NEMT bad weather policy: when to run, delay, or cancel rides

What brokers and states expect in writing

Many NEMT contracts already require a weather plan, so the question is whether yours is written down and followed. In CareOregon’s provider manual (February 2024), adverse weather means any conditions that can limit transportation, and the list runs from heavy snow and icy roads to flooding, tornado warnings, and extreme heat or cold. Its brokerages and their contracted providers must keep written procedures for severe weather, disasters, keeping the business running, and recovering afterward. At a minimum those procedures address training for staff, the way notices go out, and education for members, and a provider must share a copy on request.

CareOregon also expects each provider to plan how it will keep running trips during bad weather when that is possible, and to keep a fallback for riders whose pickups could otherwise run far behind. Its brokerages set severity levels and trip categories, post the current level on their phone systems, and tell providers when event procedures begin and change. Build your own levels so they line up with your brokers’ levels.

Other contracts set the same expectation from different angles:

• Tennessee. The TennCare health plan contract (July 1, 2026) makes the plans keep procedures for getting members to care that cannot wait, naming renal dialysis and chemotherapy, through heavy snow, flooding, tornado warnings, and extreme heat or cold. Staff training, notification, and member education must be part of it.
• MTM’s standard agreement (the January 2023 copy on Pennsylvania’s site). A provider that decides a trip cannot run because the roads are unsafe must tell both the rider and MTM of the cancellation right away.
• Minnesota. The state’s Medicaid provider manual for NEMT (revised April 2025) puts rider safety first when deciding whether to drive in inclement weather and requires notice to riders when a trip cannot run. It also makes providers bring riders they took to an appointment back to a suitable place before the weather makes that unsafe.
• New York’s MAS manual (October 2023). A provider that has to drop or cut short a trip because of weather lets MAS know the moment it finds out.

File the weather policy in your company policies and procedures binder, beside the accident and breakdown steps.

Tie your service levels to weather alerts

The simplest policy uses three service levels and ties each one to the alerts the National Weather Service issues for your area. The NWS uses three tiers: an advisory means be aware, a watch means be prepared, and a warning means take action. Each local NWS office sets its own criteria, so a Winter Storm Warning in the Southeast can take far less snow than one in the Northern Plains. A warning in your area reflects what is dangerous there.

The NWS wording behind those levels is blunt. For a Blizzard Warning it says not to travel. For an Ice Storm Warning it says travel is strongly discouraged. A Winter Storm Warning tells people to put off travel until conditions improve, and a Winter Weather Advisory tells drivers to expect winter conditions and use caution.

Two hazards need their own rules because they kill drivers who push through:

• Flooded roads. The NWS says it is never safe to drive into flood water. Rushing water 12 inches deep is enough to sweep most cars away, 2 feet will move SUVs and trucks, and the pavement beneath may already have collapsed. Every driver turns around, every time.
• Tornado warnings. The NWS warns that riding out a tornado in a vehicle is unsafe. Head for the nearest shelter when that is possible. If you can’t reach one, the NWS gives two last resorts: crouch low inside with your head covered, or get out and lie in low ground like a ditch or ravine.

Heat works differently. It seldom makes roads impassable, but it makes curbside waits and hot vehicles dangerous for older and medically fragile riders. On heat alert days, check that every van’s air conditioning works, cut outdoor waits short, and do not leave riders sitting in a parked vehicle. Minnesota’s rules require every heating and air conditioning unit in the vehicle to work, and Louisiana’s Medi Trans manual caps the time a van with riders inside can sit without its driver at five minutes.

Who makes the call

Name one person who sets the level, and a backup. Set a fixed decision time, for example 6:00 p.m. the night before, with a second look before the first run leaves. Give every driver the authority to stop and call dispatch when a road looks unsafe, whatever the level says. MTM’s Virginia handbook (approved August 10, 2026) states that scheduling pressure never justifies unsafe driving.

Protect dialysis and other life-sustaining trips

Life-sustaining trips run first at every level. CareOregon expects service for critical medical care to go on during bad weather to the extent it can, and its term covers treatment that keeps a person alive, with renal dialysis and chemotherapy as the examples. For these riders, a missed treatment is its own emergency.

Build a critical-rider list before the season starts, and limit access to the staff who use it:

• Rider name, phone, and caregiver’s phone
• Treatment type, days, and chair time
• Center name and phone, plus the backup center if the rider has one
• Level of service and home access notes, such as a steep driveway, outside stairs, or a long walk to the door

Talk to the treatment centers before a storm, not during it. Federal rules require every dialysis facility to keep an emergency preparedness plan, review it at least once every two years, and line up other facilities that can treat its patients if it has to cut back or shut down (42 CFR 494.62). Call each center when a major storm is forecast and ask whether it will open early, close, change shifts, or send patients elsewhere. The American Kidney Fund tells patients to arrange early dialysis when a storm is coming, so be ready to move pickups earlier the same day a center changes its schedule.

