NEMT driver called out sick: covering the run before the first pickup

The first call: what to get from the driver

Get what you need to rebuild the day, and nothing about the illness. Three answers matter:

1. How long they are out. The whole shift, the morning only, or several days. A driver who expects to be back by noon changes which legs you move.
2. Where the van and keys are. If drivers take vans home, the van may be parked in the sick driver’s driveway. Arrange its pickup now, or plan the day without it. This is where a written take-home vehicle policy earns its keep.
3. What the driver knows that the board does not. The side entrance a rider uses, a gate code at a group home, a facility that always runs late. Put it on the trip so the replacement driver sees it.

Skip questions about symptoms. New York’s sick leave law bars employers from requiring disclosure of confidential information about a mental or physical illness. Washington’s rules let another person give notice for an employee who cannot make the call. Write down the time the call came in, because your attendance records and any late-trip explanation will need it.

Sort the driver’s legs by what cannot move

Pull every leg assigned to that driver for the day, including afternoon returns and will-call legs that have no time yet. Then sort them:

1. Treatment that cannot be postponed. Louisiana’s Medicaid transportation manual names chemotherapy, radiation, dialysis, and opioid treatment programs as care that cannot be put off. Dialysis runs on fixed chair slots, usually three sessions a week of about 4 hours each, according to NIDDK. Clinic staff interviewed for a 2026 UC Davis Health study described late rides leading to shortened sessions.
2. Hospital discharges with a clock. MTM Health’s Virginia handbook gives the van three hours from notice to arrival on a discharge and charges liquidated damages when it misses. Louisiana’s deadline is the later of two clocks: three hours after the facility gives notice, or two hours past the scheduled discharge time.
3. Return legs. Some riders that other drivers drop off this morning are booked to come home on the sick driver’s lane this afternoon. Those returns are the easiest legs to forget at 5 a.m.
4. Routine visits. Checkups and therapy visits that the rider, the clinic, or the broker might move to another day. Moving them is not your decision. CareOregon’s provider manual says pickup and appointment times change only with the brokerage’s approval, and Modivcare’s Mississippi manual forbids changing a pickup time without contacting Modivcare first.

Riders on standing orders deserve a call even when their pickup moves only a few minutes. On recurring trips, MTM Health’s Virginia handbook expects a good-faith try at sending the same driver every time, plus a note on the record whenever someone else covers because of availability or coverage. A call-out is exactly that case: record it, and tell the regular rider who is coming instead.

If a van fails mid-route instead, the sort is similar but the riders already aboard come first. The vehicle breakdown plan covers that case.

Move legs first, then add drivers

Spreading legs across drivers already working beats calling someone in. Those drivers are awake, in credentialed vans, and often near the pickups. Work down this list:

1. Drivers with room nearby. Slide each leg to the driver whose run passes closest. Keep wheelchair legs on lift or ramp vans and stretcher legs on stretcher vans, and check that each move does not make that driver late for their own riders.
2. Part-time drivers who can start early or stay late. Check the week’s hours before you ask. Extra hours can tip a driver into overtime or past the hours limits your state or broker sets.
3. The on-call driver. Under 29 CFR 785.17, a driver waiting at home who just has to stay reachable is not on the clock, but one required to wait at or close to your premises is. The driver shifts guide covers building on-call coverage into the week.
4. The owner, a dispatcher, or anyone else on staff who holds a driver credential. Only if that person is credentialed with the broker for the vehicle type.

The credential rule has no exceptions. MTM Health’s Virginia handbook (approved August 2026) treats putting a never-credentialed driver on a trip as a 3-point infraction, and 3 points suspends the provider’s Marketplace access until the points come off. An expired credential costs 2 points, and trips run by drivers with expired documents are not paid. Lending the trips to another company does not solve it either, since MTM’s standard provider agreement allows no subcontracting unless MTM consents in writing. New York’s Medicaid transportation policy manual no longer allows a provider to subcontract trips or lease another provider’s vehicles at all, and tells a provider without enough vehicles for its trips to alert the broker as soon as possible so it can find someone else.

An example morning

Take a hypothetical eight-van fleet. At 5:10 a.m., the driver of van 4 calls out for the day. Van 4 had 11 legs: two dialysis riders with chair times at 6:30 and 7:00, a noon hospital discharge, five routine visits, and three returns.

Dispatch moves the first dialysis leg to van 2, which has an open half hour before its own first pickup. A part-time driver agrees to start at 6:00 and takes the second dialysis leg, the discharge, and the three returns. Vans 1 and 6 absorb three routine visits. The last two routine visits cannot fit without making other riders late, so dispatch phones the broker about both at 5:40, then calls the two riders.

