The citizens of Jefferson Township could end up paying twice for emergency medical services (EMS) if both the county EMS levy and the township EMS levy pass at Tuesday’s primary election.

On the election ballot, Fayette County residents will be voting on a 1.3-mill, three-year tax levy for ambulance and emergency medical services in order to keep county-wide services intact. The estimated property tax revenue that will be produced by the 1.3 mills is calculated to be $1,043,587 per year, according to the certificate signed by Fayette County Auditor Aaron Coole.

The residents of Jefferson Township will additionally be voting for a levy of their own, a 5-mill continuing levy that would generate around $700,000 and cost property owners about $175 per $100,000 of valuation annually. The levy would create and staff about seven to 10 employees for a 24/7 township EMS service, and includes the possibility for new ambulances and a place for employees to stay for their shift at the Jefferson Township Fire Department.

Jefferson Township Trustee Ryan Yenger spoke about the levy for Jefferson Township recently and explained he thought it was important for the township to have its own EMS because of the amount of time it takes the Fayette County Memorial Hospital EMS ambulance service to reach the township. If someone in Jefferson Township has to wait for a response from Washington Court House, Yenger said it could take upwards of 15 minutes or longer to reach them.

Fayette County EMS serves all 10 townships within the county.

“They say that the average response time is 12-and-a-half minutes, but that is inaccurate and what they aren’t taking into account is that our volunteers, when they do get in the squad here in Jeffersonville, change that ratio,” Yenger said. “If they have to come from Washington Court House for every single run, all 300-plus runs they say they go on, that time would not be 12 minutes. They are fortunate that they have had volunteers that have been right there in the Jeffersonville firehouse and have dropped that response time down.”

One issue that has surfaced from these two levies going to the ballot at the same time is that Jefferson Township residents could end up paying twice for EMS services. Yenger said, according to the Ohio Attorney General Mike DeWine, they have seen this issue arise before in the state.

“The office of Mike DeWine got back to us and said they have seen this happen in more than one other county where two subdivisions have this same scenario,” Yenger said. “It has always worked out where one went to the other and the commissioners, or whoever was in charge, exempted them. It would be up to the commissioners but they could exempt the township from paying the county-wide EMS levy if both pass.”

Yenger said the trustees in Jefferson Township did not want to see people have to pay for EMS services. He said they felt if the commissioners worked with them in staffing the squad currently in Jeffersonville, they could have avoided bringing their own levy to the ballot. Yenger said it falls on a volunteer — who would have to be off of work and in the area — to respond, and that is the only time the squad leaves the fire station.

“We initially asked about increasing the sales tax out at the (Tanger Outlets) mall and use that money to staff the Jefferson Township squad, and maybe help take care of some the short-fallings financially for the county-wide EMS,” Yenger said. “We were told that (the commissioners) wouldn’t do the sales tax route. So we asked if they did put on a levy that they would include staffing for Jeffersonville and some of the other outlying areas.”

After several attempts to get the county-wide system working for Jefferson Township, Yenger said they were unsuccessful with the commissioners. Finally, the trustees in Jefferson Township decided they needed to do something and brought the levy to the ballot. Yenger said the township trustees had not anticipated the commissioners to bring a levy for county-wide EMS to the ballot so quickly.

“I think that it is important that Jefferson Township and people on our end of the county get the same level of service as Washington Court House and Union Township,” Yenger said. “I think that we deserve that, and even on the county-wide EMS service, it should be a county-wide service. To define service, to me that is not service when it takes 16 to 20 minutes to get to you. When you go out and vote, you have to consider which service you want, one that is going to be five minutes from you and a familiar face or one that is 20 minutes from you and perhaps a contract company….as a lot of times it isn’t even Fayette County EMS that gets to us, it is East Ambulance or Jamestown that come get us.”

Fayette County EMS was founded in the late 1970s as a volunteer organization and operated for many years with donations from the public. Periodically, the county and/or the City of Washington Court House would purchase a truck, ambulance or other necessary equipment for the EMS.

Prior to becoming a county commissioner, Dan Dean was appointed to the EMS board around 2006, he recalled, during a time the EMS was struggling financially.

