Oregon Medicaid NEMT rates: the OHA fee schedule, brokerage pay, and member mileage

Oregon has no state ride rate for van and car companies

A transportation company in Oregon is paid by a brokerage, and the brokerage sets the price. OAR 410-136-3220 requires each open card brokerage to settle a base rate, mode by mode, with every subcontractor, with ground and air ambulance as the exceptions. For members of a coordinated care organization (CCO), the CCO’s ride service pays under its own subcontracts. The Oregon state guide lists which brokerage serves which county and CCO, and guides for RideSource, TransLink, and GOBHI Transportation Services cover three of them.

The state’s money reaches the open card brokerages through a formula, not a fee schedule. Under OAR 410-136-3200, OHA pays each brokerage one set amount per ride, figured this way:

1. Add the brokerage’s direct costs (transportation plus administration) and its indirect costs.
2. Divide by the projected number of rides per month.
3. Revisit the rate quarterly, whenever OHA changes eligibility or scope, or when other factors change the brokerage’s costs.
4. Settle up once a year from cost reports certified by a CPA, with any overpayment refunded within 60 days.

That formula matters to subcontractors in one direct way. Brokerages must make each subcontractor keep its NEMT books apart from the rest of its business, following generally accepted accounting principles, and may ask for the documents behind the costs they report to OHA.

What the OHA fee schedule still lists

OHA posts a monthly fee-for-service schedule for medical and dental services. Oregon’s state plan says transports not provided or arranged through the brokerage system are paid from that statewide schedule. The September 2026 file carries these non-ambulance transportation lines, most of them unchanged for two decades:

Treat these as reference amounts, not a price list. OHA’s Medical Transportation Services Provider Guide says every non-emergency medical transportation service needs prior authorization and that providers must contact the local brokerage before giving any ride. The guide lists the codes for other modes, such as A0100 for sedan or taxi and T2005 for a stretcher car or van, but the September 2026 file shows no price for them. The guide also has non-ambulance providers use place of service 99 and round any partial mile up to a whole mile. For what each code means nationally, see NEMT billing codes.

NEMT ambulance: the one place OHA’s base rate is the default

Ground and air ambulance trips that a brokerage arranges are paid differently. Under OAR 410-136-3180, the brokerage sends OHA documentation that it authorized the trip and tells OHA either to pay its own base rate or another amount the brokerage names, and the ambulance company bills for the authorized ride. OHA’s provider guide says to bill OHA for members outside a CCO and to bill the CCO for CCO members.

When the brokerage names no other amount, OHA’s base rate for a ground ambulance includes any procedures, medications, single-use supplies, oxygen, overhead, and the first ten miles. The September 2026 schedule lists these non-emergency ambulance amounts:

Two rules connect ambulance pay to the van rates. A subcontractor that uses an ambulance as a stretcher car or van is paid the stretcher base rate. The exception is a transport over two hours that requires a health care professional aboard to look after the member, which pays at the ambulance rate.

How brokerages must pay subcontractors

OAR 410-136-3220 is short, and nearly every line in it changes what a trip earns. For open card trips, brokerages pay as follows:

• Route. Pay follows the cheapest route between pickup and drop-off that still suits the member’s condition.
• Waiting. Time spent while the member makes their way out to the vehicle earns nothing, and neither does help getting in or out. The exceptions: the member rides your gurney and cannot shift to the facility’s, the member becomes ill after dialysis or chemotherapy, or the trip pauses so the member can pick up medicine or supplies the visit calls for.
• Vehicle mismatch. Carrying a member who walks in a wheelchair van or another non-ambulatory vehicle earns only the ambulatory base rate. Carrying a non-ambulatory member in an ambulatory vehicle, when the brokerage allows it and local ordinance permits, is paid at the non-ambulatory rate.
• Reclining wheelchairs. These earn the wheelchair base rate. A wheelchair never counts as a stretcher.
• Several members at once. The full base rate covers the first member, and each added member brings half a base rate. When the added member needs a cheaper mode, the half rate is for that cheaper mode.
• Miles. Only actual miles driven. With several members aboard, the count runs from the first pickup until the last stop, however many ride.
• A member who dies. Nothing is paid if the member dies before the vehicle arrives. If the member dies after the transport starts, payment is limited to the base rate plus mileage.
• No public charge. No payment where a city or county ordinance bars charging for the service, or where you do not charge the public for it.

