Ambulance districts occupy a unique place in Missouri’s political structure. They are formed as independent political subdivisions; They are subject to specific tax requirements in their formation, and annual audit obligations thereafter. Changes made to state ambulance district laws in 2025 have also changed the compliance landscape for the elected officials who serve on an ambulance district’s board of directors. An intimate knowledge of these challenges inspired our founding attorney to open a practice dedicated to supporting Missouri fire and ambulance districts and the professionals who operate them. Call Scarborough Law Office at 816-230-5550 to ask about our services in ambulance district law advisory services and learn how we can support the work that means so much to you.
RSMo § 190.015 provides for the formation of independent ambulance districts through a petition process similar to that used for the formation of fire protection districts under RSMO § 321.030. One difference to note is that the petition to form an ambulance district requires 10% of the votes cast in the most recent gubernatorial election, whereas the petition for fire district formation requires a flat number of 100 signatures.
The Chapter 190 process may apply differently to ambulance districts in specific counties. For this reason, potential boards of directors should familiarize themselves with the procedures for forming ambulance districts, and with the legal requirements for providing emergency medical services via an ambulance district.
Some of the most challenging legal questions involved in the operation of a Missouri ambulance district are, as with fire districts, related to state laws governing purchasing and procurement procedures for public agencies. For state agencies, RSMo § 34.040 requires a competitive bidding process for any purchase of more than $10,000; the Chapter 34 purchasing requirements that apply to statewide agencies are generally considered to apply to all purchasing and procurement applicable to all government agencies, but RSMo § 190.060, which gives ambulance districts’ boards of directors broad authority to make financial commitments on behalf of the district, does not directly apply Chapter 34 to ambulance district governance. Both ambulance districts and fire protection districts are, however, subject to audit by the Office of the Missouri State Auditor, which issues regular updates on the filing status of political subdivisions (including ambulance districts and fire districts) subject to annual financial disclosure requirements.
Those financial records will provide state officials with an opportunity to review the fiscal management of the ambulance district. Purchasing that looks to have been non-competitive may come under intense scrutiny, particularly when there is the appearance of a potential conflict of interest (as may occur, for example, where there is a close relationship between anyone on the board of directors and the party awarded a significant contract with the district). Boards of directors for both fire and ambulance districts frequently enlist the services of a Missouri attorney to assist with their purchasing and procurement compliance to help them avoid the issues that could lead to any appearance of mismanagement in public funds when the ambulance district submits its annual audit, as required by RSMo. § 190.075. Scarborough Law Office, LLC may be able to provide you with more detailed guidance specific to your district’s purchasing and procurement concerns.
The boards of Missouri ambulance districts face a flurry of new or updated legal requirements in 2026. Legislation passed in 2025 added a requirement that each ambulance district contract with a certified public accountant or accounting firm to conduct an audit of district accounts every three years; additionally, RSMo. § 190.076 requires that the results of this audit be made “freely available” electronically, with a suggestion (but not an absolute requirement) to post to the district’s website.
In keeping with the spirit of transparency evinced by 190.076, directors beginning their terms of service on the boards of ambulance districts going forward will be required to complete specific training under RSMo. § 190.053. All members of such boards will be required to complete three hours of continuing education for each term of service. While the specifications for the continuing education are less detailed than those for incoming directors, it seems clear that Missouri is emphasizing increased training for its public servants in the areas of ethics laws, sunshine laws, and accountability in the management of public funds. Do not hesitate to reach out to a member of our team to schedule a compliance consultation to ensure your ambulance district has a clear plan for tracking the training and continuing education requirements for both existing and incoming directors, and for ensuring that those requirements are met in a timely manner so that your district continues to conform to state law.
Whether you are gathering signatures to petition a county commission for the right to hold elections and form an ambulance district, or preparing your fire protection district to expand its emergency services, you are bound to encounter a variety of legal questions. If your district is already well-established, then you know that compliance requirements and the challenges of navigating the complex obligations of Missouri ambulance district law do not vanish once the district has formed. With more than two decades of experience in emergency services, Scarborough Law Office understands the needs of ambulance and fire protection districts from the inside out. Our practice was founded with the goal of smoothing the road for the dedicated directors and personnel who ensure fire protection and emergency ambulance services are available to Missourians throughout our state. Call 816-230-5550 to schedule a private consultation tailored to your district’s needs.
