When a rider keeps no-showing: reading the pattern and the steps a NEMT provider can take

One missed ride is a bad morning. A rider who misses every other Tuesday has a pattern, and patterns have causes: an appointment that moved, a ride home that came from somewhere else, a van that showed up at the wrong door. Finding the cause fixes more no-shows than any penalty.

You also have fewer tools than it seems. A provider cannot end a Medicaid rider’s rides on its own. What you control is the record, the phone calls, and a clear report to the broker, which is the party that can change how the rider books. Prevention and the door procedure live in our guide to reducing no-shows. This page starts after the third or fourth miss.

Start with your own records

Some of a rider’s no-shows may be yours. FTA’s paratransit guidance spells out the misses that never count against a rider, and the list fits NEMT just as well. A van that arrives well after the scheduled time, when the rider has given up and taken a taxi or walked to a neighbor’s, is not the rider’s miss. The same goes for a van that went to the wrong address or to an entrance the rider never uses. FTA also treats a recurring trip that kept running after the rider reported a vacation as the agency’s failure, not the rider’s.

Before calling anything a pattern, check each recorded no-show:

1. Arrival time. Did the van arrive within the pickup window, or arrive early and pull away before the wait ended?
2. Wait. Was the broker’s full waiting period met, timed from the scheduled pickup rather than from an early arrival?
3. Place. Was it the right address and the entrance the rider uses?
4. Booking. Did the trip match the rider’s current appointment, or was it an old standing order nobody updated?

FTA recommends that transit agencies review vehicle location and arrival and departure times for each no-show before proposing a suspension, and remove the ones recorded in error. Do the same review before you send a broker a list.

Read the pattern

Put the rider’s missed trips in one list: date, weekday, scheduled time, leg (to the appointment or home), pickup place, when the van arrived, how long it waited, who you tried to reach, and any reason learned later. Then look for the shape.

• Same weekday or time. Misses that cluster on one weekday often point to a standing order that has fallen out of step with the rider’s week, such as a therapy session moved from Monday to Wednesday.
• Return legs only. The rider rode with you to the appointment, then went home with a relative or by bus, and nobody told you. The fix is a call to the clinic, not a warning to the rider.
• One facility. Misses tied to one clinic can trace to a different exit, a front desk that does not call, or appointments that run long.
• After a hospital stay. A string of misses after an admission means the rides kept running while the rider was in a bed.
• Early starts. Misses on the first pickups of the day can mean the rider is not up yet, or does not hear the knock.

FTA’s test for a paratransit pattern is a fair yardstick for when to act. It weighs misses against how often the rider travels and sets a floor on the count. Its example threshold: at least three no-shows in a month that also add up to more than 10 percent of the rider’s scheduled trips. Three misses in 30 days, FTA notes, means something different for a daily rider than for one who books five trips a month. As an example, a dialysis rider with about 26 legs a month who misses three is at 11.5 percent. A rider with four legs who misses two has a high rate but only two misses.

Call the rider, then the people around them

FTA lists contacting riders with repeat no-shows, before a pattern sets in, as a good practice, to find out whether they understand how the service works. A short call answers most of it:

• Do you still need the ride on that day, at that time?
• Is the pickup spot right, and do you hear the driver arrive?
• Do you know how to cancel, and who to call?
• Is there someone else we should call before pickup?

Then go to the people who see the rider every week. Brokers do this too: under Modivcare’s MaineCare policy, when a member in a program with recurring trips has a second no-show within 60 days, Modivcare staff contact the treating facility and warn of the possible loss of arranged rides. For dialysis riders, the person to call is the facility’s social worker, a position every Medicare-certified dialysis facility must fill (42 CFR 494.140(d)). For waiver riders, it is the case manager or group home. Share the trip facts, dates, and times, and keep diagnoses out of the conversation. Our guide to HIPAA and family members covers who may be told what.

Most fixes are booking changes: a new pickup time, a paused or rebuilt standing order, or a second contact number. For broker trips, the rider, family, or facility makes those changes through the broker, and you confirm the new schedule on your board.

