09/18/2025
Carly Graf from Lee Montana News did an amazing job on this article. I subscribed in order to make a "Read Only" version of this article. I think it's too important not to share but I want to give credit where credit it due. She called me for this article and I ended up on a fire and regretfully didn't call her back.
I ask that if/when the time comes to recognize EMS/Ambulance as an "Essential Service" that you please do! Currently EMS isn't looked at by most of the United States as "essential", meaning the local fire departments and private individuals such as myself have to create an ambulance service. Not being an essential service means there are no tax dollars set aside for EMS services.
Thanks also goes out to Tim Montana for using his platform to bring this to the light. I hope to be speaking with you soon!
Alert Top Story
MT EMS crisis: ‘Please tell me something that’s more important than emergency services’
A scroll through Tim Montana’s social media most days will feature video clips of the scraggly-bearded musician’s guitar jams and photos of the Wise River watering hole-meets-concert venue he purchased two years ago.
But last week he took to his page with a different message: Montana’s ambulance system is broken, and something must be done about it.
In a 2 ½-minute video, he gave a harrowing account of trying to access life-saving medical care for a friend whose child had suffered a gunshot wound to the head.
Montana said the victim was rushed from the Big Hole Valley to the Community Hospital of Anaconda, where the patient was stabilized but in dire need of more specialized medical care that the facility couldn’t provide.
The hospital was unable to secure an ambulance, and, hooked up to a ventilator, the patient couldn’t be transported in his family’s vehicle. It took hours and dozens of calls to ground and air transport companies before the hospital could arrange an exit strategy: a helicopter crew from Helena that got clearance to fly only after the summer wildfire smoke lifted.
The victim was treated in Missoula and is currently stable, according to Montana. Community Hospital did not respond to request for comment.
Morgan Smith, the Anaconda-Deer Lodge County Attorney, said that the county EMS assists with transports from the hospital to other facilities when possible, but will turn down those requests if “completing the transport would jeopardize their ability to adequately respond to any emergency calls for service within the county.”
With his internet following, Montana’s story picked up steam. Droves of people shared similar experiences highlighting that, for residents in the state’s rural pockets, the fear of calling for help only to find out there’s nobody available to respond is part of normal life.
Despite warnings dating back years that the state’s EMS infrastructure was hurtling towards its breaking point, lawmakers have faltered in taking meaningful steps to bolster the system.
“Please tell me something that’s more important than emergency services,” Montana said in an interview with the Montana State News Bureau after he posted the video. “I’ll wait.”
'Stabilize and transport'
It takes roughly nine hours to drive from one side of Montana to the other — and that’s in the best conditions along the interstate. Many of those miles are accompanied by a clear windshield view to the horizon or the nearest mountain range with little sign of the 1.1 million people in the country’s fourth-largest state by area.
If rurality is what gives Montana its special sauce, it’s also what makes health care access a persistent challenge.
Nearly 50 critical access hospitals dot the state, providing vital care in its most remote corners. With no more than 25 inpatient beds and lower patient numbers, they provide limited services. Rarely can they offer high-level trauma or specialists.
“Stabilize and transport” is a common refrain used to describe how critical access hospitals approach emergent patients who require treatment at bigger hospitals elsewhere.
EMS services are the backbone of rural health care because they link rural residents to critical access facilities and then along to bigger hospitals when needed. When timely transport isn’t an option, the whole system is put at risk.
Montana is served by a patchwork of EMS providers. Some are run by counties. Others are operated by the local hospitals. There are independent nonprofits.
Almost all rely on volunteers. Most are critically underfunded because insurance doesn’t cover their costs, and they receive little to no money from local governments. Although a handful of private companies exist to close service gaps, they tend to be pricier.
The result is that more than 100,000 Montanans live at least a 25-minute drive from the nearest ambulance station, the most residents of any state in the country, and many of those EMS locations are hanging on by a thread.
"Montana’s rural EMS system is in crisis,” authors of a 2021 report from the state Department of Public Health and Human Services (DPHHS) wrote. “Without action it will continue to deteriorate and calls for help will not be answered.”
EMS Funding
EMS providers are only paid when they have a patient in their vehicle. That means that if Adam Johnson, the manager of Powder River County EMS, gets a call from Bay Horse, he must travel the 39 miles from Broadus, but can’t bill for his time.
When ambulance trips often clock more than an hour just to reach a patient, that’s a lot of gas, vehicle wear-and-tear and volunteer time that goes uncompensated.
“How I usually explain it to people is out here in Powder River County, you’re in the southern circle of hell,” Johnson said. “It’s comedy, but it takes so long for us to get anything in or for us to get anywhere.”
