How long a NEMT pickup really takes: service time by mobility level

What fills a pickup stop

A pickup is the time between the van stopping at the address and the van pulling away with the rider secured. The drive to the address is separate. Scheduling every stop as the same few minutes ignores that the stop is a string of steps, and their length depends on the rider, the place, and the level of service.

At the pickup, those steps are:

1. Park and announce. MTM Health’s Virginia handbook (approved August 10, 2026), which covers fee-for-service trips from October 1, 2026, has drivers who are not making a curbside pickup show identification and let the household or the facility staff know they are at the entrance. CareOregon’s manual also has drivers let the rider know they have arrived.
2. Wait for the rider, up to the payer’s limit. The next section lists those limits.
3. Give the assistance on the manifest: curb-to-curb, door-to-door, or hand-to-hand. Each goes a different distance from the van.
4. Board and secure. Buckle each rider in and tie down each wheelchair. Virginia’s handbook keeps the vehicle parked until all belts are fastened and all wheelchairs and their riders are properly secured.
5. Stow the equipment. Texas managed care has drivers help riders use lifts and ramps and put away mobility aids and folding wheelchairs, though not the rider’s other belongings.

At the drop-off, the order runs backward, plus the walk inside. Virginia’s handbook asks drivers to park so that, where possible, riders get to the door without crossing a street, and to escort members inside before driving off. On a discharge home, Louisiana’s Medi Trans manual also has the provider carry the rider’s belongings to the residence entrance.

How long the rules let a driver wait

The waiting step is the one part of the stop that broker rules set outright. After the limit, the driver reports the rider as a no-show through dispatch and moves on.

Two rules shape the waiting before the scheduled time. An early van does not start the clock, as Georgia’s section 811.3 spells out. And an early van cannot make the rider leave early: Virginia, Georgia, and CareOregon all say so, and MAS requires both rider and driver to agree to an early start. Rider readiness shortens the wait from the other side. MTM Health’s Virginia and Rhode Island handbooks want members dressed and ready 15 minutes early, and MTM’s general handbook has providers check each pickup time with the rider 24 hours before the trip.

Service time by mobility level

Boarding and securement grow with the level of service. This table lists what the rules add to each kind of stop.

Ambulatory stops

A curb-to-curb pickup is the shortest stop, because the driver stays with the van. Virginia’s handbook limits curb-to-curb help to the doors, getting in and out, and storing a mobility device, without lifting anyone. The time goes up when the rider is not where the van is. When a curbside rider is not waiting outside, CareOregon’s driver phones the rider or the brokerage to ask what to do. Large apartment complexes and campuses cause most of those calls. The pickup address problems guide covers fixing them at the booking stage.

Wheelchair stops

A wheelchair stop has a fixed mechanical part and a variable human part. The mechanical part is the lift. The federal accessibility standard for vans, 49 CFR 38.23, caps platform speed at 6 inches per second while carrying a rider and 12 inches per second while deploying or stowing. A platform rising 30 inches, for example, needs at least 5 seconds of travel with the rider aboard, before anyone rolls on.

The securement is the bigger share. Under MTM Health’s Virginia handbook, each wheelchair position has four functional tie-downs plus a lap and shoulder belt fixed to the vehicle, and Texas makes the driver check every wheelchair’s securement and every rider’s belt before driving off. Stairs change the stop entirely. Indiana’s Medicaid program pays for an additional attendant when the driver cannot load the rider alone, and names a wheelchair user who lives upstairs with no ramp as the example. That extra crew member has to be scheduled, which is a planning decision made days before the stop. For the tie-down steps themselves, see wheelchair securement standards.

Stretcher stops

A stretcher stop involves the most handling at both ends. MTM Health’s Virginia handbook requires loading headfirst, chest, hip, knee, and upper torso restraints, and a crash-tested mount. It also requires the provider to bring a scoop, Reeves, or stair chair stretcher for riders who require one, and to clean contaminated surfaces and change linens after each transport. Virginia adds that a stretcher van can carry an attendant if the trip calls for one.

The drop-off depends on the facility. For dialysis stretcher riders, Georgia’s manual defines the service as moving the rider from bed to the facility’s bed or treatment chair, and it requires the facility to have that spot open so the crew can unload right away. A crew that waits for a bed to open loses that time from every trip after it.

Facility stops: check-in, elevators, and handoffs

Facility stops often run longer than home stops because the driver goes further inside and depends on staff.

