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