A new state law allotting up to $84 million to rural ambulances may provide relief for regions such as Brewster County, as the company providing ambulance services for much of its area won’t renew its contract beyond May.
House Bill 3000, supported by the Texas Medical Association and approved by Texas lawmakers during the 2025 regular session, established a rural ambulance service grant program under the Texas Comptroller of Public Accounts’ purview. It will provide up to $84 million in financial assistance, allowing as many as 201 counties the opportunity to apply for the grants, according to a Comptroller’s office spokesperson.
“People talk about having a single standard of care across the state, and that’s just not possible because of the lack of population in certain areas and the ability to get there,” said Robert Emmick, MD, a member of TMA’s Committee on Emergency Medical Services and Trauma (CEMST).
“We’re glad they did it, and we’re glad that it’s happened,” he said regarding the state’s commitment to ambulance grants. “But to make it work, it’s going to take a prolonged commitment.”
Per the legislation, a Texas county with a population of less than 10,000 may apply for up to $500,000, and one with a population of 10,000 to 68,750 can apply for up to $350,000. More than 40 counties have applied as of this writing; the initial application window opened Jan. 1 and remains open through Jan. 31. Initial grant winners will receive money between February and May. The Comptroller’s office has more information about the program on its website, including how county judges can apply for the funds.
Counties will have up to five years to spend the funds, which are earmarked for ambulance purchases, though counties are free to choose which vendors to work with, per the Comptroller’s office. It can’t be used for other purposes, including hiring emergency medical services (EMS) professionals.
The program comes at a fortuitous time for Brewster County – which, at nearly 6,200 square miles, is Texas’ largest county, yet with a population of less than 10,000.
Emergent Air, which has provided EMS for north Brewster County since May 2022, will not renew its contract for ground ambulance travel beyond its May 2026 expiry. They handled an annual average of 600 trips to Big Bend Regional Medical Center, the region’s only hospital.
Brewster County Judge Greg Henington, serving as the county’s head of emergency management, applied for funds under HB 3000 “in the first 20 minutes it was open.”
Judge Henington believes that $500,000 could fund three van ambulances that would serve north Brewster County’s needs.
“The cost of an ambulance and equipment can run as high as $500,000 to $600,000 per vehicle,” said Joe Schmider, State EMS Director for the Texas Health and Human Services Commission. “HB 3000 will support the purchase of new ambulances and equipment by not putting a funding burden on rural organizations.”
Meanwhile, Emergent Air has pledged to temporarily provide ground ambulance services to local hospitals beyond the contract’s end date while the county works out its transition plan, according to Adrian Billings, MD, an Alpine family physician and a member of the Texas Medical Association’s Council on Legislation. Dr. Billings is part of a task force negotiating the transition to a new EMS solution.
Even with an intact EMS system, Dr. Billings says Brewster County faces challenges endemic to rural health care.
“We’ve had patients show up in the back of pickup trucks with CPR in progress,” he said. “Rural medicine is often a system of onesies – one EMS unit, one general surgeon, one emergency room doctor, one pharmacy. And when it doesn’t take much for one of those people to go out of the system, then you don’t have anybody on the bench to pull in. It’s the unfortunate reality of rural medicine.”
Those attending TexMed 2026 in Corpus Christi will have the opportunity to help with another EMS initiative – CEMST is co-hosting a blood drive on Friday, April 17, and Saturday, April 18, reflecting statewide efforts to boost prehospital whole blood supplies.
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.