Editor’s Note: This article originally appeared in the EMS1 eBook, “How to fund community paramedicine.” Learn more and download your copy now.
At Delta County (Colorado) Ambulance District, we started our MIH program with a single focus: improve access to healthcare for rural residents in the service area. The mission has evolved, but the challenges of funding the venture remain.
The initial concept was built on the same premise as nearly every other MIH program, an identified community need, a gap that needed to be filled and a plan to implement a positive change in the healthcare landscape. As drastic shortage of primary care providers and lack of urgent care clinics left many residents with only two options for non-emergent medical care: 911 with EMS response or a trip to the ED.
| MORE: Funding the rise of community paramedicine. Grants, partnerships and policy solutions to expand healthcare access and fill gaps.
The program started with a single paramedic, holding the Community Paramedic (CP-C) endorsement from the IBSC. This single paramedic started talking to any community partners that would listen about the new program the agency was starting and all the things which could be done to support them in caring for patients and the community, as well as the benefits to these partners: the program could save them money, increase efficiency and improve patient outcomes for only a nominal fee. Community partners loved the idea, but, unfortunately, many of them were strapped for cash themselves and had no funding to contribute to the cause.
The service was wanted, the price tag was not.
Partnering with public health
The start was slow, partners needed to see the value and were initially not sure how a single “ambulance driver” was going to affect positive change in healthcare outcomes for rural underserved populations. The program took any referral which came along and provided services and patient visits for no charge, or whatever the referring partner could spare.
The first funding for our community paramedicine program came from a conversation with the regional supervisor for Area Agency on Aging. The program had left over COVID funds that needed to be spent and saw value in providing clinical visits for elderly patients in the community. At $150 per visit for any patient over the age of 60 in the six-county region (a geographic area larger than the state of New Jersey), the program was in business and even had a revenue stream.
The next funding stream came from a partnership with the county health department. While the health department offered vaccines at little-to-no cost, numerous patients adversely affected by the social determinants of health (especially a lack of access to transportation) had no mechanism to get to the health department to obtain their vaccines. The health department partnered with our fledgling MIH program to bring vaccines into the homes of those with transportation barriers. Twice a week, the health department provided a list of vaccine visits, a cooler with vaccines and a stack of paperwork. The agency was paid whatever the health department could collect from Medicare/Medicaid or private insurance.
The windfall came at the end of the year, when the health department had extra money in their budget. The director asked for an invoice of what the services the community paramedicine program had provided would have truly cost. We provided an invoice (at true cost, with no markup), resulting in multiple gasps heard three counties away. The invoice for just over $30,000 was paid, but the realization set in for all parties that a program such as this would not be free.
The business of funding community paramedicine
As the program grew, patient volume was rapidly increasing, while highly trained, advanced practice paramedics and registered nurses with the experience and clinical knowledge to function autonomously and independently were not growing on trees. The job of securing funding was requiring more and more meetings. Delta County Ambulance District’s EMS chief and the original community paramedic realized this project required a business mindset.
Additional clinicians were hired over the next 18 months, resulting in 3 full-time MIH clinicians, one for each shift working a 48/96 schedule. Clinicians of this caliber are not cheap and procuring the best clinicians is even more challenging. A full-time MIH clinician earns an average of $90K/year to $115K/year. Add 40% for benefits, taxes, etc. and the team is costing roughly $520K/year in total payroll costs alone. This does not include additional overtime, vehicles or equipment.
| MORE: Personalized care catered to patients’ unique needs. How Mehlville Fire Protection District used ET3 and community paramedicine to improve overall health and quality of life for the community.
Partnering with a commercial payor
The real funding breakthrough came via partnership with a commercial payor, Rocky Mountain Health Plans (RMHP), a United Healthcare Company. The initial conversations did not go anywhere, and we were baffled as to why. We had a great product, with miles of upside potential — we could save the payor enormous sums of money through improving healthcare outcomes, yet the interest did not seem to be there. Beauty is in the eye of the beholder and value is measured by a similar metric. We realized that we were trying to sell pencils to an organization that didn’t need pencils; they needed pens.
The MIH Division Chief pursued a new course. Instead of telling RMHP what the agency could offer, he asked what RMHP needed. Where were their pain points? What were the problems they couldn’t solve? The Division Chief requested a copy of RMHP’s key performance indicators (KPIs). After identifying the metrics RMHP was struggling to meet, the Division Chief asked himself if the MIH program could deliver improved results for any of these metrics in a meaningful way. The agency absolutely could!
A new proposal was drafted, with emphasis on all the ways that the MIH program could improve struggling KPIs for RMHP, especially relating to their Medicaid contracts. Success! Soon, the Division Chief found himself in meetings with RMHPC-suite executives, including the CEO, and significant funding streams ensued.
RMHP is still the primary funding source for the community paramedicine program and nearly covers the payroll costs of the MIH team. Furthermore, RMHP has provided funding for various needs at times over the years, including a vehicle, equipment and additional funding for specific patients with special needs that result in higher costs for the program.
Grant funding for community paramedicine
Grant funding continues to be a significant source of funding for the community paramedicine program, especially for capital expenditures. We have obtained grant funding from:
- Federal grants, including:
- The Assistance to Firefighter Grant (AFG)
- Congressionally-directed spending
- State EMS grants
- Private foundations, including:
- The Gary Sinise Foundation
- Firehouse Subs Grants
As of this writing, we have no less than five grant applications under review and six grant applications currently being written.
When pursuing grant funding, be creative. One of the best grants we received was for over $250K and was a broadband grant, administered through the state with federal funds. The grant targeted rural areas with poor access to broadband and provided funding to the MIH program to bring telehealth into homes with community paramedics. There was no mention of telehealth in the Notice of Funding Opportunity (NOFO), but some creative technical writing made a case that telehealth access addressed a crucial aspect of connecting rural patients with healthcare utilizing technology, which was directly in step with the aims of the grant.
Advocate for increased fundingto support community paramedicine
When you sit down to fund your community paramedicine program, identify as an agency whether the internal savings generated by the program is worth operating the program as a cost center for the agency, based upon the downstream savings, or whether the program needs to pay for itself. Identify the community needs for which your organization is equipped to engage and affect a positive change.
Solid relationships with payors and hospitals are imperative to continued success. The ultimate solution lies in the manner which payors view EMS and these types of programs.
Engage with advocacy groups such as NAEMT or your state EMS association and get involved with legislative efforts to encourage Medicaid to pay for MIH services. Send letters to your elected representatives encouraging them to support legislation which would direct Medicare to pay for these types of services. Become an advocate for the advancement of the profession through higher professional standards, education requirements, degree requirements and action which elevate EMS professionals to a similar position as other providers.
These are the steps which allow EMS and MIH programs to be eventually viewed as providers of clinical care rather than suppliers of transportation.
This article, originally published in July 2025, has been updated.
