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MissouriSB9752026 Regular SessionSenateWALLET

Modifies provisions relating to ambulance districts

Sponsored By: Rusty Black (Republican)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

6 provisions identified: 1 benefits, 1 costs, 4 mixed.

Joining Ambulance Districts Brings Local Taxes

Residents can seek annexation with signatures from 10% of eligible voters in the proposed area or 50 voters, whichever is fewer. They file with the county clerk, and a hearing must follow within 30 days. Voters in both the existing ambulance district and the proposed area vote on joining and taxing the new area. A majority of votes across both areas approves annexation and a tax equal to the district’s existing rate. The county commission must declare annexation within 30 days after election results are certified.

Ambulance Mergers Tie Taxes To Votes

A consolidation ballot must name the new ambulance district and state its proposed tax limits. It must list property tax in cents per $100 of assessed value, a sales tax percentage, or both. Voter approval allows an initial levy up to the highest existing levy among the merging districts, as stated on the ballot. Without voter approval of a ballot-set levy, property tax cannot exceed the lowest existing property tax rate among those districts. Sales tax is also capped at the lowest existing sales tax rate.

Deadlines Help Fill Ambulance Board Vacancies

Remaining ambulance board members fill one or two seats vacated by death, resignation, or disqualification through a majority vote. County commissioners step in when the board cannot agree within 60 days or more than two seats are vacant. A majority of remaining board members or the ambulance service administrator must send a written request. Commissioners must appoint qualified replacements within 30 calendar days after receiving that request. All replacements serve the rest of the vacant terms.

Ambulance Boards Can Change Local Representation

Ambulance boards can create election areas with a two-thirds vote. The areas must be connected, compact, and close to equal in population; the county commission sets their boundaries. The commission must redraw them within 60 days after each decennial census population report reaches the governor. Directors must live in their represented area throughout their term; moving outside it disqualifies them. A board unable to find a qualified candidate for each area’s director position can end area-based elections. That change requires a public hearing and two-thirds board approval; current directors then serve districtwide for their remaining terms. A six-member board can also seek voter approval to grow to seven members or shrink to five or three. Its resolution must identify directors keeping seats, vacancies filled by later elections, and affected term-end dates; a voter majority decides.

New Rules For Electing Ambulance Directors

County commissions must provide for six ambulance directors, elected districtwide or from six areas with populations as equal as possible. Elections take place on the next regular election date. For area-based elections, initial terms are one year for areas 1 and 4, two for 2 and 5, and three for 3 and 6. For districtwide elections, the top two candidates serve three years, the next two serve two, and the last two serve one. Later terms last three years. Candidates must be U.S. citizens, at least 24, and ambulance district residents for the two years immediately before election. They no longer need to be qualified voters in the election area. When fewer candidates run than seats available, no election is held, and those candidates take office as if elected. Directors serving on August 28, 2026, remain districtwide directors for the rest of their terms.

Residents Gain Rules For Ambulance Mergers

Ambulance district mergers start through board resolutions or petitions signed by at least 10% of a district’s gubernatorial voters. All district filings must reach their county clerks in the same calendar year. The plan must list the new name, boundaries, taxes, property, assets, debts, current levies, and transition rules. It must name the district responsible for continued service; the district with the largest operating budget is presumed responsible. The initial board draws from existing boards, with at least one director from each district. Plans set a timeline of no more than 180 days, which the consolidated board can extend for good cause. Districts must post notice and publish it weekly for two consecutive weeks in every affected county, including a form explaining the plan. A joint public hearing must follow within 30 days after the second publication. Objections are due within 30 days after the hearing; signatures equaling at least 5% of votes cast for governor at the latest gubernatorial election trigger a public vote. With no objections, the county commission orders consolidation under the plan within 45 days after the hearing. After voter approval, Missouri’s Department of Health and Senior Services must prioritize and speed up work needed for the merger. The old districts end when the new board certifies required operating licenses, permits, and director training are complete. The new district takes over all powers, assets, debts, and obligations and records the merger in county records.

Sponsors & Cosponsors

Sponsor

  • Rusty Black

    Republican • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

All Roll Calls

Yes: 33 • No: 1

House vote • 5/13/2026

Reported Do Pass

Yes: 7 • No: 1

House vote • 4/9/2026

Reported Do Pass

Yes: 10 • No: 0

House vote • 4/2/2026

HCS Reported Do Pass

Yes: 16 • No: 0

Actions Timeline

  1. Delivered to Secretary of State (G)

    7/9/2026

  2. Approved by Governor (G)

    7/9/2026

  3. Delivered to Governor

    5/28/2026

  4. Signed by House Speaker

    5/28/2026House

  5. House Message

    5/14/2026House

  6. Truly Agreed To and Finally Passed

    5/14/2026

  7. House Adopts Conference Committee Report

    5/14/2026House

  8. House Submits Conference Committee Report

    5/14/2026House

  9. Reported Do Pass - AYES: 7 NOES: 1 PRESENT: 0

    5/13/2026House

  10. Voted Do Pass

    5/13/2026House

  11. Executive Session Completed

    5/13/2026House

  12. Referred: Fiscal Review

    5/12/2026House

  13. House Distributes Conference Committee Report

    5/12/2026House

  14. House Message

    5/4/2026House

  15. House Conference Committee Appointed - REPRESENTATIVES FARNAN, HINMAN, BILLINGTON, WALSH MOORE, SMITH(74)

    5/4/2026House

  16. House Message

    5/4/2026House

  17. House Refuses to Recede, Grants Conference

    5/4/2026House

  18. Taken Up

    5/4/2026

  19. Taken Up

    4/30/2026

  20. Reported to the Senate with... - HCS, as amended

    4/23/2026House

  21. Third Read and Passed with Amendments - with HA 1

    4/23/2026House

  22. HCS Adopted

    4/23/2026House

  23. Title of Bill - Agreed To

    4/23/2026

  24. Taken Up for Third Reading

    4/23/2026House

  25. Reported Do Pass - AYES: 10 NOES: 0 PRESENT: 0

    4/9/2026House

Bill Text

  • Committee Substitute

    PDF

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