New York’s emergency medical services providers walked away from this year’s state budget process without any meaningful wins, and as the last few weeks of the legislative session come up, they’re not confident this year will see any progress on their long-term recruiting, retention and financial problems.

Gov. Kathy Hochul had originally sought a change to language in state law to define EMS as “essential services,” and would have provided about $5.2 million statewide to help put that into practice. But in the final budget agreement, that language and money was stripped out. The state budget did not include any language or expenditures specifically for EMS.

Sen. Mark Walczyk, R-Sackets Harbor, blasted the omission.

“It is simply outrageous that we have failed to reorganize EMTs as essential service providers,” he said in a statement. “When I inquired about the removal of this vital provision, all I received was blanket statements, accompanied by silence.”

Walczyk co-sponsored a bill in the Senate that would have made similar changes to what the governor was proposing, which the Senate voted to pass last year. He pointed out that EMS providers have been raising the alarm over difficult conditions for years, and are dramatically losing staff.

“It’s unacceptable that the language was removed, and people will die — and I’m not trying to be hyperbolic, but people will die,” Walczyk said.

For years, EMS providers have been warning that multiple aspects of their operating models aren’t working. Medicaid, of which most EMS patients are beneficiaries, hasn’t covered the true cost of caring and transporting patients in years. Recruitment drives are turning out fewer and fewer people interested in the difficult process of becoming an EMT, and the volunteer-based organizations that serve primarily rural regions of the state are shrinking too. Meanwhile, costs are continuously increasing and as the population gets older, more people are needing more complicated care.

“We are still shorthanded,” said Jeff Call, chair of the United New York Ambulance Network and general manager of Guilfoyle Ambulance Service in Watertown.

Call said there aren’t enough training programs to rebuild the services that are losing providers to retirement, and the state is making things worse by hiring trained medical technicians at the state Bureau of Emergency Medical Services. He said there are between 70 and 80 jobs open in the bureau that the state wants to fill with people working in the field.

“That’s going to basically take people out of the current EMS system and have them work for the state EMS office, and they’ll no longer be providers,” Call said.

Call said the budget language to make EMS an essential service was a nice motion, but would have made little to no difference in the field.

“Making us essential was just a word, they didn’t put money with it,” he said. “They wanted to make EMS essential, but nobody could agree on who was going to be responsible for making it essential.”

State law prescribes that police and fire are “essential services,” and lays out which governments are responsible for providing those services. For example, state law requires that counties provide a sheriff’s office, towns provide a fire department, and that cities must provide for both a police force and a professional fire department. The language in Hochul’s original budget proposal would not have specified which levels of government have to provide EMS, and the $5.2 million was not likely to cover the costs of actually implementing the move.

The counties, represented in the state capital by New York State Association of Counties, have expressed concern that making EMS an essential service could force them to pay to operate county-wide ambulance services, another “unfunded mandate” from the state government that the counties would have to budget for with property and sales tax income.

“Essential is great, but it has to be funded, there has to be a funding source to back up that word, essential,” Call said. “Calling me essential makes me feel good, but calling me essential and then saying you’re not going to pay for it, that only makes me feel good for about seven seconds before I have to ask, ‘Who is ultimately responsible?”

Ambulance providers have a specific plan they’ve laid out to legislators, asking for $20 million per year for the next three years to be dedicated specifically to paying for Medicaid patients at the same rate that Medicare patients are paid. Because so many patients who use ambulances are on Medicaid, Call said that would help boost EMS operating budgets significantly.

“The magic number is $67 million, to bring Medicaid up to Medicare rates, which would be a huge push for EMS,” he said.

The state’s $254 billion budget for 2025-26, which passed the legislature earlier this month, includes more than $1 billion in health care-related spending.

“When you’re talking about a billion dollars in health care spending, it seems really stupid to me that EMS doesn’t get at least $20 million in that,” he said. “We got nothing in the budget.”

Call said ambulance operators and the United New York Ambulance Network will continue to push for meaningful change in state law to help buoy EMS operators. Efforts are still underway to work up a bill to classify EMS as essential, and another to boost Medicaid and other insurance pay rates for ambulance services. But Call wasn’t overly optimistic about something passing this year.

After the state budget ran overdue by more than a month, lawmakers have just about a month to wrap up voting before the six-month legislative session in Albany ends in June.

“We’re not really confident much is going to happen on our behalf, positively, just because the budget took so long,” Call said. “There’s not a lot of time left.”