Author: Matt Zavadsky

The go-to data base for conducting analysis of EMS trends ranging from finance and reimbursement to crashes and thefts – EMSIntel has now passed 4,000 news items and continues to grow.

What began as a simple weekly spreadsheet collated during the pandemic, tracking news reports about EMS, has grown into one of the most influential intelligence resources in Emergency Medical Services. EMSIntel, publicly accessible at www.emsintel.org, has surpassed 4,000 curated profession wide news stories, marking a significant milestone in its evolution from informal briefing tool to a nationally recognized platform for insight, analysis, and understanding.

The origins of EMSIntel are deliberately modest. Developed by Rob Lawrence (Pro EMS), while serving as the American Ambulance Association’s (AAA) Communications Chair, as a weekly compilation of notable EMS developments, the early version was shared with a small network of colleagues seeking clarity in an increasingly noisy information environment.

Recognizing both the value of the content and the opportunity to scale its impact, the AAA provided generous funding and support to transform EMSIntel from a static, spreadsheet-based product into the interactive and searchable platform it is today. This transition marked a pivotal moment, enabling not just collection, but structured collation and accessible analysis at scale.

As the platform matured, the Academy of International Mobile Healthcare Integration joined the collaboration, reinforcing EMSIntel’s role as a shared industry asset and ensuring its continued growth through coordinated collection, curation, and collaboration. Together, these partnerships have anchored EMSIntel firmly within the EMS ecosystem, both reflective of and responsive to its evolving needs.

From its earliest days, EMSIntel has been guided by a disciplined approach to curation and interpretation. Rodney Dyche (Patient Care EMS Solutions) serves as Chief Curator, overseeing the identification and classification of developments from across the United States and internationally. Matt Zavadsky (PWW|AG / Executive Director AIMHI) provides analytical leadership, translating thousands of individual entries into thematic insights that reveal the pressures, trends, and opportunities shaping EMS systems. Rob Lawrence shapes the input into briefings and articles to inform of issues, concerns and alerts.

An analytical summary of EMSIntel and a downloadable Excel file of the EMSIntel log, complete with source references, is updated each month on AIMHI’s News site.
 

This structure and support allows EMSIntel to move decisively beyond aggregation. With more than 4,000 curated entries, the platform now supports meaningful thematic analysis across workforce challenges, reimbursement reform, ambulance patient offload times (APOT), mobile integrated healthcare, and system resilience. It offers not just a snapshot of events, but a longitudinal understanding of how the EMS landscape is changing.

That insight is increasingly being put to use. EMSIntel analysis has supported briefings for policymakers at both state and federal levels, providing evidence and context to inform legislative and regulatory discussions. It has also been cited in journalistic reporting, helping frame EMS issues within a broader, data-informed narrative.
“EMS has no shortage of information, but it often lacks shared understanding,” said Rob Lawrence. “EMSIntel was created to bridge that gap, turning noise into insight, and insight into something that can inform decisions, policy, and public awareness.”

As EMSIntel enters its next phase, the focus will remain on expanding its analytical capability while maintaining the disciplined curation that underpins its value. The milestone of 4,000 entries is not simply a measure of scale, but a signal that EMS now has a growing intelligence function, one capable of tracking, interpreting, and communicating the realities of a complex and evolving system.

About www.EMSIntel.org
EMSIntel is a curated intelligence platform focused on tracking and analyzing developments across the Emergency Medical Services sector. Created by Rob Lawrence and supported by Chief Curator Rodney Dyche and Analyst Matt Zavadsky. EMSIntel provides thematic insight into emerging trends and issues affecting EMS systems, policy, and practice. Learn more at www.emsintel.org

Published analysis derived from EMS Intel
Leading into 2026: The four actions every EMS leader must take: Leading into 2026: The four actions every EMS leader must take
EMS at the edge: Inside a year of reckoning and redesign: EMS at the edge: Inside a year of reckoning and redesign
Funding on fire: Communities are saying the quiet part out loud: Rethinking EMS funding: New models for ambulance service sustainability
Fast & spurious: America keeps losing ambulances and the fix is cheap: Prevent ambulance thefts: Keep paramedics, patients and the public safe

Two news reports last week that could impact EMS reimbursement should catch the attention of EMS leaders.
 
The first report signals that Medicare is considering making enrollment in Medicare Advantage (MA) the ‘default’ enrollment option.
 
As reported in the August 2025 PWW|AG EMS Financial Index Report, MA claims represent 56.9% of all ambulance claims, with Medicare Part B representing 43.1% of claims. The average reimbursement from MA plans is $25 lower than Medicare Part B. Additional enrollees in MA plans could have a negative impact on EMS reimbursement.

The second report reveals that the average out-of-pocket premiums for Affordable Care Act (ACA) enrollees rose 58% this year after the expiration of enhanced subsidies. Also, 1.2 million fewer people enrolled in ACA plans in 2026 compared to 2025. 
 
