Can a transportation provider bill Medicaid when a rider no-shows?

The short answer and the rules behind it

A no-show is not billable to Medicaid. Medicaid pays for a covered service, and on a missed ride the service never happened. Three federal positions settle it:

1. No federal share. In SMD 23-006, the Medicaid Transportation Coverage Guide issued September 28, 2023, CMS rules out federal financial participation for transporting a beneficiary who never shows up for the ride. Any state payment for it would get no federal match.
2. No charge to the rider. The same guide rules out charging the beneficiary for the missed ride, whether the state or the provider would collect it. NC Medicaid’s summary of the CMS policy gives the reasoning: a missed appointment “is not a distinct reimbursable Medicaid service, but a part of providers’ overall costs of doing business.”
3. Full payment. 42 CFR 447.15 requires providers to treat the Medicaid payment, together with any required cost sharing, as full payment.

The guide also bars states from cutting off rides over no-shows or lateness, however often they happen. States may add steps instead, for example making the rider confirm the ride that morning or the night before. The money comes back a different way: CMS allows states to cover rider no-shows and no-load miles through the way they pay for transportation. Where a state does that, missed trips are paid for through the rate, not per incident.

Which missed trips count as no-shows

The billing answer depends on what actually happened at the door. These cases get confused on trip logs, and they are treated differently:

Nebraska’s rule shows how broadly states define the term. 471 NAC 27 counts a trip as a no-show when either the client or the NEMT provider fails to arrive as scheduled for a trip that was not cancelled, and it lists no-shows among the services Nebraska Medicaid does not cover. CMS treats a provider who never arrives the same way: there is no federal share in any payment for that trip, since nothing covered took place.

What state Medicaid manuals say

Each program below treats a missed ride as something to record, not bill. The differences are in the details around it.

The pattern for an operator is simple. Treat a missed ride as unbillable to Medicaid, and put your effort into the record, because the record is what protects the trips you did run. The trip cancellations guide covers how to log each kind of cancellation.

How brokers and health plans handle them

Brokers follow the same rule and add procedure. Their manuals decide when a driver may leave and what counts as proof.

• MTM Health. Its Virginia provider FAQ puts no-shows and door cancellations in the same bucket: neither is reimbursed. It wants providers to reach the member a day ahead, check that the ride and pickup time still work, and cancel when the member says they are not going. MTM’s general handbook (August 2022) has the driver stay at the right address until 10 minutes after pickup time, then report the no-show live, through MTM Link or by phone, before driving off.
• MTM Health in Virginia. Under MTM’s August 10, 2026 Virginia handbook, a pickup is on time anywhere from a quarter hour before the scheduled time to a quarter hour after it. A member still not ready when the window closes is handled under MTM’s no-show procedure, after the driver tries a call or text.
• Medicare Advantage ride benefits. Plans that cap rides can count a no-show against the member. Wellcare’s transportation FAQ says a missed ride may be deducted from the member’s total number of rides.

The MTM Health broker guide covers the rest of its trip rules.

Provider no-shows are billed against you

When your vehicle is the one that fails to appear, the money runs the other way. Broker agreements price provider no-shows directly:

• The WellTrans Provider In Network Agreement, dated October 16, 2025, assesses $100 per occurrence, as liquidated damages, whenever the vehicle is a no-show, and waives them only when the cause was beyond the provider’s control and reported to WellTrans before the scheduled pickup.
• MTM Health’s Virginia handbook defines vendor no-shows as “failure or refusal to complete assigned trips” and sets the standard below 0.25 percent. A provider that falls short risks an improvement plan, liquidated damages under its service agreement, or removal from the network.

Reassign a missing driver’s trips before pickup time, not after. The broker penalties guide walks through disputing an assessment.

North Dakota’s rider-charge rule

North Dakota’s January 2026 manual is the one manual here that lets a provider charge Medicaid riders for missed rides. It allows direct billing to members only when the provider bills every rider for missed appointments, applies the policy equally, posts it publicly or gives it to riders in writing, and puts no separate charge on Medicaid members.

That sits uneasily with CMS’s 2023 guide, which bars providers from charging a beneficiary for no-shows. If you operate in North Dakota and want to use the rule, ask ND Medicaid for written confirmation and file it with your policy. The North Dakota rates guide covers the rest of that state’s NEMT billing.

Charging no-show fees outside Medicaid

Your own contracts are where a no-show fee belongs. Private-pay riders, families, and facilities that buy rides outside Medicaid agree to your terms, so the fee is a business decision rather than a program rule. To make it hold up:

1. Spell out, in writing and before the first trip, the fee amount, the cancellation cutoff, and the driver’s wait.
2. Define what counts: not present at pickup, cancelled at the door, or cancelled after the cutoff.
3. List when you waive it, such as a hospital admission or your own late arrival.
4. Charge it the same way every time, from the same trip evidence.
5. Keep Medicaid members out of it, unless your state has confirmed otherwise in writing.

Fill-in wording is in the no-show policy template. The private-pay guide covers pricing. To see what missed trips cost a fleet today, use the no-show cost calculator.

Never bill a missed ride as if it happened

Submitting a missed ride as if the trip happened counts as a false claim. Under the False Claims Act (31 U.S.C. 3729), a person who knowingly presents a false claim owes triple the government’s damages and a civil penalty on each claim. Under 28 CFR 85.5, a penalty assessed after July 3, 2025 is a minimum of $14,308 and a maximum of $28,619 per claim. The statute counts deliberate ignorance and reckless disregard as acting knowingly, so careless trip logs do not protect a provider. See the False Claims Act entry.

New York shows how states check. Its manual requires trip records, including a driver attestation, for every leg, kept six years after payment, and it recoups payment when they are incomplete, unacceptable, or false.

The records that decide a disputed no-show

Say a rider reports that no van arrived, and the broker asks for proof. What settles it is a record created as events happened, not a driver’s memory a week later. Build each no-show record from:

• Arrival. The time the vehicle reached the correct pickup address, ideally with its GPS position.
• The wait. When the wait started and ended, measured against the minutes your contract requires.
• Contact attempts. Calls or texts to the rider, with times.
• The report. When dispatch or the broker was told, and that it happened before the driver left.
• Attestation. The driver’s own statement that no trip occurred, the way New York requires.

Keep the records as long as your programs require: seven years in North Dakota and six in South Dakota, for example. The documentation requirements guide lists the rest of a complete trip record.

Proof at the door with HealthRide

HealthRide keeps recorded wait times on no-shows, along with GPS miles and timestamps on every trip. Drivers update each trip’s status from the driver app as they work, including when they reach the pickup, so the arrival and the wait are on file if a broker or rider disputes a missed ride. No-shows stay separate from cancellations, which keeps the reports accurate.