFIT
To continue to provide Emergency Medical Services to the communities served.
SUMMARY OF RECOMMENDED ACTION
Approval of Resolution 25-R-085.
FISCAL IMPACT
Increases as outlined:
| FY25 | FY26 | FY27 | FY28 | |
| Cibolo | $662,028.24 | $794,433.89 | $953,320.67 | $1,000,986.70 |
| Increase | $132,405.65 | $158,886.78 | $47,666.03 | |
| Schertz | $791,273.28 | $949,527.94 | $1,139,433.52 | $1,196,405.20 |
| Increase | $158,254.66 | $189,905.58 | $56,971.68 | |
| Live Oak | $290,411.52 | $348,493.82 | $418,192.59 | $439,102.22 |
| Increase | $58,082.30 | $69,698.77 | $20,909.63 | |
| Universal City | $356,549.52 | $427,859.42 | $513,431.31 | $539,102.87 |
| Increase | $71,309.90 | $85,571.89 | $25,671.56 | |
| Selma | $213,095.76 | $255,714.91 | $306,857.89 | $322,200.79 |
| Increase | $42,619.15 | $51,142.98 | $15,342.90 | |
| Comal Co ESD 6 | $163,225.11 | $220,353.90 | $231,371.59 | $242,940.17 |
| Increase | $57,128.79 | $11,017.69 | $11,568.58 | |
| Santa Clara | $14,138.64 | $16,966.37 | $20,359.64 | $21,377.62 |
| Increase | $2,827.73 | $3,393.27 | $1,017.98 | |
| Marion | $21,742.32 | $26,090.78 | $31,308.94 | $32,874.39 |
| Increase | $4,348.46 | $5,218.16 | $1,565.45 |
RECOMMENDATION
Approval of Resolution 25-R-085.