California has more Medi-Cal patients than any other state, but it pays less than almost all of them for ambulances to carry the low-income, disabled or older adults to where they need to go.

On Tuesday, an unusual alliance of ambulance workers and their bosses announced they will urge the governor and California lawmakers to raise the reimbursement rate for Medi-Cal, the state’s version of the national program, Medicaid, which pays for medical assistance to Californians in need.

The low reimbursement rate means that many needy patients get put on the back burner while waiting for nonemergency medical transportation, ambulance owners told The Chronicle. The owners say they can rarely raise pay for first responders and are forced to hike up the price for privately insured patients.

Ambulance owners call it “cost-shifting,” which means charging private customers far more for ambulance rides than they otherwise would if they weren’t losing money on Medi-Cal patients.

“In San Francisco, an ambulance charge could be $2,000, $3,000 because you have such a high portion of Medi-Cal patients,” said Jimmy Pierson, who runs a company in Solano County and is president of the California Ambulance Association.

The situation has left ambulances short-staffed, as many paramedics and emergency medical technicians quit, according to the California Emergency Medical Services Coalition, the new alliance. Too few people are ready to take their places because the pandemic shut down training facilities for so long, the group says.

“Our emergency medical services system is on life support,” ambulance owner Melissa Harris, who serves on the board of directors for the California Ambulance Association, said Tuesday.

Roughly a third of all ambulance rides in the state are Medi-Cal customers, who don’t pay for their rides themselves, Pierson said. Instead, the state pays ambulance companies $111.48 per ride — the same amount it’s paid since 2013, when California cut the reimbursement rate by 10%, Harris said.

North Dakota, the most generous state, reimburses ambulance companies at a rate five times higher than California for similar patients in the nation’s Medicaid program, according the 2019 American Ambulance Association State Medicaid Rate Survey, which the coalition shared with The Chronicle.

Only four states pay less than California: Kentucky, North Carolina, Rhode Island and Delaware, according to the survey. Ohio, just above California in reimbursement rates, pays 11% more, or $125.09 per ride.

The California Emergency Medical Services Coalition, including unions up and down the state, is asking the Legislature to pay $350 a ride — a rate they say the state can afford, now that it’s reported a $46 billion budget surplus.

“It takes a special type of person to work in the emergency medical field,” said Shelly Hudelson, a spokesperson for the International Association of EMTs and Paramedics, noting that the first responders often miss meals, work mandatory overtime, and are required in some circumstances to spend hours waiting with patients in emergency rooms until a bed can be found for them.

If the patient has Medi-Cal, the state won’t reimburse for those hours sitting around in what the industry calls “wall time.”

“With a starting salary of $15 to $17 for EMTs, they’re leaving in droves for fast-food jobs,” Hudelson told a news conference announcing the group’s grassroots lobbying effort, which includes a petition.

California lawmakers are in budget season now, planning for the 2022-23 fiscal year and considering where to spend the state’s resources.

No one from the Assembly Budget Committee responded immediately to a request for comment about whether a higher Medi-Cal reimbursement rate for ambulances is on the table.

A spokesperson from Gov. Gavin Newsom’s Department of Finance declined to comment but said that in January, Newsom proposed rescinding the 10% cut to Medi-Cal reimbursements for providers of medical air transportation and nonemergency medical transport — but not for ambulances.