This possibility was discussed in our summer Pulse of EMS Finance webinar series, explaining that reduced ACA enrollment due to provisions contained in the OBBBA could shift commercially insured patients to uninsured, or Medicaid programs.
 
We strong encourage EMS leaders to closely monitor these types of developments, and consider modeling what these changes may mean for their revenue cycle.

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CMS considering automatic enrollment in a Medicare Advantage plan

The idea is part of the conservative Project 2025 policy.

By Susan Morse

March 24, 2026

https://www.healthcarefinancenews.com/news/cms-considering-automatic-enrollment-medicare-advantage-plan

The Centers for Medicare & Medicaid Services is considering a policy to automatically enroll seniors in a Medicare Advantage plan, according to STAT.

Chris Klomp, director of Medicare and deputy administrator for CMS, told STAT his team is mulling the feasibility of models that would either automatically enroll beneficiaries into a private Medicare Advantage plan or an accountable care organization that participates in the Medicare Shared Savings Program or similar program. 

Klomp said either choice would be better than enrolling beneficiaries in a fee-for-service arrangement, which is Medicare. Individuals could still opt into a different insurance arrangement, he said. 

Klomp is senior advisor to Health and Human Services Secretary Robert F. Kennedy, Jr. 

In February, Kennedy announced in an email to staff that he was remaking his leadership team, putting Klomp in charge of overseeing all HHS operations, according to Politico.

Currently, original Medicare is the default option for seniors who don’t make a choice. Over half of seniors enrolled in a Medicare plan choose a Medicare Advantage plan.

Moving to MA as the default option is part of the conservative Project 2025 policy blueprint, which has made other recommendations that HHS has initiated such as Medicaid work requirements. 

Medicare Advantage (MA), a system of competing private health plans, is the major alternative to traditional Medicare for America’s large and growing cohort of seniors. The program provides beneficiaries with a wide range of competitive health plan choices—a richer set of benefits than traditional Medicare provides and at a reasonable cost. Equally as important, the MA program has been registering consistently high marks for superior performance in delivering high-quality care. Critical reforms are still needed to strengthen and improve the program for the future.”

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ACA premium costs up after subsidies expire

By Peter Sullivan

March 30, 2026

https://www.axios.com/newsletters/axios-vitals-f319f390-2b23-11f1-8489-774d2aecabb5.html

Average out-of-pocket premiums for Obamacare enrollees rose 58%, or $65 per month, this year after the expiration of enhanced subsidies, new federal data shows.

Why it matters: The data helps quantify the effects of the fierce partisan battle in Congress over whether to extend the subsidies, which ended in no action.

By the numbers: The average Affordable Care Act out-of-pocket premium rose from $113 per month in 2025 to $178 per month in 2026, according to the CMS report.

• There are also more enrollees in “bronze” plans with higher deductibles this year: 40% of enrollees compared with 30% last year.
• Larry Levitt, executive vice president of health policy at KFF, wrote on X that the average premium increase would have been higher if some people had not switched into bronze plans with higher deductibles to try to keep their premiums down.

The big picture: 23.1 million people signed up for 2026 coverage, down 1.2 million from 2025.

• CMS touted its enforcement actions, which it said removed coverage or subsidies from nearly 1.5 million people found to be ineligible.

The study referenced in this news report found that 400+ hospitals are at risk of closing or cutting services due to Medicaid funding reductions, particularly affecting essential services like maternity and mental health. And, most hospitals affected are in urban, not rural areas.

Why this matters to EMS
As we have shared in recent articles and webinars, for EMS, this could mean:

• Fewer destination options
• Longer transport times
• Loss of specialty care access
• Increased APOT times
• Reduced unit availability
• Increased reliance on 911 as the safety net
• Greater use of EMS for non-emergent but unmet needs

What EMS agencies should do

• Map at-risk hospitals and identify alternate destinations now
• Develop dynamic patient navigation protocols (e.g., bypass rules, specialty routing)
• Consider dispatch triage programs
• Expand sustainable MIH/CP programs
• Expand Treatment in Place (TIP) and Transport to Alternate Destination (TAD) programs
• Plan for cross-jurisdictional, regional coordination

This isn’t just a hospital problem; it’s a system transformation moment that EMS agencies can leverage for system sustainability.

EMS agencies should continue to shift from “transport providers” to “mobile healthcare agencies”.

Medicaid cuts threaten hundreds of hospitals, new report finds

Together, the hospitals provide care for nearly 7 million patients across the U.S., according to the analysis.

By Berkeley Lovelace Jr.

March 31, 2026

https://www.nbcnews.com/health/health-news/medicaid-cuts-threaten-hundreds-hospitals-new-report-finds-rcna265789

More than 400 hospitals across the United States are at high risk of closing or cutting services because of the Medicaid cuts in President Donald Trump’s “big, beautiful bill,” according to an analysis from the progressive watchdog group Public Citizen.

