Can my home care agency bill Medicaid for driving clients?

Only under a service that pays for transportation. That can be waiver non-medical transportation, if you are certified for it in the client's waiver, or NEMT, if you enroll as a transportation provider or contract with the broker. Your personal care enrollment does not cover rides. Indiana, for example, requires a separate provider ID to bill transportation, apart from any other enrollment the company holds.

Can a caregiver drive a client to a doctor appointment?

The answer changes by state and by program. Texas Primary Home Care and Community Attendant Services allow escort to appointments but exclude direct transportation by the attendant and refer members to the Medical Transportation Program. Minnesota's CFSS program counts driving the participant as part of instrumental activities of daily living when the service plan includes it. Check your state's personal care rules first.

Does waiver transportation count as NEMT?

No. Waiver non-medical transportation covers trips to waiver services and to the community activities a participant's plan lists. NEMT pays for rides to Medicaid-covered medical care. CMS's guidance for waiver applications bars using waiver transportation in place of NEMT, so a waiver participant's doctor visit is billed as NEMT or as an administrative cost, never as a waiver service.

What insurance does a home care agency need when staff drive clients?

At minimum, coverage for the agency when staff use their own cars, often called employers non-owned auto liability, plus commercial auto on any vehicle the agency owns. Some personal auto policies exclude business driving, so staff coverage may not respond. Broker NEMT work adds its own floors, such as MTM's $500,000 combined single limit on every vehicle used.

Do hours driving and hours giving care count together for overtime?

Yes, when the same agency employs the worker for both. Federal rules compute overtime on all hours worked in the week, and when the jobs pay different rates, the regular rate is a weighted average of them. Home care agencies cannot use the companionship exemption under 29 CFR 552.109, so aides are owed overtime past 40 hours.

Should a home care agency start with waiver rides or NEMT?

Start where your clients already are. If many are waiver participants who need rides to day programs and community activities, waiver transportation fits your existing case management relationships. NEMT means a broker contract or separate Medicaid enrollment, stricter vehicle and driver credentialing, and more trip documentation, but it pays for medical rides that waiver transportation cannot.

Add Transportation to a Home Care Agency: The Rules (2026)

Home care agencies start with what a new transportation company lacks: clients who already know them and case managers who already call them. Adding rides looks like a natural step, and it can be. But rides are not one service. Waiver transportation, Medicaid NEMT, and private-pay rides each have their own rules, and a caregiver driving a client during a care visit is a fourth question, with answers that differ from state to state. Sort out which one you are adding before you buy a van or tell staff to start driving.

Three ways to add rides

Route	What it pays for	Who pays	What you need first
Waiver non-medical transportation	Rides that reach waiver services and the community activities listed in the participant’s plan	The state’s home and community-based services waiver	Certification as a provider of that waiver service
Medicaid NEMT	Rides to Medicaid-covered medical care	A state Medicaid agency, a broker, or a health plan	Transportation enrollment separate from your care enrollment, or a broker contract
Private pay	Any ride the client or family buys	The client or family	Local vehicle-for-hire rules and commercial insurance

An agency can run more than one of these at once. The routes do not share paperwork, rates, or credentialing, so plan each one on its own. For the private-pay side, see starting a non-medical transportation business.

Which ride belongs to which program

The destination decides the program, not the rider.

A doctor, dialysis, or therapy visit covered by Medicaid is NEMT. CMS’s guide for waiver applications forbids swapping waiver rides in for the medical transportation every state already owes its members. For a waiver participant, that ride is billed as state plan transportation or as an administrative cost, never as a waiver service.
A ride to adult day services, a job, or a community activity named in the service plan can be waiver transportation, where the waiver covers it.
Free help comes first. Where a relative, friend, neighbor, or community group will give the ride without charge, CMS expects the plan to use them before paying for one.
One payment per ride. If a waiver service like adult day health already builds transportation into its rate, the state has to have a way to stop a second transportation claim for the same ride. And when a provider drives clients only as a side part of another service, CMS tells states to fold that cost into that service’s rate or add a cost component for it.

Indiana shows how states draw the line. Its transportation module exempts rides to 1915(c) waiver services from the fee-for-service broker, but nonemergency rides for waiver members to anything other than waiver services must go through the broker, Verida. See waiver transportation for more on how these rides are authorized.

Waiver transportation: what a state rule asks for

Waiver transportation rules are set state by state, often by the agency that runs the waiver. The Ohio Department of Aging’s rule for non-medical transportation providers (OAC 173-39-02.18, effective February 1, 2025) shows the level of detail to expect:

Provider types. The Ohio Department of Aging certifies only agency and non-agency providers for this service.
Backup. The provider must have a plan to cover rides if one of its drivers or vehicles cannot run.
Two-way communication. Drivers need a radio or cell phone while transporting.
Vehicles. A yearly check by an ASE-certified mechanic, and a documented daily check of any vehicle that carries riders in wheelchairs, covering tie-downs, belts, and the ramp or lift.
Drivers. At least two years with a valid license, first aid and CPR training from a state-approved organization, a clean drug test from a certified lab, background checks, and a passenger assistance course within six months of hire.
Trip records. For each trip: the rider’s name, date, pickup point and time, destination and drop-off time, driver’s name, and a unique identifier from both the driver and the rider attesting to the trip.
Rates. For the PASSPORT waiver, one trip, one-way or round, is billed as a single unit at a maximum rate set in a separate Medicaid rule.

