EMS leaders across the country are constantly balancing growing community needs with limited resources. Whether it’s improving response times, expanding coverage to underserved areas, or maintaining service levels amid rising costs, many agencies face the challenge of doing more with finite funding and staffing.
Sandoval County, New Mexico, provides a useful example of how communities can address these challenges through long-term planning and strategic investment.
Like many rural areas, portions of Sandoval County have historically faced barriers related to distance and access to care. The county serves a large geographic area and includes multiple Tribal Nations, creating unique challenges for healthcare delivery and emergency response. County leaders recognized that strengthening emergency medical services would require more than short-term solutions. It would require a sustainable approach that could support the system for years to come.
Achieving that goal was not an overnight process. In 2019, Sandoval County began working with PCG to design and implement an Ambulance Supplemental Payment Program (ASPP), a funding mechanism that allows eligible providers to leverage supplemental Medicaid payments and reinvest resources into EMS operations.
As County Deputy Manager Eric Masterson explained, the county initially viewed the program as an opportunity to support community medicine and outreach efforts. Over time, county leaders recognized its broader potential to strengthen emergency medical services across the region.
“When I heard about this program, we jumped on board quickly… However, I started recognizing these funds were going to be a much more impactful revenue source for us than I initially realized.”
The ASPP launched with seven participating providers across New Mexico in 2024, and Sandoval County received approximately $1.6 million in supplemental funding in 2025. Those funds helped support the county’s first dedicated paramedic facility in the northwest portion of the county, allowing local leaders to recruit, train, and hire personnel to serve an area that previously had limited access to advanced emergency medical care. Prior to these investments, residents in some areas could wait 45 minutes to an hour for paramedic-level response when the nearest available unit was dispatched from another community. The new facility was designed to bring those services closer to residents and improve emergency response capabilities across the region.
Sandoval County’s experience highlights an important reality for EMS agencies: financial sustainability plays a significant role in an organization’s ability to meet community needs. Funding supports everything from staffing and equipment to infrastructure improvements and service expansion. Without adequate resources, even the most dedicated agencies can struggle to keep pace with increasing demands.
Programs such as Medicaid supplemental payments and State Directed Payment programs have created new opportunities for many agencies to strengthen their financial position and invest in priorities that may have previously been out of reach. These programs can help agencies address longstanding operational needs while providing greater flexibility to plan for the future. For communities, the benefits of these investments can be substantial. Additional funding may support expanded coverage areas, updated equipment, workforce investments, or initiatives designed to improve access to care. It can also provide EMS leaders with the ability to focus on long-term system improvements rather than solely addressing immediate operational challenges.
Much of the work required to secure and maintain these funding opportunities happens behind the scenes. Cost reporting, reimbursement methodologies, compliance requirements, and program administration are rarely visible to the public, but they often serve as the foundation for investments that directly benefit patients and communities.
The impact of that work was evident in Sandoval County’s experience. Reflecting on the importance of the supplemental funding, Fire Chief Chris Bagley noted that without the additional revenue, a significant portion of the county would have lost local emergency response coverage and relied on services located 45 minutes away. While residents may never see the administrative effort involved, they experience the outcomes. They benefit from stronger emergency response systems, reliable access to care, and EMS agencies that are better equipped to meet the needs of their communities.
As EMS organizations continue to navigate rising costs, workforce pressures, and increasing service demands, supplemental payment programs remain an important tool for supporting long-term sustainability and system improvement. Sandoval County’s experience demonstrates how strategic funding investments can help communities strengthen emergency medical services and improve access to care. As Deputy Chief of EMS Kenny Snow observed, the program created opportunities not only for the community but also for the agency’s workforce, supporting growth, training, and expanded service capabilities. More broadly, it serves as a reminder that innovative funding solutions can play an important role in helping EMS agencies build resilient systems that are prepared to meet community needs well into the future.