“What was happening was reimbursement rates for Medicaid and Medicare were ever-decreasing and costs were ever-increasing,” Dean said in an earlier interview with the Record-Herald. “So the EMS was not going to be viable on its own. In about 2007 or 2008, the hospital (Fayette County Memorial Hospital) agreed to take over EMS. The commissioners at the time were nice enough to appoint me from the EMS board to the hospital board so that there would be a transition involving someone who had knowledge on the subject. I was on the hospital board for a couple of years. So the hospital took it over because they were not only going to do EMS services, they were going to do transports. That way it could make up the cost difference and make it viable again. But about a year after they started that, the rules changed on how transports would be paid by Medicaid and Medicare. Instead of paying per transport, they gave the nursing home I believe an extra dollar and 10 cents a day per patient, and then left it up to them to contract with somebody to do all the transports from there. So now the hospital was not able to make it cost-effective…they were going to lose money.”

Dean added that it actually harms the hospital to run an EMS because of cost reimbursement realities, and because the hospital is critical access, however EMS is not.

“What that means is the federal government withholds about $250,000 dollars in costs that the hospital would be reimbursed through Medicare reimbursement and now they don’t,” said Dean.

When now State Senator, Bob Peterson, resigned as a commissioner, Dean was appointed by the local Republican Central Committee to fill out the remainder of Peterson’s term, beginning January of 2010.

“Once I was appointed, I could no longer serve on the hospital board. And one of the first problems that came up when I became commissioner was how to make the hospital whole,” Dean said. “The hospital had come to the City of Washington and the commissioners saying, ‘We’re going to have to give (EMS) back to you.’ So we came up with a solution of making the hospital whole in order to have one unified county system rather than see it disintegrate and have something like two townships and the city form their own EMS. It would have been a cost redundancy as far as administration, payrolls, the amount of trucks….let alone the confusion when they have to do a dispatch. It was much better to keep one county system.”

At that time, the commissioners made the decision to reimburse the hospital. The county has provided $3.3 million to fund county EMS services over the past five years.

“We started doing it with around $500,000 to $600,000 a year to make them whole. In other words, to cover any losses they had. Every year we renewed that and it’s worked fine for the last five or six years,” said Dean. “We were doing that with our sales tax money as it had been increasing every year and was providing us the revenue to be able to support the community. This year, the sales tax revenue for the county has decreased.”

According to records provided by the commissioners, sales tax revenue received by the county has steadily increased over the past five years until 2017. In 2011, the county received nearly $6.8 million; in 2012, $7.1 million; in 2013, $7.5 million; in 2014, $8.1 million; in 2015, $8.2 million; and in 2016, $9.2 million. In 2017, that number dipped from $9.2 million to just short of $8.6 million.

“One reason for this is Medicaid-managed care has kicked in, so we started losing an estimated $50,000 dollars a month beginning in September,” said Dean.

The county has committed to fund EMS with $650,000 in 2018.

“This coming year, the state is making the county kind of whole with some funds that they’re replacing to make up the $600,000 deficit,” Dean said. “We went to all the townships, the city and the villages and told them how much we can make up. For the rest of it, we asked them to come up with 10 dollars per capita in their city, village or township. That way it would raise approximately $290,000 because they have about 29,000 people in Fayette County. Then the hospital would have the extra money this year to start replacing trucks again.”

When asked why the county’s taxpayers should vote for this levy, Dean reiterated: “In my opinion, it makes sense financially to have one unified system. You don’t have the redundancy of manpower and equipment. It is the most cost-effective to have one system for the county and it’s a good system. It’s been working well. You almost never hear anything bad about our EMS service from the community, but you do hear things like, ‘They saved my life.’ In the old days, you used to pay like 60 dollars a year if you wanted to buy a membership for EMS and then you wouldn’t have to pay anything else. Basically this is going to be about 50 dollars per $100,000 value. I hate to equate it to the old membership, but it is going to be a cost to all landowners and indirectly to anybody who rents. But we do think this is the best system.”

Stay with the Record-Herald for more coverage of the May 8 primary election.

Record-Herald Editor Ryan Carter contributed to this article.