April 25, 2025
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FROM THE NYS ASSOCIATION OF COUNTIES:
For two years, counties have called attention to a growing crisis facing emergency medical services (EMS) in many communities across the state. Increasing wait times, a lack of volunteers, and inadequate reimbursements have devastated many EMS agencies, leaving residents vulnerable in times of medical emergencies.
After failed attempts to reach a compromise with Governor Hochul and State Legislators, the New York State Association of Counties (NYSAC) is calling on state leaders to reject any language in the state budget that would establish a new mandate on all counties to develop individual EMS plans with oversight under a Statewide EMS council. This new mandate would add layers of cost and complexity to an already overburdened EMS system.
Since the unveiling of the SFY 2026 Budget proposals, counties have sought to amend language contained in Part R of the Health and Mental Hygiene budget bill to provide counties with the flexibility to support local EMS systems based on each communities’ need, rather than a one-size-fits-all state mandated approach.
NYSAC Executive Director Stephen Acquario said, “While counties have led the charge to enact reforms that would bring down costs for providers and give counties the flexibility to address their communities’ needs, the current system works at the local level, where EMS providers and towns convene with each other to address provision of service within a geographic area. In certain instances, these jurisdictions approach counties to assist with gap coverage and “fly cars” are often made available by counties to assist where possible. What is missing is simple, a financing vehicle to assist in the provision of EMS services, such as an optional and broader county, town, city and village EMS taxing jurisdiction.
“Unfortunately, the language contained in this year’s budget brings a sledgehammer where a scalpel is needed. Instead of providing counties with the flexibility to establish taxing districts to help community partners address gaps in coverage, it imposes additional mandated programs on counties that history has proven simply raise the cost of living for local taxpayers.
“The Governor and State Legislature need to go back to the drawing board and work with all levels of local government to develop a proposal that addresses the root causes of the EMS crisis and provides counties with flexible tools to support local partners while not imposing new mandates on local taxpayers.”
Counties are calling on State Lawmakers to reject these proposals and focus on a more workable plan designed to bolster existing EMS systems, not replace them with a new state mandate on counties and local taxpayers.
See The Part R Legislation, Below:
Part R – Ensure Access to EMS
Purpose:
The bill would support the creation of a resilient, equitable, and interconnected Emergency Medical Services (EMS) system that addresses existing service gaps and meets the evolving needs of New York’s diverse communities and declare EMS as an essential service.
Summary of Provisions and Statement in Support: 9
This bill would establish the Emergency Medical Community Assessment Program (EMCAP) to develop standardized scoring metrics which will be used to evaluate the performance of EMS agencies across the State. Further, this bill will codify several definitions related to EMS delivery, which are needed to ensure consistency in the provision of services.
This bill also requires the Statewide EMS Council and the Department of Health to develop a Statewide Comprehensive Emergency Medical System Plan, which will be refined by the creation of individual county EMS plans. Such plans will focus on the enhancement of facilities, workforce optimizations, and overall regional system performance. Specifically, counties must incorporate EMCAP findings within their plans to address identified coverage gaps, while also facilitating the integration of services across their region. Counties will also be required to designate primary response agencies, which will be required to respond to all requests for service, except in instances of capacity limitations.
This bill would also designate EMS as an essential service, requiring all municipalities to provide adequate EMS response capacity to meet community needs. The provisions of this bill would not apply to any city with more than one million residents.
This bill also authorizes municipalities to establish special districts for the purpose of financing and implementing EMS service expansion within their region, as needed to comply with the designation of EMS as an essential service. These provisions expressly prohibit any overlap of these special districts, ensuring a fair distribution of revenues to be used in support of expanded EMS services. Municipalities will be prohibited from dissolving any pre-existing ambulance district, except in instances where the county provides explicit consent to assume the responsibility for EMS services previously provided for by that district.
This bill would also authorize the Commissioner of Health to approve and deploy EMS demonstration programs to promote innovation in the delivery of EMS services, and test novel delivery methods developed by agencies and practitioners.
Budget Implications:
This bill is necessary to implement the FY 2026 Executive Budget and would result in additional expenditures of $5.6M in Fiscal Year 2026.
Effective Date:
This bill would take effect 6 months after it shall have become law.