Hand back what you cannot cover, by phone, before the pickup

Call the broker the moment you know a leg will not be covered. Three of the four documents below want 24 hours of notice, so by the morning of the trip the turnback window for that day’s work has usually closed, and so has the button in the portal. This is a phone call.

Rhode Island adds one more limit: trips you took from MTM’s Marketplace are not eligible for turnback, and trying to turn one back can cost you Marketplace access.

Short notice is not always penalized, but the exceptions are written narrowly. Modivcare’s Mississippi manual waives the replacement cost for circumstances outside your control, naming a sudden breakdown or an accident as examples, if you report them when they happen. WellTrans exempts documented emergencies and acts of God from its 12-hour rule. CareOregon’s manual speaks to illness directly. It counts drivers out sick among the acceptable reasons for a reassignment request, and it treats a pattern of last-minute reassignments as grounds for a corrective action plan that can cut the rides you are offered.

Habits count against you in other ways. MAS, the statewide broker in New York, warns providers that a refusal in the last 48 hours before pickup makes a stakeholder complaint ten times as likely. Modivcare may send fewer trips to providers who reroute late or without valid reasons. Louisiana’s manual says a provider that cannot perform a trip must tell the broker at once, so the broker can secure an alternate provider.

Whoever handles call-outs also has to be reachable. WellTrans charges $100 each time no one with decision-making authority answers or calls back within an hour during business hours, or while a rider is aboard one of your vans.

What you cannot do is let the leg quietly go unrun. MTM Health scores any assigned trip left undone as a vendor no-show, and its Virginia providers must keep those under 0.25 percent of trips. A late turnback is still far better than a missed trip.

Calls to riders and facilities

Once the plan is set, call every rider whose pickup time or driver changed, earliest first. Modivcare’s Mississippi manual requires a call to each waiting member when a pickup will run 15 minutes or more late, with the expected arrival time and any alternate pickup arrangements. MTM Health’s Virginia handbook asks for a call to the member or facility plus notice to MTM, which then works with them on another pickup if needed.

Call dialysis centers and hospital discharge planners directly, because their schedules move with your arrival time. The late driver playbook sets out the order of those calls, and rider notifications covers automatic reminders.

What you can and cannot ask of a sick driver

The U.S. Department of Labor says federal law does not require paid sick leave. Unpaid leave under the FMLA, up to 12 weeks for certain medical situations, reaches only drivers with a year on the job and 1,250 hours worked in the past year, and only where you employ 50 or more people within 75 miles of their worksite. The rules that touch a 5 a.m. call-out mostly come from states and cities. Three examples:

• California. Labor Code 246(m) asks for notice as soon as practicable when the need for sick leave is unforeseeable. Section 246.5(b) bars requiring the employee to search for or find a replacement worker as a condition of using paid sick days, and 246.5(c) bars denying the leave, firing, or otherwise punishing an employee for using it.
• New York. Labor Law 196-b ties the amount to headcount. Employers with four or fewer employees owe up to 40 hours of unpaid leave (it must be paid if the employer cleared more than $1 million in net income the year before), employers with 5 to 99 owe 40 paid hours, and employers with 100 or more owe 56 paid hours. Leave accrues at no less than one hour per 30 worked, and the employer may not require disclosure of confidential information about the illness.
• Washington. For an unforeseeable absence, WAC 296-128-650 lets an employer require notice as soon as possible before the shift starts, unless that is not practicable, and another person may call in when the employee cannot. The notice requirement applies only if it is in a written policy employees were told about. Verification can be required only for absences of more than three days (WAC 296-128-660).

Neither state lets you demand much warning for a sudden illness, so a fever that starts at 4 a.m. may reach you at 5. Build the day around short notice. Put the call-out procedure, the notice windows, and any documentation rule in your driver attendance policy, and check your state labor department’s rules before you discipline anyone for a sick day.

After the day: records and the roster

Write down what happened while it is fresh:

• the time of the call-out and who took it
• each leg that moved, and to which driver
• each call to the broker, with the time, the person, and any reference number
• any trip that ran late, and the reason

Then look for a pattern. If call-outs bunch up on Mondays or after holidays, those are the days to keep a spare driver. The drivers per van guide shows how to build that relief into the roster.

Rebuilding the day in HealthRide

Once the absent driver’s trips are unassigned, the strip above HealthRide’s dispatch board turns amber and lists exactly what still needs attention, and each trip moves with one drag onto another driver’s lane. Assigning a wheelchair trip to a van without a lift stops you with a clear explanation, and expired credentials surface as warnings before a trip is assigned. Ryder Go can also plan your whole day in one click.