Tuolumne County Health and Human Services Agency-Emergency Medical Services (EMS)/Tuolumne County Ambulance Services
Sonora, California — July 17, 2026
The County is providing the following information to ensure residents have accurate facts regarding the transition of ambulance services and recent public statements concerning Mercy Medical Transportation (MMT) and Manteca District Ambulance (MDA).
The County recognizes that emergency medical services are critically important to our community and understands the challenges experienced by EMS professionals who underwent a significant employment transition following MDA’s decision not to renew its contract. Recent public discussion has raised questions regarding the transition of ambulance services in Tuolumne County. To provide clarity and context, the County is sharing a factual timeline of significant events and actions taken throughout this process so residents have an accurate understanding of how decisions were made.
Background and EMS System Assessment
In February 2025, Tuolumne County contracted with Healthcare Strategists to conduct an independent, comprehensive Emergency Medical Services (EMS) System Assessment. The purpose of the assessment was to evaluate whether the County’s ambulance service model continued to best meet community needs, identify opportunities to improve system performance and response reliability, and develop recommendations for the future of EMS in Tuolumne County.
MDA’s Notice of Non-Renewal
On June 24, 2025, the County received written notice from MDA stating that it would not renew its Ambulance Services Agreement when it expired on June 30, 2026. This notification initiated the County’s process to procure a new ambulance service provider to ensure the continued delivery of emergency medical services without interruption.
Although MDA had announced its intent not to renew the contract, the County continued working to identify opportunities to help address MDA’s increasing operating costs through the end of the contract term while the EMS System Assessment was being completed.
On August 12, 2025, MDA requested amendments to its existing agreement, including:
- A one-time payment of $582,000 for increased personnel costs, including implementation of a 10% wage increase for field employees;
- County assumption of insurance responsibilities for County-owned ambulances and equipment; and
- Authorization to install vehicle cameras and telematics.
On September 2, 2025, HHSA informed MDA that it was prepared to seek Board approval for both the requested funding and insurance changes. To support that request, the County requested documentation regarding MDA’s operating budget, financial shortfalls, insurance costs, and vehicle accident history. HHSA also asked MDA to consider extending its agreement beyond June 30, 2026, until completion of the EMS System Assessment and implementation of its recommendations.
The County did not receive the requested financial documentation.
Within its proposal, MDA also advised the County that its employee health insurance program had become financially unsustainable and was projected to increase by approximately 11 percent beginning in December 2025.
On September 17, 2025, MDA declined the County’s proposal and instead indicated it would only discuss an entirely new agreement. Because a new agreement would require a competitive procurement process under County policy, the County would need to issue a Request for Proposals (RFP), allowing all qualified providers the opportunity to submit proposals.
Competitive Procurement Process
On November 4, 2025, Healthcare Strategists presented the completed EMS System Assessment to the Board of Supervisors.
Following the presentation, the Board accepted the consultant’s recommendation to continue the County’s public-private ambulance service model and authorized staff to conduct a competitive RFP process.
The County released the Ambulance Services RFP on December 19, 2025.
On January 5, 2026, A mandatory pre-bidders conference was held to review the RFP process, timeline, proposal requirements, and answer questions from potential proposers.
On January 19, 2026, MDA notified the County that it would not submit a proposal.
In its letter, MDA stated it could not responsibly submit a proposal because increasing costs associated with staffing, equipment, regulatory compliance, employee benefits, and overall financial sustainability had outpaced what it believed could be supported within the service model and RFP requirements.
On January 22, 2026, MDA expressed interest in obtaining a permit to operate as a private ambulance provider in Tuolumne County after their contract expires. Tuolumne County is not designated as an Exclusive Operating Area (EOA), meaning state law allows multiple-qualified ambulance providers to operate if they meet applicable County permitting and regulatory requirements.
Although Tuolumne County is not an EOA, no additional ambulance providers had sought to operate within the County for approximately 38 years. As a result, the County was required to establish and implement permitting procedures, clarify and revise portions of the ordinance, develop associated fees, and complete the necessary legal and Board approval processes before applications could be processed.
By the due date of February 13, 2026, the County received proposals from three qualified providers:
- Mercy Medical Transportation
- Oak Valley Hospital District
- Global Medical Response (AMR)
A five-member evaluation panel reviewed each proposal. Before the evaluation process began, all panel members completed conflict-of-interest and confidentiality statements and confirmed that they had no actual or perceived conflicts of interest with any of the three proposers.
