EMS faces a tough balance between rising costs and Medicaid rates that haven’t kept pace. If you’ve been following the headlines or living them, you know this isn’t just a passing challenge. It’s the reality for agencies across the country, especially in rural communities where every dollar and every responder counts.
This year, the conversation around EMS funding got louder and more urgent. Our new PCG white paper, Use of Medicaid Ambulance Supplemental Payment Program (ASPP) Funds: A National Survey, put numbers to what many have felt for years. ASPP dollars are keeping ambulances rolling, and for over 90 percent of survey responses from EMS agencies, those funds are “very” or “extremely” important to survival. When you ask EMS leaders what would happen if that support fades, the answer is clear: service cuts, staffing shortages, and a heavier burden on local taxpayers.
But 2025 wasn’t just about the funding gap. It was a year of big policy shifts and new opportunities. The passage of HR1 changed the game for Medicaid reimbursement, introducing new caps on provider taxes and state-directed payments. Agencies spent months trying to decode what these changes would mean for their budgets and their ability to serve their communities. While some programs like GEMT and ASPP weren’t directly mentioned in the legislation, the ripple effects are already being felt. States are bracing for reduced federal support, and EMS leaders are asking tough questions about sustainability and innovation.
Throughout the year, PCG worked with agencies navigating these changes. We saw firsthand how federal guidance like CMS P22 and SMD 23 006 opened doors for expanded reimbursement. Think Treatment in Place, alternative destinations, and telehealth. These models aren’t just buzzwords; they’re reshaping how care is delivered, especially for patients who don’t need a hospital trip but still deserve timely, skilled attention. Yet, reimbursement for these services remains patchy, and the regulatory gray zones around balance billing and Treat No Transport keep agencies guessing.
The true cost of EMS also came into sharper focus. National data from the CMS Ground Ambulance Data Collection Survey revealed a stubborn gap. The average cost of a single EMS transport far exceeds the average reimbursement. Labor remains the biggest expense, but indirect costs like dispatch, billing, and facility maintenance are just as critical. Agencies that understand their numbers are better positioned to advocate for fair funding and make smart decisions about service delivery.
Rural health transformation was another headline. The Rural Health Transformation Program (RHTP) promised new funding and support for agencies willing to innovate, collaborate, and invest in workforce development and technology. For rural EMS, where recruiting and retaining skilled professionals is a constant challenge, these opportunities couldn’t come at a better time.
Looking ahead, the big question is: How do we keep EMS strong and responsive in the face of shifting policies and financial pressures? The answer isn’t simple, but the trends are clear. Agencies need diversified funding streams, robust data infrastructure, and real engagement with frontline providers and the communities they serve. Innovative models like Treatment in Place, transport to alternate destinations, and mobile integrated health are gaining traction, but they need consistent reimbursement and regulatory support to scale.
2025 showed us that EMS is more than a safety net. It’s a lifeline. The choices we make now, from how we fund services to how we support our workforce, will shape the future of emergency care in every community. As we move into 2026, let’s keep asking the hard questions. What would our communities look like without strong EMS support? How can we rethink care delivery to meet evolving needs? And most importantly, how do we make sure the people behind every siren have the resources and recognition they deserve?
If you’re an EMS leader, policymaker, or just someone who cares about public health, now’s the time to get involved. The stakes are high, but so is the potential for meaningful change.
Looking to 2026, the Rural Health Transformation Fund is set to become a major focus for EMS providers. With new funding streams and a spotlight on rural innovation, agencies will have the chance to rethink how emergency care is delivered in communities that have long faced unique challenges. The fund is designed to support workforce development, technology adoption, and collaborative models that bring together EMS, hospitals, and other health partners. For rural EMS, this means new opportunities to recruit and retain skilled professionals, invest in digital health tools, and build stronger networks of care.
What’s especially exciting is how these investments will accelerate the growth of mobile integrated health and community paramedicine. As more states recognize the value of EMS teams providing preventive, chronic, and post-acute care outside of traditional emergency response, we’ll see expanded reimbursement and new care models take root. Agencies will be able to connect patients to social services, reduce unnecessary transports, and deliver care where it’s needed most, right in the community. The Rural Health Transformation Fund isn’t just another grant program; it’s a chance to build resilience, improve access, and ensure that every community, no matter how remote, has the emergency care and proactive health support it deserves. The momentum behind mobile integrated health and community paramedicine is only going to grow, making 2026 a pivotal year for EMS innovation and impact.
