Kuyahoora Valley Ambulance Corps may have to close due to low membership and high costs and other organizations could follow if something doesn't change.
"This is becoming a crisis in Upstate New York," said Assemblyman Robert Smullen.
Greg Eisenhut has worn many hats over the years, but he's currently the Mohawk Valley Ambulance Corps' President.
It's allowed him to have an in-depth understanding of challenges facing rural ambulances.
"There's a disaster waiting to happen here unless the system is fixed," Eisenhut said.
MOVAC transitioned to paid staff years ago, but the rural service is also struggling due to low payments from Medicaid and Medicare, which is what covers most of their patients.
"We cut all forms of waste that we can cut," Eisenhut said. "We patched together ambulances that probably are worn out and outdated because no bank will give us financing."
With Medicare, MOVAC gets back an average of 30 to 36-percent and with Medicaid 10 to 16-percent. Responders said they frequently lose money just by doing their jobs because reimbursement rates so low.
The problem isn't exclusive to Kuyahoora and MOVAC. The rates are being studied by state leaders who are also looking at how to get EMS considered an essential service.
"That would allow some level of support from the local governments, but what we want to make sure with that is, is that that's what the local governments want," Smullen said.
The absence of a service can affect other agencies. Herkimer County's Emergency Services Director John Raymond said, even now, organizations can get tied up taking calls.
"What happens is so that ambulance is not responding, and not answering, it starts putting a strain on other ambulances and other services," Raymond said. "They're pulling an ambulance out of their area to cover a call there. Then they get a call, and it kind of creates a daisy chain or chain reaction."
MOVAC's President said change needs to happen soon to keep ambulances running.
"Leaders have got to come together and say, 'How fast do we want response times to be?'," said Eisenhut.
Ambulance companies say there are also issues with direct pay when it comes to private insurance, and that's because, sometimes, people just don't pay up. The crew at Kuyahoora is asking towns in their district to consider a new tax.
There's a push for change in Onondaga County too. The Chairman of the legislature is calling on state leaders to raise Medicaid transportation reimbursement rates, which he says haven't budged in nearly a decade.