Raising your NEMT prices: notice, contract terms, and how to tell customers

Which prices you can raise

You can raise the prices you set. You cannot raise the prices a payer sets for you. Sort your customers before you plan anything:

The Medicaid rows come with a firm rule. Under federal regulations, a provider in the program must accept the Medicaid payment, together with any cost sharing the state plan sets, as the full amount owed (42 CFR 447.15). A higher private price never reaches a Medicaid rider. To improve those rates, negotiate at renewal; our guide to broker rates covers how to judge an offer, and what Medicaid pays for NEMT lists state rates.

If you also bill Medicaid, check how your state uses your public price on claims before you change it. Our entry on the usual and customary charge explains why that price list matters.

Size the increase from your own costs

Base the new price on what a trip costs you to run. A competitor’s rate or a round number is not a cost. Our pricing guide and the cost per mile calculator walk through the math.

Here is what moved over the past year:

• Fuel. Regular gasoline cost $4.465 a gallon on average nationwide in the week of September 28, 2026, according to the Energy Information Administration. That is $1.347 more than a year earlier. Diesel averaged $6.382, up $2.628.
• Prices overall. The Consumer Price Index for All Urban Consumers rose 3.4 percent in the 12 months ending August 2026. Its gasoline index rose 27.4 percent over the same period.
• Mileage. For driving on or after July 1, 2026, the IRS set its business mileage rate at 76 cents, replacing the 72.5-cent rate used January through June, and pointed to recent fuel price increases.

Not every cost rose. The CPI’s motor vehicle insurance index fell 0.8 percent from July to August 2026. Use your own renewal quote, payroll, and fuel receipts, not national averages.

Here is how the math works on one hypothetical private-pay wheelchair trip:

A 30 percent jump in fuel adds only $1.20 here, because fuel is a small share of the trip. Wages move the total more. Run the same table for each level of service, since stretcher and wheelchair trips carry different costs.

Read every agreement before you announce anything

Facility agreements decide how and when you can change the price. Pull each one and note:

1. Term and renewal date. Some agreements fix prices for the whole term.
2. The price clause. Fixed, adjustable on notice, or tied to an index.
3. Notice rules. How much notice, in what form, and to whom.
4. Escalation or fuel clauses already in place, and whether you have been using them.
5. Termination rights. How easily the facility can leave if it dislikes the new price.

If an agreement fixes the price until renewal, wait, or ask for an amendment with a reason the facility can take to its managers. Our facility transportation agreement template shows where each clause sits.

Build price changes into new agreements

Every new agreement should say how the price moves, so next year’s increase is a formula instead of a negotiation. Three approaches work.

A fixed yearly step

The simplest version raises rates by a set percentage on each anniversary of the agreement. Both sides know the number in advance. The weakness is that it ignores what costs actually did.

A CPI clause

A CPI clause moves the rate by the change in a named price index. The Bureau of Labor Statistics publishes guidance for writing one:

• Define the base price the clause applies to.
• Name the exact series. “CPI” alone is ambiguous. Specify the population, area, item, and base period, for example CPI-U, U.S. city average, all items, 1982-84=100.
• Use the U.S. city average. BLS recommends it for escalator clauses because metro indexes have much larger sampling errors and swing more.
• Use data that is not seasonally adjusted. BLS calls seasonally adjusted data inappropriate for escalation, partly because it can be revised for up to five years.
• Pick a reference month and an interval. The index comes out about two weeks after the month it measures, so May’s CPI arrives in mid-June. Yearly adjustment is the most common.
• Add a cap or floor if you want one, and a method for handling major index revisions.

Example: a clause uses August as its reference month and caps increases at 5 percent. The CPI-U rose 3.4 percent in the 12 months ending August 2026, so a $51.00 base rate becomes $51.00 × 1.034 = $52.73 for the next contract year.

A fuel surcharge

A fuel surcharge adds a set amount per trip or per mile when a public fuel price passes a threshold. Tie it to the Energy Information Administration’s national weekly price, which anyone can look up for free.

Example: a surcharge of $0.35 per trip for every full 25 cents that regular gasoline averages above $3.50. At the $4.465 average for the week of September 28, 2026, that is three full steps, or $1.05 per trip. Write down the benchmark, the base price, the step, and how often the surcharge resets.

Government contracts follow their own rules. Federal fixed-price contracts with economic price adjustment tie changes to established prices, actual labor or material costs, or cost indexes named in the contract (FAR 16.203-1). Use the clause the contract gives you. Our guide to government NEMT contracts covers bidding.

Give notice the right way

Notice is where increases go wrong. Follow the agreement first. Where there is none, these are reasonable practices:

Decide ahead of time whether trips booked before the effective date keep the old price, and say so. Keep every old price list with its dates. Your rate sheet should show the new effective date at the top.

A price increase letter outline

Keep the letter short and specific. A customer should understand the change from the first two sentences.

1. Subject line with the word “rates” and the effective date.
2. The change and the date in the first sentence.
3. Old and new rates in a small table: base rate by level of service, per-mile rate, and wait time.
4. The reason in one or two plain sentences, such as fuel and wage costs.
5. What stays the same: service hours, response times, and prices on trips already booked, if that is your policy.
6. What the customer needs to do: nothing, sign an amendment, or update a purchase order.
7. A named contact with a direct phone number.

A sample opening, to adapt: “Starting December 1, 2026, our wheelchair base rate will change from $51 to $54 per one-way trip. Mileage and wait time rates are unchanged. Trips booked before December 1 keep their current price.” The numbers are an example.

Handling pushback

Expect questions. Be ready with a short answer and your numbers:

• Show the cost change in one line, such as fuel and driver pay per trip.
• Offer a trade where it helps you: a rate locked for 24 months in exchange for a longer term, or a better rate for standing trips that keep a van full.
• Phase it in for a large account, half now and half in six months.
• Hold the floor. A discount below your cost per trip only moves the loss onto your books.

Keep the decision your own. The Federal Trade Commission says the antitrust laws require each company to set its prices on its own, and competitors who discuss current or future prices, costs, or bids can draw scrutiny. Keep your pricing plans out of conversations with other owners.

Keeping prices straight in HealthRide

HealthRide keeps a rate schedule for each payer, prices each trip when it is booked, and builds each facility’s invoice from its completed trips at those prices. Riders and facilities pay by card through a pay link or a saved card, and checks go into the same ledger. See invoicing.