Your guide to Measure S, El Dorado County’s proposed sales tax increase

El Dorado County voters will decide this November whether to approve a 30-year sales tax increase that would generate an estimated $13 million annually for hospital improvements, emergency response and wildfire prevention.

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The three-eighths-cent sales tax was first proposed by Marshall Hospital, the only acute care hospital on El Dorado County’s West Slope, and later supported by the El Dorado County Fire Chiefs Association.

Marshall Medical Center, which operates Marshall Hospital in Placerville as well as medical facilities throughout the West Slope, has said it needs about $40 million to complete upgrades required to meet state seismic standards.

Measure S would direct money to hospital improvements, local fire agencies and nonprofit organizations conducting wildfire-prevention work. During the first full fiscal year, half of the revenue would go to eligible hospitals, 45% to fire agencies and 5% to eligible nonprofits.

The sales tax rate in unincorporated El Dorado County is currently set at the state minimum of 7.25%. In Placerville and South Lake Tahoe, the rates are 8.25% and 8.75%, respectively. Measure S would increase each rate by 0.375 percentage points, bringing the rate to 7.625% in areas where it is currently 7.25%. Placerville’s rate would rise to 8.625%, while South Lake Tahoe’s would rise to 9.125%.

Opponents have criticized using a countywide sales tax to help finance improvements at Marshall. Members of the California Taxpayer Protection Committee, who signed the argument against the measure in , called it a “sweetheart deal for a single private hospital” and criticized the additional funding for fire agencies.

What is the ballot measure asking?

Measure S asks voters to approve a 0.375% special sales tax throughout El Dorado County for 30 years. Because it is a special tax, revenue could be spent only for the purposes specified in the measure. A majority of voters must approve the measure for it to pass.

During the first full fiscal year after the measure takes effect, it would direct 50% of sales tax revenue to eligible hospitals. The measure defines an eligible local hospital as a general acute care hospital that was located in El Dorado County as of Jan. 1, 2025, and licensed to operate at least 100 acute-care beds.

Eligible hospitals could use the money for improvements to medical facilities, including intensive care and trauma care facilities, operating rooms, laboratories, clinics and imaging facilities. Another 5% of the revenue would go to qualifying nonprofit organizations for wildfire prevention, while 45% would go to local fire agencies.

Eligible nonprofits would be required to help homeowners reduce wildfire risk through vegetation management, maintaining defensible space, home hardening, evacuation planning, emergency alerts and communications and other fire mitigation activities. To qualify, the organizations must have been located and operating in El Dorado County as of Jan. 1, 2025.

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After the first full fiscal year, the hospital’s share would no longer be fixed at 50%. Instead, it would receive an amount based on how much it owes each year on debt issued for qualifying capital projects. The measure requires enough funding to maintain a minimum debt-service coverage ratio of 1.5. The measure could support debt for projects totaling up to $125 million over 30 years.

Five percent of total tax revenue would continue to go to qualifying wildfire-prevention nonprofits, while the remaining money would be distributed among local fire agencies. The measure specifies how that fire-agency funding would be divided, based on the proportion of full-time fire engines each agency operated as of November 2025.

The measure would also establish a seven-member oversight committee of El Dorado County residents to review how the money is spent. The committee would review an annual independent audit and issue a public report on whether expenditures complied with the measure. Its members would be required to have backgrounds in public finance, firefighting or emergency medical response, disaster preparedness or public safety, or hospital and emergency medicine.

Who is funding the measure?

The campaign supporting Measure S has largely been funded by Marshall Medical Center, which has contributed $600,000 to the committee backing the measure since January 2025, according to campaign finance filings.

Marshall-affiliated organizations and funds have contributed another $50,000, including Marshall Primary Care Medical Associates Inc.

Companies in the construction, architecture and real estate industries have also made contributions, including $30,000 from El Dorado Hills-based RCP Construction and $20,000 from Bogard Construction.

Opposing the measure, Reform California’s political action committee reported $4,540 in independent expenditures against Measure S. Patriots of El Dorado County, a local general-purpose political committee, also reported an independent expenditure of about $690 for signs opposing the measure.

Who else is supporting the measure?

Measure S has been endorsed by several local officials and fire agencies, including El Dorado County Superintendent of Schools Ed Manansala, Placerville City Council member John Clerici, former county supervisors Wendy Thomas and John Knight and the boards of the El Dorado County Fire Protection District and El Dorado Hills Fire Department.

The El Dorado County Chamber of Commerce and local firefighter unions also support the measure.

Read more Your guide to Measure S, El Dorado County’s proposed sales tax increase