The same rule excludes rides for a medical purpose, rides that Medicaid or another source already funds, rides family or friends will give free, and escort or transportation by a participant-directed provider. Ohio’s developmental disability waivers use a separate rule, OAC 5123-9-18. See IDD transportation services and the Ohio state guide.

NEMT is a separate door

Your home care enrollment does not cover NEMT. How you get in depends on how the state runs rides.

Separate enrollment. Indiana requires a separate transportation provider ID before a company bills any rides, under provider type 26, with specialties for taxis, ambulatory and non-ambulatory common carriers, and others. To serve fee-for-service members, the company must then sign Verida’s provider agreement and finish credentialing within 60 days.
Broker only. In Georgia, Verida arranges every Medicaid ride statewide, and recruiting and contracting transportation providers is part of its job. Your path in is Verida’s request for qualifications.
Closed to new companies. Utah’s manual states that “Medicaid does not accept applications for additional NEMT providers.” A company can serve Utah members only through a contract with Modivcare.

NEMT credentialing has its own checklist. Verida’s Georgia checklist, for example, asks every driver for a motor vehicle report and a current criminal background check, asks owners and drivers for drug screens, and asks the company for a current business license and proof of liability coverage. The steps for Medicaid transportation enrollment and your state guide are the place to start.

When caregivers drive clients during a visit

Settle this before anything else, because the answer changes at the state line and between programs in one state.

Texas: escort yes, transport no. In Primary Home Care and Community Attendant Services, the escort task means accompanying the person to appointments or on errands, within the hours already authorized. HHSC’s handbook says it does not include direct transportation of the person by the attendant, and it points members to the Medical Transportation Program for rides. In one of its billing examples, HHSC treats three hours of transportation as a task the provider may bill the person privately, because Medicaid does not pay for it.
Minnesota: driving can be part of care. Under the community first services and supports law (Minn. Stat. 256B.85), instrumental activities of daily living include helping the participant travel, including to medical appointments, and traveling includes driving and accompanying the participant, as set in the service delivery plan. The same law says the mobility task under activities of daily living does not include transportation.
Ohio: the waiver rule excludes some drivers. The Ohio Department of Aging’s transportation rule leaves out escort or transportation by a participant-directed provider.

Read your state’s personal care rules, and your managed care contracts, before an aide puts a client in a car. When the rules allow it, write it into the care plan and the aide’s job description, and track ride time the way your state counts it.

Insurance and liability

Adding rides adds a new kind of claim: a crash with a client aboard. NEMT liability covers the claims in depth. For an agency, three points matter most.

Staff cars. State Farm notes that some personal auto policies exclude business driving. Employers non-owned auto liability protects the agency if an employee at fault in their own car on agency business leads to a lawsuit against the agency. It does not replace the employee’s own auto coverage.
Agency vehicles. Company vans need commercial auto coverage. Broker contracts set floors: MTM’s standard agreement requires $500,000 combined single limit auto liability for any and all vehicles used on its trips, plus $500,000 in general liability.
Mileage. When an agency pays staff back for miles, the IRS business rate is a common yardstick. For driving from July through December 2026 it is 76 cents per mile, after 72.5 cents from January through June.

Wheelchair riders raise the stakes, because they need a lift or ramp, trained drivers, and a securement routine on every trip. See using a personal vehicle for NEMT for what brokers ask of a vehicle before it carries riders.

Pay and hours when one person does both jobs

An aide who also drives is still one employee of one employer, and the hours add up.

Overtime applies. Under 29 CFR 552.109, third-party employers such as home care agencies cannot claim the companionship exemption from minimum wage and overtime. The Labor Department proposed on July 2, 2025 to allow it again, and the current rule still bars it.
Hours combine. When an employee does two kinds of work in a week at different rates, 29 CFR 778.115 sets the regular rate as a weighted average across all hours worked at all jobs. As an example, an aide with 32 care hours and 12 driving hours in a week has worked 44 hours, and the 4 hours past 40 are overtime.
Credentials follow the task. A caregiver who drives NEMT trips must meet the broker’s driver standards, and a caregiver who drives waiver trips must meet the waiver rule, even though the same person already passed your home care screening.

See NEMT driver overtime for how operators schedule around the 40-hour line.

A launch checklist for agencies

Pick the route. Waiver transportation, NEMT, private pay, or a mix, based on where your clients’ rides actually go.
Read the governing rule for each route. The waiver service definition, the NEMT manual or broker agreement, and your state’s personal care task list.
Enroll separately. A transportation provider ID, a waiver service certification, or a broker contract, as the route requires.
Decide who drives. Dedicated drivers, or caregivers with transportation written into their role. Pull a motor vehicle report on each one, and credential each one for every program they drive for.
Buy the right coverage. Commercial auto on agency vehicles, non-owned auto liability for staff cars, and any limits your broker or waiver requires.
Separate the records. Keep ride records apart from care visit records, showing miles, pickup and drop-off times, and a rider signature for every trip.
Price private-pay rides. Use how to price NEMT trips to set rates that cover the driver, vehicle, and wait time.

Keeping rides separate from care in HealthRide

Rides need their own schedule, drivers, and invoices, apart from care visits. In HealthRide, trips go on a dispatch board where you assign them in one motion, and standing rides repeat on their own. Completed trips gather into invoices priced from each payer’s rates. Riders and facilities can pay by card with pay links and saved cards, and checks you record land in the same ledger. See invoicing and recurring trips.

Adding rides to a home care agency: waiver transportation, NEMT, and the liability that comes with it