Update From CalChiefs Treasurer

PP GEMT IGT PROGRAM UPDATE & AUDIT ALERTS

Dear CalChiefs Members,

I want to give you all an update on the current PP GEMT IGT program, as well as touch on some of the issues with the audits currently going on with the now “dormant” old GEMT program.

Regarding the current PP GEMT IGT program, I am receiving inquiries almost daily, or being asked about the continued viability of the program, and as recently as this week was told by a chief officer—emphatically and with conviction—that the program was going away in 2026. When I challenged this chief on his source for the information, he stammered and made a reference to a presentation done recently. I am, of course, familiar with the consultant/legal team that had put the information out and had already reviewed it. It was full of speculation, maybes, and “what ifs.” It was conducted by one of the largest law firms, which is a favorite of the private ambulance industry. Don’t get me wrong—they put out some of the best educational material, have great conferences, and I have and do recommend them to our members. However, I ask you to consider the source before reacting to the “sky is falling” as gospel.

That said, there is no crystal ball, and it is not 100% clear yet what changes in the Medicaid program may be coming. I am keeping myself—and therefore our organization—apprised of facts, and I try not to get distracted by the so-called experts who may or may not have an agenda different from the California Fire Service.

I will remind our group that the PP GEMT IGT program is an “entitlement” program and not a “provider tax” program. As of this writing, the issues being discussed by Congress are related to “provider tax” programs, as I pointed out in a previous memo to our group and spoke about at the CFED conference.

To this point, I wanted to share with you the recent correspondence I received from DHCS (please see below). The quotes are purposeful, as this is not edited. My goal is to give you and your CMs, Finance Managers, or elected officials actual real-time information about the program.

As to the eligible but non-participants list referenced, CalChiefs is working through the area directors to reach out to those agencies and ascertain if they need help in understanding or following the process, as well as explaining that if they don’t participate, those of us who do must pay their NFS (nonfederal share).

"Hello CalChiefs,

The PP-GEMT team would like to share a few updates following the completion of CY 2025 Invoice #3. We are happy to report that the program has successfully collected 99.9% of the invoiced IGT amounts. One provider, Long Valley Fire Protection District, withdrew from the program during Invoice #3 due to financial setbacks. In addition, South San Joaquin County Fire will be joining as a new funding entity (FE) for Invoice #4 and City of South Pasadena expressed interest as a FE for CY 2025, and we are following up with them to potentially onboard for Invoice #4 as well.

Attached is the Invoice #3 non-participant list, which identifies known in-state public providers who did not participate as FEs during CY 2025 Invoice #3 but are eligible to do so. Consistent with previous communications, we have highlighted providers with 100 or more managed care GEMT trips and have included relevant notes outlining our ongoing efforts to onboard new FEs for CY 2025.

Please let us know if you have any questions.

Thank you,

Bianca Burgess | Associate Governmental Program Analyst"

SPA 25-0002 PUBLIC NOTICE

For the second update, I wanted to highlight the audits of the final years of the “dormant” old GEMT program.

As a review, that program was a CPE (certified public expenditure) program. In order to support your claim of true cost, we all had to fill out cost reports. These cost reports must be audited as part of the approval process from CMS. So, if we are all being audited—but you did nothing wrong—it is simply part of the process of that program. These next audits will be the last, as the program no longer exists. The current PP GEMT IGT (intergovernmental transfer) programs are not subject to audits. So, the point is: you are not being audited on the current program.

I know this can be confusing if you are new to your position and have not experienced this in the past. The A&I (Audits and Investigations) team is “catching up” on the final years of that program.

That being said, we are consistently hearing that costs which had been allowable in the past are now being rejected, and A&I/DHCS is demanding that you repay the overpayment—sometimes called a “clawback.”

I have been working with the EMS Section to find consistency in what these issues are, which auditor is making the change, and why. This is active work in progress. The goal is to find commonality and be able to go back to DHCS and A&I to re-educate the group as to our costs. It appears there are at least some new auditors who were not part of the program before and may not have the understanding or history of the program.

My recommendation to you is to get a “why” from A&I/DHCS in writing and feed that through the EMS Section so we are armed with that information and can push back with the department on your behalf.

In closing, I know that this is a lot of information, and these programs of alphabet soup are confusing. I highly recommend you take the time to listen to the CalChiefs podcast I did with then-President Chief Tubbs, where we walk through the programs at a more reasonable pace.

CALCHIEFS PODCAST

Respectfully,

Ted Peterson
CalChiefs Treasurer
Deputy Fire Chief, Southern Marin Fire District