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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.