Email or print a PDF of this page. This might take 10-15 seconds.Voters will be asked to approve funding for emergency medical services (EMS), more commonly referred to as “the ambulance tax.”
Current law (federal, state, and local) allows variation in how government entities provide (or do not provide) emergency medical services (EMS), including ambulance services. Iowa’s statutes require local delivery of law enforcement and fire protection, which may deliver first-responder medical services in some instances. However, townships and city governments have historically collected the financial resources and infrastructure for Iowa’s EMS protection, with most of the actual service coming from volunteers. In more-urban areas, paid ambulance services provide reliable care, with most crews staffed at paramedic level.
Background
With voter approval, local governments can generate local funds for EMS in the form of local income surtaxes, local property taxes, or a combination of both. In 1992, the Iowa Legislature authorized the creation of EMS districts. For their support, voters may pass property tax levies of not more than $1.00 per $1,000 of assessed value on all the taxable property within the district. Later, the Legislature permitted a 1% local income surtax for counties to utilize for EMS. The tax revenue may be used to purchase or rent EMS apparatus, equipment, and material and to employ EMS and other personnel.
The first county to implement local taxes specifically to support EMS was Appanoose County, which imposed the maximum 1% surtax on its residents in 1994. The first cities to use the EMS property tax were Riceville and Sheffield.
In 2021, Iowa legislators changed the law pertaining to EMS to allow counties to seek voter approval for a local income surtax up to 1% and a property tax up to $0.75 per $1,000 of taxable valuation. The legislation still did not mandate EMS at the state level, instead maintaining local decision-making to ensure sufficient interest among residents in increasing their tax burdens for such services.
The ballot questions facing voters in 2024 reflect the most-recent EMS property tax law changes.
Counties Currently with EMS Levies
Shortly after the enactment of the 2021 law, eight counties placed referenda to introduce the new taxes on their November 2022 ballots, and five reached the required 60% threshold for passage: Jones, Kossuth, Osceola, Pocahontas, and Winnebago. Populations in the three other counties, Calhoun, Floyd, and Worth, did not.
Voters in Cedar, Benton, Ida, and Shelby Counties joined those with approved EMS property taxes in November 2023. Additional counties imposed the tax in 2024, with Louisa County voters approving the measure in March and voters in Henry and parts of Worth County doing so in September. According to the Iowa Department of Management, 12 counties currently use the EMS property tax for the 2025 fiscal year.
A Clarification of “EMS”
Iowa budget documents use the acronym, EMS, for two purposes. Emergency management services refer to all frontline response organizations and personnel who provide immediate assistance and support during emergencies. The primary objective of these agencies is to save lives, protect property, and ensure public safety during the immediate response phase of emergencies. This broader EMS includes police, fire departments, search and rescue teams, specialized response units, and emergency medical services.
Across Iowa, more than 3,000 separate entities govern and tax for emergency management services, including approximately 870 cities, 1,700 townships, several hundred emergency medical services departments, legacy benefitted fire districts and fire boards, 28E agencies,1 and non-profit corporations. Today, most fire departments list emergency medical calls as their most voluminous activity, in many cases comprising 70% or more of those departments’ annual responses.
To learn more about how your county funds emergency management, select the county name from the menu bar at the top of this page. Ambulance services are included in the “public safety & legal services” category.
1 28E references Iowa Code Chapter 28E, which permits the merging of two governmental entities to create a new “agency” that becomes its own governmental body with the purpose of providing a particular service, in this case fire and/or EMS protection.