Evolving EMS Service Delivery Through Mobile Integrated Health

Fire and EMS agencies across the country are operating in a service environment that continues to shift. While emergency response and transport remain core responsibilities, a growing share of 911 calls are related to chronic medical conditions, behavioral health needs, medication management, and gaps in access to primary care. Many of these encounters do not require emergency department transport, but they do require timely assessment, follow‑up, and coordination.

Mobile integrated health and community paramedicine programs have developed as structured ways for EMS agencies to respond to these needs. Rather than operating outside the EMS system, these programs extend it by allowing EMS clinicians to deliver services in homes and community settings and to work more closely with healthcare and social service partners. Recent Medicaid policy developments indicate that these models are increasingly being incorporated into state coverage strategies, moving beyond time‑limited pilots toward more durable policy pathways.

Mobile Integrated Health as a Service Delivery Framework

Mobile integrated health and community paramedicine function as a flexible service delivery framework. Program design varies based on community needs, state scope‑of‑practice rules, and payer policy. This flexibility has allowed states to incorporate these models into Medicaid through different mechanisms, including State Plan Amendments.

A clear example of this approach is North Dakota State Plan Amendment 25‑0026, approved by the Centers for Medicare and Medicaid Services in January 2026 with an effective date of October 1, 2025. Through this amendment, North Dakota added coverage for community paramedic and emergency medical technician services as preventive services under section 1905(a)(13) of the Social Security Act and 42 CFR 440.130(c).

Rather than creating a new standalone benefit category, the amendment aligns community paramedicine services with existing preventive service authority, establishing a clear and administratively familiar pathway for Medicaid reimbursement.

Post‑Hospital Follow‑Up and High Utilizer Programs

One common application of mobile integrated health and community paramedicine is post‑hospital discharge support. In North Dakota’s SPA, covered services explicitly include post‑hospital discharge follow‑ups to evaluate recovery, ensure adherence to discharge instructions, and manage ongoing care to reduce the risk of readmission. Services must be recommended by a physician or other licensed practitioner, with standing orders or protocols permitted.

High‑utilizer interventions are also consistent with the covered service components described in the amendment. North Dakota authorizes in‑home health assessments, chronic disease monitoring and education, medication compliance checks, and referrals to social and mental health services when delivered by licensed community paramedics and emergency medical technicians within their scope of practice.

State Approaches to Medicaid Support for Community Paramedicine

While North Dakota provides a clear example of explicit Medicaid coverage for community paramedicine services, other states illustrate different policy approaches to supporting similar goals.

Minnesota represents an earlier model of Medicaid alignment. Minnesota Medicaid has long recognized community paramedicine services through its state plan, allowing certified community paramedics to provide services such as post‑hospital follow‑up, chronic disease monitoring, medication management, and immunizations under defined billing and care‑coordination requirements. Minnesota’s approach is frequently cited as one of the first formal Medicaid pathways for community paramedicine and demonstrates that these models can be sustained over time within a traditional fee‑for‑service framework.

In contrast, Colorado has more recently focused on Medicaid coverage for community‑based preventive services delivered by non‑traditional providers, particularly community health workers, through State Plan Amendments using preventive service authority. While Colorado’s approved SPAs do not currently extend Medicaid coverage to community paramedicine or mobile integrated health services, they reflect a broader Medicaid strategy of expanding preventive and community‑based care delivered outside of traditional clinical settings. This policy direction relies on the same preventive service authority later applied by North Dakota and illustrates how similar statutory pathways could be used to support mobile integrated health models.

Together, these examples demonstrate that states are using different policy levers to pursue similar objectives, including improved access to care, reduced avoidable utilization, and stronger community‑based service delivery.

Treat‑in‑Place and Preventive Care Services

While the North Dakota amendment does not use the term “treat in place,” it authorizes a range of services that support care delivered outside of traditional clinical settings. Covered services include minor medical procedures within scope of practice, immunization administration, laboratory specimen collection, and point‑of‑care testing when delivered in a home or community setting.

By defining these services as preventive, the SPA creates a reimbursement pathway for care delivered without emergency department transport, provided services are within scope and recommended by an authorized practitioner. Functionally, these services support treatment outside the emergency department while remaining anchored in Medicaid’s preventive service framework.

Behavioral Health and Care Coordination

The North Dakota SPA also reflects Medicaid’s growing emphasis on care coordination and behavioral health access. Covered community paramedicine services include referrals to social and mental health services and home safety assessments, recognizing that non-medical factors frequently contribute to emergency service use.

This emphasis aligns with broader Medicaid trends in other states, including expanded mobile crisis response and community‑based behavioral health services delivered outside hospital settings.

The Rural Health Transformation Program and State‑Led Investment

The Centers for Medicare and Medicaid Services’ Rural Health Transformation Program is a multi‑year federal initiative designed to support state‑led efforts to strengthen and modernize rural health care systems. Through this program, funding is awarded to states, which retain broad discretion over how resources are applied within federal guidelines.

While the program does not establish ongoing reimbursement for services, it may provide states with a flexible tool to support early‑stage activities related to mobile integrated health and community paramedicine. This can include planning and design work, assessment of community needs, evaluation of existing EMS and care delivery systems, and investments that help improve coordination, infrastructure, or workforce capacity. In this way, the Rural Health Transformation Program may help states lay the groundwork for community‑based care models and support the transition from policy concepts to operational programs.

The Role of Data and Performance Measurement

As states adopt State Plan Amendments like North Dakota’s, expectations related to documentation and performance measurement increase. While SPA 25‑0026 does not prescribe specific metrics, the structure of covered services implies the need to document service delivery, practitioner recommendations, and outcomes related to preventive care and chronic disease management.

Programs operating under similar Medicaid authorities commonly track hospital readmissions, emergency department utilization, follow‑up compliance, and EMS operational measures such as unit availability and response‑time reliability.

Implications for Fire and EMS Leaders

For fire and EMS leaders, State Plan Amendments such as those adopted in North Dakota, Minnesota, and Colorado illustrate that mobile integrated health and community paramedicine can be incorporated into Medicaid through a range of policy approaches. Collectively, these examples describe how states are addressing EMS‑delivered services within broader community‑based care and coverage frameworks, including preventive services and care delivered outside traditional clinical settings.

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