Emergency Medical Services (EMS) Home Rule State Law Fact Sheet Tables

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Table 1: Summary of Laws Pertaining to Local Government Autonomy and Local EMS Funding Mechanisms, in Effect as of January 31, 2022

Table 1, Summary of Laws Pertaining to Local Government Authority and Local EMS Funding Mechanisms
Alabama California Georgia Massachusetts Ohio
Permitted Local Taxes
  • Property
  • Property
  • Sales
  • Realty Transfer
  • Property
  • Sales/Excise
  • Property
  • Property
  • Sales
  • Realty Transfer
Special Districts Authorized
  • Tax Increment (state authorization required)
  • Fire Services
  • Hospital
  • Emergency Medical Services
  • Community Services
  • Health
  • Tax
  • Fire Services
  • General Services
  • Tax
  • Fire Services
  • Special Improvement
  • Tax
  • Fire Services
  • Hospital
  • Emergency Medical Services
Local Fees Authorized
  • User/Services Fees
  • User/Services Fees
  • General Fees
  • User Fees
  • Impact Fees
  • License Fees
  • User/Services Fees
  • License Fees
  • User/Services Fees

Local Tax Restrictions

 Alabama California Georgia Massachusetts Ohio
Authorized Public Purposes for Local Property Taxes
  • Debt Repayment
  • Capital Expenditures
  • Hospitals
  • General Health Care
  • Debt Repayment
  • Capital Expenditures
  • Fire Services
  • Public Safety
  • Health
  • Hospitals
  • Debt Repayment
  • Hospitals
  • Fire Services
  • Emergency Medical Services
  • Capital Expenditures
  • Health
  • Public Safety
 (None Identified)
  • Debt Repayment
  • Hospitals
  • Fire Services
  • Emergency Medical Services
  • Capital Expenditures
  • Health
Property Taxes Assessed Annually Annually (None Identified) Annually Annually
Maximum Tax Assessment Rate (For Countiesa)
  • General Property: 5%
  • Debt Repayment for Infrastructure Projects: 25%
  • Additional 10 mills per $100 authorized for hospital expenditures
  • Additional 4 mills per $1.00 for hospital expenditures
  • General Property Tax: 1%
  • Property Tax for Debt Repayment: 4%
  • Sales Tax: 2%
  • Sales Tax: 1%
  • Property Tax for Hospitals: 7 mills
  • Municipal Development Property Tax: 3 mills
  • Non-Residential Real Property Tax for Community Improvement: 2.5%
  • Maximum Municipal Property Tax Assessment Rate: 2.5%
  • General Property Tax: 1% or 10 mills
  • Property Tax for Hospitals: 1 mill
  • Realty Transfer: $0.30/$100
Circuit Breaker Programs
  • General Population
  • Age
  • Veteran Status
  • Disability
  • Income
  • General Population
  • Age
  • Veteran Status
  • Disability
  • Income
  • Age
  • Income
  • Veteran Status
  • General Population
  • Age
  • Income
  • Veteran Status
  • Disability
  • Age
  • Disability
Split Rate Land Tax (None Identified) For Improvements Only (None Identified) (None Identified) (None Identified)
Other Limitations
  • Geographic Limitations
  • Minimum Population
 (None Identified) (None Identified) (None Identified) (None Identified)

