West Virginia EMS Funding 101

This post provides an overview of emergency medical services (EMS) funding in West Virginia. As outlined below, virtually all of the state’s counties have developed their approaches over the years, and further exploration of this subject is expected.

An Overview
  • West Virginia does not have a statewide, permanent funding source for emergency medical services (EMS).
  • Under state law, local governments are not obligated to provide EMS (see below for additional information).
  • Most counties provide some level of financial support for local EMS, but the level of support varies substantially.
  • The state government has recently provided additional dollars to help support EMS in West Virginia, but these programs and funding are not currently permanent.
  • EMS in West Virginia is generally delivered through a combination of local government-affiliated services, nonprofit organizations, for-profit corporations, and services affiliated with fire departments. Historically, most of them have operated independently of the local government.
  • The state Office of Emergency Medical Services, restricted by its funding and capacity, performs a largely regulatory role.

What to watch: The West Virginia EMS Coalition has worked to lobby legislators for permanent financial solutions at the state level. This session, they’re advocating for another year of salary enhancement dollars and a new program for ambulance funding.

Overview and Background

West Virginia does not have a statewide, permanent funding source for emergency medical services (EMS). As a result, counties are faced with the challenge of ensuring EMS is available – but they are not required to by state law. Communities around West Virginia, if they choose to, fund EMS through a combination of ambulance fees, excess levies, and general budget support. There are some federal EMS grants available but are generally restricted to nonprofits and government entities for short-term needs.

Recent Developments

In 2022, the state launched the “Answer the Call Initiative,” allocating $10 million in financial support for EMS provider training. The one-time funding originated from federal COVID aid. Additionally, legislators passed a bill creating a “salary enhancement fund” aimed at supplementing the wages of EMS providers in West Virginia; however, a permanent funding source was not identified. Subsequently, a separate bill was passed to allocate additional funds to local fire departments, with permission for use in emergency medical services under specific circumstances. Despite efforts from the WV EMS Coalition, attempts to secure financial support for initiatives such as an equipment fund have been unsuccessful.

State Office of EMS

The West Virginia Office of Emergency Medical Services (OEMS) operates as a state agency under the Department of Health and Human Resources (DHHR). Primarily focused and funded for regulatory functions, the office oversees tasks such as EMS agency licensing, personnel certification, trauma center designation, and other relatively specific responsibilities.

The office has faced funding changes over the past decade, leading to diminished capacity and placing a heightened financial strain on agencies pursuing licensure. A report from the WV EMS Coalition indicates that agency fees have increased, primarily in response to the office requiring additional revenues due to budget cuts from the state’s general funds.

Local Funding

In rural communities, like those in West Virginia, EMS organizations might be named after the town or county they serve but often function as financially independent entities. As mentioned earlier, counties are not obligated under state law to provide emergency medical services. Furthermore, there is no permanent funding stream allocated to counties for the operations of local 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 the approval of 60% of voters (see the 2024 legislative session for clarification or changes on this requirement). 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 involves 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 a 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.

Map LabelDescription
Ambulance FeesThese counties have ambulance fees, all of which provide above-average local funding (on a per-capita basis).
Excess Levy for EMS – Tier AThe counties listed in this tier provide (on a per-capita basis) above-average funding to local EMS (among EMS excess levies only).
Excess Levy for EMS – Tier BThe counties listed in this tier provide (on a per-capita basis) below-average funding to local EMS (among EMS excess levies only).
Significant General
County Funds for EMS
These counties provide above-average local funds out of their general revenues – without excess levies or ambulance fees.*
No or Limited County Funds Allocated for EMSThese counties fall into the following criteria: informal financial support (such as one-time donations), limited financial support, or no financial support at all.
Information PendingInformation is pending and will be coming soon. If you have any information to contribute from these counties, please contact me.
Important Note: “Above average” as mentioned above only takes the raw amount of funding provided into consideration. It does not include other important potential variables, such as geography, distance to closest hospitals, and other important financial factors.
*More analysis/review is needed for these counties.

Map Source: WV State Auditor’s Office, county websites, and direct correspondence with county leaders.