Each proposal was independently reviewed, presentations were conducted, and vendors were scored using the criteria established in the RFP.
Mercy Medical Transportation received the highest overall evaluation score and was selected as the highest-ranked proposer.
Panelists Scores:
| Vendor | E1 | E2 | E3 | E4 | E5 |
| MMT | 80.0 | 95.0 | 90.0 | 95.8 | 79.6 |
| AMR | 60.0 | 72.0 | 77.2 | 86.6 | 76.6 |
| OVHD | 62.2 | 71.2 | 62.4 | 87.8 | 71.6 |
Transition to Mercy Medical Transportation, Inc.
Following contract negotiations, the Board of Supervisors approved an Ambulance Services Agreement with Mercy Medical Transportation on April 21, 2026.
Following Board approval, Mercy immediately began transition planning, recruitment of incumbent employees, hiring activities, and operational preparations.
The County’s agreement required Mercy Medical Transportation to make its best efforts to hire qualified incumbent non-supervisory employees and to provide wages and benefits comparable to those offered by surrounding rural ambulance providers. Although the benefits package differs from the one previously offered by MDA, information available to the County indicates that Mercy maintained the existing wage scale and implemented a competitive benefits package that includes employer-paid employee health insurance, multiple medical plan options, paid leave, holiday pay, and a retirement plan with employer matching contributions.
Certain operational training did not occur until after July 1 due to transition logistics and associated training costs.
Ambulance Permitting and Ordinance Updates
While transitioning a 39-year ambulance services contract from MDA to Mercy Medical Transportation, County staff simultaneously developed and implemented a permit process to comply with California requirements for a non-exclusive operating area. At the same time, the County worked to maintain a coordinated countywide ambulance system that supports public safety, consistent dispatch, and orderly emergency response.
To accommodate the new permit process, the Board of Supervisors amended the ambulance chapter of the Tuolumne County Ordinance Code on April 21, 2026.
On May 1, 2026, MDA submitted an application for a permit to privately operate in Tuolumne County. At that time, the County was still completing the legal, regulatory, and operational processes necessary to implement and administer the new permitting program.
On July 7, 2026, the Board of Supervisors further amended the ordinance code establishing updated ambulance provider application and permit fees, dispatch and information technology service fees, and an annual Consumer Price Index (CPI) adjustment. While private ambulance providers bill patients’ insurance and other payers for ambulance services, the County remains responsible for EMS oversight, system coordination, permitting, emergency dispatch, and information technology infrastructure. The adopted fees are intended to recover a portion of those public costs associated with operating within the County’s EMS system.
Moving Forward
Tuolumne County remains committed to providing reliable, high-quality emergency medical services for residents and visitors. Mercy Medical Transportation brings more than 30 years of experience providing ambulance services in both rural and urban communities, including neighboring Mariposa County and the San Diego region.
Following the Board of Supervisors’ approval of the Ambulance Services Agreement on April 21, 2026, Mercy worked within a limited transition period to recruit and hire more than 40 employees, complete required onboarding and training, implement new operational systems, and prepare an enhanced deployment model that includes additional ambulance resources to better serve the community. As with any transition of this magnitude, some training and operational activities continued after July 1 as new personnel, systems, and processes were fully implemented.
Throughout this process, the County’s decisions were guided by the recommendations of an independent EMS System Assessment, direction from the Board of Supervisors, and a competitive public procurement process designed to identify the provider best qualified to serve Tuolumne County.
The Board of Supervisors, County leadership, the Local EMS Agency, and the Health and Human Services Agency are not only responsible for overseeing the County’s emergency medical services system, they are also members of this community whose families, friends, neighbors, and loved ones might rely on these services in the event of an emergency. Like the community we serve, we care deeply about ensuring that every resident and visitor has access to safe, dependable, and high-quality emergency medical care. Throughout this transition, our priority has been, and will continue to be, the continuity of care and the delivery of exceptional emergency medical services for Tuolumne County.
The County recognizes that changes of this magnitude can be challenging for employees, patients, and the community. We appreciate the dedication and professionalism of all EMS personnel, past and present, who serve Tuolumne County and remain committed to working collaboratively with Mercy Medical Transportation and our public safety partners to ensure a reliable, coordinated, and high-quality emergency medical services system for our community.