The fallout could make it harder for millions of people to get care and put thousands of health care workers’ jobs at risk as hospitals lose a key source of federal funding. Medicaid covers about a fifth of all hospital spending.

The Medicaid cuts come in phases, with more significant changes, including work requirements, in 2027 and limits on how states raise funds in 2028. Overall, the law is expected to reduce federal Medicaid funding by roughly $1 trillion over the next decade.

“We’re seeing hospitals that are already under severe financial strain having to make decisions about how to stay financially solvent,” said Eileen O’Grady, a researcher in Public Citizen’s Congress Watch division and the report’s author. “That has pretty clear implications for people who live in that community. It also has ripple effects on other hospitals in those communities.”

The analysis draws on hospital financial data from the Centers for Medicare and Medicaid Services from 2022 through 2024, covering about 95% of U.S. hospitals. The group defined at-risk hospitals as those in which Medicaid and other low-income government programs made up at least 20% of revenue and that have been operating at a loss in recent years.

The report doesn’t estimate when hospitals could close or cut services.

“Closure is the worst-case scenario, but it also doesn’t preclude hospitals from having to make really tough decisions about cutting services that might be essential to those communities but are just no longer financially viable,” O’Grady said.

Across the country, hospitals have already made statements warning they may need to lay off staff or scale back care, including maternity and mental health care, because of the Medicaid cuts.

For many patients, hospitals are the last place to turn when there are few or no other options for care.

“When hospitals close, patients have less access to the care that they need,” said Gideon Lukens, director of research and data analysis on the health policy team at the Center on Budget and Policy Priorities, a nonpartisan research group. “They have to travel further or wait longer in other hospitals that become overcrowded. That additional time can be the difference between success and failure of time-sensitive, potentially life-saving treatments.”

The closures also add strain to the hospitals that take on the extra patients.O’Grady said doctors end up having “less patience, less time, less capacity to provide the highest quality care.”

“It can be very dangerous for hospitals to be under this kind of strain,” she said.

The analysis found a total of 446 at-risk hospitals, with at least one at-risk hospital in 44 states and Washington, D.C.

About 60% of the at-risk hospitals — 267 facilities — are in urban areas, even as much of the debate around Medicaid cuts has focused on rural hospitals. Black and Latino people stand to be the most affected by the cuts.

The hospitals span both Democratic and Republican-led states, though the states with the largest number of at-risk hospitals are California, New York, Illinois and Washington.

Republicans also represent several congressional districts with the highest number of at-risk hospitals. House Republicans who voted for the Medicaid cuts have 196 at-risk hospitals in their districts, while Senate Republicans — all of whom back the cuts — represent 146 at-risk hospitals in their states, according to the analysis.

The cuts could lead to a worsening crisis, especially for rural hospitals, said Zachary Levinson, the project director of the KFF Project on Hospital Costs.

He said that by his estimates, Trump’s law sets aside $50 billion to support rural communities, but could reduce federal Medicaid spending in rural areas by far more — about $137 billion over a decade.

James Jackson, the CEO of Alameda Health System in Oakland, California, said the Medicaid cuts represent an “existential threat.”

Alameda Health System, which gets 60% of its revenue from Medicaid payments, announced in December that it would lay off nearly 300 employees and lose more than $100 million annually by 2030. (The health network was not included on Public Citizen’s at-risk list, though the report notes its financial troubles.) The layoffs, set to take effect in March, have since been delayed.

Proposed cuts included mental health services, care for patients with chronic conditions and an ambulatory plastic surgery program. Jackson said closing hospitals is not on the table, but the system has continued to look at scaling back services.

“I don’t think the impact is going to be a positive one,” he said. “We are often the provider of last recourse, so if we’re not able to provide a service, there will be a delay in receiving care at one of the other systems in the area or they may not provide it at all.”

Trinity Health, a Michigan-based hospital system with facilities in other states, said it’s projected to lose $1.5 billion due to “recent and future government policy changes.”

In January, it said it was laying off 10.5% of its billing staff. One of its hospitals, St. Mary’s Sacred Heart Hospital in rural northeast Georgia, announced last October it was closing its maternity unit.

In a statement, a Trinity Health spokesperson shared a previous statement that said in part that “more reductions” are being considered by the federal government and it’s “not possible to simply absorb such a significant financial impact without making thoughtful, forward-thinking changes.”

EMS agency leaders should stay abreast of potential further changes to HHS, its agencies, and federal grant programs.

