December 3, 2025 - On Tuesday, Tuolumne County officials provided the following Community Information update on Ambulance Services:
Importance of a Strong Ambulance System
A reliable, high-performing ambulance system is essential to protecting public health and safety in Tuolumne County. Residents and visitors depend on rapid 9-1-1 response times, safe transport, and coordinated medical care—especially in a geographically diverse county where travel time and resource availability directly influence health outcomes. An effective system also ensures timely interfacility transfers between the local hospital and higher-level care centers, a service currently provided through the County’s contracted ambulance provider. These transfers are vital to patient outcomes, supporting continuity of care and ensuring individuals receive the appropriate level of treatment without delay. Ensuring long-term stability, accountability, and system resilience is a central priority as the County prepares for the next ambulance services contract.
Background
On June 24, 2025, Manteca District Ambulance (MDA) notified the County that it would not renew the existing contract but expressed interest in considering a new agreement.
County policy, however, requires any new agreement to be established through a competitive RFP process.1
During this same period, an independent EMS system assessment was already underway. Conducted by Healthcare Strategists, the assessment was evaluating all components of the County’s emergency medical services system—including 9-1-1 response, interfacility transfers, operational structures, and system sustainability—with the goal of providing recommendations for enhancements.
In July 2025, the County's Health and Human Services Agency (HHSA) invited MDA to submit a proposal addressing financial pressures impacting the remainder of the current contract term. MDA requested the following:
- County assumption of insurance responsibilities for Ambulance fleet and all associated emergency response equipment
- Permission to install drive cameras and telematics at MDA’s expense on all emergency response vehicles
- A one-time disbursement for rising personnel costs to be added immediately to MDA’s FY 24/25 contract.
1 No ambulance provider has operated continuously in Tuolumne County since June 1, 1980; therefore, none meet the requirements of Health and Safety Code Division 2.5. In cases where this provision is not met, the standard practice in California is to secure EMS services through a competitive procurement process.
County Response and Negotiations
On August 29, 2025, HHSA responded in support of the requested one-time funding in addition to the current contract amount and the assumption of insurance coverage, pending Board of Supervisors approval. HHSA outlined key conditions for consideration of an amended contract:
- MDA responsibility for insurance deductibles when contracted MDA personnel are at fault for vehicle collisions
- County access to DMV records for MDA personnel for insurance coverage purposes
- Submission of budget documentation, insurance premium information, and a five-year accident history
HHSA also requested a six-month contract extension to maintain service continuity while completing the EMS system assessment.
On September 17, 2025, MDA declined the proposed amendment and extension, stating that they were unwilling to accept the specified conditions. They further indicated that any additional communication regarding the contract should be directed to the MDA Board of Directors, rather than to the direct leadership team who had previously been handling the negotiations.
EMS System Assessment and Board Action
On November 4, 2025, Healthcare Strategists presented preliminary findings from the County’s EMS Assessment. Various EMS models were presented as options for the Board’s consideration, including the following:
- Maintain the status quo: Continue the current public-private contractual partnership and issue a new RFP. In this county, the County of Tuolumne has been the sole provider of ambulance services, owns all the vehicles and equipment, but contracts with a private company for personnel to operate them.
- Establish an Exclusive Operating Area (EOA): Pursue lengthy State approval for an EOA and fully privatize the system through a single contract, which would require dissolution of the Ambulance Enterprise Fund.
- Bring operations in-house: Transition ambulance services to direct County management by hiring EMT, paramedic, and management staff positions to oversee and operate daily ambulance functions.
Staff recommended maintaining the public-private model and initiating an RFP. The Board of Supervisors voted in approval for this recommendation.
On November 18, 2025, the Board approved an amendment to Healthcare Strategists’ contract to extend their work and support the RFP development.
Next Steps
Health Care Strategists is currently preparing the Request for Proposals, which will be released in the near future.
Contact
Tuolumne County Health and Human Services Agency
Michelle Clark, Assistant HHSA Director
(209) 533-5711
mclark@co.tuolumne.ca.us
Source: Tuolumne County
