How to Reduce NEMT Deadhead Miles: What They Cost and 9 Ways to Cut Them

What counts as a deadhead mile

A deadhead mile is any mile a vehicle drives with no rider on board. CMS uses the terms no load miles and unloaded miles for the same thing: mileage the driver travels without a Medicaid beneficiary in the vehicle, including the return drive after a rider no-show (Medicaid Transportation Coverage Guide, SMD 23-006, September 2023).

In a normal NEMT day, deadhead comes from five places:

• The first run. From your lot, or the driver’s home, to the first pickup.
• Between trips. From each drop-off to the next pickup.
• The last run. From the final drop-off back to the lot.
• No-shows. The drive out to a rider who is not there, and the drive away.
• Repositioning. Moving a van toward a will-call or a same-day trip.

The opposite is a loaded mile, driven from pickup to drop-off with the rider aboard. Loaded miles are the ones mileage rates normally pay for.

Why deadhead costs you twice

Deadhead costs you once in fuel, wear, and driver time, and again because it is usually unpaid.

CMS states that no load miles generally cannot be paid as a direct service or administrative activity. It also recognizes that empty miles are a real cost for transportation providers, so states may build that cost into their payment rates. States may also cover unloaded mileage separately in limited circumstances, when the most appropriate and economical provider would face extraordinary costs to reach the rider. A state has to submit a state plan amendment before it can claim federal matching funds for that coverage.

For a rough cost per mile, the IRS business standard mileage rate is 76 cents per mile for July 1 to December 31, 2026, up from 72.5 cents for the first half of the year. It is a tax figure, not your real operating cost, but it is a published, neutral starting point until you have your own number from fuel, maintenance, insurance, and depreciation.

How to measure your deadhead share

Deadhead share = (total miles minus loaded miles) ÷ total miles × 100

Loaded miles come from the trip records for each leg. Total miles come from the odometer or GPS for the vehicle’s whole shift. Record both for every vehicle, every day.

Here is a worked example for one van on one day:

That is one van. Run the same math across the fleet each week, then sort drivers and routes by deadhead share. The deadhead cost calculator does the arithmetic for your own miles and rates.

Nine ways to cut deadhead

1. Chain trips. Build each run so the next pickup sits close to the last drop-off. It attacks the between-trip miles that repeat all day, and it works best when you plan the whole fleet at once rather than van by van. The route optimization guide explains why.
2. Assign by zone. Give each van a home area for the day, so it is not crossing town between every trip.
3. Start drivers near their first pickup. Where your insurance and policies allow, let drivers start from home or from a second parking spot closer to the day’s first riders.
4. Plan returns with the outbound run in mind. A van that drops a rider near a clinic at 9:00 can take a rider from that clinic at 9:30 instead of driving back empty.
5. Stage for will-calls. During the hours your dialysis centers and clinics release riders, keep a capable van nearby instead of sending one from across town. The will-call guide covers how much capacity to hold.
6. Turn back trips that do not fit, early and for a valid reason. A trip that strands a van 30 miles from its next job can cost more than it pays. Brokers do limit this. CareOregon accepts reassignment requests for trips outside your service area or hours, but treats a pattern of cherry-picking only the best-paying trips, or returning many trips last minute, as grounds for a corrective action plan.
7. Fill gaps with nearby work. Broker fill-in trips, facility runs, and private-pay rides near your routes turn empty miles into loaded ones. Modivcare, for example, runs a marketplace where its transportation providers can pick up extra trips during slow periods to fill gaps left by cancellations, no-shows, or long waits.
8. Group riders where contracts allow. Two riders from one neighborhood to one clinic can share a run, within ride-time limits. The Medi Trans manual in Louisiana does not allow any rider in a multi-load vehicle to ride more than 45 minutes longer than the direct trip.
9. Review weekly. Look at deadhead share per driver and per route, find the worst few, and rebuild them first.

Deadhead you can price in

Some empty miles are unavoidable, especially in rural areas. On work where you set the price, build them into the rate:

• A base or pickup fee covers the drive to the rider and the first few minutes.
• An out-of-area charge covers pickups beyond your normal zone.
• A minimum fare keeps very short trips from losing money.

For Medicaid work, rates are set by the state or broker, and the CMS flexibility for unloaded mileage exists only in states that adopt it. The trip pricing guide covers how to set private-pay and facility rates, and the NEMT KPIs guide shows how deadhead fits with revenue per vehicle hour.

A before-and-after example

A hypothetical 5-van fleet drives 820 total miles a day, 450 of them loaded, for a deadhead share of 45.1%. After reworking routes by zone and chaining trips, it drives 740 total miles for the same 450 loaded miles, a share of 39.2%. That is 80 fewer empty miles a day. At 76 cents a mile over 22 working days, the fleet saves about $1,338 a month, plus the driver hours those miles used to take. Those hours can carry more trips.

Doing it faster

Ryder Go plans and assigns the whole day in one click, starting from where each driver actually is, so routes come out tighter with fewer empty miles. You can review each plan before it applies. HealthRide’s trip log and driver activity report use miles from recorded GPS routes, so you have real numbers to measure your deadhead share. See the route optimizer for how it works.