Toronto paramedics are facing a nearly $4 million shortfall thanks to a funding cut from the provincial government, according to a memo circulating among city officials.

On April 26, the Ministry of Health informed the city the province's 2019 land ambulance grant funding would remain static from the year before — and without a cost of living allowance increase, reads the memo from city manager Chris Murray.

According to Murray, Toronto Paramedic Services estimates having no hike to the cost of living in this year's grant will mean a $3.85 million shortfall to the city, the equivalent of a 3.5 per cent cut.

The memo also reveals the city's latest calculation for this year's overall shortfall is nearly $178 million — which includes funding changes for Toronto Paramedic Services, Toronto Public Health, subsidized child care, and funds the city expected from a planned hike to its share of gas tax revenue, which was scrapped by the province.

"They're cutting our ability to prevent diseases from happening in the first place, and now they're cutting our ability to respond to people when they get sick," said board of health chair Joe Cressy.

Mayor John Tory, who is currently in Los Angeles for meetings with television and film studios, also released a statement, saying the city "will keep making the case that these unilateral, retroactive cuts to child care and public health will hurt residents, especially kids and families, and threaten Toronto's prosperity."

This is extremely concerning as we are working hard with the City to develop a comprehensive 5 year staffing plan to support unprecedented emergency call volume growth. We would welcome consultation with the province on this matter. <a href="https://t.co/lhJC2XJut7">https://t.co/lhJC2XJut7</a> —@416TPSUnit

Premier Doug Ford's government, meanwhile, disputes the city's calculations on the total impact.

Ministry of health spokesperson Travis Kann also said the province is making investments toward reducing the time it takes to provide critical emergency care and stressed this year's paramedic funding freeze follows several years of hikes.

"Municipalities received a 5.8 per cent increase in land ambulance service funding in 2017 and a 5.3 per cent increase in funding in 2018," Kann said in a statement.

The amount provided to the city's paramedics in 2018, he noted, was roughly $106 million.

Health Minister Christine Elliott, during an interview with CBC Toronto, said this year's amount is "stable funding" that will give the fleet "ample opportunity and resources" to perform services.

By staying the same for 2019, the injection amounts to less than half of Toronto Paramedic Services' overall gross operating budget of roughly $234 million, which increased by nearly six per cent from the year before.

Concern over Toronto paramedic staffing levels

The static funding and lack of cost of living allowance hike follows rising tension over emergency response times and staffing levels within the city's paramedic fleet.

As CBC Toronto reported earlier this year, figures obtained from the city through Freedom of Information requests by CUPE Local 416, the union representing frontline paramedics, suggest the number of ambulances available to help Toronto residents is dropping to the point where emergency response times are hovering at around 40 per cent higher than provincial guidelines.

While the city has hired more than 200 paramedics over the last five years, coupled with additional hiring through the 2019 budget, union representatives cautioned actual staffing levels haven't risen since 2016 due to resignations and retirements.

"Paramedics are burning out left and right," said Mike Merriman, the paramedic and EMS unit chair for CUPE Local 416, who now worries the funding change could hinder further efforts to beef up staffing in the years ahead.

"There's an aging population, there are issues with the opioid crisis, and paramedics are stretched to the limits as it is," he said.

According to the city's latest budget documents, paramedics are expected to respond to a record 337,265 medical emergencies in 2019 — or nearly 1,000 a day.

But, during the 2019 budget process, city staff assumed pressures on the fleet would be "partially offset" by expected increases in ministry of health grant funding, which now no longer exists.

In Ottawa, local paramedics are also experiencing a similar funding freeze from the province, CBC Ottawa reported on Wednesday.