Imagine calling 911 for a medical emergency and being told no units are available. For many rural communities in Iowa, that scenario is becoming increasingly common. Unlike fire and police protection, ambulance service in Iowa is not considered an “essential service” under state law. This means local governments are not required to provide or contract for EMS, nor is there a dedicated funding mechanism to sustain it long-term.
A Petition for Reliable Funding
The Lisbon-Mt. Vernon Ambulance Service (LMVAS) is taking steps to change that reality for its communities. LMVAS has submitted a petition to the Linn County Board of Supervisors seeking creation of a Benefitted EMS District under Iowa Code Chapter 357F. The service will soon present a similar petition to the Johnson County Board of Supervisors, along with separate petitions to the Mount Vernon and Lisbon City Councils under Iowa Code Chapter 357G to form City Emergency Medical Services Districts.
If approved, these districts would establish a dedicated and reliable funding stream to support ongoing ambulance operations in rural areas around Lisbon and Mount Vernon.
The Strain on Rural EMS
For now, LMVAS relies heavily on billing revenue, modest municipal contributions, grants, fundraising, and a core group of volunteers. But pressures on rural EMS are mounting. Across Iowa, services are closing their doors, forcing neighboring agencies to absorb calls. This leads to longer response times and added strain on already thinly stretched providers.
A “perfect storm” of challenges including fewer certified EMS providers, rising equipment costs, and stagnant insurance reimbursements is making sustainability increasingly difficult in rural areas, where few alternative funding sources exist.
Challenges for LMVAS
Although LMVAS currently maintains enough revenue to operate, the lack of consistent and reliable support threatens its future stability. Call volumes have doubled over the last seven years, and the Iowa Bureau of EMS has reported a steady decline in certified providers every year since 2018. Volunteer-based services like LMVAS face added hurdles, as many community members cannot commit the time required for lengthy training, especially at advanced levels such as Advanced EMT or Paramedic.
Modern volunteerism also presents challenges: busier family and work schedules mean more volunteers are needed to cover the same number of shifts. Advanced training further complicates staffing, with Paramedic certification requiring a full-time, one- to two-year commitment. Rising tuition costs add to the burden, while ambulance revenues remain stagnant. Medicare reimbursement, which covers about 62% of transports, has seen only minimal increases. Medicaid, covering roughly 13% of transports, has not increased reimbursement rates in more than a decade.
What Happens Next
The Linn County Board of Supervisors will review LMVAS’s petition and decide whether to move forward. If approved, the proposal would advance to a public hearing and could ultimately require a vote of eligible rural residents. Similar petitions will go before the Mount Vernon and Lisbon City Councils, with the goal of establishing three coordinated EMS districts.
In March, a special election is scheduled to select local trustees and set a property tax levy. The current plan would fund 24/7/365 paramedic staffing, ensuring at least one paramedic is always on site to reduce response times for life-threatening emergencies.
For homeowners, the estimated cost is about $94 annually or roughly $7.80 per month for a $300,000 home.
A Sustainable Future
Formal EMS districts not only provide long term reliable funding, but would also open LMVAS to additional funding programs such as a federal Medicaid supplement program, which could generate an additional $40,000 in revenue each year. Together these programs will allow LMVAS to provide Excellent EMS care well into the future.
By saying “Yes” to a Joint Lisbon-Mt. Vernon Area Ambulance District, you are saying “Yes” to a sustainable future for our locally operated ambulance service and saying “Yes” to maintaining Excellence in EMS for Lisbon, Mt. Vernon, and the rural areas we serve! If you have questions, would like to learn more, or invite an LMVAS representative to talk to your organization reach out to us at [email protected] or visit our website at www.lmvas.org.