WALKER — Amid a quarter-million-dollar operating shortfall, local governments are working together to preserve ambulance service for the Walker region.
The city of Walker has been the sole taxing entity for the North Memorial Health-Walker ambulance district, which serves Walker as well as nearby Hubbard and Cass County communities like Akeley, Laporte and Hackensack.
But Walker officials notified both counties last fall that the city could no longer support the ambulance district due to its limited taxing capacity, and they would seek to relinquish its Ambulance Service License.
On Tuesday, Jan. 21, Cass and Hubbard County commissioners unanimously passed resolutions to form a special joint taxing authority for the Walker ambulance district.
Many rural emergency medical services providers are based in a city and supported by taxes paid by city residents. But they also serve nearby townships, residents of which typically don’t pay the tax.
This financing structure is compounded with other issues rural EMS providers face, like staffing shortages, rising costs and stagnant federal reimbursement rates.
North Memorial Health leaders reported a $251,000 shortfall in the provider’s operating budget for the Walker district last year. Of the Walker service’s payers, 69% were Medicare and 10% were Medicaid. While each ambulance ride costs the service $1,466 on average, Medicare reimburses between $907 and $985 per ambulance run. But if patients are treated on scene and not transported to a hospital, there's no reimbursement at all.

In the wake of the city’s decision, county commissioners were left with a choice: allow the Walker ambulance district to be absorbed into other neighboring districts or create a special taxing district to support the Walker Ambulance Primary Service Area.
The Walker ambulance is required to respond to emergency calls inside its PSA within 30 minutes, and commissioners expressed concern that wait times could be even longer if ambulances came from Deer River, Remer, Park Rapids, Brainerd or Bemidji.
Reno Wells, a former emergency medical technician for the Walker ambulance service and the Hackensack Fire Department, told Cass County commissioners during the meeting’s public hearing that the joint tax district makes sense for supporting the service.
“Lot of questions, a lot of issues out there that will have to be sorted out. How many ambulances were going to be placed? How much is it really going to cost?” Wells commented. “I support what you're about to do hopefully, and I think it's best for the citizens in this PSA.”
East Hubbard County Fire District member Roger Geimer told Hubbard County commissioners he hopes the move will support additional ambulances. The Walker ambulance district currently supports a single emergency vehicle.
Geimer shared that in a recent emergency, his crew had to wait for a Longville ambulance because Walker’s and Park Rapids’ vehicles were occupied.
“We have to figure something out for this,” Geimer said. “A half-hour is way too long for a heart attack or stroke victim.”
As far as adding additional vehicles or staffing to the Walker ambulance fleet, Hubbard County Board Chair Steve Keranen said it will be looked at as the new special taxing authority board works through its timeline.
"It all does come in at an additional cost, so we just certainly need to be aware of that, but federal reimbursements for Medicare and for Medicaid are really what's hurting hard,” he said.
The special taxing authority board will be comprised of three commissioners from Cass County and two from Hubbard, with respect to the percentage of tax revenue expected to be collected from each county.
The board would have the authority to levy for maintaining the ambulance service’s operating needs at the current level, up to $650,000 per year, beginning in 2026.
The new board will then have to compose a set of bylaws before drafting a request for proposals for an ambulance provider, with North Memorial expected to be the sole bidder.