Communities rely on Emergency Medical Services (EMS) as a lifeline. Across the country, momentum is building to formally recognize EMS as an essential public service, moving EMS systems from a fragmented patchwork of providers to an accountable function of local and state government. As of mid‑2025, at least 21 states and the District of Columbia have taken steps to codify EMS as essential, reflecting a growing acknowledgment that communities depend on EMS as indispensable public good. PCG’s white paper, From Patchwork to Promise: Why Designating EMS as an Essential Service Matters Now, examines this shift.

“EMS providers are expected to respond 24/7, yet many do so within systems that were never designed to support long-term sustainability,” said Dr. Haley L. Schlechta, author of the white paper. “Recognizing EMS as an essential service is a pivotal step toward addressing workforce challenges, financial instability, and uneven access to care, particularly in rural and underserved areas. The moment demands more than acknowledgement; it calls for action that strengthens the EMS workforce and ensures communities can rely on timely emergency care.”

While designation alone does not solve all the challenges EMS agencies face, it reframes the financial questions facing these systems. Instead of asking how agencies survive on transport-based reimbursement, policymakers must ask how to ensure continuous EMS readiness.

EMS is a readiness‑based system, not a volume-driven business. Agencies must staff, train, equip, and maintain 24/7 response capability regardless of call volume. While essential service laws do not automatically create funding, they legitimize public investment in EMS readiness. While EMS funding is often framed as a cost, growing evidence suggests that stable EMS systems reduce downstream public expenditures:

• Faster response times reduce morbidity and mortality
• Community paramedicine and treatment-in-place programs divert avoidable emergency department visits
• Reliable EMS access supports hospital viability, particularly in rural areas

Essential service designation also strengthens the case for wage stabilization, funded training pipelines, and regional staffing models that reduce duplication and improve resilience. EMS turnover rates routinely exceed those of other public safety and healthcare professions, driving overtime costs, burnout, and service unreliability.

Essential designation creates clarity. By defining EMS as essential, states and local governments can establish clear coverage obligations, align authority with responsibility, and delineate roles across state, county, and provider levels. When these roles are explicit and paired with accountability, data transparency, and governance discipline, EMS systems are better positioned to plan proactively rather than respond reactively to a crisis.

Download From Patchwork to Promise: Why Designating EMS as an Essential Service Matters Now.

Check out PCG’s other white papers on EMS funding:

• Download Use of Medicaid Ambulance Supplemental Payment Program (ASPP) Funds: A National Survey
• Download Cost of Service Analysis as the Foundation for Sustainable EMS Rate Setting

About the Author

Dr. Haley L. Schlechta, MPA, DPA, Consultant—Health Finance.

Dr. Schlechta is a consultant at PCG who partners with local government providers across the country to enhance program performance and maximize Medicaid revenue through cost reporting, reimbursement optimization, and operational improvement strategies. She brings extensive experience supporting public sector clients through policy analysis, project management, and financial and operational assessments. At PCG, Haley leads and supports work across Public Safety and Health & Human Services, including Medicaid rate analysis, cost of service studies, provider assessment programs, and Ambulance Supplemental Payment Programs (ASPP) or Ground Emergency Medical Transportation (GEMT) programs. With several years of direct Medicaid cost reporting experience, she has facilitated training in identifying the true cost of EMS transport and applying rate analysis methodologies to strengthen Medicaid reimbursement outcomes. Haley is well-versed in Medicaid ambulance reimbursement structures and EMS financing models in multiple states. She serves as the client lead and project manager for partners in South Carolina, Ohio, Oklahoma, Texas, Washington, Kentucky, and Florida—helping government-based healthcare providers optimize reimbursement, strengthen program operations, and achieve sustainable results.