Some people call 911 when they think something is wrong, but it isn’t, Johnson said, and first responders want to be able to help ease those fears. Or they just need a quick check-in, and taking them to a hospital would be medically unnecessary.
If a call doesn’t warrant medical transport, EMS providers often walk away having not charged anything for their time because it’s not billable to insurance. But insurance is how most Montana EMS companies stay afloat.
When a person is transported in an ambulance, EMS sends the bill to Medicaid, Medicare or a private insurer. Operators are quick to point out that Medicaid and Medicare rates don’t come close to covering their costs. Montana is one of the lowest-paying states in the region for basic and advanced life support ground transfer services.
Justin Grohs, the manager at Great Falls EMS, said that about 25% of the 911 calls they respond to don’t require transport. That means a quarter of their calls result in no revenue at all.
Montana stands apart from its neighbors in failing to require Medicaid reimbursement for “treat and no transport” scenarios. Washington, Idaho, North Dakota, South Dakota, Utah, and Wyoming all require Medicaid to pay for this time.
“Are we a patient care industry? Or a billing industry?” said Lyle Fisher from Plains Community Ambulance. “That’s where a lot of people are stuck. We are at a crossroads.”
There has been little appetite from the Legislature for increasing reimbursement rates directly. But House Bill 56, sponsored in 2025 by Great Falls Republican Rep. Ed Buttrey, himself a former EMT, and signed into law by GOP Gov. Greg Gianforte, directs the state health department to impose a fee on ambulance providers that can then be used to generate more federal Medicaid match dollars.
Ambulance providers from across the state called the mechanism a lifeline that would help them keep the doors open. DPHHS must now request permission from the Trump administration to roll out the policy. The White House's budget, dubbed the "Big Beautiful Bill" as it made its way through Congress, would limit how large of a fee the state can impose on ambulance providers to generate more federal funding, but not for a few years.
Montana doesn’t consider EMS an “essential service” in the way it does law enforcement and fire services, which means the state isn’t obligated to fund or provide ambulance response. Only 13 states have made the "essential service" designation, according to the National Conference of State Legislatures, a think tank that has been tracking the issue.
Sen. John Fuller, R-Kalispell, sponsored a resolution to have legislative staff study over the next 18 months the potential of recognizing EMS as an essential service and identify gaps in the current system. Lawmakers will hear a presentation about these study efforts at next week's Children, Family, Health and Human Services Interim Committee meeting in Helena.
EMS staffing
Fisher is Plains Community Ambulance’s lone paramedic, the highest level of licensure in emergency response medicine. Two more people are enrolled in paramedic courses, but it will take about a year for them to be ready.
“The last few weeks, I’ve been the only one on it consistently,” he said. “And I’m only really able to commit to night shifts because I also coach high school football. It’s tough.”
Ambulance providers say it’s become harder to recruit volunteers as first responders.
First, there’s the training. It can take months to get certified as an emergency medical technician, and then they must participate in continuing education. There’s the time commitment required to make a local EMS service viable. Most people are working other full-time jobs and have families of their own, so signing up for 12- or 24-hour shifts is no easy feat. The challenge has become even more severe as towns turn over to seasonal residents, so the volunteer pool shrinks.
Wise River Ambulance in the Big Hole Valley — which would have been the closest outfit to respond to the emergency Montana detailed in his video — shuttered in 2022 after failing to recruit volunteers after longtime responders stepped away. Local 911 calls are now dispatched to EMS services in Butte, Anaconda, Dillon or elsewhere.
Staffing challenges create logjams in how quickly an ambulance can respond to calls. First responders can find themselves having to choose between responding to a 911 call and providing transport to a patient who needs vital care in a different town, or juggling multiple emergency calls at a time with a shoestring staff.
Just last week, for example, Fisher said he had to turn down a transfer of a trauma patient from Clark Fork Valley Hospital, the critical access hospital in Plains, to Missoula because he was the only person on call.
The EMS department in Laurel, a town of roughly 7,000 people west of Billings, received 1,238 requests for service in 2023 and couldn’t respond to 14% of them due to staffing issues. When that happens, calls go out to surrounding counties to see if other departments have availability.
Laurel voters in 2023 approved a mill levy to bump up their own property taxes in order to generate funding for the ambulance service to bring on staff and reward longtime volunteers.
But some are eager to see more done than stopgaps or disparate county-by-county fixes.
“This has been an issue that has bothered me for a long time, knowing the gaps in service,” said Sen. Derek Harvey, a Butte Democrat who has been a first responder with the fire department for decades. “It always comes down to money and does the state see it as a priority to cover these areas?”
The Butte musician agrees.
“I am taking this straight to Helena,” Montana said. “I will make so much noise. These elected officials are going to hate me if they don’t do something about this.”
Carly Graf is the State Bureau health care reporter for Lee Montana.
