Cutting NEMT fuel costs: routing, idling, tires, and fuel cards

Why fuel deserves a plan in 2026

Fuel prices have moved fast this year. EIA’s weekly survey had regular gasoline at a national average of $4.478 on September 21, 2026, which is $1.305 higher than a year before, with diesel at $6.529. Prices also vary widely by place: the Gulf Coast averaged $3.972 for regular that week and California $6.003.

Your revenue does not follow the pump. Broker and Medicaid rates are set by fee schedules and contracts, so unless yours carries a fuel adjustment, every extra cent per gallon comes out of margin. The only levers you control are how many miles you drive, how much fuel each mile takes, and where the gallons go.

Measure fuel per mile and per trip

You cannot cut what you do not measure. Track three numbers for every van, every week: gallons bought, miles driven, and completed trips. From those you get the figures that matter:

Take one hypothetical wheelchair van over a week: 1,150 miles, 62 gallons, and 95 completed trips, with fuel at $4.478 a gallon. Fuel spend is $277.64. That is 18.5 miles per gallon, about 24 cents a mile, and $2.92 per trip.

Compare against the sticker, then against yourself

Window stickers are a reference point, not a promise. The EPA gives the 2026 Chrysler Voyager and the 2026 Honda Odyssey a combined rating of 22 miles per gallon, and the front-wheel-drive 2026 Toyota Sienna, which is sold only as a hybrid, a combined 36. Passenger vans at or above 10,000 pounds GVWR, and cargo vans over 8,500 pounds GVWR, are exempt from testing, so a conversion built on one of those vans may have no rating at all.

Your real number can come in lower. Conversion equipment, riders, and mobility devices add weight, and the federal fuel economy site estimates about 1% in lost mileage for every extra 100 pounds, a figure based on a 3,200-pound vehicle. So use the sticker to spot outliers, then track each van against its own history. A van that drops two miles per gallon in a month has a problem, whatever its sticker says.

The vehicle choice matters too. At $4.478 a gallon, a 22-mile-per-gallon van spends about 20 cents a mile on fuel and a 36-mile-per-gallon hybrid about 12 cents. Over 1,000 miles a week, that gap is roughly $80, before purchase price and upkeep. The cost per mile calculator puts fuel next to your other costs.

Drive fewer empty miles

The cheapest gallon is the one you never burn. Miles driven with no rider aboard, called deadhead miles, burn fuel just like loaded miles and usually earn nothing.

The main moves are planning the whole fleet at once so each drop-off sits close to the next pickup, starting drivers near their first rider, and returning trips that do not fit early enough to be reassigned. In Virginia, MTM Health wants turnbacks no later than 24 hours before pickup. Where a broker allows shared rides, grouping riders headed the same way lowers fuel per rider, and MTM Health’s Virginia handbook caps the extra time on board at 45 minutes beyond the average direct travel time. The deadhead guide covers the full list, and the route optimization guide explains why planning every van together beats planning them one by one.

Two fuel-specific habits belong in the plan as well:

• Schedule fill-ups. Put refueling into gaps in the day, at stations on the route, instead of detours with a rider waiting. GSA’s own fleet guidance tells drivers to buy regular self-service fuel at the stations with the lowest price.
• Skip premium. Buy the grade the owner’s manual calls for. GSA bars premium fuel on its fleet cards unless a vehicle requires it.

Set an idling policy

Idling is easy to miss because the van is not moving. It burns 0.25 to 0.5 gallon an hour, according to the federal fuel economy site, and engine size and air conditioning decide where in that range a van lands. A restart costs about 10 seconds of fuel. For vehicles without automatic start-stop, the site suggests averaging no more than about 10 engine starts a day and, within that budget, turning the engine off whenever a stop will last more than a minute.

NEMT has long waits built in. NIDDK describes in-center hemodialysis sessions of about four hours. As a hypothetical example, if 10 vans each idle through one two-hour wait a day at half a gallon an hour, that is 10 gallons a day. Over 250 working days it is 2,500 gallons, or about $11,195 at $4.478 a gallon.