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Trump budget targets $15.8B in HHS cuts: 9 things to know

By: Madeline Scheetz, Andrew Cass, and Alan Condon

April 3, 3036

https://www.beckershospitalreview.com/hospital-management-administration/trump-budget-targets-15-8b-in-hhs-cuts-9-things-to-know

The Trump administration’s fiscal year 2027 budget released April 3 proposes a $15.8 billion cut to HHS, while requesting $1.5 trillion for defense, a 44% increase. The budget would dramatically reshape federal spending priorities across healthcare and national security.

It would also restructure the federal health bureaucracy, eliminating familiar agencies, cutting $5 billion in programs deemed wasteful and replacing them with a new entity called the Administration for a Healthy America.

Below are nine notes on the fiscal year 2027 budget: 

1. HHS faces a $15.8 billion cut. The budget requests $111.1 billion for HHS in fiscal 2027, representing a 12.5% reduction from 2026. The administration framed the cut as a move to eliminate “bloated, woke and inefficient programs” and refocus on core priorities. 

The budget comes nine months after President Donald Trump signed into law the One Big Beautiful Bill Act, which outlined nearly $1 trillion in Medicaid cuts and restructured several key healthcare programs. Among the most contentious aspects of the OBBBA were its cuts to Medicaid; the legislation adds work requirements, more frequent redeterminations, and adds new limits on state-directed Medicaid managed care payments and oversight.  

President Trump has also signaled a broader shift in how the federal government approaches healthcare funding. Speaking at an April 1 White House event, he said it is “not possible” for the federal government to fund Medicare, Medicaid and childcare, arguing this responsibility should be on individual states while federal resources focus on priorities such as national defense, NBC News reported April 2. 

2. NIH loses $5 billion; 3 institutes eliminated. The administration alleges that the National Institutes of Health “broke trust of the American people with wasteful spending, misleading information, risky research, and the promotion of dangerous ideologies that undermine public health.” At the program level, the budget requests $41 million in funding for NIH research, a roughly $5 billion cut over 2026 funding. The proposal calls for the elimination of the National Institute on Minority Health and Health Disparities, Fogarty International Center and the National Center for Complementary and Integrative Health.

The proposed cut is significantly smaller than the administration sought in its 2026 budget. That plan proposed cutting NIH’s funding by $18 billion. That proposal was ultimately rejected by Congress. Last year the administration also proposed consolidating a significant number of the NIH’s 27 institutions and centers, which lawmakers also rejected.

3. A new agency replaces several familiar ones: the Administration for a Healthy America. The budget establishes the Administration for a Healthy America as part of a “major reorganization” of HHS. 

AHA would consolidate functions previously spread across the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, the CDC, and the Office of the Assistant Secretary for Health. The goal is to bring nutrition services, food safety, chronic disease prevention, and behavioral health under one roof, cutting $5 billion in programs the budget described as duplicative, inefficient, or misaligned with the Trump administration’s policies. It also creates a new $4.1 billion Behavioral Health Innovation Block Grant to replace several existing behavioral health funding streams, which the administration criticized for funding programs including transgender health services and DEI initiatives.

4. Global health funding cut by $4.3 billion — PEPFAR restructured. The budget cuts $4.3 billion from global health programs, leaving $5.1 billion in total. The Trump administration framed this as a shift from “Beltway Bandit” contracts toward an “America First Global Health Strategy.” The budget said roughly 40% of the President’s Emergency Plan for AIDS Relief funds under the Biden administration supported actual service delivery like medications, testing, commodities and healthcare workers, with the remainder consumed by duplicated administrative costs and supply chain overhead. PEPFAR would operate through unified bilateral compacts moving forward designed to improve efficiency. The budget eliminates funding for certain reproductive health services, circumcision programs and LGBTQ-related health services under this restructuring.

5. The Hospital Preparedness Program would be eliminated. The $240 million Hospital Preparedness Program — housed within the Administration for Strategic Preparedness and Response — is slated for elimination. The budget argues its activities can be absorbed by CDC’s Public Health Emergency Preparedness Program and stronger state efforts. HPP has been the main federal platform through which hospitals fund surge capacity planning, disaster response infrastructure and healthcare coalition development. Its potential elimination comes as hospitals are still processing the operational and financial lessons of the COVID-19 pandemic, and as preparedness leaders have warned about the sector’s vulnerability to future events. 

6. VA healthcare investment spikes. Not all healthcare news in the budget is a cut. The VA would receive a $1.5 billion, or 9%, funding boost to $144.9 billion, including $4.2 billion for EHR modernization and $130 million for AI and automation investments in veterans claims processing. The department’s Oracle Health EHR implementation — which could cost nearly $50 billion — and its growing investment in AI-driven revenue cycle functions follows trends playing out across the broader healthcare landscape. The VA is set to install the EHR at 13 medical centers this year, beginning with four hospitals in Michigan, and could finish the program by 2031. The project was put on hold in 2023 as the agency and Oracle worked out technical and patient safety concerns.

