Ambulance Billing and Tax Dollars

Why does Kootenai County EMS charge for ambulance services and also collect property tax revenue?
Great question — and we’re glad you asked.

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Ambulance Billing

Kootenai County Emergency Medical Services System (KCEMSS) was designed to recover much of its operating costs through user fees rather than fully funding EMS services through property taxes.

However, KCEMSS has limited control over how much it is paid for most ambulance transports.

In 2024:

• 61% of patients were covered by Medicare
• 12% were covered by Medicaid

These government programs determine:

• The total allowable payment for ambulance services
• The portion assigned to the patient as their responsibility
• The amount that must be written off as a contractual adjustment

Medicare allowable rates (Medicare payment plus patient responsibility) are significantly lower than the actual cost of providing ambulance services. This is a well-documented national issue. Although Medicare conducted a multi-year ambulance cost data study, no major reimbursement changes had been implemented as of this writing.

In Fiscal Year 2024, KCEMSS wrote off more than $4.7 million in contractual adjustments due to government payer limits.

Because these amounts cannot be recovered from Medicare or Medicaid, KCEMSS must offset the shortfall using:

• Property tax revenue
• Grants
• Other supplemental funding sources

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Tax Dollars

KCEMSS operates as the Ambulance District for Kootenai County. Property owners will see this line item on their annual property tax assessment.

In FY2024:

• KCEMSS received $3.7 million in property tax revenue
• This was $1 million less than the amount written off in contractual adjustments that same year

What Does the Levy Rate Mean?

For 2024 the Ambulance District levy rate was: 0.00007340
(Just over $0.07 per $1,000 of assessed value.)

For example:

• A home with a taxable assessed value of $500,000 would pay $36.70 per year to support ambulance services.

KCEMSS maintains one of the lowest ambulance district levy rates in the State of Idaho.

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Why Both Billing and Taxes?

Ambulance billing alone does not cover the true cost of operations due to government reimbursement limits. Property tax revenue helps ensure:

• 24/7 emergency response coverage
• Trained paramedics and EMTs
• Equipment and ambulance readiness
• Community emergency preparedness

This blended funding model allows KCEMSS to provide reliable emergency medical services while keeping the tax burden comparatively low.

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Current Billing Rates: