Ambulance Supplemental Payment Programs: A Critical Lifeline for EMS Agencies Nationwide

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Ambulance Supplemental Payment Programs: A Critical Lifeline for EMS Agencies Nationwide

Updated on: March 31, 2026

Published on: March 31, 2026

For two decades, PCG has partnered with Emergency Medical Services (EMS) providers to address a persistent challenge: Medicaid reimbursement rates that fail to cover the true cost of care. Since 2006, PCG has worked with government-owned and operated EMS agencies and state Medicaid programs to develop and implement Ambulance Supplemental Payment Programs (ASPPs), which help close this funding gap.

PCG has supported more than 550 EMS providers across 18 states, helping agencies recover over $1.8 billion in supplemental Medicaid funding. As departments face rising operating costs, workforce shortages, and declining Medicaid enrollment, ASPPs have become increasingly essential. Today, more than 35 states either operate or are developing an ASPP, yet historically little data has existed to clearly demonstrate their operational impact.

To address this gap, PCG conducted a national survey of 625 EMS agencies participating in ASPPs across 17 states. The survey examined how supplemental payments are distributed and reinvested and included narrative feedback on the consequences of funding reductions. The findings are published in Use of Medicaid Ambulance Supplemental Payment Program (ASPP) Funds: A National Survey.

The findings are clear: ASPPs are foundational to EMS operations. More than 90% of respondents reported that ASPPs are either very important or extremely important to their continued operation. Agencies rely on these funds to maintain staffing, replace equipment, and sustain service. In states that experienced ASPP reductions, respondents reported staffing shortages, deferred equipment replacement, reduced service capacity, and increased pressure to privatize EMS services.

As James Cairns, co-author of the white paper, explains:

“The financial headwinds encountered by fire and EMS agencies are well documented in the literature. There is considerably less information available on alternate funding mechanisms which support continuity of the indispensable services these agencies provide. This survey provides a channel for providers to quantify the significance of one of these mechanisms—Medicaid Ambulance Supplemental Payments—at a critical time for the federal alternative funding landscape.”

The survey reinforces that sustainable EMS funding is not simply a fiscal concern; it is a public health imperative. PCG recommends that states without ASPPs work to pursue program development and implementation, while states with existing programs should expand participation and regularly reassess program design to maximize financial benefit.

Miles Brown, co-author, emphasized the urgency of the findings:

“The current setup with EMS funding across the country isn’t cutting it—and now we have the numbers to back it up. Over 90% of our clients said that ASPPs are either very or extremely important for the continued operation of their department.”

As EMS agencies navigate an increasingly challenging funding environment, ASPPs remain one of the most effective tools available to protect emergency medical services—and the communities that depend on them—today and into the future.

Learn more:

About the Authors:

James Cairns, MPH, Consultant—Health Finance.

Mr. Cairns is a Consultant in PCG’s health practice area based in Cleveland, OH, with extensive experience working on healthcare finance projects, including ASPP. His project portfolio at PCG includes revenue optimization and cost reporting through Medicaid cost settlement as well as operations management, inpatient hospital quality, rate setting, and strategy. Mr. Cairns has worked on behalf of individual governmental EMS agencies in Florida, Ohio, Texas, and Washington, and acts in a statewide project management and oversight capacity for the Massachusetts Ambulance Certified Public Expenditure Program. He also manages data collection, review, and site audits for the Colorado Hospital Quality Incentive Payment (HQIP) Program. Prior to joining PCG, Mr. Cairns worked in legal epidemiologic research investigating the intersection between Medicaid policy and health outcomes. His publications include peer-reviewed articles on coverage and outcomes related to podiatric care and infant health risk factors.

Miles Brown, MBA, Senior Consultant—Health Finance

Mr. Brown is a Senior Consultant based in Charlotte, NC, who serves several projects that support state and local health agencies in improving their fiscal operations. Mr. Brown contributes to revenue maximization engagements for governmental ambulance service providers participating in the Texas ASPP, Colorado EMS Supplemental Payment, Maryland Emergency Service Transporter Supplemental Payment Program (ESPP), New Mexico Emergency Ground Ambulance Services (EGAS) Program, and the Iowa Ground Emergency Medical Transportation (GEMT) Program. He works closely with some of the state’s largest providers, assisting with the preparation of annual cost reports and other key deliverables. Mr. Brown has also served in a project support capacity for School-Based Services initiatives serving public school districts throughout the entire state of Wisconsin. Mr. Brown’s most recent accomplishments include serving as the cost reporting lead for public ambulance providers in six different states.

Katelyn Milkiewicz, Intern

Ms. Milkiewicz is an MPH student and Intern in PCG’s health practice area based in Austin, TX. Ms. Milkiewicz has experience providing ASPP support in several states, including Florida, Georgia, Idaho, Illinois, Iowa, Kentucky, New Mexico, Ohio, Oklahoma, South Carolina, Texas, Washington, and Wisconsin. In addition to her work assisting EMS providers, she has provided programmatic support on the Colorado Hospital Quality Incentive Payment (HQIP) Program.