Rapid City (SD) FD may need to reduce ambulance coverage area without funding solutions
This is a very well-done news report, with logical options articulated by the Rapid City Fire Chief.
The issues in South Dakota highlight the plight of agencies trying to provide the service levels desired by the community, in the face of rising costs and stagnant fee-for-service reimbursement; especially in the absence of state legislation for essential service designation, Medicare and Medicaid reimbursement levels, and effective patient protection from balance billing legislation that requires state regulated health plans to provide adequate reimbursement for ambulance service.
An analysis of the average charges and reimbursements for ambulance agencies in South Dakota derived from the PWW|AG Q1 2026 EMS Financial Index reveals the following:
Rapid City (SD) FD may need to reduce ambulance coverage area without funding solutions
SDPB | By Delainey LaHood-Burns
Published May 4, 2026
———————–
https://www.sdpb.org/healthcare/2026-05-04/rcfd-may-need-to-reduce-ambulance-coverage-area-without-funding-solutions
Emergency medical service providers across the nation say they are on the brink of collapse, and many ambulance providers in South Dakota are struggling to keep their doors open. While rural services have been hit hard, even the state’s urban EMS organizations are facing difficult choices.
Currently, the Rapid City Fire Department is fighting to maintain its coverage of areas outside of city limits. Since its inception in 2003, the department has served a roughly 3,200 square mile area, including Rapid City, Box Elder, New Underwood, Summerset and portions of Pennington, Custer and Meade County.
In December 2025, Rapid City Fire Chief Jason Culberson sent letters to the city’s neighboring jurisdictions indicating that the ambulance service can no longer sustainably cover areas outside city limits without funding support. An example of one of these letters, sent to the Meade County Commission, can be found online.
According to Culberson, this comes as the costs to operate an ambulance service have skyrocketed, while insurance reimbursement rates are stagnating. Additionally, Rapid City and the surrounding communities are growing substantially, leading to increased call volumes. According to population estimates, Rapid City has grown by nearly 12,000 people since 2020.
“We’ve stretched our folks to the max. We’ve asked them more and more and more all along,” said Culberson. “In 2010, we were doing about 10,000 to 12,000 calls, and now we’re doing 22,000 calls.”
Culberson said the department handled 2,655 medical calls outside of Rapid City last year. In order to continue the level of coverage they’ve operated at, more units and staff are needed.
The Rapid City Fire Department’s ambulance service is an enterprise fund, with the vast majority of its revenue generated through the transportation of patients. However, reimbursement rates for those patient transports are significantly less than the actual cost of an ambulance run.
“Ultimately, the insurance providers are determining what it cost to provide the service,” Culberson explained in a Meade County Commission meeting in March. For example, the base rate of a Basic Life Support call outside of Rapid City limits costs $1,080. In contrast, Culberson said Medicaid only reimburses $255.71 for that same call.
About 72 percent of the Rapid City Fire Department’s ambulance payer mix comes from government health insurance programs, including Medicare, Medicaid, Veterans Affairs and Indian Health Services.
Over the last five years, Culberson said reimbursement rates for those payers have generally plateaued.
“So you see this leveling off of reimbursement, the costs that have shot up since 2020,” said Culberson. “We used to be able to buy an ambulance for about $150,000, and now they are $250,000 to $300,000.
So those two have just diverged from each other. We’re at a point that we need to ask for help.”
In his letter, Culberson stated that the Rapid City Fire Department will need to stop its ambulance response coverage to some of its surrounding jurisdictions if formal funding agreements aren’t reached by the end of December 2026. However, he said the department will do everything it can to not leave people without ambulance services in an emergency.
“I want to be clear that as long as progress is being made going forward, that we’re not going to stop just because there isn’t a contract totally inked and penned,” said Culberson.
“We’ve gone down this path before it got to this point where it’s an emergency, where we were trying to work on it and nothing ever happened,” he continued. “It just stagnated, stalled and stopped. So that’s why I put a deadline on it. My whole goal is to move forward. But I also want to be clear, if no progress is getting moved forward, we may have to make the hard decision not to respond to those areas.”
According to Culberson, he’s had positive conversations with the surrounding communities that could lose their coverage. He says those areas have several options in terms of funding, including setting up contractual service agreements, forming ambulance taxing districts or trying to get coverage from other ambulance providers outside of the Rapid City Fire Department.
“The county could just put it in their line item as a budget line item and be able to fund it, which I think is an option – a very easy one,” said Culberson. “Another option is the tax district route, which not always is popular for obvious reasons. When you’re starting to talk about adding onto our property taxes, which are already high. So those are really the two main options. Or the last option is that the areas [decide] they don’t want to have ambulance services, period. I don’t like that option. I don’t think it’s a great option, especially if I lived in that area.”
In South Dakota, there’s no statutory requirement for counties or cities to provide ambulance services to their residents. Therefore, if an existing ambulance provider closes or must reduce its coverage area, impacted communities can be left with no ambulance service in an emergency.
State lawmakers are working to address this issue with the Emergency Medical Services Funding Task Force, which meets this summer. The task force will study funding mechanisms to support EMS as an essential service, similar to fire and law enforcement.
“My hope is they find a realistic funding source to get a baseline of EMS throughout the state of South Dakota,” said Culberson. “Relying on volunteers and other municipalities just to cover the entire state on hopes that they will continue to provide services, those days are done.”
While the issue with Rapid City Fire Department’s ambulance service affects multiple counties and municipalities, Culberson believes there are simple and achievable solutions that will ensure citizens have continued coverage. He also said those solutions don’t need to be costly, especially if each area can contribute its portion so the RCFD can continue the broader level of service it’s provided for decades.
Currently, the Rapid City Fire Department has several small contracts with entities like Summerset and Conata Basin to provide coverage.
Although he feels positive about the progress made so far, Culberson says it’s been hard to face the breaking point that EMS has reached.
“This one’s a big one for me,” said Culberson. “The first half of my leadership career was EMS, and this was always something I worked on. Try to make it sustainable and make it appropriate and make sure everybody was cared for. And so when we get to this point where we’re having to ask for funding in order to just provide a basic level of service, that’s a tough spot.”