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How EMS agencies can work with states to obtain Rural Health Transformation Program funding
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Rural America faces a growing health access crisis. Declining hospital resources, limited behavioral health services and workforce shortages are placing tremendous strain on already fragile rural health systems. At the same time, EMS remains a trusted and reliable point of access for millions of rural residents — often serving as the front door to care when no other options exist.
But rural EMS agencies are in a crisis of their own, due largely to funding, staffing and geography. Grant opportunities available through the Rural Health Transformation Program (RHTP) may perfectly align state and rural EMS agency goals.
EMS leaders should use these references as a springboard to ensure they are communicating with their state agencies who are developing grant applications.
For EMS agencies, this is a moment to lead. By partnering strategically with state governments, EMS leaders can help shape applications; secure funding; and build sustainable, innovative care models that benefit rural patients and stabilize local EMS operations.
EMS agencies provide critical, often 24/7 medical access in rural regions, but their role is frequently overlooked in large-scale health transformation efforts. The RHTP guidance from CMS recognizes the importance of integrating multiple sectors — including EMS — into new models of rural care.
By participating early in state-led planning and grant application efforts, EMS agencies can:
Influence program design to ensure prehospital and mobile care are built into state transformation plans
Access federal funding to support innovative EMS-led models like community paramedicine and mobile integrated healthcare (MIH)
Expand partnerships with hospitals, clinics, behavioral health providers and public health agencies
Strengthen financial stability by demonstrating EMS value in preventive and longitudinal care, not just emergency response
EMS leaders should establish direct communication with state health departments, Medicaid agencies and the governor’s health policy teams as soon as possible.
Request inclusion in planning committees or stakeholder groups shaping the state’s OBBBA application.
Share data on EMS call volumes, patient demographics and unmet rural health needs.
Highlight specific ways EMS can support maternal, behavioral and access-focused goals.
2. Align EMS capabilities with the state’s RHTP priorities
To strengthen the state’s application, EMS agencies can demonstrate alignment in areas such as:
Behavioral health integration:
using community paramedicine to support patients in crisis
Access expansion:
ensuring rapid access to care in frontier and underserved areas
Telehealth partnerships:
enabling on-scene connections with physicians or behavioral health providers
3. Propose Innovative EMS models
EMS agencies can prepare proposals or concept papers that states can include in their applications. Examples include:
Mobile behavioral health crisis response teams staffed by community paramedics
Rural care coordination hubs integrating EMS data into broader health system networks
Post-discharge follow-up and chronic disease management visits to reduce hospital readmissions
Integrated overdose response programs with linkage to treatment
4. Build strong coalitions
EMS agencies should partner with hospitals, Federally Qualified Health Centers (FQHCs), behavioral health providers and community-based organizations to present multi-sector solutions. States are more likely to fund projects that show cross-system collaboration.
5. Leverage data to demonstrate impact
Grant applications are strongest when backed by evidence and measurable outcomes. EMS agencies can:
Provide data on avoidable ED transports and high-frequency 911 users
Demonstrate potential cost savings from MIH/CP programs
Identify the lead state agency responsible for the OBBBA application and request to be part of the planning process
Prepare a concise concept proposal that aligns EMS capabilities with rural health transformation goals
Engage hospital and behavioral health partners to present a unified, multi-sector vision
Gather and present compelling EMS data that demonstrates impact, access, and innovation
Stay informed on deadlines and provide technical input as states finalize their grant submissions
A defining opportunity for EMS
The Rural Health Transformation Program through the OBBBA Model is not just another grant opportunity — it’s a strategic investment in the future of rural health care. EMS agencies have a rare chance to shape state-led reforms, secure funding for sustainable innovation and solidify their role as an indispensable part of the rural health safety net.
By stepping up as active partners, not just service providers, EMS leaders can help ensure rural communities receive the accessible, coordinated and equitable care they deserve.
