Item 30 - Fiscal Year 2026-27 Budget Work Study Session

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Fiscal Year 2026-27 Budget Work Study Session May 5, 2026 Page 8 ALS 2 (Higher Acuity) $1,4851 $3,049 1 $2,041 — $3,200 Mileage (per mile $23 $26.19 1 $10 — $27 This proposed adjustment is not expected to materially increase out-of-pocket costs for most patients. Approximately 76.5% of transports are covered by Medicare and Medi-Cal, which reimburse based on fixed federal and state fee schedules and are not affected by the City's adopted rates. Commercial insurance accounts for approximately 10% of transports. For these patients, insurers primarily pay reimbursement, and patient cost- sharing is generally limited under State law. For the remaining transports not covered by Medicare, Medi-Cal, or commercial insurance, the City would continue to use existing billing practices and payment plan options to help manage affordability. If approved, the City would continue to align its paramedic service charges with OCEMS rates, which are typically updated annually. This approach would ensure the City maintains consistency with regional providers and avoids falling below market rates in future years. Aligning with OCEMS rates would improve cost recovery for paramedic services while maintaining consistency with regional providers. The additional revenue associated with this adjustment is included in Exhibit 3 as part of the City's balancing measures. Technology Fee Evaluation As discussed during Early Direction, staff has continued to evaluate a potential technology fee associated with the City's upcoming implementation of its new permitting and licensing system. Staff is currently finalizing a proposed fee structure. While this evaluation is still underway, an estimated revenue amount has been included in Exhibit 3 as part of the balancing options presented for City Council consideration. Staff is seeking City Council feedback on whether to proceed with bringing forward a formal technology fee proposal for consideration. Any proposed fee would be evaluated for compliance with applicable state law and limited to the reasonable cost of providing the associated services. Sober Living Homes There are two primary types of facilities operating in the City. Residential Care Facilities are state-regulated and provide some form of medical care, which may include mental health services. These facilities are not subject to our local Ordinance or our local business tax. Sober-Living Homes, a subset of Group Homes, are not state-regulated. These facilities are subject to the City's business tax. In August 2025, the City Council updated the Municipal Code to impose regulatory standards and require use permits based on the size and nature of the uses. City Council could further direct staff to pursue nuisance abatement for both types of facilities, with the potential to recover our abatement costs, including attorney fees. Nuisance abatement is a lengthy process that requires significant staff time and documentation to pursue legal action.