West Virginia EMS Funding 101

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Overview and Background

West Virginia does not have a statewide or permanent funding source for emergency medical services (EMS) at the state level. As a result, local communities are faced with the challenge of ensuring EMS is available – but they are not required by state law. In fact, most states don’t consider EMS an “essential service” like fire protection or law enforcement. However, many states have funding mechanisms in place to support local EMS organizations without this designation.

Recent Developments

In 2022, the state created the “Answer the Call Initiative,” which provided $10 million in financial support to EMS provider training. The source of the one-time funding came from federal COVID aid. Legislators also passed a bill creating a “salary enhancement fund” that would supplement the wages of EMS providers in West Virginia, but did not provide a permanent funding source. The Legislature also recently passed a bill providing additional money for local fire departments, and the money is permitted for emergency medical services in some circumstances. The WV EMS Coalition has pushed the Legislature for other financial support, like an equipment fund, but this has been unsuccessful.

State Office of EMS

The West Virginia Office of Emergency Medical Services (OEMS) is state agency under the Department of Health and Human Resources (DHHR). Much of the office’s work is largely regulatory, for example, EMS agency licensing, personnel certification, trauma center designation, and more fairly narrow functions. The office has experienced funding cuts over the last decade, resulting in less capacity and an increased financial burden on agencies seeking licensure. Agency fees have risen, according to a report from the WV EMS Coalition, largely because the office needed additional revenues given budget cuts from the state’s general funds.

Local EMS

In rural communities, such as those found in West Virginia, EMS organizations might bear the name of the town or county they serve but often operate as financially independent entities. As previously mentioned, counties have no obligation under state law to provide emergency medical services. Additionally, there is no permanent funding stream of money to counties to provide EMS.

This has resulted in quite varied approaches in the state. If county governments want to provide local funding, they essentially have three options: excess levies, ambulance fees, and general county budget support.

Excess levies, currently utilized in 18 counties, are the most common source of local EMS funding in West Virginia. Unlike the other funding methods mentioned on this page, excess levies must appear on voters’ ballots and require approval of 60% of voters. They can be in place for a maximum of five years before renewal is required.

In short, when voters approve excess levies, they are allowing the county government to exceed its maximum levy rates. For counties, the downside of excess levies involve the fluctuating nature of tax collections, fairly short terms, and achieving the support of 60% of voters. Several counties, including Wayne, Tucker, and Monroe, have had voters reject EMS excess levies.

"Even the agencies that are fortunate enough to receive funding through a county ambulance levy are dependent on insurance reimbursement for much of their operating revenue. Multiple counties have experienced declines in levy collections as property assessments have dropped in coal and other industrial communities. One southern West Virginia county has experienced a 42% decline in ambulance levy collections between 2015 and 2021."

- WV EMS Coalition, Level Zero: Funding and Workforce Shortages Place EMS Response at Risk in the Mountain State

An ambulance fee, not to be confused with a bill for using an ambulance, is essentially a tax that can only be used to help provide EMS at the county level. They are generally billed on a per-household basis, and some counties require businesses to pay as well. Unlike excess levies, ambulance fees can be imposed without direct voter approval, only requiring the majority vote of the county commission.

While this funding mechanism can provide substantial financial support, imposing a new tax can have its challenges. For example, Monroe and Tucker counties have repealed their ambulance fees amid public pushback.

A handful of West Virginia counties offer significant financial support for EMS out of their general revenue budgets, meaning they don’t have a special source of revenue like the ones outlined above. Putnam County, for example, takes this approach. This method of support is not particularly popular as most counties generally require a special funding mechanism.

More common are one-time donations, funds for specific purchases, and in-kind contributions from county general revenue budgets. This type of financial support is often irregular, and tracking this type of support is very difficult to analyze given the limited available information.