Yes. A city can add telehealth to the water, sewer, or trash bill, notice every account, run a decline window, and leave the rest enrolled. Algonquin, Illinois, kept 70 percent of households after that window.
What is a telehealth utility-bill program?
The city adds a telehealth line item to a bill it already sends. Every account is in unless the household opts out during a published window (and usually any time after). It is still a municipal telehealth program: residents get a clinician line, the city pays the vendor, and the uninsured are included because the bill follows the household, not a job. The utility is only the collection method.
The Census of Governments covers local revenue and utility operations; see Census of Governments. Whether a non-utility charge can ride that bill under your charter and state law is a city-attorney question, not a vendor question.
Opt-out or opt-in?
| Opt-out (utility line) | Opt-in (signup) | |
|---|---|---|
| Default | Every household is in | Every household is out |
| What the city must do | Notice, a decline path, a refund or skip rule | Marketing, until people remember to enroll |
| Typical result | Algonquin: 70% retained after notice + decline (observed) | Low single-digit enrollment unless you staff a campaign |
| Political risk | “You put it on my water bill” | “Nobody knows we have this” |
Opt-out needs a real decline path or you earn the angry emails you feared.
What must the opt-out path include?
- Written notice before the first bill (mail, bill insert, city site).
- A decline path with no trip to city hall: phone, web form, or both.
- A name-and-address match to avoid opting out the wrong account.
- A rule for declines after the first bill (prorate or next cycle).
- A rule for accounts opened after launch.
Algonquin’s 70 percent is the observed retention after such a window. Budget the vendor contract on the retained share, not 100 percent of meters.
Who changes the billing system?
City staff, or the city’s utility vendor under a city work order. TAP does not log into Tyler, Munis, CIS, or any billing system, and runs no script against your meters.
TAP can:
- Hand your staff a file of households that asked TAP to drop coverage (name, address, phone).
- Point to a peer city on the same platform (Algonquin used Tyler) that ran the one-time opt-out load.
Ongoing opt-outs run a handful a week, bucketed with other bill complaints. The one-time load at launch is the real work; plan staff time for that week, not an FTE.
Is this legal?
It depends on state law, the utility’s enabling ordinance, and whether the charge is framed as a fee for a city service. Have your attorney read the ordinance before anyone designs a postcard. This is not legal advice.
HIPAA sits on the clinical vendor, not the water clerk, who should not see diagnoses. See HHS HIPAA Privacy Rule. The bill line can say “city telehealth” without a patient name.
General fund, grant, or utility line?
- General fund: clean, but it competes with every department every year.
- Grant: good for start-up. HRSA Rural Health and state RHTP sub-awards are the usual rural path. Grants end.
- Utility opt-out: stable household money, higher political heat at launch, staff work on the file.
Some cities mix them: grant in year one, utility line after the award. Do not tell council the grant will last.
What results sit next to the 70 percent?
Keep funding and clinical results apart.
Observed, funding: Algonquin 70 percent household retention after notice and decline.
Observed, clinical / EMS: Ferris, Texas, 20 percent fewer non-emergent EMS runs and more than 50 percent resident adoption (City Manager Brooks Williams). TAP: 93 percent of encounters resolved without another claim; 9.9/10 resident rating. TAP works with 780+ public-sector partners, not all on utility billing.
Modeled: $450 to $900 per avoided non-emergency dispatch (municipal cost-to-serve). The model does not depend on the collection route.
Council packet, one page
- The ordinance or resolution language for the line item.
- The notice and decline script, in the languages already on your bills.
- Who in finance or utilities will load the opt-out file. Name a person.
- Algonquin 70 percent, labeled observed; a budget at 60 percent for cushion.
- A line that TAP gets no Tyler login.
Ask about a utility-bill launch
Send the attorney the ordinance question first, then send TAP your household count and 12 months of non-emergent EMS runs. TAP will not touch billing.
Request a local EMS savings estimate
Last reviewed: September 2026.