7. AHRQ is effectively eliminated. The Agency for Healthcare Research and Quality would see a proposed $129 million cut, eliminating most of the agency’s current operations. The administration characterizes much of AHRQ’s research portfolio as duplicative of work already conducted at NIH and proposes moving select statistical functions into a newly created HHS Office of Strategy.

8. LIHEAP scrapped — again. For the sixth time, the administration is proposing to end the Low Income Home Energy Assistance Program. The administration argues that the $4 billion program is unnecessary because states have policies preventing utility disconnection for low-income households.  

9. WHO and Pan-American Health Organization would be defunded entirely. The budget provides zero funding for the World Health Organization, after the U.S. withdrew in late January. It also cuts funding for the Pan-American Health Organization. 

“These corrupt organizations have shown no independence from inappropriate political influences, such as when the WHO aided in the COVID-19 coverup,” the budget said. 

The 92-page budget proposal is available here.

Here’s the County’s assessment of potential EMS impacts. What’s interesting is they seem to be focusing on cost increases but did not identify the additional looming revenue hit.

Potential strain on emergency services

Valentine also warned that the changes could increase pressure on the emergency medical system if residents lose health coverage and delay treatment until medical emergencies arise.

Valentine said a worst-case scenario — such as the closure of a local hospital — could significantly increase emergency room demand at San Joaquin General Hospital and St. Joseph’s Medical Center.

Emergency medical services officials estimate the county hospital could see a 32% increase in emergency medical service deliveries and a 23% increase in emergency room volume in that scenario.

Meeting that demand could require adding four additional ambulances daily, costing roughly $150,000 per week, Valentine said.

Resources:

July 2025 PWW|AG Webinar on Potential HR 1 Impacts on EMS

https://www.ems1.com/legislation-funding/the-one-big-beautiful-bill-act-what-ems-leaders-must-know-now

https://aimhi.mobi/wp-content/uploads/2026/03/7-17-25-Table-of-Major-Provisions-in-HR-1-That-May-Impact-EMS.pdf

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San Joaquin County warns of $76.9M in costs due to Trump’s ‘Big Beautiful Bill’

Public health services facing largest losses, and clinics and hospital warn of ripple effects, strain on emergency services

Hannah Workman, The Stockton Record

March 11, 2026

https://www.recordnet.com/story/news/politics/government/2026/03/11/trump-one-big-beautiful-bill-san-joaquin-county-costs/89074087007

Key Takeaways:

• San Joaquin County officials warn a new federal law could shift up to $76.9 million in annual costs to the county.
• The “One Big Beautiful Bill Act” makes changes to Medicaid and other safety-net programs, impacting local budgets.
• County health services, particularly behavioral health, face the largest potential revenue losses due to reduced Medi-Cal funding.

San Joaquin County officials warned this month that federal policy changes tied to the One Big Beautiful Bill Act — including provisions scheduled to take effect after the 2026 midterms — could shift up to $76.9 million in costs to the county and increase pressure on hospitals, health clinics and social service programs.

The measure, signed by President Donald Trump on July 4, 2025, is a sweeping 10-year, $4.1 trillion fiscal package that extends many provisions from the 2017 tax cuts and makes major changes to federal safety-net programs. The legislation increases funding for defense and border security, raises the federal debt limit and reduces spending on programs such as Medicaid and the Supplemental Nutrition Assistance Program while adding new work and eligibility requirements for some recipients.

County Administrator Sandy Regalo told the San Joaquin County Board of Supervisors on Tuesday, March 3, that the county estimates an annual budget impact of $50.9 million to $76.9 million.

“The range reflects the best case scenario to the worst case scenario in San Joaquin health clinics and the county hospital,” Regalo said.

Health services facing largest losses

County officials said the Health Care Services Agency could see financial impacts of $30.4 million to $34.4 million, with behavioral health programs expected to experience the largest share of lost revenue.

Health Care Services Director Genevieve Valentine said the county anticipates a significant drop in Medicaid revenue, known as Medi-Cal in California, tied to potential eligibility changes.

Behavioral health programs, which currently serve about 13% of residents who are uninsured or underinsured, could see the number of uninsured residents increase by as much as 35% over the next 18 months, Valentine said.

The department projects $22.5 million in lost Medi-Cal revenue, the largest reduction among the county’s health programs.

Public health services could also see reductions.

Valentine noted that $1.2 million in funding for the CalFresh SNAP-Ed nutrition education program was eliminated in September 2025, affecting community partnerships that provide nutrition education and healthy food demonstrations in schools and neighborhoods.

Additional state requirements could also create unfunded costs for programs such as the California Children’s Services program, which provides medical support for children with complex conditions. San Joaquin County serves about 4,000 children with chronic illnesses, and officials estimate potential county costs could reach $500,000 over the next 18 months if children lose Medi-Cal coverage.