Here is a hypothetical example. If your agreed wheelchair base rate were $40 and you carried two wheelchair members from different homes to the same dialysis center, the brokerage would pay $40 for the first member, $20 for the second, plus the actual mileage, counted from the first pickup until arrival at the center.

Member mileage, meals, and lodging

Some members get paid to drive themselves, and those trips never reach a van. Oregon’s state plan, under SPA 23-0019 (approved September 6, 2023, effective April 1, 2023), ties member and attendant reimbursement to IRS figures: mileage at 75 percent of the IRS standard rate, all-inclusive; meals at 50 percent of the IRS standard meal rates; and lodging at 100 percent of the IRS standard rate. Volunteer drivers are paid at the GSA mileage rate for business miles.

OHA’s October 24, 2023 notice put the first amounts under that method into effect on November 1, 2023, and the 2026 Open Card handbook shows the current ones:

The rules around those amounts come from OAR 410-136-3240 for open card members:

• The brokerage must approve the travel in advance, and the member has 45 days after the travel to ask for reimbursement.
• Meals require at least four hours of round-trip travel outside the local area, starting before 6 a.m. for breakfast, covering 11:30 a.m. to 1:30 p.m. for lunch, or ending after 6:30 p.m. for dinner.
• Lodging is paid when the member would have to leave before 5 a.m., would get home after 9 p.m., or has a documented medical need.
• One attendant may be covered when medically necessary, but never for the attendant’s time.
• Brokerages pay within 14 days of verifying the appointment and may hold amounts under $10 until they reach $10.

OAR 410-141-3960 holds CCOs to the same floor: mileage, meals, and lodging at no less than OHA’s allowable rates, with the same 45-day window. A0090 is the code for that mileage.

Records and audits behind the pay

Payment can be clawed back long after a trip if the records do not hold up. The rules in division 136 that reach a subcontractor directly:

• Ride records. Brokerages keep service and billing files organized by subcontractor, and the record for each ride includes the date, the mode, and the driver’s full name. The rule expects brokerage and subcontractor records to be detailed enough for an outside reviewer to validate the claims (OAR 410-136-3300).
• Audits. Brokerage and subcontractor records can be audited at least yearly by OHA, the Secretary of State’s auditors, the state’s fraud control unit, or the federal government. A payment can be denied or taken back when a review finds the ride did not follow the rules (OAR 410-136-3320).
• Excluded people. No brokerage may sign or pay a subcontractor, provider, or driver currently barred from Medicaid, Medicare, or CHIP through suspension, debarment, or exclusion, or one convicted of a crime related to those programs.
• Workers’ compensation. Any brokerage or subcontractor with employees needs this coverage unless an exemption applies, and each brokerage has to hold its subcontractors to it (OAR 410-136-3060).

More open card members in 2027

OHA has told Healthier Oregon members, the group that gets full OHP benefits without regard to immigration status, that federal changes will move all of them out of CCOs and into OHP Open Card starting January 2027. Their rides will run through the open card brokerages and the OAR 410-136 rules above instead of CCO ride services. A company that works mostly for a CCO ride service may want a subcontract with its county’s open card brokerage in place before that shift.

Pricing Oregon trips in HealthRide

Oregon brokerages pay a base rate per mode plus actual miles, so each trip’s mode and mileage decide what you are owed. Every HealthRide trip carries its service level, each leg keeps its GPS-recorded miles, and invoicing builds each brokerage’s invoice from them. The ride history a brokerage or auditor asks for comes out of reports as an export.