Mills County supervisors vote to place EMS funding measure on the ballot after advisory council recommendation

The Mills County Board of Supervisors voted to place a proposed funding measure for emergency medical services on the ballot this fall after hearing an advisory-council report that described staffing shortages, aging volunteers and mounting equipment costs.

Advisory-council chair Michael George and EMS presenters outlined a two-option funding framework authorized under Iowa law: an ad valorem property levy (up to $0.75 per $1,000 of assessed valuation) and an income surtax tied to the state income tax base. The council recommended the board pursue a ballot initiative “up to 75¢ per $1,000 valuation,” and proposed that an EMS trust fund be overseen by the EMS Systems Advisory Council while final expenditure authority remain with the board.

Presenters highlighted operational strains countywide. John Stacy, representing local fire/EMS leadership, urged the board to consider coverage gaps shown on service maps and longer round trips for transport, warning that districts without a transport squad can be responsible for roughly 150–300 square miles when a neighboring service is out. “It's becoming unacceptable to drive 20 to 25 miles to get to a patient,” Stacy said, noting some round trips reach about 100 miles.

A county EMS presenter identified only as Matt described workforce and cost pressures: average responder age “is 60 years plus,” volunteer recruitment is declining, training and biennial CEU requirements are time-consuming, and equipment costs are high — a new ambulance was cited at roughly $398,000 and cardiac monitors at about $70,000 each. The presenters also illustrated the limits of billing revenue, saying insurance write-offs often leave agencies recovering approximately 40–45% of billed charges; one example used in the presentation described a $2,500 billed claim that yielded $33.87 in reimbursement.

The advisory council provided fiscal examples tied to Mills County valuations (presenters cited a FY2026 county assessed valuation of about $1,300,000,000). At a levy of 15¢ per $1,000, the council estimated just over $200,000 in revenue; at the full 75¢ per $1,000, they estimated just over $1,000,000. Presenters gave household examples: on a $210,000 assessed-home example, a 15¢ levy equates to roughly $15 per year while a 75¢ levy would be about $75 per year. The presenters clarified that the income surtax applies to the Iowa state income tax base (an example used: a 1% surtax on a $100,000 income tax base would be about $38/year), not to gross income.

After board discussion and public clarification, a motion to allow the EMS funding measure to be placed on the ballot this fall was made and seconded. Roll call recorded Sayers: Aye; Miss Crouch: Aye; Mayberry: Yes. The chair announced the motion carried.

Next steps included drafting ballot language and further coordination with county staff and the EMS Systems Advisory Council. The council recommended the trust fund be administered under the advisory body with annual expenditure recommendations brought to the Board of Supervisors.