Speaker numbers apply only to this recording.
The Finance Committee of the City of Waukesha met on Tuesday, September 29, 2026, at 6:00 PM in the Council Chambers at Waukesha City Hall, 201 Delafield Street. Members present were Joe Pieper, Doreen Wigderson, Mike Anderson, and Rick Lemke; Dale Matthews was absent. Ald. Evert was also present. The committee received no public comment, approved the previous meeting minutes, and acted on two business items before adjourning at 6:47 PM.
The EMS chief and Administrator Brown presented the request, joined virtually by Megan Bernero, Client Success Director for EMS Management and Consultants (EMSMC). EMSMC has worked with the city for more than four years. The policy would apply to EMS treatment and transport services, including treatment without transport.
The policy discussion traced EMS billing history: resident and non-resident rates were established in the 1990s; Medicare and Medicaid billing rules drove rate changes from 1999 onward; and in 2016 the city adopted a soft collection policy and uniform rates. After 2016, city residents were not billed for balances left after Medicare, Medicaid, or private insurance paid, while non-residents remained responsible for unpaid balances. Cost recovery was about $1.35 million in 2015, rose by just under $650,000 to about $1.9 million after the 2016 change, and reached $2.35 million in 2025. In 2025 there were 5,552 transports, 87% of them residents. Staff estimated that reinstating resident balance billing would add just under $750,000 (about $746,000), bringing cost recovery to about $3.1 million.
Resident cash recovery was about $404 per trip versus $558 for non-residents. Gross charge recovery was 18.3% for residents and 25.8% for non-residents, making non-resident recovery about 38% higher. Staff cited cost recovery, common industry practice, and budget resilience as reasons for the change. They listed comparable and neighboring Wisconsin communities—including Eau Claire, Janesville, Wausau, Sheboygan, Oshkosh, Brookfield, Pewaukee, Lake Country, Western Lakes, New Berlin, Menomonee Falls, Heartland, Sussex, and Big Bend—as agencies that balance bill residents. Administrator Brown said the city's five-year cost-to-continue forecast showed about a $500,000 gap in 2028, and this revenue would help project balanced budgets for 2027 and 2028.
The retained hardship process would mirror hospital waiver criteria, and payment plans would be available without proof of hardship; the default plan would be $25 per month, with a credit card option to pay the balance within 12 months. Staff estimated 3,500 to 4,500 bills would be sent to residents for balances not covered by insurance, Medicare, or Medicaid. The policy would take effect January 1, 2027, and would not apply to existing balances.
During discussion, Ald. Anderson asked whether the $746,000 figure represented all uncollected amounts, whether additional collection would cost the city more, and whether payment plans required hardship documentation. Staff replied that the estimate was based on the billing company's historical data, that collection costs were already covered by the billing contract, and that payment plans are a convenience and do not require hardship documentation; the waiver path does require documented hardship meeting hospital-like criteria. Ald. Lemke expressed support for balance billing but proposed a $250 per-call cap, citing an example of an 82-year-old Medicare recipient receiving a $250 bill. Ald. Pieper noted he was surprised resident gross recovery was only 18.3% and said residents still receive significant value from fire department services funded by the levy. Megan Bernero explained that almost 70% of the city's payer mix is Medicare and Medicaid, whose allowed amounts are below gross charges, so the 25.8% non-resident recovery is close to the maximum collectible amount.
A motion to adopt the balance billing policy was made by Pieper and seconded by Wigderson. Ald. Lemke moved to amend the motion to cap charges at $250, with a second by Anderson. The amendment failed 2-2: Ayes were Anderson and Lemke; Nays were Pieper and Wigderson; Matthews was absent. The original motion then carried unanimously, 4-0, with Matthews absent.
Dustin Nolan, Recycling and Solid Waste Manager, presented the resolution to set the 2027 fee for residential garbage and recyclables collection at $165 per household, up from $160 in 2026. The increase aligns with the 3% escalator in the city's contract with John's Disposal and includes about $1 per household for 30% of Nolan's salary and benefits for contract administration, a cost not included in the original $160 fee. Nolan noted that estimates for household growth and landfill tonnage are built into the calculation, so the effective increase could be close to but not exactly 3%.
Ald. Lemke supported the 3% increase because it tracks the contract escalator and because the city moved garbage costs out of the levy under state levy limits. He opposed raising the fee in advance as unfair to taxpayers. Administration staff responded that Wisconsin statute requires fees to be reasonably related to the cost of service, so multi-year prefunding would not be allowed. Ald. Anderson asked whether the city saved money by switching from Waste Management to John's Disposal. Nolan replied that Waste Management proposed about a 10% increase under an extension, while the RFP-selected contract with John's increased by less than 5%; therefore, even with the 2027 increase, costs remain below a Waste Management extension. Nolan also said new homes receiving occupancy permits later in the year would receive prorated invoices, not free service through year-end.
A motion by Pieper, seconded by Wigderson, to set the 2027 fee at $165 per city-issued garbage cart for automated-service properties and $165 per address for manual-service properties was approved unanimously, 4-0, with Matthews absent.
Good evening, everyone. We'll call the Tuesday, September 29th, 2026 meeting of the Finance Committee to order. We do have a quorum this evening. Next item on our agenda is the Pledge of Allegiance. Please rise. I pledge of allegiance to the flag of the United States of America. And to the republic for which it stands. One mission under indivisible with liberty and justice for all. All right, next item on the agenda is public comment. Are there any members of the public that wish to address the finance committee this evening? All right. Seeing no public comment, we'll go on to item number four A, which is approval of the minutes for the 8th of September. Any changes to those minutes from the committee? All right, seeing those changes, no changes, those minutes are approved through unanimous consent. Move to our two business items this evening. Item number 5A is review and possible action on the EMS balance billing policy. Chief Coplin, Chief Lemminger here this evening. Chief, I'll turn it over to you. All right, thank you. I'll just take a few minutes to review what the EMS billing history in the City of Waxhaw has been and then walk through what the request is to the policy change. We do have a representative from our billing company joint who has joined us virtually tonight. So I will ask Megan if she could please introduce herself and give just a brief background on the billing company, which is EMS MC. Sure. Thanks for having me tonight. My name is Megan Bernero. I'm the client success director with EMS Management and Consultants. I oversee the Midwest Territory, which includes the entire state of Wisconsin. And we bill for over 220 clients within the state. We were acquired a couple years ago, and so was part of that transition. But worked with the city for the past uh four plus years, and um it's been a pleasure. So thanks for having me, and let me know if I can uh answer any questions tonight. All right, thank you. So as we move into the presentation, we are going to talk a lot about ambulance transports. That's kind of the thing we'll talk about the most, but I do want to mention that this includes treatment, no transport. So treatment, no transport means we would have responded to a person's home, treated them for something, but they didn't need transport to the hospital. Um so this does include that as well. So to start out with, um, how did the uh billing in City of Waukesha evolve? Uh starting in 1991, there was a uh that's when EMS billing started in City of Waukesha, and there was a a uh non-resident rate established, but there was no resident fee at the time. Then uh between 1994 and 1996, uh there was a resident rate established, and that was separate from the non-resident rate. Between 1999 and 2005, there were various changes made, and these are things that are related to how Medicare or Medicaid allowed for billing, Medicare and Medicaid pretty much determine how billing can go and what's billable and what's not. Um so different rates were added, and you can see those rates there, like BLS, ALS, mileage, ALS2, and so on. Uh through from 2009 to 2015, there were periodic rate adjustments. Uh and the um in 2015 is where some discussion started about a potential policy change.