Local Government Bond Restrictions

 Alabama California Georgia Massachusetts Ohio
Permitted Local Government Bonds
  • Municipal Bonds
  • Revenue Bonds
  • General Obligation Bonds
  • Municipal Bonds
  • Revenue Bonds
  • General Obligation Bonds
  • Special Purpose Bonds
  • Revenue Bonds
  • General Obligation Bonds
  • Special Purpose Bonds
  • Tax Increment Bonds
  • Municipal Bonds
  • Municipal Bonds
  • Revenue Bonds
  • General Obligation Bonds
Authorized Public Purposes for Local Government Bonds
  • Capital Expenditures
  • General County Purposes
  • Hospitals
  • Fire Services
  • Public Safety
  • Municipal Infrastructure
  • Capital Expenditures
  • General County Purposes
  • Hospitals
  • Fire Services
  • Public Safety
  • Municipal Infrastructure
  • Emergency Medical Services
  • Capital Expenditures
  • General County Purposes
  • Hospitals
  • Capital Expenditures
  • Municipal Infrastructure
  • Capital Expenditures
  • Hospitals
  • Fire Services
  • Public Safety
  • Emergency Medical Services
Bond/Debt Percent to Not Exceedb
  • 75% of annual proceeds from local special taxc
  • Up to 85% of the county’s income or revenue for the fiscal yeard
  • Percentage of the local government’s assessed property valuee
  • 10% of local government’s assessed property value (general limitation)f
  • 75% of all taxes levied from preceding fiscal year (temporary)g
  • Total taxes levied from preceding fiscal year (temporary borrowing)h,i
  • 10% of local government’s assessed property valueh,j
  • 2% of the local government’s assessed property value for hospital construction & 1 mill per taxable dollar for maintenancek
  • 75% of estimated proceeds of special taxes leviedl
Other Limitations
  • Maximum Term
  • Geographic Limitations
  • Maximum Term
  • Maximum Interest Rate
  • Maximum Term
  • Maximum Interest Rate
  • Maximum Term
  • Amount Borrowed
 (None Identified)

Voter Overrides, Voter Approval, and Public Awareness

 Alabama California Georgia Massachusetts Ohio
Override Limits
  • “Hard ceiling”: Voters may override the general tax limits up to a specified maximum.m
  • No general override of 1% tax limit, but tax limit is not applicable to some specific taxes or special assessments to cover bonds.
  • No general property tax limit to override.n
  • Specially authorizes property taxes, such as a tax authorized for hospitals, may have limits that cannot be overridden.
  • Tax limit can be overridden with supermajority vote.
  • Property tax limit can be overridden by a majority vote or a charter provision.
Requires Voter Approval
  • Additional taxes to fund hospitals.
  • Adjustment of tax assessment ratios.
  • Tax rate increases
  • Special taxes
  • Special district borrowing to be repaid through taxation
  • Establishment of special districts authorized to impose taxes and provide services
  • Issuance of bonds
  • Imposition of sales tax
  • Issuance of bonds
  • Creation of special districts or redevelopment zones
 (None Identified)
  • Hospital tax in excess of the general 1% limit.
Requires Public Hearings and Notices Public hearings and notices required for debt and for the creation of “emergency assistance programs,” including those related to ambulance services. Public hearings and notices required for mutual aid contracts for services such as emergency medical services and police, and fire suppression assessments.

Public notices required for short term borrowing.

 Public hearings and notices required for municipal bonds.

Public notices required for development impact fees which can pay for emergency, rescue, and other facilities.

Public hearings required prior to issuance of local bonds.

(None Identified)

a Municipal assessment rate varies by municipality, but often is higher than county rates.

b Some limits described in this table may apply to a specific type of bond only.

c ALA. CONST. art. XI, § 215.03 (West, Westlaw through 2021 amendments)

d Some statutes will limit the amount of bonds based on the anticipated revenue or income of the local government. See CAL. GOV’T CODE § 53822 (West 1980) (tax anticipation warrants/notes may not exceed 50% of county’s revenue); CAL. GOV’T CODE § 53858 (West 1982) (bond including interest cannot exceed 85% of the estimated taxes, income, revenue, cash receipts, and other moneys of the local agency).

e Percentages vary per statute. For example, see CAL. GOV’T CODE § 29909 (West 1968) (bond cannot exceed 5% of the county’s taxable property); CAL. GOV’T CODE § 43605 (West 1955) (bonds for public improvements cannot exceed 15% of county’s assessed property value); CAL. GOV’T CODE § 61126 (West 2005) (general obligation bond cannot exceed 15% of assessed taxable property within the district); CAL. HEALTH & SAFETY CODE § 13906 (West 1987) (bond cannot exceed 3 times the district’s actual income from property taxes); CAL. GOV’T CODE § 53841 (West 1957) (bond cannot exceed 85% of levied taxes).

