Opt-out option for ambulance

As property tax remains a hot topic across the state, the idea of a tax opt-out may raise concerns for some taxpayers. But when it comes to emergency medical services (EMS), cutting costs could be more costly than you think. 

The Hill City Ambulance District has chosen to opt-out of the proposed tax levy—the maximum tax levy for ambulance districts is $0.60 per thousand dollars of taxable valuation. The service is asking for an additional $125,000 in order to maintain operations and continue providing adequate services to the area. 

To opt-out means the taxing entity—in this case the ambulance service—needs more money from property taxes than the state allows under current law. 

“We’re renewing one that has been in existence for what, the last 10 years?” said Bill Miner, the secretary of the board of directors for the Hill City Ambulance District. “It wasn’t something new; it’s a continuation.”

A separate opt-out helped fund the construction of a new ambulance building after the department lost access to its current housing at the expanding Hill City Volunteer Fire Department. The renewed request is aimed at covering daily operating expenses. 

“To staff and have equipment and everything for the ambulance to operate is very expensive,” said Miner. “The reimbursement that we get from insurance companies from Medicare/Medicaid, is only a fraction.”

A basic ambulance call costs around $1,200, according to Miner. But the service typically only receives around $680 in reimbursement. Sometimes, EMS crews respond to calls where the patient ultimately refuses treatment, releasing the individual from financial responsibility and leaving the EMS on the hook for time and resources used.

Compounding the issue is the fact that South Dakota does not consider EMS an essential service like police or fire departments. This means cities and counties are not required to provide EMS coverage. Having EMS is a local decision and brings about unique funding challenges.

“It’s very, very difficult for the rural ambulance services,” said Miner.

Efforts have been made to require counties and municipalities to provide EMS but it continues to get voted down in legislation. This year House Bill 1043 was introduced by Rep. Eric Emery to require counties and municipalities to provide EMS. The bill also aimed to create an EMS fund through increased court costs and state appropriation to support EMS, particularly in smaller communities. The bill, however, failed in the House Appropriations Committee due to concerns about creating unfunded mandates to local governments. 

“It comes back to who’s going to pay. A large area of West River is rural and sparsely populated. How do you fund medical services?” Miner said.

In rural areas, challenges with staffing and funding can lead to longer response times or, in some cases, no response at all.

Rural EMS closing their doors is not uncommon in South Dakota. In 2023, the Wall Ambulance Service faced potential shutdown due to financial and staffing shortages. Other communities, such as Enning and Bison, have also experienced temporary closures. 

When one rural EMS service shuts down, it places added strain on neighboring departments—many of which are already stretched thin—or forces emergency calls to be handled by agencies farther away, leading to longer response times. In critical situations, that lost time can be lost lives.

“You just think when you dial 911 someone will come, but that’s not always true,” said Miner.