• How far the driver goes. Under CareOregon’s manual, door-to-door service means walking the rider from the pickup door or desk out to the van, then into the destination’s waiting room, with no check-in. Its hand-to-hand service includes checking the rider in and handing them to a specific person, and the rider is never left alone along the way.
• Time to check in. Virginia’s handbook tells drivers to plan arrival so riders have enough time to enter the facility and complete any check-in before the appointment. Texas schedules drop-offs between 15 and 60 minutes ahead of the appointment.
• Opening hours. CareOregon’s manual keeps drivers from dropping riders off earlier than 15 minutes ahead of a facility’s opening, unless the rider requests it. MAS bars drop-offs for ambulette level or higher before the office opens. On trips where the provider owes door-through-door service, a rider who cannot safely get inside is taken back to the pickup address.
• Stairs and elevators. A 2025 National Academies report on combining ADA paratransit with on-demand service notes that transit agencies can set their scheduling software to allow extra stop time for riders who use mobility devices or live in buildings with stairs or elevators, either automatically from the rider’s profile or trip by trip.
• Discharges. Hospital discharges add paperwork, a wheelchair from the provider in some cases, and belongings. Virginia gives providers three hours from notice to arrive for a discharge. See hospital discharge transportation and the nursing home pickup guide.

Dialysis returns deserve their own profile. NIDDK notes that standard hemodialysis can leave patients tired or washed out for hours afterward, and that a sudden fall in blood pressure during treatment can leave them feeling weak or dizzy. Georgia’s manual assigns weighing and transfer to the dialysis chair to the facility’s care team. The walk back to the van is the driver’s, so give the return stop more time than the morning pickup.

Measure your own averages

Your own trip records beat any rule of thumb, because stop times depend on your riders, your vehicles, and your towns. Research on a large paratransit system shows how much detail matters. A study of more than 5 million data points from the Société de transport de Montréal’s paratransit service, published in 2020, found that vehicle type, ambulatory or wheelchair rider, a support person, boarding or alighting, the location, the time and day, and residential or non-residential places all had a significant effect on dwell time. After the agency switched its scheduling to the new estimates on August 1, 2018, on-time performance improved.

To build your own numbers:

1. Collect four timestamps per leg: arrived at pickup, rider on board, arrived at drop-off, and drop-off complete.
2. Compute the pickup stop as the time from the later of arrival or the scheduled pickup to the rider on board. That keeps an early van’s idle time out of the service figure.
3. Compute the drop-off stop as arrival at the destination to drop-off complete.
4. Group the results by level of service, assistance level, and place type: private home, apartment building, nursing facility, hospital, dialysis center.
5. Drop no-shows and cancellations from the sample, since they measure the wait rule rather than service.
6. Use a typical value and a slow-day value for each group, such as the median and the 80th percentile, over at least four weeks.

Here is a hypothetical result for one fleet, to show the shape of the output. The minutes are examples, not benchmarks.

A table like this also flags single addresses. A nursing facility whose pickups keep landing in the slow column is a conversation with its staff about having residents ready.

Padding a schedule without wasting the day

Padding works when it sits where the time is actually lost.

• Pad by stop profile, not per trip. A flat ten minutes on every trip wastes the ambulatory stops and still shorts the stretcher discharges. Set the stop time from the rider’s level of service and the place type, the way the National Academies report describes agencies setting extra time by rider profile.
• Do not count on early boarding. Arriving ahead of the scheduled pickup to build slack does not help, because the rider is free to wait until the booked time.
• Watch early arrivals. Padding that lands riders too early breaks other rules. Texas caps early arrival at one hour, and Louisiana’s Medi Trans manual at two hours or opening time, whichever is later.
• Pad the day’s first stops and the facilities. A late first pickup carries its delay through the whole run, and facility stops vary the most.
• Review monthly. Compare scheduled and actual times per group. Raise the stop time where late pickups cluster, and trim it where drivers keep arriving early and idling.

Stop times feed straight into capacity. Longer stops mean fewer trips per van per day, as the trips per day guide works through, and they are one of the main reasons arrival estimates miss, covered in why NEMT arrival times miss. For how misses are scored against the pickup window, see on-time performance.

Getting the numbers from HealthRide

HealthRide’s trip log lists each leg’s scheduled and actual pickup and drop-off times and exports as a spreadsheet, which is the raw material for the averages above. The on-time report in reports tracks punctuality on every leg, overall and per driver, so you can see whether a change to your padding helped.