Clinics and hospital warn of ripple effects

County-run health clinics could also be affected. About 85% of clinic patients rely on Medi-Cal, and officials estimate 2,000 to 4,000 patients could lose coverage or cycle on and off the program.

That could translate into $5 million to $9 million in lost annual revenue for the clinics, Valentine said.

Because the clinics are required to provide care regardless of insurance status, Valentine said reduced outpatient access could lead to more patients seeking emergency treatment at hospitals.

San Joaquin General Hospital CEO Rick Castro said the hospital — one of 12 public hospitals in California — could face $11 million to $30.8 million in potential financial impacts, depending on how federal and state policy changes unfold.

Castro said the hospital is already experiencing heavy patient volume.

“Today the hospital sits at 197 [patients],” Castro told supervisors. “We have about 100 adult beds and 97 patients in hallways and different areas. It’s a bigger challenge.”

Castro cautioned that some projections represent worst-case scenarios and may depend on future political and policy decisions.

“There’s a part of me that is not sure those scenarios are going to come to fruition,” Castro said.

Social services workload expected to rise

Changes tied to the One Big Beautiful Bill Act could also increase administrative costs for county staff responsible for determining eligibility for benefits.

More frequent eligibility checks and expanded work requirements for Medi-Cal and CalFresh recipients would require additional verification and case processing.

About 314,000 San Joaquin County residents — roughly 39% of the population — are enrolled in Medi-Cal, Human Services Agency Director Chris Woods said.

Beginning in 2027, nearly 85,000 residents in the Medicaid expansion population may be required to document work, education, volunteer activity or exemptions every six months to maintain coverage.

Statewide, officials estimate the additional administrative workload at $231 million annually, with San Joaquin County’s share projected at about $4.6 million per year.

CalFresh changes could add another $103 million statewide in workload costs, while reductions in federal reimbursement for program administration could shift $2.7 million per year to the county.

Combined, those changes could cost the county nearly $9 million annually, Woods said.

Potential strain on emergency services

Valentine also warned that the changes could increase pressure on the emergency medical system if residents lose health coverage and delay treatment until medical emergencies arise.

Valentine said a worst-case scenario — such as the closure of a local hospital — could significantly increase emergency room demand at San Joaquin General Hospital and St. Joseph’s Medical Center.

Emergency medical services officials estimate the county hospital could see a 32% increase in emergency medical service deliveries and a 23% increase in emergency room volume in that scenario.

Meeting that demand could require adding four additional ambulances daily, costing roughly $150,000 per week, Valentine said.

County leaders push for state action

Supervisors said the financial risks highlight the pressure counties face when implementing state and federal programs without sufficient funding.

District 5 Supervisor Robert Rickman, who represents the county in the California State Association of Counties, said the issue is a top concern among local governments statewide.

“These cost shifts that are coming down could completely disrupt counties and the basic services that we deliver,” Rickman said.

Rickman said county officials plan to work with state lawmakers to seek long-term funding solutions.

“Our county is being proactive rather than sitting on our laurels and waiting for the state or anyone else to rescue us,” Valentine told supervisors, noting that internal work groups have already begun planning responses.

Supervisors said they will continue advocating for funding to prevent service cuts.

“County solvency is on the line,” Rickman said. “Shifting costs to counties without significant resources attached is not an option.”

You can access a copy of the Rural EMS Task Force report here.

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NY’s rural EMS system on ‘brink of collapse.’ Inside the fight to save it

Emily Barnes

USA TODAY Network-New York

March 12, 2026

https://www.lohud.com/story/news/politics/2026/03/12/ny-rural-ems-system-is-collapsing-what-that-means-for-public-safety/89097779007

Rural emergency medical service agencies across New York are in need of funding and systemic changes to continue helping save lives, a newly released report about the state’s EMS system reveals.

The New York State Rural Ambulance Task Force, created in 2021 to evaluate the state’s rural ambulance services, released its inaugural report in January, asserting that the reliability of the system continues to decline.

“The rural EMS system in New York State is teetering on the brink of collapse,” the report stressed.

“The cascading consequences of these issues manifest in prolonged EMS response times, exposing patients in crisis to heightened risks of serious medical and traumatic complications,” the report added, noting the crisis was “further stressing the healthcare system as a whole and robbing communities of their neighbors.”

Here’s how some Albany lawmakers are proposing to address the growing issue.

How many rural EMS agencies are there in New York?

There are 1,157 rural EMS agencies across 44 counties in New York, the report shows, noting counties with populations under 200,000 are considered rural under federal standards.

What often sets rural agencies apart from urban ones is that cities and larger towns are able to sustain private ambulance agencies, resulting in better wages and benefits and more personnel, the New York State Association of Counties says.

In Greene County, for example, there are multiple independent town agencies and two nonprofits running their EMS system, Greene County Administrator Shaun Groden said during a news conference held in Albany on Wednesday, March 11.

