Many states have turned to community paramedicine to ensure access to primary and preventive care and reduce emergency department use—and its financial impact on the health care system. A 2023 survey by the National Association of Emergency Medical Technicians reported that about 400 emergency medical service agencies across the country have launched mobile integrated health or community paramedicine programs.
Community paramedicine allows EMS clinicians such as emergency medical technicians and paramedics to provide primary health care and preventive services—and receive reimbursement for them—without transporting patients to an emergency department. One model adopted by fire departments, Community Assistance Referral and Education Services, has been shown to significantly reduce 911 calls, emergency department visits and hospitalizations. Instead, community paramedics might visit people after an emergency department visit or hospitalization to help with chronic disease management and education or to connect patients to community resources and supports.
While their scope of practice varies by state, community paramedics perform tasks that might overlap with other health care professionals, such as community health workers, who serve as liaisons between health and social services and the community.
Community paramedics might:
- Provide and connect patients to primary care services.
- Complete post-hospital follow-up care.
- Integrate services among local public health agencies, home health agencies, health systems and other providers.
- Provide education and health promotion programs.
- Provide services not available elsewhere in the community, such as primary care and preventive services.
As part of combined mobile integrated health and community paramedicine programs, health care professionals such as nurses can assist a paramedic and provide higher levels care, including running diagnostic medical tests.
Many private and public payers have community paramedicine programs to reduce costs. At least seven states reimburse for community paramedicine services under Medicaid, and at least 14 states reimburse for treatment without transport on 911 calls specifically.
- In three states, only the Medicaid program reimburses CP services.
- In 12 states, only commercial health plans reimburse CP services.
- In four states, both the Medicaid program and commercial health plans reimburse CP services.
- In 14 states, Medicaid programs reimburse for treatment without transport on 911 calls.
About 5% of patients account for 25% of emergency department visits. Studies in Maine and Wisconsin found that community paramedicine programs were associated with decreases in emergency department visits. Community paramedicine programs can extend the reach of health care providers, especially in rural and underserved communities. The California Emergency Medical Services Authority notes that, as first responders, EMS clinicians are uniquely positioned for this type of work as they are:
- Located in nearly all communities.
- Able to respond during all hours of the day.
- Generally trusted and accepted by the public.
- Qualified to make health assessments outside of a facility setting.
- Operating as part of an organized system of patient care.
There are several challenges to integrating community paramedicine into the health care system, including funding and reimbursement, integration with health information systems, scope of practice regulations and duplication of services.
Licensure, Certification, Scope of Practice
Examining licensure, certification and scope of practice is often a first step for many states as they explore and integrate community paramedicine.
The training and certifications EMS clinicians receive align with the tasks performed through community paramedicine models. While the prerequisites to obtain a license or certification vary by state, community paramedicine may be incorporated into EMS clinician licensure or certification or established with separate requirements in statute.
North Dakota is among the states integrating community paramedicine into EMS clinician licensure. It includes transportation to alternate destinations within the definitions of emergency medical services, and it required Medicaid reimbursement for community paramedicine services in 2021.
Other states establish separate licensure or certification processes for EMS clinicians providing CP services. Earlier this year, Arkansas incorporated training on social drivers of health within its 160 hours of classroom and clinical education for community paramedics. Alabama clarified the licensure requirements for community paramedics to prohibit the state board of health from requiring a college degree for licensure as a community paramedic, although programs are still subject to board approval.
California established a community paramedicine pilot program in 2014, allowing the state EMS authority to evaluate its effectiveness across 14 pilot sites. A 2019 evaluation found that the program saw over 4,300 patients and reduced medical costs by more than an estimated $3 million. The state expanded the parameters of community paramedicine and established oversight committees to manage the program in 2021.
New Jersey established a Mobile Integrated Health Program and a director of state EMS in the Department of Health. Mobile Integrated Health has a broader scope than community paramedicine and may also involve nurses, community health workers and other medical professionals.
For more information on community paramedicine, see NCSL’s brief Beyond 911: Expanding the Primary Care Role of First Responders Through Community Paramedicine or visit NCSL’s Scope of Practice Policy legislation database, which tracks state actions on community paramedicine.
Saquib Syed is an intern with NCSL’s Health Program.
This article is supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services as part of an award totaling $813,543 with 100% funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS or the U.S. government.