Bill
HB 5695
The bill creates a state plan to grant supplemental Medicaid funds to eligible public GEMT ambulance providers, offsetting costs with federal matching funds.
Status and purpose
- Enacted as Public Act 275 (2024). The Act creates a framework directing the Michigan Department of Health and Human Services (DHHS) to seek a Medicaid State Plan Amendment (SPA) to implement a supplemental reimbursement program for eligible public ground emergency medical transportation (GEMT) providers (ambulances) that serve Medicaid beneficiaries. The intent is to draw down federal Medicaid matching funds to help close the gap between Medicaid payments and actual ambulance operating costs.
Key deadlines and timeline
- DHHS must initiate the SPA process no later than 90 days after two or more eligible GEMT providers submit a complete, acceptable cost report to the department.
- Participation by providers is voluntary.
- DHHS may use intergovernmental transfers (IGTs) or certified public expenditures (CPEs) to secure federal matching funds.
Who is eligible
- Eligible GEMT provider: a public provider that
- provides ground emergency medical transportation to medical assistance recipients,
- is enrolled as a Medicaid provider for the claiming period, and
- is owned or operated by an “eligible governmental entity.”
- Eligible governmental entities include: the state, cities, counties, fire authorities, townships, ambulance authorities, federally recognized Indian tribes, or other local units of government.
Core program provisions
- DHHS may limit the program to costs that are allowable under Title XIX of the Social Security Act (federal Medicaid law).
- DHHS must submit claims and necessary assurances to CMS that only federally allowable expenditures are claimed.
- Supplemental payments must be:
- distributed exclusively to eligible providers,
- calculated under a payment methodology based on GEMT services provided to Medicaid recipients,
- equal to the amount of federal financial participation (FFP) received for an eligible provider’s Medicaid-related GEMT costs, but when combined with other Medicaid reimbursements must not exceed 100% of actual costs (as determined under the state Medicaid plan).
- Providers must make documentation, data, and certifications available to DHHS to establish that expenditures qualify for FFP.
- Payments cover services for both fee‑for‑service and managed care Medicaid recipients.
Fiscal impact and limits
- DHHS implementation and administrative costs estimated up to $1.5 million (FY 2024–25 appropriation noted).
- No direct recurring state programmatic cost projected; the program is intended to increase federal funding to participating public providers and be passed through to them.
- Amount of federal reimbursement depends on variables such as the Federal Medical Assistance Percentage (FMAP) or specific program FMAP (e.g., Medicaid expansion rates).
Practical effects and considerations
- Expected to benefit public ambulance services by supplementing Medicaid revenues to better match actual operating costs; proponents argue this can improve staffing, equipment, and service availability.
- Only public providers that can document CPE/IGT-style expenditures will generally qualify—private ambulance companies are not covered under the program’s eligibility definition.
- Federal approval is required; CMS rules and temporary pauses on new GEMT approvals may affect timing of federal funding availability.
Compiled from official sources — confirm details with the bill’s official record.
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