A workable policy has four lines:

1. No rider aboard, engine off. Shut the engine off for any wait longer than a minute or two when no one is in the van.
2. Rider aboard, keep them comfortable. Run heat or air as the weather requires. MAS in New York expects vehicles to be adequately heated and cooled.
3. Pre-condition, do not idle for hours. In extreme heat or cold, start the van a few minutes before the rider boards.
4. Follow local limits. New York City caps idling at three minutes, or one minute next to a school or park, with a narrow exception when the engine powers a loading or unloading device. For a wheelchair lift, follow the lift maker’s instructions.

Put the policy in writing, train it, and check it. If your vehicles report engine hours, compare idle time by van each month.

Hold tire pressure at the door-jamb number

Soft tires cost fuel every mile. Proper inflation adds about 0.6% to mileage for a typical vehicle and as much as 3% in some cases, according to the federal fuel economy site, and every 1 psi the tires average below spec costs roughly 0.2%. The target pressure is on the placard in the driver’s door jamb or glove box and in the owner’s manual. The figure molded into the tire sidewall is a maximum, not a target.

Do not wait for the warning light. Federal rules let a tire run 25% below its recommended cold pressure before the monitoring light is required to come on. For a tire that should run at 40 psi, that can mean 30 psi. Add a cold-tire pressure check to the pre-shift inspection. MAS already has drivers record a check of each van ahead of every shift, so the pressure reading fits a routine you should have anyway. The vehicle inspection checklist has a line for it.

A few other upkeep items move fuel use:

• Oil grade. Using the grade the manufacturer recommends improves mileage 1% to 2%, according to the federal site.
• Warning lights. A check-engine light can signal a fault that lowers fuel economy. Do not let it ride for weeks.
• Dead weight. Carry the securement straps, first aid kit, and equipment your contracts require, and clear out the rest.
• Air filters. On modern fuel-injected engines, a clogged filter hurts acceleration but not mileage, so change it on schedule rather than for fuel.

The vehicle maintenance guide covers a full service schedule.

Coach the driving

Driving style moves fuel use more than any upkeep item on this page. The federal fuel economy site says aggressive driving, meaning speeding, fast acceleration, and hard braking, can cut mileage by roughly 15% to 30% on the highway and 10% to 40% in stop-and-go traffic. Mileage also drops quickly above 50 mph.

Smooth driving is already part of the job. MTM Health’s Virginia handbook bars speeding and aggressive driving and says safety must never give way to schedule pressure. Riders with injuries, dialysis fatigue, or wheelchairs feel every hard stop. So frame fuel coaching as ride quality:

• Compare miles per gallon by driver and van each month from fuel card data.
• Ride along with the drivers at the bottom of the list.
• Build schedules with enough slack that nobody has to race to make a pickup window.

The federal site also reports that in-vehicle feedback on driving style gives a typical driver about a 3% gain, and around 10% for drivers who use it on purpose to save fuel.

Control spending with fuel cards

Fuel cards turn every fill-up into a record you can check. Set them up with these controls:

Most of these mirror the federal government’s own rules. GSA’s fleet card program issues one card per vehicle with one driver ID per card, tells drivers to enter correct odometer readings and keep PINs away from the card, sets transaction limits by vehicle type, and bans convenience store and personal purchases.

Then review exceptions every week. GSA’s 2024 training materials show what misuse looks like in the data:

• Several transactions a few minutes apart on one card.
• Odometer readings that jump around or repeat.
• More fuel in a short span than the vehicle’s tank can hold.

Reconcile each van’s fuel against its recorded miles. If a van bought 70 gallons in a week it drove 900 miles, the math says it got under 13 miles per gallon, and someone should ask why.

Price fuel into the work you control

When you set the price yourself, as with facility agreements and private-pay riders, add a fuel clause that adjusts the rate when fuel moves past a set point, tied to a public index such as the EIA weekly retail price for your region. The trip pricing guide covers building fuel into a rate sheet in the first place.

Doing it faster

Most fuel savings start with the plan. With HealthRide’s Ryder Go, your whole day is planned in one click, and routes are built to cut the empty miles between riders, as shown on the route optimizer page. HealthRide also keeps GPS-recorded miles for every trip, a solid record to set beside your fuel card data.