Sonora, CA — There are questions about who will provide ambulances services for Tuolumne County when the existing contract with Manteca District Ambulance (MDA) expires on June 30, 2026.
MDA has provided a notice of intent not to renew the current agreement, due to rising costs, but has expressed a desire to work out a revised contract.
The Tuolumne County Health and Human Services Agency has released an update to the community detailing the situation, noting that the county is preparing to launch a competitive Request for Proposals (RFP) to find the best path forward.
The decision comes following several months of negotiations and a comprehensive review of the County’s Emergency Medical Services (EMS) system. The Tuolumne County Board of Supervisors recently voted to maintain the current public-private partnership model and move forward with the RFP process in hopes of ensuring stable and high-quality 9-1-1 response and critical patient transfers.
The county update released notes that the situation began on June 24, 2025, when MDA informed the County’s Health and Human Services Agency (HHSA) of its intent not to renew the existing contract. Though MDA expressed interest in a new agreement, county policy, mandated by state law, is that any new contract be established through a competitive RFP process.
In July 2025, amidst an ongoing independent EMS system assessment, MDA submitted a proposal to amend the current contract, citing financial pressures. Their requests included:
- The county assuming insurance responsibilities for the ambulance fleet and emergency equipment.
- A one-time disbursement to cover rising personnel costs for the remainder of the current fiscal year.
- Permission to install drive cameras and telematics on vehicles at MDA’s expense.
In August, Tuolumne County supported the requested one-time funding and the assumption of insurance coverage, pending Board approval. However, the County included specific conditions for the amended contract, including:
- MDA retaining responsibility for insurance deductibles in cases where their personnel were at fault for collisions.
- County access to DMV records for MDA personnel for insurance purposes.
Additionally, HHSA requested a six-month contract extension to guarantee service continuity while the EMS system assessment was finalized.
On September 17, 2025, MDA declined the proposed amendment and the extension, citing the conditions as unacceptable. MDA directed that all subsequent contract communication be addressed to their Board of Directors, effectively ending the negotiation with the direct leadership team.
An independent EMS assessment, conducted by Healthcare Strategists, presented preliminary findings to the Board of Supervisors on November 4, 2025. The assessment reviewed the entire system, including response times, interfacility transfers, and operational structures.
The strategists offered three possible models for the future of Tuolumne County’s EMS system:
- Maintain the Status Quo: Continue the current public-private contractual partnership by issuing a new RFP. (The County owns all vehicles and equipment, but contracts with a private entity for operations).
- Establish an Exclusive Operating Area (EOA): Pursue a lengthy state approval process to fully privatize the system under a single contract.
- Bring Operations In-House: Transition ambulance services to direct County management, hiring all EMT, paramedic, and management staff.
County staff recommended maintaining the current successful public-private partnership and initiating a competitive RFP. The Board of Supervisors subsequently approved this recommendation.
“A reliable, high-performing ambulance system is essential to protecting public health and safety,” an HHSA representative noted in the community update. “Residents and visitors depend on rapid 9-1-1 response times, safe transport, and coordinated medical care—especially in a geographically diverse county.”
The Board also approved an extension of the Healthcare Strategists contract on November 18, 2025, to secure their support in developing the new RFP. The Request for Proposals, which could include MDA and potentially others, is expected to be released in the near future.
