Dear Payers: Stop Asking If MIH Works. Start Asking Why You’re Not Paying for It.

(article published by Orlando E Rivera, DNP, MBA, RN, Oct 7, 2025)

Mobile Integrated Health (MIH) is no longer theoretical. It’s a proven solution to many of the most pressing challenges in healthcare today, from unnecessary emergency department use to gaps in chronic disease management and post-acute care.

Yet, despite evidence of its success, many payers continue to refuse reimbursement. This article calls for an end to delay tactics and challenges insurers, CMS and Medicaid authorities to stop asking whether MIH works and start funding the programs that already do.

INTRODUCTION

The American healthcare system is stretched thin. Emergency departments are overcrowded, EMS crews are overwhelmed and patients often fall through the cracks of fragmented care.

Mobile Integrated Health (MIH) is the response we’ve been waiting for.

It bridges the gaps connecting EMS with primary care, public health and behavioral health services. And while EMS has long adapted to meet the evolving needs of patients, reimbursement models have not.

The question is no longer “Does MIH work?” The question is: “Why are we still not paying for it?”

EVIDENCE FROM THE FIELD - MedStar Mobile Healthcare (Fort Worth, TX)

What was once MedStar Mobile Healthcare (Fort Worth, TX), now integrated into Fort Worth Fire Department as of July 2025, had one of the most established and studied MIH programs in the nation.

Launched to serve high-frequency 911 users and patients with chronic conditions, the program demonstrated measurable results. According to MedStar Mobile Healthcare (2022):1

• 911 utilization was reduced by up to 80% among enrolled patients.

• Hospital readmissions fell by more than 50% for participants in chronic care management.

• Patients receiving home-based interventions reported increased satisfaction and confidence in managing their conditions.

Yet even with this success, MedStar highlights an ongoing challenge: sustainable reimbursement remains elusive.

Minnesota Department of Health – Rural MIH Evaluation

In 2023, Minnesota Department of Health (2023)2 conducted a robust evaluation of rural MIH programs across the state. The findings reinforced what EMS leaders already know:

• MIH reduced preventable ED visits among patients in remote areas.

• Paramedics delivering in-home follow-up care filled gaps left by provider shortages.

• Patients expressed high trust in the EMS clinicians delivering non-urgent care services.

Despite its effectiveness, the report emphasized that long-term funding remains a barrier to program expansion, particularly in underserved rural communities.

THE REIMBURSEMENT GAP

What do both Texas and Minnesota have in common?

They’ve proven that MIH can reduce costs, improve care and increase patient engagement but they’re still waiting for payment models to catch up.

The issue lies in outdated policies that define EMS primarily as transportation providers.

According to Centers for Medicare & Medicaid Services (2024),3 reimbursement is generally limited to medically necessary transports to approved destinations. There is no routine payment mechanism for treatment in place, navigation services, or in-home follow-up, unless the patient is transported.

This model not only discourages innovation, it incentivizes inefficiency.

WHAT HAPPENED TO ET3?

When Centers for Medicare & Medicaid Services (2022)4 launched the Emergency Triage, Treat and Transport (ET3) model, it was hailed as a game changer. It allowed EMS providers to receive Medicare reimbursement for treatment in place or alternative destinations recognizing that not every patient needs a hospital.

But despite early promise, CMS sunset the ET3 model in 2023. The final evaluation noted that while the clinical model was sound, participation challenges and inconsistent payer alignment hindered broader implementation.

The conclusion? MIH works. But without full payer engagement, it cannot scale.

STATES ARE READY. ARE PAYERS?

The National Association of State EMS Officials (2023)5 has published guidance on how states can use Medicaid waivers to fund MIH services. Several states are pursuing these options but progress is slow and fragmented.

State Medicaid agencies and commercial insurers must stop waiting for federal directives and start leveraging these waiver pathways now. EMS agencies are ready to deliver. The public is ready to receive. It’s the payer community that’s still hesitating.

WHO’S RESPONSIBLE FOR THE STALEMATE?

Let’s be clear:

• EMS has innovated.

• Patients have responded.

• Outcomes are documented.

Yet the programs remain grant-funded, patchwork and vulnerable.

So, who’s accountable?

• Is it CMS, for ending ET3 without a follow-up model?

• Is it commercial insurers, for continuing to reimburse outdated EMS definitions?

• Is it state Medicaid directors, for failing to operationalize waiver flexibilities?

Someone must step forward. Because the only thing worse than ignoring the data is forcing successful programs to shut down for lack of payment.

THE WORKFORCE COST OF PAYING LATE

The financial failure to reimburse MIH services is not just a billing issue, it’s a workforce one.

MIH programs require experienced, highly trained EMS professionals capable of autonomous decision-making, chronic care engagement and behavioral health de-escalation. But when funding is unstable, retention becomes unsustainable.

In Fort Worth, MedStar reported significant workforce satisfaction among medics participating in MIH, citing reduced burnout and increased patient impact as major motivators. Yet many of these same paramedics remain technically unbillable under existing CMS or commercial payer definitions because they didn’t transport the patient.

In Minnesota, rural MIH providers expressed concern that without reimbursement pathways, the burden of running these programs fell on a few highly motivated individuals, raising concerns about long-term viability.

If reimbursement continues to lag behind innovation, we risk losing the very professionals trained to carry these programs forward. Reimbursement isn’t just about financial sustainability, it’s about workforce retention, respect and realism.

CALL TO ACTION

To Payers:

You’ve seen the reports. You’ve witnessed the savings. Stop hiding behind outdated definitions and start reimbursing MIH for what it actually does: prevent emergencies, reduce costs and improve lives.

To CMS:

Reintroduce a national model that supports EMS as care providers, not just transporters. Leverage the lessons from ET3 and ensure payer participation is mandatory, not optional.

To State Leaders:

Use the Medicaid flexibility available to you. States like Minnesota have shown it works. Others must follow.

CONCLUSION

The value of MIH is no longer theoretical. It’s real. It’s measurable. And it’s being delivered right now in homes, communities and rural counties across the country.

But success without reimbursement is just a pilot. And pilots don’t scale.

The evidence is in. The failure to pay is no longer defensible.