f See GA. CONST. art. IX, § 5, ¶ I (West, Westlaw through 2021 amendments) (debt cannot exceed 10% of county’s assessed property value); GA. CONST. art. IX, § 5, ¶ II (West, Westlaw through 2021 amendments) (total debt for special district purposes cannot exceed 10% of assessed taxable property value in the county). Debt to fund schools may be exempted in certain cases.

g See GA. CONST. art. IX, § 5, ¶ V (West, Westlaw through 2021 amendments) (total amount of temporary loans cannot exceed 75% of county’s gross tax revenue).

h These limits apply to cities, towns, and districts, which are the primary local government units in Massachusetts responsible for providing services.

i See MASS. GEN. LAWS ANN. ch. 44 § 4 (West 1992) (temporary loans cannot exceed the county’s aggregate tax levies from preceding year for county purposes; however, for district purposes, a county’s temporary loan cannot exceed the taxes, rates, and services from proceeding year (debt limit for new districts is fixed by vote of the district)).

j See MASS. GEN. LAWS ANN. ch. 44 § 10 (West 2004) (a city’s indebtedness cannot exceed 5% of the equalized valuation of the city or town. A city may authorize debt greater than 5% [not to exceed 10%] provided that the excess debt be authorized by the municipal finance oversight board).

k See OHIO REV. CODE ANN. § 513.08 (West 1991) (debt for hospital purposes cannot exceed 2% of the district/county’s tax valuation); OHIO REV. CODE ANN. § 513.081 (West 1991) (debt for hospital purposes cannot exceed 3% of the hospital district’s tax valuation).

l See OHIO REV. CODE ANN. § 5705.193 (West 1991) (tax anticipation note cannot exceed 75% of estimated special taxes).

m Kleinman, AJ. Tax Limits and the Future of Local Democracy. Harvard Law Review. 2020; 133:1884–1962. https://harvardlawreview.org/2020/04/tax-limits-and-the-future-of-local-democracy/. The term “hard ceiling” is used to describe the local tax override limits in Alabama. It was not used in this study’s coding protocols and datasets.

n School tax limits can be overridden, but they are excluded from this study since they do not apply to emergency medical services.

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Table 2a: State Laws in Effect as of January 31, 2022

Table 2a: State Laws in Effect as of January 31, 2022
Statewide Local Government Autonomy Taxes Special Districts
Alabama
  • ALA. CONST. art. XI, §§ 215, 215.01, 215.02a, 215.03a, 216, 216.01a, 216.02a, 216.03a, 216.04 (West, Westlaw through 2021 amendments)
  • ALA. CONST. art. IV, § 94.02 (West, Westlaw through 2021 amendments)
  • ALA. CODE § 22-3-10 (1940)
  • ALA. CODE § 40-7-62 (1971)
  • ALA. CONST. art. IV, § 94.02 (West, Westlaw through 2021 amendments)
California
  • CAL. CONST. art. XI, §§ 1 to 7 (West, Westlaw through 2021 amendments)
  • CAL. CONST. art. XI, §§ 13 to 15 (West, Westlaw through 2021 amendments)
  • CAL. CONST. art. XIII, §§ 1, 2, 12, 20, 22, 24, 25.5, 26, 29, 35, 36 (West, Westlaw through 2021 amendments)
  • CAL. CONST. art. XIII A, §§ 1 to 4 (West, Westlaw through 2021 amendments)
  • CAL. CONST. art. XIII C, §§ 1 to 3 (West, Westlaw through 2021 amendments)
  • CAL. CONST. art. XIII D, §§ 3, 4 (West, Westlaw through 2021 amendments)
  • CAL. GOV’T CODE § 23004(e) (West 1947)
  • CAL. GOV’T CODE § 29100 (West 2011)
  • CAL. GOV’T CODE §§ 29922 (West 1947), 29923 (West 1957)
  • CAL. GOV’T CODE § 30004 (West 1947)
  • CAL. GOV’T CODE §§ 43095 (West 1949), 43401 (West 1959), 43632 (West 1949), 43770 (West 1949)
  • CAL. GOV’T CODE §§ 50075 (West 1980), 50076 (West 1979), 50077.5 (West 1986), 50078 (West 1986), 50078.2 (West 1986), 50078.5 (West 1983), 50078.19 (West 1982)
  • CAL. GOV’T CODE §§ 53313 (West 2014)(amended 2022), 53313.5 (West 2018)(amended 2022), 53313.6 (West 2007), 53314.3 (West 1987)
  • CAL. GOV’T CODE § 53730.01 (West 1988)
  • CAL. GOV’T CODE §§ 53972.5 (West 1987), 53978 (West 1987)(amended 2021)
  • CAL. GOV’T CODE § 61121 (West 2005)
  • CAL. HEALTH & SAFETY CODE §§ 13910 to 13914 (West 1987), 13938 (West 2001)
  • CAL. HEALTH & SAFETY CODE §§ 32200 (West 1945), 32202 (West 1958), 32203 (West 1971), 32221 (West 1996), 32243 (West 1945), 32312 (West 1959)
  • CAL. REV. & TAX. CODE § 93 (West 1989)
  • CAL. Rev. & Tax. CODE §§ 2270 (West 1975), 2280 (West 1976), 2280.01 (West 1979), 2286 (West 1977)
  • CAL. REV. & TAX. CODE §§ 7201 (West 1955), 7203 (West 2004), 7284 (West 1990)(amended 2021), 7284.2 (West 2008)(amended 2022), 7285 (West 2014), 7285.5 (West 2014), 7285.9 (West 2011), 7285.91 (West 2018)
  • CAL. REV. & TAX. CODE § 9501 (West 1995)
  • CAL. GOV’T CODE §§ 53312.7 (West 2007), 53313 (West 2014)(amended 2022), 53316 (West 1988),
  • CAL. GOV’T CODE § 53972.5 (West 1987)
  • CAL. HEALTH & SAFETY CODE § 13815 (West 2001)
  • CAL. HEALTH & SAFETY CODE § 32001 (West 1965)
Georgia
  • GA. CONST. art. IX, § 2, ¶¶ I, II, III (West, Westlaw through 2021 amendments)
  • GA. CODE ANN. §§ 36-35-3 (West 1998), 36-35-5 (West 1965)
  • GA. CODE ANN. § 36-34-1 (West 1962)
  • GA. CODE ANN. § 25-3-4 (West 1984)
  • GA. CONST. art. IX, § 4, ¶¶ I, III (West, Westlaw through 2021 amendments)
  • GA. CONST. art. IX, § 7, ¶ III(c) (West, Westlaw through 2021 amendments)
  • GA. CONST. art. IX, § 2, ¶ VII (West, Westlaw through 2021 amendments)
  • GA. CODE ANN. § 36-42-16 (West 1992)
  • GA. CODE ANN. § 36-43-4 (West 1992)
  • GA. CODE ANN. § 36-61-8 (West 2015)
  • GA. CODE ANN. § 36-5-22.1 (West 1987)
  • GA. CODE ANN. §§ 48-8-110.1 (West 2015), 48-8-120 (West 2004)
  • GA. CONST. art. IX, § 2, ¶ VI (West, Westlaw through 2021 amendments)
  • GA. CONST. art. IX, § 7, ¶ I (West, Westlaw through 2021 amendments)
  • GA. CODE ANN. § 36-31-12 (West 2012)
  • GA. CODE ANN. § 36-42-16 (West 1992)
  • GA. CODE ANN. § 36-43-4 (West 1992)
  • GA. CODE ANN. § 36-44-17 (West 2009)
Massachusetts
  • MASS CONST. amend. art. II, §§ 1, 2, 6 (West, Westlaw through 2021 amendments)
  • MASS GEN. LAWS ANN. ch. 44A § 10 (West 1980)
  • MASS GEN. LAWS ANN. ch. 48 § 69 (West 1959)
  • MASS GEN. LAWS ANN. ch. 59 § 2 (West 1954)
  • MASS GEN. LAWS ANN. ch. 44 § 9 (West 2016)
  • MASS GEN. LAWS ANN. ch. 111 § 4 (West 1920)
Ohio
  • OHIO CONST. art. X, §§ 1, 2 (West, Westlaw through 2021 amendments)
  • OHIO CONST. art. XVIII, §§ 2, 3, 7 (West, Westlaw through 2021 amendments)
  • OHIO REV. CODE ANN. § 504.01 (West 1991)
  • OHIO REV. CODE ANN. §§ 513.01 (West 1953), 513.081 (West 1991), 513.09 (West 1953)
  • OHIO REV. CODE ANN. §§ 505.39 (West 2016), 505.71 (West 2019)
  • OHIO REV. CODE ANN. § 749.01 (West 1953)
  • OHIO REV. CODE ANN. § 307.057 (West 1994)
  • OHIO REV. CODE ANN. §§ 322.02 (West 2011), 322.05 (West 1999)
  • OHIO REV. CODE ANN. § 715.71 (West 2014)
  • OHIO REV. CODE ANN. § 749.01 (West 1953)
  • OHIO REV. CODE ANN. §§ 5705.03 (West 2020)(amended 2022), 5705.191 (West 2012), 5705.192 (West 2016)(amended 2022), 5705.22 (West 2010), 5705.01 (West 1953)
  • OHIO REV. CODE ANN. §§ 505.37 (West 2019)(amended 2022), 505.375 (West 2016), 505.43 (West 2021)
  • OHIO REV. CODE ANN. § 307.052 (West 1996)
  • OHIO REV. CODE ANN. § 715.70 (West 2015)

a Statutes that only apply to or exclude specific counties.

Note: This table lists all state laws analyzed that were interpreted to be related to local autonomy, local property taxes, other local taxes to fund local EMS, and special districts that may provide local EMS. It does not list every law analyzed in this study.

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Table 2b: State Laws in Effect as of January 31, 2022

Table 2b: State Laws in Effect as of January 31, 2022
Mutual Aid Contracts Bonds Fees
Alabama
  • ALA. CONST. art. XI, § 215.03a (West, Westlaw through 2021 amendments)
  • ALA. CODE §§ 11-87-1, 11-87-3 (1975)
  • ALA. CONST. art. XI, § 215.03a (West, Westlaw through 2021 amendments)
  • ALA. CODE §§ 11-47-1 (1940), 11-47-2 (1986)
  • ALA. CODE § 11-81-51 (1940)
  • ALA. CODE §§ 22-21-78 (1949), 22-21-141 (1978), 22-21-149 (1978), 22-21-320 (1982)
  • ALA. CODE § 40-7-69 (1971)
  • ALA. CODE § 11-87-4 (1975)
California
  • CAL. GOV’T CODE § 23004(c) (West 1947)
  • CAL. GOV’T CODE § 53316.2 (West 2013)
  • CAL. GOV’T CODE §§ 54981 (West 1978), 54981.7 (West 1996)
  • CAL. GOV’T CODE §§ 55603 (West 1949), 55603.5 (West 1994), 55632 (West 1970)
  • CAL. HEALTH & SAFETY CODE §§ 13863 (West 1998), 13878 (West 1987)
  • CAL. CONST. art. XVI, § 18 (West, Westlaw through 2021 amendments)
  • CAL. GOV’T CODE § 23010 (West 2020)
  • CAL. GOV’T CODE § 29900.5 (West 1992)
  • CAL. GOV’T CODE §§ 53313(g) (West 2014)(amended 2022), 53506 (West 1993), 53857 (West 1972)
  • CAL. HEALTH & SAFETY CODE § 13925 (West 1987)
  • CAL. HEALTH & SAFETY CODE § 32315 (West 1982)
  • CAL. GOV’T CODE § 53313.1 (West 1992)
  • CAL. GOV’T CODE § 54982 (West 2016)
  • CAL. GOV’T CODE § 54985 (West 2009)
  • CAL. GOV’T CODE §§ 61122, 61123 (West 2005)
  • CAL. HEALTH & SAFETY CODE § 13916 (West 1987)
Georgia
  • GA. CONST. art. IX, § 3, ¶ I (West, Westlaw through 2021 amendments)
  • GA. CODE ANN. §§ 36-34-2 (2012), 36-34-4 (West 1992)
  • GA. CODE ANN. § 36-71-11 (West 1990)
  • GA. CONST. art. IX, § 5, ¶¶ II, IV, V, VI (West, Westlaw through 2021 amendments)
  • GA. CONST. art. IX, § 6, ¶ I (West, Westlaw through 2021 amendments)
  • GA. CONST. art. IX, § 7, ¶ IV (West, Westlaw through 2021 amendments)
  • GA. CONST. art. IX, § 2, ¶ VII (West, Westlaw through 2021 amendments)
  • GA. CODE ANN. § 36-34-6 (West 1962)
  • GA. CODE ANN. § 36-42-9 (West 1984)
  • GA. CODE ANN. § 36-61-12 (West 2015)
  • GA. CODE ANN. § 36-62-6 (West 2006)
  • GA. CODE ANN. §§ 36-80-2 (West 1983), 36-80-25 (West 2015)
  • GA. CODE ANN. §§ 36-82-63 (West 1978), 36-82-64 (West 1970)
  • GA. CODE ANN. § 36-44-14 (West 2009)
  • GA. CONST. art. IX, § 7, ¶ III(c) (West, Westlaw through 2021 amendments)
  • GA. CODE ANN. § 36-42-16 (West 1992)
  • GA. CODE ANN. § 36-70-24(3)(B) (West 2004)
  • GA. CODE ANN. § 36-71-1 (West 1990) (amended 2021)
Massachusetts
  • MASS. GEN. LAWS ANN. ch. 43C § 15 (West, 1992)
  • MASS. GEN. LAWS ANN. ch. 40 §§ 4 (West 1989), 4A (West 2021), 4J (West 2010), 4K (West 2010)
  • MASS. GEN. LAWS ANN. ch. 44 §§ 4 (West 1992), 16 (West 1986)
  • MASS. GEN. LAWS ANN. ch. 40 §§ 5F (West 1993), 22F (West 1998)
  • MASS. GEN. LAWS ANN. 44 § 53E (West 1981)
Ohio
  • OHIO REV. CODE ANN. §§ 513.07 (West 2019), 513.18 (West 2010)(amended 2022)
  • OHIO REV. CODE ANN. §§ 505.371 (West 2019), 505.43 (West 2021), 505.44 (West 2013), 505.71 (West 2019), 505.72 (West 2013)
  • OHIO REV. CODE ANN. § 302.21 (West 1969)
  • OHIO REV. CODE ANN. §§ 307.05 (West 2013), 307.052 (West 1996), 307.055 (West 2013)
  • OHIO REV. CODE ANN. § 715.691 (West 2018)
  • OHIO REV. CODE ANN. § 749.161 (West 1971)
  • OHIO REV. CODE ANN. §§ 513.08, 513.12 (West 1991), 513.13 (West 2010)
  • OHIO REV. CODE ANN. § 505.401 (West 2003)
  • OHIO REV. CODE ANN. § 339.15 (West 1984)
  • OHIO REV. CODE ANN. § 323.06 (West 1989)
  • OHIO REV. CODE ANN. § 715.82 (West 2021)
  • OHIO REV. CODE ANN. §§ 505.441 (West 2011), 505.72 (West 2013), 505.721 (West 2004), 505.84 (West 2011)
  • OHIO REV. CODE ANN. § 307.055 (West 2013)

a Statutes that only apply to or exclude specific counties.

Note: This table lists all state laws analyzed that were interpreted to be related to the ability of local governments to enter mutual aid contracts, issue bonds, and establish fees for local EMS purposes. It does not list every law analyzed in this study.

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