Advancing the EMS profession
Online Legislative Service

Send an email to your representatives and ask for their support of these important issues. Visit the Online Legislative Service (open to all in EMS), Take Action on an issue, and send a templated email in just minutes. Our goal is to have 10,000 emails sent!

The “One Big Beautiful Bill Act” (OBBBA or H.R. 1) was signed into law on July 4, 2025. As discussions continue around its potential effects on the EMS community, NAEMT’s leadership and national partners have begun studying the potential impact of this new law on EMS agencies and the patients we serve. 
View a summary of major provisions that may impact EMS, and suggested actions EMS agency leaders can consider.

Prior to the law’s enactment, NAEMT actively advocated against the harmful impact that reduced Medicaid funding would have on the nation’s EMS system, as part of the Modern Medicaid Alliance. Now enacted, this law will reduce Medicaid spend over time by roughly $1 trillion and impact the ACA (Affordable Care Act) marketplace. These cuts are concerning and may create unease among patients, EMS practitioners, first responders, and community members.

OBBBA will alter the way states receive federal Medicaid funding, giving state governments a significant role in shaping how these changes are implemented. Some of the changes in the law will begin to impact patient Medicaid eligibility in 2026. However, many of the larger changes in state Medicaid funding won’t start to roll out until 2028, gradually ramping up over several years.

EMS agencies have time to assess OBBBA’s long-term impact to fully understand the implications. NAEMT will continue working with partners, elected officials, and state EMS advocates, to clarify the details and share information to assist with your local planning efforts.

NAEMT and our collaborators will work to mitigate certain policy changes before they take effect and will offer implementation guidance to support the EMS community. We are committed to keeping you informed as details become available.



Home / Advocacy / Key NAEMT Legislative Issues

Key NAEMT Legislative Issues

Advocating on behalf of the EMS community is core to NAEMT’s mission. NAEMT works to make sure that EMS is involved in the development of federal policies, plans and programs that impact our workforce and our communities. NAEMT advocates for laws and regulations that help ensure EMS practitioners have the funding, training, equipment, and support needed to provide excellence in patient care and maintain their mental and physical well-being. These are some of the key legislative issues that NAEMT is undertaking this year.


2025 Requests to Congress 

Overview of 2025 NAEMT Congressional Requests (executive summary)

Treat in Place (TIP) 

Please support H.R. 2538, the Comprehensive Alternative Response for Emergencies (CARE) Act, introduced by Reps. Mike Carey (R-OH) and Lloyd Doggett (D-TX). This bill would create a pilot program to test and evaluate the Treatment In Place (TIP) model under the Center for Medicare and Medicaid Innovation (CMMI). Senate companion legislation will be introduced in the near future.


Mobile Integrated Health (MIH) 

Please ask Congress to support the Community Paramedicine Act, H.R. 4011, introduced by Rep. Emanuel Cleaver (D-MO) and others. This bill would create a grant program under the Secretary of Health and Human Services (HHS) to support Mobile Integrated Healthcare (MIH) Community Paramedicine (CP) programs. Eligible applicants in rural and underserved communities could receive grants to: 

  • Hire community paramedicine personnel; 
  • Purchase necessary equipment, including personal protective equipment, uniforms, medical supplies, and vehicles; 
  • Pay for certification courses; and 
  • Conduct public outreach and education on the patient-centered outcomes that can be achieved through community paramedicine. 

Medicaid, EMS, and the Federal Budget 

Communities across the nation rely on 24/7/365 availability of EMS for the sick, injured, elderly, and disabled and Medicaid is either the largest or second largest payer for the majority of ambulance services, especially in rural and underserved communities. 

  • Please ask Congress to remember that EMS receives significant funding from the Medicaid program.  As they complete Budget Reconciliation this summer, members of Congress must not make Medicaid changes that reduce the availability of ambulance service throughout the country. EMS agencies are already struggling with below cost Medicare and Medicaid reimbursement that has resulted in ambulance deserts and delays in lifesaving care.

SIREN Grant Program 

The Supporting and Improving Rural EMS Needs (SIREN) Act created a grant program specifically for rural public and non-profit EMS agencies and fire departments to purchase equipment, provide training, and meet other critical needs, called the Rural EMS Training and Equipment Assistance (REMSTEA) grant program. 

  • Please ask Congress to include $33 million in the FY2026 budget for SIREN Act grants to provide much needed resources to already strained EMS agencies working to provide life-saving medical care to the patients in their communities. 

Workforce PARA-EMT Act 

EMS is facing crippling staffing challenges that threaten the availability of critical emergency healthcare services. The shortage of EMTs and Paramedics is resulting in longer 9-1-1 response times and delays in interfacility transfers, putting patients who need urgent health care at unacceptable risk.  

  • Please ask Congress to cosponsor H.R. 2220, the Preserve Access to Rapid Ambulance Medical Treatment (PARA-EMT) Act, introduced by Reps. Brad Finstad (R-MN) and Marie Gluesenkamp Perez (D-WA), which would help address the Paramedic and EMT shortage. The bill would:
  • Provide $50 million to the Office of the Assistance Secretary for Preparedness and Response (ASPR) for grants open to all ambulance service providers to fund Paramedic and EMT recruitment and training.
  • Reduce barriers that prevent U.S. military veterans from becoming certified as civilianParamedics and EMTs.
  • Request that the Secretary of Labor (in coordination with the HHS Secretary) conduct a study on the current and projected EMS workforce shortage and report their findings.

Congressional EMS Caucus (available to US House Representatives only)

The EMS Caucus helps Congress understand EMS issues and promotes policies that help EMS practitioners provide life-saving medical care in emergencies, cost-saving care management in non-emergent or emergent situations, and disaster response at any time. Please ask U.S. House Representatives to join the EMS Caucus. 


EMS Counts Act
EMS consists of a diverse group of first responders and health care practitioners who often serve in dual roles, including Paramedics, Emergency Medical Technicians (EMTs), and dual-role Firefighter/EMTs and Firefighter/Paramedics. These professionals respond to more than 40 million calls for service annually, and they are critical to ensuring public health and safety.

  • Please support H.R. 3791, the EMS Counts Act, sponsored by Reps. GT Thompson (RPA) and John Mannion (D-NY) in the House, and soon to be introduced by Sen. Susan Collins (R-ME) in the Senate. This bill would require the Department of Labor (DOL) Bureau of Labor Statistics (BLS) to make changes to its system to accurately count the total number of EMS practitioners by accounting for those who also serve as firefighters

Protecting Access to Ground Ambulance Medical Services Act of 2025
This bill would extend the add-on payments at their current levels of 2% urban, 3% rural, and 22.6% super rural until December 31, 2027, and support efforts to further raise add-on percentages. These payments are set to expire on September 30, 2025.

  • Please support S. 1643/H.R. 2232, the Protecting Access to Ground Ambulance Medical Services Act of 2025, introduced by Sens. Catherine Cortez Masto (D-NV), Susan Collins (R-ME), Bill Cassidy (R-LA), and Peter Welch (D-VT) in the Senate and Reps. Claudia Tenney (R-NY) and Terri Sewell (D-AL) in the House.