What broker and state member policies allow

Restrictions come from the broker or state, follow written steps, and carry notice and appeal rights. CMS’s 2023 transportation coverage guide rules out denying rides over missed pickups or late riders, however often they happen, and lists the extra steps it accepts, such as making the rider confirm each ride the evening before or the same morning. The reducing no-shows guide walks through that list. Two more points in the same guide matter here. Before limiting rides in any way, a state should first write to the member, setting out what it did to accommodate them and which behavior led to the extra step. A state may also offer to reimburse rides the member arranges, but it cannot force a member to arrange their own. State and broker member policies then set their own counts:

• Georgia. The DCH NEMT manual (October 1, 2026 version) warns members that repeated no-shows or cancellations, two being enough, can end in suspension or termination, and it promises a member two warning letters from the broker before any adverse action. Appendix L sets the trigger: after two occasions of any mix of no-shows, late-for-pickup events, or cancellations at the door, the broker sends a warning by certified mail. Two warnings lead to a denial letter that explains reconsideration and appeal, and the broker keeps providing rides during the appeal unless unsafe behavior continues. A member has 30 calendar days from the termination letter to appeal to DCH.
• North Carolina. The state’s managed care NEMT policy, in its January 1, 2025 amendment, lets each health plan write its own no-show rules as long as they are no less restrictive than the MA-3550/2910 reference policy. That policy calls for a counseling call after a first missed trip without good cause, a warning after a second within three months, and a 30-day suspension after a third within three months. Dialysis, chemotherapy, and other critical-needs riders keep their rides to those treatments no matter how many trips they miss, though rides to other appointments can be suspended.
• AmeriHealth Caritas North Carolina. Its 2026 member handbook says that after a member’s second no-show, the plan’s transportation service provider can require a confirmation call from the member one hour ahead of each pickup.
• Maine. Modivcare’s MaineCare rider no-show policy (March 2026) sends a letter after each no-show and counts a cancellation less than 24 hours before pickup as a possible no-show. A third no-show inside the 60-day period that starts with the first limits the member to self-drive reimbursement or mass transit for 90 days, with 60 days to appeal.

Read these next to CMS’s position. Whatever a policy says, the broker or state applies it, sends the letters, and hears the appeal.

Why you cannot cut the rider off yourself

Your part of the rules is narrow. You can decline trip offers, and you can turn back assigned trips inside the broker’s notice window. Using turnbacks to end one rider’s service is a different act: it makes a decision the rules give to the broker, and it leaves a trail of turnbacks the broker will see. Notice windows and the limits on refusals are in when a provider can refuse a ride.

What you can do is make the broker’s decision easy:

1. Send the missed-trip list with arrival times, waits, and every contact attempt.
2. Say what you found when you called the rider and the facility.
3. Ask for a specific change, such as a confirm-before-pickup requirement or a rebuilt standing order.

Billing does not change the picture. Payment for a member no-show depends on the program, and CMS’s guide bars charging the Medicaid rider for one. See whether you can bill Medicaid for no-shows.

The ADA paratransit rule, for contrast

A company operating paratransit for a public transit agency takes on the agency’s ADA duties for that service (49 CFR 37.23). There, a suspension is allowed only for a “pattern or practice of missing scheduled trips,” and trips missed for reasons outside the rider’s control, operator error among them, do not count (49 CFR 37.125(h)). Before suspending, the agency must notify the rider in writing with the specific trips and the proposed sanction, let the rider present their side, and send a written decision. An appeal puts the suspension on hold.

FTA’s guidance adds limits of its own:

• Length. Up to one week for a first offense is reasonable, and suspensions longer than 30 days are generally excessive.
• No fines. Agencies may not charge fares for trips scheduled but not taken or require a fine to restore service. FTA does not step in when a rider facing suspension voluntarily agrees to pay for missed trips instead.
• Late cancellations. They may count as no-shows only when made less than one to two hours before pickup, and only for reasons within the rider’s control.
• Return trips. An outbound no-show does not cancel the ride home. FTA requires return and later trips to stay on the schedule unless the rider or another reliable source says they are not needed.

Private-pay riders: deposits and prepayment

With private-pay riders, your written terms decide. Put the no-show rule in the agreement the rider accepts before the first ride, and hold every private-pay rider to the same terms. Options include a card on file with a signed authorization form, prepayment once a rider has missed a set number of rides, or a deposit that rolls into the next trip. The no-show policy template is a starting point. Keep these terms away from Medicaid riders, since CMS bars both states and providers from billing the beneficiary for a missed ride.

Pulling one rider’s no-show history from HealthRide

HealthRide records the wait on every no-show, along with GPS miles and on-time records, so the record shows when the van arrived and how long the driver waited. Rider text reminders can go out the day before and shortly before pickup. Export the trip log from reports and sort one rider’s missed legs by weekday and leg.