“Because they’re all independent, we have varying wage and benefit packages,” Groden said. “And you have EMTs who work for multiple agencies in order to earn sufficient annual revenue, sometimes working 70-80 hours a week.”

“I don’t want to be the patient who would be attended by an EMT on hour 80,” Groden added.

The lack of financial support for smaller community EMS agencies has led to what the task force is calling a “patchwork system” of differing approaches to provide EMS coverage throughout the state, leading to longer response times, staffing issues and sometimes even the closure of an ambulance service.

The stakes of fixing the problem have been highlighted across local media reports and industry trade studies in recent years.

Ambulance services in the Town of Enfield in Tompkins County saw an average response time of over 20 minutes in 2021, up from just more than 12 minutes in 2017, The Ithaca Voice reported. And in the Hudson Valley, where scores of communities lean heavily on volunteer ambulance services, county officials learned of hundreds of cases where patients found alternative ways to get to hospitals due to delayed ambulance responses, USA TODAY Network reported.

Patrick Quinn, Vice President of McNeil & Co., the insurance firm that represents the state’s fire and EMS services, said 10 fire and EMS facilities closed across the state in 2025 and four have already closed in 2026.

Rural services are also unique in that they often have much longer distances to travel to transport those in need to area hospitals. Greene County, which has a population of just over 47,000 as of 2023 doesn’t have a hospital, according to Groden. The closest hospitals — Columbia Memorial Health and Cobleskill Regional Hospital — are in neighboring Columbia and Schoharie counties.

What problems need to be addressed to strengthen the NY’s EMS system?

The most immediate concerns are funding shortfalls due to outdated insurance reimbursement systems and lack of revenue being generated in the time between calls, as well as less EMS practitioners amid rising system demands, the new report states.

“The Task Force report confirms what many of us have been warning about for years; that EMS services, especially in rural areas, are at risk,” Assemblywoman Donna Lupardo, a Southern Tier Democrat, said. “Our highest priority is to acknowledge that the current funding model is unsustainable, with Medicaid reimbursement rates woefully inadequate.”

Medicaid reimbursement rates are a topic actively being considered by lawmakers in the fiscal year 2027 budget.

According to local and state officials, EMS agencies in New York receive less than half of what it costs to take the Medicaid-insured call. For example, a Greene County fire chief specifically said his town of Catskill department receives around $290 in reimbursement from Medicaid for a call that costs them $650.

For future consideration, Senator Michelle Hinchey, a Hudson Valley Democrat, said a grant program similar to the V-FIRE Grant Program initiated in 2023, which provides critical funding to strengthen volunteer fire departments and districts statewide, could be beneficial for the EMS system as well.

“This is one of the most important issues that we can be talking about right now,” Hinchey said during the news conference. “We have to do more … We have a responsibility to show up and stand up for (EMS workers) so they can continue to do that work and so that we, in our rural communities but across the entire state, have access to healthcare. This is a life-or-death issue.”

If enacted, Colorado will join a list of states that require insurance coverage for treatment in place (TIP) services. It’s interesting that the commercial insurers wanted to be excluded from the initiative, especially with the fiscal note showing savings to the Medicaid program of $2.1 million in the first fiscal year, starting in July 2026, $4.6 million in the following fiscal year, and $4.9 million in future years. This is the financial information agencies can use to help promote more legislative efforts to make TIP a covered service.

Click here to view the bill.

Click here to view the fiscal note.

Ambulance services would get funding boost while saving Colorado millions under new bill

KUNC | By Lucas Brady Woods

March 4, 2026

https://www.kunc.org/politics/2026-03-04/ambulance-services-could-get-funding-boost-while-saving-the-state-millions-under-new-bill?_amp=true

State lawmakers are working on a bill that they say would create much-needed funding for Colorado’s emergency medical services and save the state millions of dollars a year in health care spending.

The measure, House Bill 26-1069, would expand the list of services that EMS agencies can bill to the Colorado Department of Health Care Policy and Financing, which administers the state’s Medicaid program, or to private insurance companies.

Ambulance services in Colorado have been struggling with funding for years. A 2023 state study found that many EMS agencies in Colorado were operating without enough funding in large part because insurance reimbursement rates, from both the state and from commercial insurers, are significantly lower than the agencies’ actual costs.

Democratic state Rep. Katie Stewart of Durango, a former EMT, is sponsoring the bill and says funding issues continue to threaten Colorado’s emergency medical services, especially in the state’s rural areas.

“We are already seeing the effects of this lack of funding and this lack of support,” Stewart said. “The ramifications of not supporting our folks in EMS means that we will not have these workers to show up when you dial 911.”

Other sponsors of the measure are state Rep. Lisa Feret, of Arvada, and state Sen. Kyle Mullica, of Thornton, both Democrats.

