Funding Stat! States Secure Timely Support for EMS Systems

Funding Stat! States Secure Timely Support for EMS Systems

In nearly 370 bills last year, lawmakers stabilized financing and modernized data gathering for emergency medical services.

State legislatures enacted nearly 370 bills in 2025 addressing emergency medical services. (Matt Gush/Getty Images)

State legislatures enacted nearly 370 bills in 2025 addressing emergency medical services, according to NCSL's EMS Legislation Database. Lawmakers sought to stabilize financing, strengthen response systems and modernize data infrastructure within EMS. While approaches vary, enacted legislation shows a few common strategies: enhancing system sustainability, improving outcomes for time-critical emergencies and supporting EMS personnel.

Using Transportation-Linked Revenues for EMS

At least 46 states and Washington, D.C., used transportation-related revenues and targeted appropriations to support EMS operations, which are critical for speedy care to those injured in vehicle crashes. These revenues, often derived from traffic fines, fuel taxes or registration fees, can help diversify funding streams and reduce volatility, particularly in rural or high-need areas.

• Alabama lawmakers (HB 378) authorized the Pickens County Commission to levy and collect an additional vehicle license and registration fee. Funds collected are to provide ambulance services for the county.
• Colorado (SB 206) appropriated $368,000 from the Highway Users Tax Fund EMS account, which is supported by motor fuel taxes and registration fees.
• Texas (SB 1018) increased the share of traffic fine revenue distributed to trauma facilities and EMS agencies from 30% to 50%.

Together, these approaches highlight how states are linking EMS funding to roadway use and injury prevention systems.

Grants and Structured Funding Models

States also created and refined grant programs and dedicated accounts to address regional disparities and emerging system needs.

• Arkansas (HB 1841) created the ARRIVES Fund, which distributes dollars to county governments and EMS agencies based on population while prioritizing rural areas.
• Utah (SB 209) established an EMS critical needs account that provides grants to agencies and local governments to stabilize coverage statewide.
• Maine (LD 245) established a permanent state commission to strengthen EMS system oversight and directed the Department of Public Safety to conduct an EMS funding needs analysis to support regional collaboration and system improvements.

Purpose-built funds enable legislatures to align dollars with coverage and access goals while retaining flexibility in implementation.

Integrating Data Collection and Reporting

Modernizing EMS data systems remained a legislative focus last year, particularly regarding reporting to the National Emergency Medical Services Information System, or NEMSIS, a national repository that collects and shares data on EMS calls.

• California (SB 101) funded an IT project that upgrades the state's crash database, improves real-time reporting and enhances the ability to cross-reference EMS, crash and trauma data.
• Georgia (SR 216) called for a study on vulnerable roadway users that references pedestrian safety data from the National Highway Traffic Safety Administration and emergency room visit data from the Georgia Emergency Medical Services Information System and the Georgia Trauma Registry.
• Idaho (HB 206) established a time-sensitive emergency registry for population-based data on trauma, stroke and cardiac emergencies in coordination with EMS and hospital provider systems, including NEMSIS.

Improved data integration supports performance measurement, resource targeting and coordination across EMS, trauma and transportation safety systems.

Trauma Systems and Prehospital Blood Programs

Legislatures continued in 2025 to invest in trauma system capacity, including expanded prehospital blood programs, which allow EMS personnel to give blood products at an injury scene or while transporting a patient, delivering care during a critical window when severe bleeding can be life-threatening.

According to the National Highway Traffic Safety Administration, 43% of the 40,901 people who died in traffic crashes in 2023 were alive when first responders arrived. Uncontrolled bleeding is a leading cause of preventable death. and providing blood earlier in care can significantly improve a patient's chances of survival, according to the American College of Surgeons.

• Massachusetts (HB 4240) appropriated $30,000 to support a regional mobile blood transfusion program.
• Texas (SB 1) appropriated $10 million to EMS agencies across the state through a statutorily created subcommittee overseeing the statewide whole blood program.
• Washington (SB 5167) allocated $500,000 to stabilize its blood supply by staffing donation centers and supporting mobile blood drives.

These measures focus on increasing access to time-critical interventions, especially in rural communities, where many agencies experience challenges relating to EMS response times and staffing.

Bolstering the EMS Workforce

Workforce issues remained a consistent theme across last year's EMS legislation. State agencies continue to face staffing shortages, high turnover rates, limited advancement opportunities and difficulty recruiting in rural areas. These challenges affect EMS system performance and delay response times, particularly in high-need communities.

To address these issues, at least 40 states and Washington, D.C., enacted policies related to EMS clinicians' scope of practice, certification, licensure processes and support programs. Scope of practice refers to the activities and procedures EMS personnel are authorized to perform under their state license or certification, including administering medications, advanced airway procedures and other interventions.

• Illinois (SB 1295) required 911 telecommunicators who provide dispatch for emergency medical conditions to be trained in CPR, including protocols for out-of-hospital cardiac arrests and CPR instructions for callers.
• Mississippi (HB 1268) created the Save Our Service Member Task Force and the State First Responder PTSD and Suicide Prevention Task Force to make recommendations to the Legislature.
• North Dakota (HB 1419) extended the benefits of public employee retirement systems to permanent employees, peace officers, firefighters, dispatchers, EMS personnel and correctional officers.

At least 18 states also set standards for pediatric emergency care and improved coordination among EMS, health care and school professionals around pediatric emergency readiness.

• Maryland (SB 676) required the Department of Health and the Maryland Institute for EMS Systems to adopt regulations on minimum perinatal care for hospitals statewide.
• Missouri (SB 68) required public school administrations to coordinate with EMS providers to develop and implement school cardiac emergency response plans.

Together, these legislative actions reflect efforts to strengthen workforce stability and readiness, recognizing that staffing capacity and training are central to EMS system performance. A prepared and well-supported workforce remains central to EMS system resilience and effective emergency response.

Looking Ahead

Many of the 2025 EMS-related bills focused on funding sustainability, trauma systems, workforce supports, data modernization and improving access to care-trends anticipated to continue in 2026 legislative sessions.

Looking forward, states are also incorporating EMS system improvements into their Rural Health Transformation Program applications. The program, was established under the One Big Beautiful Bill, provides $50 billion to states to address rural health care access and workforce and technology challenges. All 50 states applied, and at least 19 of them addressed rural EMS challenges, signaling interest in enhancing EMS capacity, expanding community-based care models, stabilizing rural EMS agencies, and modernizing trauma and data systems.

Legislative trends suggest continued momentum in strengthening EMS systems to meet evolving community needs and ensure timely, high-quality emergency response.

Aneesa Turbovsky is a policy associate in NCSL's health program.