By Abigail Roberts
Lincoln County EMS (LCEMS) may have to make some changes to ambulance operations in the county due to increasing financial instability, according to a report from the LCEMS Board of Directors.
It’s not a problem that is unique to Lincoln County – rural EMS agencies across the nation are facing budget issues due to inadequate reimbursements as well as rising costs in fuel, supplies, equipment and employee benefits.
In 2017, Lincoln County’s ambulance services were consolidated into one countywide system and the tax rate was raised to sustain the consolidated system. Currently, Lincoln County EMS operates and maintains four EMS bases across the county to provide adequate coverage to all residents. The goal of consolidation was to create a stronger, more reliable emergency medical response system for all of Lincoln County.
About 36% of the LCEMS budget is derived from the Ambulance Taxing District, which gives quarterly disbursements. Disbursements for the 2025-26 fiscal year totaled a little under $1.3 million, according to LCEMS Director Ashley Powell. LCEMS expenses for the year was about $3.7 million.
Powell said about 62% of the budget comes from billing reimbursements and the remaining 2% comes from grants.
Transportation reimbursement rates are legislatively driven and not decided locally. Legislation to address the growing concern and rising costs failed to make it out of committee this year, Powell said.
House Bill 447 would have required insurance companies to reimburse ground ambulances at a rate set by the local government, or, if there is not a local rate set, 400 percent of the Medicare rate or an out-of-network provider’s billed charges.
Powell said until the federal and state governments pass legislation to combat the issue, rural EMS agencies will continue to have to make tough decisions.
While it would not solve all of the financial issues, the LCEMS Board of Directors is asking the Lincoln County Ambulance Board to approve a four-percent tax revenue increase in hopes of covering the cost of living increases. LCEMS employees have not received a raise in the last five years, he said.
LCEMS has requested a four-percent revenue increase in the property tax rate each year, but it has only been approved once since 2017.
“We’ve increased less than $100,000 in nine years,” Powell said.
The LCEMS report said a four-percent revenue increase would generate an estimated $50,000-$70,000 in additional revenue.
“In 2017 the tax rate was set at 9.8 (cents per $100 value) to support the countywide consolidation,” a report from LCEMS states. “Each year that number has dropped (compensating rate) to bring in approximately the same money as 2017.”
The compensating rate was 7.8 cents per $100 of assessed value for the 2025-26 fiscal year, according to the report.
“For most years, that has meant little to no increase in money,” the report states. “To make up for past years and to secure the continued service footprint of operations, an increase in tax rate must be taken.”
LCEMS says they could restructure current operations by closing one station and reducing daily staff to 7 employees but the board said that would increase response times to the affected area of the county, place greater strain on staff and equipment and risk further staff attrition in an already challenging recruitment environment.
“Currently we are less-paid than surrounding counties on an hourly rate,” he said. “The importance of recruitment and retention of qualified personnel…it makes it difficult when you can’t compete.”
Property tax rates have dropped as assessment values have risen, he said.
“So in 2017 we were at 9.8 (cents per $100 of assessed property value) and in 2025 we’re at 7.8 cents,” he said. “So it has dropped two whole cents per $100.”
Had the Ambulance Board taken the 4% revenue increase each year, it would have generated an additional estimated $1.8 million over the 9-year period, Powell said.
Beginning July 1, LCEMS will be “browning out” one station every day on a rotating basis for the least busy stations (Station 3 in Waynesburg and Station 4 in Crab Orchard).
“That means for a short period of time we would not staff that location,” he said. “For the most part there will be days or times of days that those two stations will not be staffed.”
The stations will still be in operation, there will just be some days, or certain times of some days, that they will not be staffed. Ambulances will still be covering the entire county, Powell said.
“LCEMS has no choice but to make cuts to secure the future of the Ambulance Service,” the LCEMS report states. “If we don’t scale back now until we see an increase in funding, then the sustainability of our whole system is in jeopardy. We would rather make cuts now and be sustainable than run the risk of not having a system to provide service at all in the future.”
Powell said expense growth is outpacing revenue growth with an overall increase in expense at 6 to 10%.
Liability insurance increased by 11% since last year. Health Insurance increased by 50% over the last couple of years, Powell said. The price of ambulances has increased by 100%. The cost of medical supplies has increased 25% over the last four years. Medical equipment has risen by 25% in the last five years.
Last year alone LCEMS saw a 45% increase in fuel costs. Electric costs also rose by 5.9% last year.
“The U.S. inflation calculator said the healthcare cost inflation has gone up 25.8% since 2017,” Powell said. “So while 64% of our budget comes from healthcare reimbursements, billing revenue, stuff like that, there really needs to be an increase in that as well.”
Powell said LCEMS is not in danger today, but they are looking at the foreseeable future and planning accordingly.
“Ambulance services of our size around the state, with our call volume, typically run 2 to 3 trucks a day. We have been running 4 trucks to man the 4 stations. I call that a Cadillac system. So to be able to maintain the Cadillac system that was set up in 2017 it’s going to take more revenue to continue to operate that system,” he said. “It doesn’t mean that no one is going to get an ambulance, in any area, it just means that we are moving forward until we get some kind of increase amount that is sustainable. We have to evaluate going back to a regular system that is equivalent to surrounding areas.”
Some surrounding states have passed legislation to increase commercial insurance payments, he said. But Kentucky has yet to make that happen.
“Our goal is to maintain the system that we can live with and have rather than riding the Cadillac system out until there is no funding left,” Powell said. “LCEMS Board of Directors is being proactive in the sustainability of the Lincoln County EMS system.”
SO YOU KNOW
The Lincoln County Ambulance Board meets at 7 p.m. on the third Monday every month. The board meets at the Lincoln County Courthouse.
You can find the full LC EMS Financial Sustainability report below:
