For decades, EMS agencies could survive year-to-year by subsisting on insurance reimbursements and billing patients. Those days have passed, due to both stagnant insurance reimbursement rates and the rising costs of both labor and materials.

In recent years, more and more agencies have turned to their member municipalities for funding assistance to cover the shortfall. This funding comes either in the form of taxpayer money through a special EMS tax capped at a half-mill or a direct contribution from the municipality’s cash reserves.

“If something doesn't change with how we're funded, we cannot maintain the same quality of care that we give right now on how we're reimbursed,” said Lynn Curl, operations director for Harmony EMS.

According to Curl, Harmony EMS received no direct funding from any of its 10 member municipalities until recently.

“Up until the last two or three years, municipalities did not give us any direct funding at all,” Curl said. “Nobody gave us any contributions.”

Curl credited both Forward and Jackson townships with being the first to financially support Harmony EMS directly, starting between 2024 and 2025.

“I think Jackson Township and Forward Township saw the writing on the wall and they were very proactive with seeing the EMS crisis happen and they just wanted to make sure that it didn't happen for their residents,” Curl said.

In Harmony EMS’ coverage region, as of 2026, Jackson Township, Harmony, and Zelienople have implemented a half-mill tax to support the service, while Lancaster Township is deducting a half-mill’s worth of tax revenue from its general fund to support the agency.

“Lancaster said that they weren't going to raise any of their taxes. They’re just giving us what the half-mill equivalent is,” said Curl.

Forward Township continues also to help in its own way, splitting funds between three services that cover the municipality.

“We've heard nothing from Evans City or other townships as of yet what they've decided to do,” Curl said.

While based in neighboring Mercer County, Superior Ambulance Service provides emergency medical service for Harrisville, Marion Township and parts of Mercer Township in Butler County. According to Superior EMS chief Doug Dick, all three municipalities currently provide funding for the agency to the equivalent of a half-mill of property tax.

Both Harrisville and Mercer Township maintain a half-mill EMS tax. Marion Township contributes directly from its general fund, according to Supervisor Craig Pierce.

Likewise, Quality EMS — which serves Adams and Middlesex townships and Mars, Valencia, Callery and part of Forward Township — did not receive any municipal funding until 2024.

In late 2023, Conrad Pfeifer, executive director of Quality EMS, made his first round of presentations to the six municipalities his service covers to ask for financial assistance. At the time, he called upon each municipality to contribute an amount equal to $55 per resident per year, an amount he said would cover the agency’s operations budget for three years.

While Quality EMS didn’t get quite that amount of support in the end, Pfeifer said all six municipalities are making financial contributions to help keep the agency afloat, whether through direct contributions or through an EMS tax.

“It was probably too much too soon, so we got less than ($55 per resident),” Pfeifer said. “(But) we are very fortunate to work with our municipal leaders, and they all contributed because they understand the need for EMS and the importance of patient care.”

Adams Township, which accounts for nearly half Quality EMS’s call volume, will contribute $150,000 to the agency in 2026 over four quarterly installments. In May 2025, Middlesex Township voted to contribute $35,000. According to its approved budget for 2026, Mars is set to contribute $12,985, part of which includes a 0.5-mill EMS tax.

“Periodically, Mars has made contributions to Quality, until recently including it as a tax on residents,” said Mars Borough Mayor Gregg Hartung.

Although Quality did not receive the full amount it asked for, Pfeifer said his agency is lucky in the grand scheme of things.

“It has not been the norm, and it still is not the norm, for EMS agencies to receive direct funding,” Pfeifer said. “It has only started probably two or three years ago.”

For example, as of 2026, East Butler Ambulance Service receives no funding from either an EMS tax or direct annual contributions from any of the four municipalities in its coverage area. These include the borough of East Butler, Oakland and Summit townships and part of Clearfield township.

“The municipalities have helped in the past with capital purchases,” said East Butler EMS director Aaron Cumberland. “Whenever it's time to replace an ambulance or cardiac monitors, I've gone to municipalities and asked for money, and they've made a donation that way. But we do not receive regular funds from them.”

Forward Township is unique among Butler County municipalities in that it is split among three different EMS agencies: Butler Ambulance Service, Harmony EMS and Quality EMS.

Beginning in 2024, Forward Township’s board of supervisors decided upon a unique arrangement to financially support the agencies. Each now receives a one-third share of Forward Township’s annual receipts from a Local Service Tax on income, which are being distributed as a grant.

The township estimates the total amount of the grant will come out to $26,099 this year.

Butler Ambulance Service covers more of Butler County than any other EMS agency with 16 municipalities in its coverage area. In the latter part of 2025, paramedic Jesse Haas went to each of them with a presentation asking for financial assistance.

Of those, according to Haas, both Penn Township and Connoquenessing Borough have agreed to make unspecified financial contributions in 2026.

“They have not provided dates. It was dependent on when their revenue and money comes in,” Haas said. “Both of them made it sound like they are not a specific tax. They are just taking it out of their general fund.”

Haas added the service also entered into discussions with Prospect Borough and Clay Township.

“Prospect Borough understands and would like to do something, but that is as far as those conversations have gone,” Haas said. “All the conversations I've had with all the municipal leaders have been receptive.

“Some say they understand the problems that we're going through, but they're not quite sure how their municipality is going to handle that.”

In the latter part of 2025, Chuck Lewis, chief of the ambulance division of Saxonburg Volunteer Fire Company went to all five municipalities in its coverage area to make a presentation to their supervisors or council members to ask for financial assistance.

In response, both Jefferson and Winfield townships, along with Saxonburg, added a half-mill EMS tax. Winfield decreased the rest of its real estate tax by a half mill to compensate for the newly-added tax.

According to Lewis, the other two municipalities — Clinton and Buffalo townships — also provide, or are planning to provide, an annual contribution equal to half a mill in taxes to support Saxonburg’s emergency medical services.