Currently, ambulance services in Colorado must be reimbursed only when they transport a patient to an emergency room. Under the bill, they could also be reimbursed for treating someone on-site without transporting them, a practice commonly called treatment in place.

Scott Sholes, EMS Chief of Durango Fire & Rescue, called the current system “a historical funding pitfall” during his testimony to lawmakers in support of the bill.

“We get some of the reimbursement only when we transport patients using the most expensive means – ambulances – to the most expensive destinations – that’s the hospital emergency rooms,” Sholes said. “But we don’t get reimbursed for providing clinically appropriate treatment, rendering ambulance transport unnecessary.”

A number of other states already allow EMS agencies to bill for treatment in place, and Congress is considering legislation to expand federal reimbursements for it.

The measure would also require Colorado, but not private insurers, to reimburse emergency medical responders when patients are taken to behavioral health clinics instead of emergency rooms or if telehealth services are used during an emergency call.

An earlier version of HB-1069 would have required private insurance companies to reimburse EMS agencies for such situations and would have allowed ambulance services to reimburse for transportation to other locations as well, like urgent care clinics.

But Stewart said those provisions were removed to appease health insurance companies, which originally had concerns about the bill.

“As introduced, House Bill 1069 did raise some substantial concerns for our members,” said Kevin McFatridge, Executive Director of the Colorado Association of Health Plans, during a legislative hearing on the bill. “We appreciate these efforts and believe they reflect meaningful progress toward addressing many of the operation and affordability concerns raised by carriers.”

Stewart also assured lawmakers during the committee hearing that nothing in the bill would prevent ambulances from taking patients to emergency rooms.

“This will not stop anyone from being transported to an ER if that is what they want or need,” Stewart said. “Instead, this will empower EMS and patients to make the smartest decisions about their care.”

Apart from providing funding for EMS agencies, the measure would likely save Colorado millions of dollars a year in health care spending because it would result in fewer emergency room and hospital visits. Any savings are particularly significant this year as lawmakers struggle to balance a billion-dollar budget deficit driven largely by the cost of health care.

Nonpartisan legislative fiscal analysts project the bill would save $2.1 million in the first fiscal year, starting in July 2026, $4.6 million in the following fiscal year, and $4.9 million in future years.

A separate proposal working its way through the legislature, House Bill 26-1238, would define emergency medical services as essential in state law. The change would allow ambulance services to receive state funding reserved for public safety, emergencies, or disasters.

Legislative committees unanimously approved both bills and they now await consideration in the House.

In EMS, clinical excellence depends on operational readiness — and readiness starts long before the first patient contact. From supply chain disruptions to expired medications, missing equipment, and inconsistent restocking practices, logistics and materials management can quietly determine whether field teams are prepared… or scrambling.

This AIMHI webinar will explore best practices for building a resilient, efficient, and accountable logistics system that supports high-performing mobile healthcare operations. Participants will learn how leading organizations manage inventory, standardize equipment readiness, reduce waste, improve vendor coordination, and create systems that ensure the right resources are available at the right time — across diverse response environments.

Designed for EMS leaders, logistics professionals, and operational decision-makers, this session will highlight practical tools, emerging innovations, and proven strategies that enhance both patient care and financial sustainability.

Attendees will leave with actionable approaches to strengthen supply workflows, improve compliance, and ensure operational teams can focus on what matters most: delivering care.

Key Topics Include:

                • Inventory control and standardization across mobile units

                • Medication and equipment lifecycle management

                • Reducing supply waste and managing cost pressures

                • Technology solutions for tracking and accountability

                • Aligning logistics operations with clinical performance goals

Panelists:

Josh Duffy joined REMSA Health in 2005 and has held a variety of roles, including AEMT, supervisor, and manager. He is now the Director of Support Services, overseeing product supplies and vendor relationships, logistics and fleet operations for more than 75 ambulances and support vehicles, and facilities maintenance across all locations. He holds an Associate of Applied Science and a Bachelor of Science from Columbia Southern University, is a Certified Professional Purchasing Manager (CPPM), and maintains multiple industry licenses and certifications.

Dusty Edwards is a Logistics Manager with Mecklenburg EMS Agency, bringing extensive experience in field support operations and resource management. Since joining the agency in 2005, he has been committed to improving operational efficiency, supporting frontline clinicians, and ensuring mission-critical readiness across the organization.

Jonathan Washko is a healthcare executive with 40 years of EMS experience. Currently Assistant Vice President at Northwell Health Center for EMS and Assistant Professor of Emergency Medicine at Hofstra/Zucker School of Medicine, he’s a recognized expert in EMS system design, high-performance EMS, and mobile integrated healthcare. He consults internationally, driving innovation in telehealth and community paramedicine. A prolific author, researcher, and speaker, Mr. Washko transforms healthcare through technology and innovative, patient-centered solutions.