FEMA finds the standby ambulance costs are not eligible because the costs were not reasonable and necessary. Appeal Letter Nancy Ward Director California Governor’s Office of Emergency Services 3650 Schriever Avenue Mather, California 95655 Margaret Olaiya Director, Finance Agency Santa Clara County 70 West Hedding Street East Wing, 11th Floor San Jose, California 95110 Re: Second Appeal – Santa Clara County, PA ID: 085-99085-00, FEMA-4482-DR-CA, Grants Manager Project 151901/Project Worksheet 587, Immediate Threat, Allowable Costs & Reasonable Costs Dear Nancy Ward and Margaret Olaiya: This is in response to the September 29, 2025 transmission from the California Governor’s Office of Emergency Services, which forwarded the referenced second appeal on behalf of Santa Clara County (Applicant). The Applicant is appealing the U.S. Department of Homeland Security’s Federal Emergency Management Agency’s (FEMA) denial of $166,080.00 for the costs of standby time for contract ambulance services. As explained in the enclosed analysis, I have determined the standby ambulance costs are not eligible because the costs were not reasonable and necessary. Accordingly, I am denying this appeal. This determination is the final decision on this matter pursuant to 44 C.F.R. § 206.206. Sincerely, /S/ Robert M. Pesapane Director, Public Assistance Enclosure cc: Robert J. Fenton Regional Administrator FEMA Region 9 Appeal Analysis Background The coronavirus (COVID-19) pandemic resulted in a major disaster declaration for the state of California on March 22, 2020, with an incident period from January 20, 2020, to May 11, 2023. Santa Clara County (Applicant) requested $166,080.00 in Public Assistance (PA) funding for the costs of contract ambulance services incurred between March 31, 2020, through May 2, 2020 for COVID-19 patients or suspected COVID-19 patients. The contract provided for onsite and offsite ambulances for the Federal Medical Center (FMC), a temporary medical care facility. Each ambulance was available for life support and transportation services. Under the contract, the Applicant agreed to pay for each hour of standby time for the onsite and offsite ambulances. In addition, for each transported patient not covered by Medicare, Medicaid, or other third-party payors, the Applicant agreed to pay a separate fee for transportation services within its jurisdiction along with mileage costs. FEMA prepared Grants Manager Project 151901 to document the requested costs for 33 days of 24-hour standby time, plus transportation fees for five patients transported to a temporary medical care facility or a hotel.[1] On January 11, 2025, FEMA issued a Determination Memorandum denying funding. FEMA found the Applicant did not provide documentation to demonstrate the claimed work was an eligible emergency protective measure. First Appeal The Applicant appealed in a letter dated February 19, 2025, asserting it entered into an agreement with a private ambulance service to reduce the spread of COVID-19 and facilitate efficient use of limited medical resources. The Applicant argued its costs for standby ambulance services are eligible to pre-position resources for patient transport to medical facilities or to quarantine COVID-19 positive persons at hotels. The Applicant stated the costs were necessary and prudent based on the data available at the time of the declared incident. The California Governor’s Office of Emergency Services (Recipient) transmitted the appeal in a March 10, 2025 letter, with its support. On July 24, 2025, the FEMA Region 9 Regional Administrator denied the appeal, finding the Applicant had not demonstrated the need for standby ambulance services was reasonable and necessary. Further, because the Applicant did not use the standby ambulances for eligible evacuation purposes, FEMA found the pre-positioning of those resources did not constitute eligible emergency work. In addition, based on the invoices submitted, FEMA found the Applicant only used the ambulance service to transport five individuals, four to the temporary medical center (FMC) and one to a quarantine hotel. FEMA found that even if those transportation activities were potentially eligible, the total billed amount for those services fell below the minimum project threshold of $3,300.00, making them ineligible for Public Assistance funding.[2] Second Appeal In a September 22, 2025 letter, the Applicant submitted a second appeal, asserting that pre-positioning and standby of medical transport resources is consistent with FEMA policy and precedent and is eligible under the PA program. In addition to its prior explanation that the ambulances provided for patient transport to medical care facilities and quarantine hotels, the Applicant also claims that the ambulances were on standby to augment existing resources at FMC and provide emergency medical services at the temporary medical facility. The Applicant states that the presence of the standby ambulances, even when not in use, was necessary and prudent given the unpredictable surge conditions and the need to prevent the collapse of hospital emergency departments. In support, the Applicant provided a prior FEMA second appeal analysis regarding the eligibility of pre-positioning resources, a statement from an executive physician at Santa Clara Valley Health Care, and a copy of a March 2020 order to shelter in place signed by the Applicant’s Public Health Officer. The Recipient transmitted the appeal on September 29, 2025, with a letter stating its support. Discussion Eligible emergency work includes emergency protective measures that are necessary to save lives and protect public health and safety.[3] For emergency protective measures to be eligible, the applicant is responsible for showing the work is required due to an immediate threat resulting from the declared incident.[4] Eligible emergency protective measures may include emergency medical care and transport.[5] FEMA’s Coronavirus (COVID-19) Pandemic: Medical Care Eligible for Public Assistance policy (Medical Care Policy) provides that the work and cost of medical care for COVID-19 declarations may be eligible when associated with primary medical care facilities or temporary and expanded medical facilities.[6] Under FEMA’s Medical Care Policy, eligible medical care activities and associated costs include emergency medical transport related to COVID-19, triage and medically necessary tests and diagnosis related to COVID-19, and necessary medical treatment of COVID-19 patients.[7] To be eligible, costs must be directly tied to the performance of eligible work, necessary and reasonable to accomplish the work properly and efficiently, and adequately documented.[8] A cost is reasonable if, in its nature and amount, it does not exceed that which would be incurred by a prudent person under the circumstances prevailing at the time the applicant makes the decision to incur the cost.[9] It is the applicant’s responsibility to provide documentation to substantiate its claim as eligible and to clearly explain how those records support its appeal.[10] Here, the Applicant is seeking reimbursement for standby ambulance services, arguing that it needed to have standby services available for the potential emergency medical transport of COVID-19 or suspected COVID-19 patients.[11] However, the Applicant has not provided documentation showing it used the ambulances to transport COVID-19 patients or suspected COVID-19 patients more than five times in the 33-day period.[12]The Applicant does not explain how it evaluated the need for the 24-hour, 7-day a week (24/7) standby ambulance services, and it has not demonstrated the standby costs were reasonable given the limited documented use of those vehicles for potentially eligible work. Next, the Applicant asserts it required the standby ambulances to support on-site medical care at a temporary medical facility (FMC). Specifically, the Applicant argues that the ambulance standby costs were necessary because FMC was only equipped with basic medical infrastructure, and standby ambulances could augment existing resources to provide immediate, critical life-sustaining support.[13] However, the Applicant has not demonstrated that it used the ambulances to provide emergency medical treatment at the temporary facility, or that the infrastructure limitations of FMC required it to incur costs for 24/7 standby ambulance services.[14] Thus, FEMA finds the Applicant has not provided documentation to justify that its requested costs for 24 hour, 7-days a week of standby ambulance services for the emergency medical transport of individuals were reasonable or necessary based on the actual or projected need.[15] Conclusion