For the first time in his life, 19-year-old Grant Mitchell spoke up at a government meeting. He felt he had to.
Mitchell, who has autism, was one of several disability rights advocates who addressed the Mecklenburg County Board of Commissioners Wednesday night on the hot-button issue of how the county will collect overdue Medic bills.
The advocates are worried about the county’s proposal to begin having the tax collector’s office collect overdue ambulance bills through wage and bank account garnishment.
“The whole purpose of me being here is so I can do the most amount of good,” Mitchell said. “To speak for the people who don’t have voices.”
Wage garnishment could be devastating for people with disabilities, Mitchell told commissioners.
Medic officials have said that something must be done to recoup overdue bills, because the system loses so much money on unpaid bills — even as activists continue to speak out against the proposed moves.
Medic says it has three options to recoup overdue payments: use garnishment, increase rates or receive more taxpayer money.
The average bill for an ambulance ride in the last fiscal year — $1,140 — was more than double the operating cost for that ride, according to Medic. That’s because many bills never get paid, Medic Deputy Director Jeff Keith said. County subsidies for the agency are at an all-time low, according to Medic’s annual report.
And Medic noted that other North Carolina counties have made similar changes to improve ambulance bill collections in recent years. There are 27 other counties which use some form of garnishment to collect overdue EMS bills, according to Medic.
That includes counties which use third-party collections agencies and the North Carolina Debt Setoff program, which only garnishes lottery winnings and state tax refunds.
Mecklenburg County already uses those forms of debt collection. Its new proposal would go further, and allow the county to garnish wages or bank accounts.
Activists helped stall that move last month but several Mecklenburg commissioners say they haven’t heard alternative proposals from county staff. Commissioner Pat Cotham says she expects a response from County Manager Dena Diorio within a month.
Of the 27 counties which use any type of garnishment for overdue bills, only seven confirmed to the Observer that they collect those bills through wages or bank account garnishment: Cabarrus, Cleveland, Davie, Granville, Pasquotank, Stanly and Stokes counties.
Seven other counties told the Observer they do not collect overdue EMS bills through wage or bank account garnishment, or through the county tax collector’s office. Another, Onslow County, said it collects bills in part through the tax collector’s office but not through wage or bank account garnishment.
Twelve counties did not respond to the Observer about how they use garnishment. In Wake County, according to its EMS website, the agency contracts with a third-party collections company.
Mecklenburg is by far the largest county that is proposing garnishment.
Near Charlotte, Cleveland County began garnishing wages to collect overdue EMS bills in July, according to county spokeswoman Janet Hart. But the county has limits in place so it doesn’t create “undue hardship,” Hart said.
It doesn’t garnish wages of someone who makes less than a gross pay of $5,000 per quarter, or someone who is a Medicare or Medicaid patient. Hart said Cleveland County will work with people to find out “what amount they can comfortably pay per month,” and limit the garnishment to that amount.
In Cabarrus County, officials use wage but not bank account garnishment to collect overdue EMS payments, spokeswoman Kasia Thompson said.
Over the summer, Cabarrus wrote off all overdue ambulance and library bills from fiscal year 2015 — a total of $1.4 million. Such write-offs are common practice for Cabarrus County after three years, Thompson said.
Medic writes off some bills as “charity write-offs,” spokeswoman Grace Nelson said, including $5.1 million in fiscal year 2019.
The cost of business
Keith, Medic’s deputy director, said there are a lot of factors that go into EMS bills — labor, technology and facility costs are all part of driving up rates.
Medic has roughly 600 employees and operates dispatch for itself and all county fire department calls outside of the city of Charlotte. It has 72 ambulances, and moved into a new, 183,000-square-foot facility on Wilkinson Boulevard early last year.
“The cost of that labor, the parts, the maintenance, the upkeep, it’s part of the bill,” Keith said. “Without it, we would not be reliable, people would have a whole different set of problems they’d be worried about.”
Medic’s reliance on county subsidies is at an all-time low, according to Medic’s annual report.
On average, the county paid for $93 per transport in the last fiscal year, when the average cost per transport was $559. That compares to $207 in fiscal year 2010, when the average cost per transport was $521.
Medic has 35,177 accounts that are past due for a total of $28.7 million, the county said in September.
Of those claims, 2,678 were over four months past due, totaling $2.2 million — an average of $821 per claim.
A mobile ER
Disability rights advocates have asked why emergency medical services in Mecklenburg operate differently than police and fire — which don’t charge a fee for users.
But there’s a big difference between the services, Keith said. “We are more akin to the hospitals than we are to public safety despite the lights and sirens on the truck,” he said. “We run a 72-bed, mobile emergency department.”
Individuals aren’t billed directly for police services because they pay through taxes, Keith said.
The majority of Medic’s funding comes from fees for service, and county taxpayers pay for 17%.
Even if the county took over all operating costs for Medic, taxpayers would still be paying for services more than once, Keith said. That’s because Medicare and Medicaid reimbursements make up about half of Medic’s business.
’We’ve got to figure this out’
Wage garnishment isn’t a good option to collect past-due emergency medical bills, according to Commissioner Mark Jerrell.
“Imagine taking someone who’s already struggling financially and then garnishing the only check that they have,” Jerrell said. “That could be potentially catastrophic.”
Commissioner Cotham believes the county will work with low-income people to avoid garnishment. Still, she said there are probably people who can afford to pay ambulance bills and don’t.
She said she’s never heard of the county using wage garnishment to collect other types of overdue bills: “That’s not our style,” Cotham said.
That’s not good enough for Tera Long, a health advocate who attended the latest meeting with Mitchell.
“(Mitchell) is truly a hero for speaking his mind about wage garnishment,” Long said. “Because this policy, if passed, will inevitably impact him.”
She’s afraid people will call ride-share services, or drive themselves to the hospital instead of calling 911 if they fear their wages will be seized to pay for bills.
Long said she wants to see commissioners sit down with Medic and negotiate a better deal — a deal to spend more county dollars on the agency.
“We don’t hate Medic, Medic saves our lives,” Long said. “But we’ve got to figure this out.”