Rides for community health center patients: how health centers fund and buy transportation

Transportation is a required health center service

Health centers that receive federal Health Center Program grants under Section 330 must provide a set of required primary health services, and the law names transportation in that set. Under 42 U.S.C. 254b(b)(1)(A), required services include “services that enable individuals to use the services of the health center (including outreach and transportation services…)”. The program regulation says the same thing in plainer terms: transportation “as needed for adequate patient care” for residents of the service area who have special difficulty reaching the center (42 CFR 51c.102(h)).

HRSA, which runs the program, defines transportation services as those that let patients reach health center services when transportation would otherwise be a barrier. Its examples are transport vehicles, bus tokens or vouchers for public transit, and links to other community transportation programs.

The program is large. For 2025, HRSA’s Uniform Data System (UDS) counts:

Transportation is a small line in health center budgets: $141.9 million out of $54.7 billion in total reported costs. But every funded center must provide it as needed, which makes each health center near your garage a possible customer.

Three ways a health center provides rides

The services a health center offers are recorded in its HRSA-approved scope of project on Form 5A, in one of three columns. The column tells you whether the health center pays for the ride and whether you would be a contractor.

Column II is the contract you want. HRSA’s Compliance Manual (Chapter 4) says a Column II service reflects that the health center pays for the care a third party provides under the agreement.

Two HRSA points make these contracts simpler than clinical ones:

• Less paperwork. Contracts for enabling services such as transportation do not need the clinical provisions, like documentation in the patient record or follow-up care, because those services are generally not recorded in the patient record.
• Scope has to match. If a health center has a transportation contract that its Form 5A does not show in Column II or III, HRSA calls that a scope inaccuracy finding. Ask early whether the center’s scope already lists contracted transportation in Column II.

Where the money comes from

Health centers can pay for rides from any of their revenue sources. The 2025 UDS shows the main sources outside patient billing:

A transportation budget can draw on any of these. Ask whether a state, county, or foundation grant already pays for rides, because that grant’s terms may shape the contract, the reports it needs, and when the money runs out.

Vehicles have their own federal source. The Federal Transit Administration’s Section 5310 program pays for transportation projects serving seniors and people with disabilities, with buses and vans among its standard examples. Private nonprofit organizations are eligible subrecipients, as are state and local government bodies and public transit operators. Subrecipients apply to the state department of transportation, or to the designated recipient in large urban areas.

How a health center buys: federal procurement rules

When federal award money pays for a contract, the health center must follow its own written procurement procedures, and those procedures must conform to the federal grant rules in 2 CFR 200. HRSA’s Compliance Manual (Chapter 12) spells out what that means for a vendor:

• Open competition. Procurements paid with federal award money must be conducted with full and open competition. A non-competitive award is allowed only when the purchase is under the micro-purchase threshold, only one source can fill it, an emergency will not allow a delay, the agency approves in writing, or competition proved inadequate after soliciting several sources.
• Rates in the contract. Contracts with other providers for services in the health center’s scope must include a schedule of rates and a method of payment.
• Oversight and records. The health center must oversee contractor performance, needs access to your records and reports tied to its work, and keeps contract records for three years after its final financial report.

The dollar thresholds come from the federal rules:

A health center can set lower thresholds than these in its own procedures. Grant recipients are also bound by the federal suspension and debarment rules (2 CFR 200.214), so expect the health center to confirm your company is not suspended or debarred.

For a small fleet, the practical path is to be one of the qualified sources a health center calls for quotes, then earn a larger, competed contract with good service. Our guide to government NEMT contracts covers bidding on public solicitations.

Serving uninsured patients

Section 330 requires health centers to assure that no patient is denied care because of inability to pay, and their fee rules follow the patient into your contract. Under HRSA’s sliding fee requirements (Chapter 9), when a health center charges for a service it provides through a Column II contract, it must discount that fee:

• A full discount for patients at or below 100 percent of the federal poverty guidelines, or a nominal charge if the center chooses one.
• Partial discounts, in at least three pay classes, for patients between 100 and 200 percent.
• No discount above 200 percent.

The simplest setup is to bill the health center for every ride and let it decide what patients pay. Do not collect fares from patients unless the contract says how, and at what amount.

Payer order matters too. For the 47.9 percent of patients on Medicaid or CHIP, the state’s Medicaid ride benefit may cover medical trips, since federal rules put each Medicaid agency in charge of members’ rides to care (42 CFR 431.53). A health center contract is most useful for the rides no program pays for: uninsured patients, trips a benefit does not cover, and patients who cannot wait for a broker’s notice period.

When a health center gives patients free rides, federal anti-kickback rules apply to it. The local transportation safe harbor (42 CFR 1001.952(bb)) expects the rides to follow a uniform policy, go unadvertised, carry only established patients, and be paid for by the health center itself, with no driver paid by the number of patients carried. Because the health center must carry the cost itself, never bill another payer for a ride it has already paid for.

What to offer a health center

Health centers report transportation costs to HRSA each year, so a clear monthly invoice with trip counts by site helps their UDS report and their grant reports. The facility transportation agreement template is a good starting point, and our facility contracts guide covers outreach.

Running health center rides in HealthRide

Health center staff can request rides through their own HealthRide portal and follow each vehicle live. Standing weekly appointments are scheduled once and keep repeating, and every completed ride lands on the health center’s monthly invoice. The reports show completed and on-time trips for the monthly review.