Give riders the numbers they need too. CDC advises dialysis patients to keep contact numbers for their own center and another nearby center, and lists the KCER hotline (1-866-901-3773) and the National Kidney Foundation help line for patients who cannot reach their clinic.

Large events can also bring facility evacuations. In its 2023 transportation coverage guide (SMD 23-006), CMS says Medicaid NEMT can take a beneficiary out of a nursing home or other medical facility that a disaster has made unsafe and into one that is still operating, across state lines if that is where the closest open facility is. A move from one home in the community to another, made for personal reasons like being nearer relatives, is not covered. Ask each broker how it authorizes these trips before you need one. The dialysis transportation software guide covers running standing dialysis schedules day to day.

Tell the broker, facilities, and riders early

On a weather day, notice is the part of the job that protects your contract. Give it in this order.

1. The broker. Under CareOregon’s manual, a provider that has to scale back tells the brokerage how much capacity it has lost, and asks at once for any trips to be reassigned so there is still time to move them. The MAS manual and MTM’s standard agreement both call for notice the moment you know a trip will not run.
2. The facilities. Call dialysis centers, clinics, and day programs with the list of their patients whose rides are delayed or cancelled.
3. The riders. CareOregon asks providers and drivers to tell members about weather delays in advance whenever possible, with an estimated arrival time or word that the trip cannot be done.

Sample messages to adapt:

Delay: “Snow is slowing the roads today. Your driver is about 30 minutes behind and should reach you around 10:15. Call us at [number] with any questions.”

Routine visit cancelled: “Because of the ice storm warning, we are not running routine rides today. We have told your clinic. Please call us at [number] and we will help you set up a new ride.”

Log every decision and call: the alert in effect, the time the level was set, the trips affected, and who was told when. CareOregon excuses delays from weather or traffic that affect everyone on the road, but the log is what proves it was the weather. The late pickup playbook covers the individual delay calls.

Get vans and drivers ready before the season

Weather readiness happens in October, not on the morning of the storm.

Vehicles. CDC’s winter guidance lists the fall checks: antifreeze level, winter windshield washer fluid, tire tread and pressure, and the heater, defroster, brakes, battery, emergency flashers, exhaust, and oil. It also advises keeping the gas tank near full to help prevent ice in the tank and fuel lines. Put those checks into your vehicle maintenance schedule for the fall.

Equipment. Minnesota’s rules require a blanket in every vehicle year round and an ice scraper between October 1 and April 30. CareOregon wants tire traction devices on board when the roads need them, along with other seasonal gear. CDC’s emergency car kit adds items worth carrying all winter:

• Phone charger and spare batteries
• Extra hats, coats, mittens, and blankets
• A shovel, plus sand or cat litter to give the tires grip
• Water and snack food
• Jumper cables
• A flashlight, hazard reflectors, and a bright distress flag

Drivers. Brief every driver at the start of the season. The NWS advice for winter driving is to clear all snow and ice from the vehicle before leaving, slow down even when roads only look wet, pull over when visibility gets too poor to see, and stay with the vehicle if it gets stuck. The guide to van breakdowns with riders aboard covers what to do if a van is stranded with riders inside.

Sample policy wording

The wording below is a starting point. Change the times and levels to fit your area, your brokers’ severity levels, and your insurer’s requirements.

1. Purpose. This policy sets how the company decides to run, limit, or stop service when weather makes travel unsafe, and how it protects riders who depend on life-sustaining treatment.
2. Decision owner. The operations manager sets the service level by 6:00 p.m. the day before and reviews it before the first run. The owner is the backup.
3. Service levels. Level 1 (advisories): all trips run with added travel time. Level 2 (winter storm, extreme cold, flood, or extreme heat warnings): life-sustaining trips, hospital discharges, and rides home only. Level 3 (blizzard, ice storm, flash flood, or tornado warnings, or a government travel ban): no new pickups until conditions allow.
4. Critical riders. Dispatch keeps a list of riders receiving dialysis, chemotherapy, or other life-sustaining care, updates it monthly, and schedules those riders first at every level.
5. Driver safety. Drivers never enter flood water and may stop and call dispatch whenever a road looks unsafe. No driver is disciplined for that decision.
6. Notice. Dispatch tells each broker about reduced capacity as soon as a level is set, calls facilities with the list of affected riders, and contacts every rider whose trip is delayed or cancelled.
7. Records. Dispatch logs the level, the time it was set, every affected trip, and every notice given.
8. Training and review. Staff are trained on this policy at hire and every fall. Management reviews it after each weather event.

Running a storm day in HealthRide

When the weather turns, HealthRide’s dispatch board lets you move or cancel trips in a few clicks, and the live map shows where every van is. Announcements in team chat reach all your drivers at once, and riders can follow their driver live from a text link.