In the northwest region of Sandoval County, New Mexico, getting emergency medical care has never been easy. Roads stretch for miles between communities, and healthcare facilities are few and far between. For some residents, the nearest clinic can feel impossibly far away, especially in an emergency.

“We have a rural area of Sandoval County in New Mexico that’s really, in a lot of ways, very challenging to get any sort of healthcare providers to,” said Eric Masterson, Sandoval County’s Deputy County Manager. “As in all rural regions of the United States, healthcare access is very, very limited—and it’s no different here.”

Sandoval County serves a large population, including members of 12 different Tribal Nations, making the county one of the highest concentrations of Tribal jurisdictions. Within the same county lines sit pockets of the Navajo Nation, the Jicarilla Apache Nation, and others, each with distinct leadership, priorities, and dynamics. For emergency medical services (EMS) providers, this meant navigating not just distance and staffing shortages, but also sovereignty, trust, and coordination across many different communities.

For the last 30 years, much of the region in the county relied on a single private clinic as its healthcare provider. The clinic provided medical care, dental services, pharmacy access, and for a time, ambulance services as well. But as time went on, it was clear that the clinic’s ambulance services were no longer financially sustainable, and the clinic had announced they were shutting down EMS services in July 2026.

Now rewind back to 2019, when the county began working with PCG to design and implement an Ambulance Supplemental Payment Program (ASPP). ASPPs are increasingly used nationwide to strengthen the financial foundation of EMS agencies by leveraging supplemental Medicaid payments, allowing agencies to reinvest in services without increasing costs for patients or local governments.

“When I heard about this program, we jumped on board quickly. The first conversation we had about the program was to help with community medicine, community outreach, and community healthcare,” said Masterson. “However, I started recognizing these funds were going to be a much more impactful revenue source for us than I initially realized. We started transitioning to what would this look like if we were to supplement services or even provide services at the paramedic level, which is new to that far northwest region of the county where there’s limited access and a lot of call volume. It’s an area where, because people don’t have healthcare access, 911 is called often. If it’s a very critical call and they need paramedics, currently, the closest paramedic is 45 minutes to an hour away.”

The ASPP stood up with seven providers participating across the state in 2024. Sandoval County received $1.6 million back into the county in 2025. These funds allowed Sandoval County to, for the first time in history, build a paramedic facility, and train and hire staff in that region of the county. These paramedic services are planning to go live on July 1, 2026 and will greatly reduce those response times.

“We identified how many people we were going to need, then we were able to hire and start a training academy,” said Chris Bagley, Sandoval County’s Fire Chief. “We are graduating 14 personnel at the end of April from the academy and as of July 1, we will have that station up in the northwest part of the county. It’s the first time in history they’ll have paid paramedic/firefighter staff in the region.”

As the county prepared to build the new facility, leaders knew that community response would be just as critical as funding or infrastructure. With 12 Tribal Nations and multiple municipalities, county officials approached outreach deliberately, recognizing that each community needed to be engaged on its own terms. Rather than relying solely on formal announcements, the county focused on trusted local voices to help explain what the new facility would mean for residents.

“What we’ve identified is that there are community leaders that are engaged in the day-to-day workings of this region,” Masterson said.

These leaders played a key role in translating technical changes into meaningful reassurance, helping residents understand that the new facility represented an expansion of care, not a reduction. Their involvement helped move community reaction from uncertainty toward confidence.

A pivotal part of that response came from the region’s primary healthcare clinic, because the clinic had long been central to community health, its support carried significant weight as EMS responsibilities transitioned to the county.

The new facility is preparing to go live in July of 2026 with expanded paramedic services that’ll increase clinical capabilities in the field, improve response readiness, and strengthen coordination across the region. While the program is still in its early stages, county leaders describe it as one of the most impactful EMS initiatives the county has undertaken.

“I can’t say enough that if it wasn’t for this revenue, I mean, an entire portion of our county, about 1100 square miles, would have just not had service in July,” said Bagley. “The service would have been coming from 45 minutes down the road.”

For residents, this new facility means higher-quality care sooner. For responders, it means training and support, and for the county, it means greater resilience in a system that once felt uncertain.

“This is making a huge impact on the department, on the community. It also opened opportunities for people to grow, as we send more people to paramedic school. It’s not just been good for the community, but the individuals in the organization are getting a lot out of it as well,” said Kenny Snow, Sandoval County’s Deputy Chief of EMS. “It’s caused a lot of growth and change in our department. We’re excited to be serving this community that really has not been served at this level before.”

Learn more:

• Ambulance Supplemental Payment Programs: A Critical Lifeline for EMS Agencies Nationwide
• PCG’s Public Safety Consulting Services