The new Pennsylvania state budget includes nearly 21-million-dollars to increase ambulance Medicaid reimbursement rates, but E-M-S agencies say that’s not nearly enough. Officials with the Ambulance Association of Pennsylvania say their companies are unlike other first responders because they rely entirely on billing reimbursements and fundraising. Residents generally don’t pay up-front costs for their services. The 21-million was included in the new state budget signed in early August but further legislative action is needed for the state to actually spend the funds.