2026 Legislative Agenda - *Download as a PDF

When Minnesotans call 9-1-1, they expect an ambulance to arrive quickly with trained professionals ready to save lives. That expectation is at risk in communities across the state due to a workforce shortage, chronic underfunding, and a fragile funding model that does not pay for readiness.

2026 Priorities: Workforce • Funding • Sustainability

MAA is focused on practical solutions that stabilize ambulance services statewide, protect patient access, and strengthen Minnesota’s EMS system. MAA continues to oppose unfunded mandates that will burden an already stretched, critical resource.

1) Workforce: Build and Retain the EMS Pipeline

Minnesota ambulance services face a staffing crisis that threatens response times and patient care – especially in Greater Minnesota. We must recruit new EMTs and paramedics, retain experienced professionals, and support provider well-being.

• Reauthorize Paramedic Scholarships ($3.5 million) to train and place paramedics in the workforce.

• Support EMT and first responder pathways, including high school EMS and earn-while-you-learn models.

• Expand mental health support for EMS providers with an appropriation of up to $5 million ($2.5 million/year) by expanding the Minnesota Fire program to include EMS.

2) Funding: Fix the Reimbursement Gap

Ambulance services respond 24/7, regardless of reimbursement. Providers respond to roughly 600,000 emergencies each year, yet reimbursement – often limited to hospital transport – fails to cover the cost of care, creating a $763 million shortfall in 2023.

• Increase Medicaid reimbursement rates so providers are not forced to operate at a loss.

• Monitor and respond to federal Medicaid reforms to prevent cuts and replace proposed losses in federal dollars.

• Support solutions that recognize readiness as infrastructure—not just transport volume.

• Require Medicaid reimbursement for treatment-in-place and transport to alternative destinations, recognizing that EMS incurs costs and delivers care even when a patient is not transported to a hospital.

3) Sustainability: Maintain and Stabilize Recent EMS Investments

Recent one-time funding helped prevent service reductions, but it is not a long-term solution. MAA supports ongoing EMS funding so services can maintain staffing, equipment, and 24/7 readiness.

• Pass ongoing EMS sustainability funding to stabilize ambulance services statewide.

• Provide targeted support for rural and regional services with long distances, low call volumes, and high fixed costs.

• Create long-term funding structures that prevent reductions, delayed equipment replacement, and closures.

4) Non-Emergency Medical Transportation: Strengthen and Stabilize the NEMT System

NEMT supports hospital discharges, nursing home transfers, and other medically necessary transports. When NEMT is unstable, these trips shift to 911 ambulances – diverting emergency resources and increasing costs.

• Support sustainable funding for a stable, statewide NEMT program.

• Develop a model prioritizing credentialed, qualified, and proven NEMT providers.

• Require pre-approval for hospital-based NEMT transports to ensure appropriate use.

5) Workplace Mandates: Protect 24/7 EMS Staffing Under ESST & PFML

In 2023, the Legislature enacted two major paid leave mandates impacting every employer in Minnesota: Earned Sick and Safe Time (ESST) and Paid Family and Medical Leave (PFML). ESST took effect January 1, 2024, and PFML took effect January 1, 2026. While well-intended, these mandates create unique challenges for 24/7 emergency response services where staffing is not a convenience – it is a matter of life and death when minutes matter.

• Pursue statutory and/or rule changes to treat EMS as the third leg of the public safety stool – consistent with exemptions already provided for police and fire.

• Strengthen verification and documentation standards to prevent misuse that undermines shift coverage and response readiness.

• Clarify rules to ensure leave mandates do not unintentionally create public safety gaps in continuous emergency response operations.