Partnering with assisted living and senior communities for resident rides
A senior living transportation partnership is an agreement for an outside provider to carry a community's residents, usually to medical appointments and sometimes on outings. State licensing rules can require assisted living communities to provide or arrange rides to health care. Residents or families pay for most rides, Medicaid waivers and ride programs cover some, and the agreement sets who books, who pays, and what each ride costs.
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How senior communities handle resident rides
Senior communities need rides for residents who no longer drive, and state licensing rules can make the community responsible for getting residents to health care. The community can meet that duty with its own vehicle, with an outside provider, or with a mix. An outside provider who understands those rules can build steady work with these communities.
CDC figures for 2022 put the number of residential care communities, which include assisted living, at about 32,200, with 988,800 residents and 1.3 million licensed beds.
Each state licenses assisted living under its own rules, so the transportation duty depends on the state. Two large states show how this works:
- Florida. Under rule 59A-36.007, an assisted living facility must help residents make and remember appointments for medical, dental, nursing, or mental health services. It must also provide transportation to those services or arrange it through family and friends, volunteers, taxis, public buses, or transportation agencies.
- California. Basic services at a residential care facility for the elderly include arranging to meet health needs, including transportation. Under 22 CCR 87465, the licensee provides that transportation directly or makes arrangements for it, and may limit it to the nearest facility that meets the resident’s need.
“Arrange” is the word that matters for you. A community that arranges rides through an outside company meets its duty without owning a van, which makes it a buyer.
Own vehicle or outside provider
A community may run a van or small bus for group trips and call outside providers for the rest. Each option carries costs the community weighs, and knowing them helps you pitch.
| Factor | Community’s own vehicle | Outside provider |
|---|---|---|
| Staff | A driver on payroll, plus backup when the driver is out | The provider supplies and trains drivers |
| Licensing | A commercial driver’s license if the vehicle is designed for 16 or more passengers, including the driver | The provider’s responsibility |
| Wheelchair riders | The community must still give wheelchair users equivalent service | The provider brings accessible vehicles |
| Cost | Fixed: vehicle, insurance, fuel, maintenance, driver wages | Per trip or per hour, only when used |
| Best fit | Scheduled group trips to stores and events | One-to-one appointments, wheelchair and stretcher rides, same-day needs |
Two federal rules explain the middle rows.
Driver licensing. Under 49 CFR 383.5, a vehicle designed to carry 16 or more passengers, including the driver, is a commercial motor vehicle, and its driver needs a commercial license. A community that buys a larger bus takes on that requirement.
Equivalent service for wheelchair users. Under the Department of Transportation’s ADA rules, a private business that is not mainly in the business of transporting people but runs a demand-response service must make that service, viewed as a whole, equivalent for riders with disabilities, including wheelchair users (49 CFR 37.171). Equivalence is judged on response time, fares, service area, hours and days, information, reservations, capacity limits, and any trip-purpose restrictions (49 CFR 37.105). The department’s own interpretation says this may require arranging accessible vehicles, either by buying them or by coordinating with other providers.
That is a real opening. A community with a van that has no lift needs a way to serve the resident who uses a wheelchair on the same terms as everyone else. Because fares are one of the tests, that resident should not pay more for the same trip than a neighbor who rides the community van. Offer to be that service, and price it so the community can absorb any difference.
Who pays for resident rides
Several payers can be involved in a single community. Sort out the payer for each type of ride before the first trip.
| Payer | When it applies | What you need |
|---|---|---|
| Resident or family | Appointment and personal rides that no other payer covers | A rate sheet, and a card on file or an account billed monthly |
| The community | Rides included in the community’s fees, or rides it chooses to cover | A written agreement and a monthly invoice |
| Medicaid ride program | Medical appointments for residents on Medicaid | Trips booked through the state program, broker, or health plan |
| Medicaid waiver | Waiver residents, for services the state’s waiver covers | Enrollment as a waiver provider where the state requires it |
| Medicare Advantage plan | Residents whose plan offers a ride benefit | Authorization from the plan’s transportation vendor |
Medical appointment rides for Medicaid members run through the state’s program, because federal rules require each state plan to describe how the Medicaid agency gets members to and from providers (42 CFR 431.53). Those trips follow the state or broker rules, not your agreement with the community. Our Medicare Advantage guide covers plan ride benefits, and residents enrolled in PACE follow their program’s rules (see our PACE guide).
When the community passes ride charges through to residents, its resident contracts matter. In Florida, section 429.24 requires every assisted living contract to state the services, the rates or charges, and at least 30 days’ written notice of a rate increase. Give a Florida community your rate changes well ahead of that window.
Waiver residents
Some assisted living residents have their services paid by a Medicaid home and community-based services (HCBS) waiver. These programs pay for care, not housing: federal rules bar federal Medicaid money for room and board in most waiver services (42 CFR 441.310(a)(2)). The resident pays rent and meals from their own income.
A waiver can include its own transportation service, separate from medical rides. Florida’s Long-Term Care program, for example, lists assisted living as a covered service and separately lists transportation to and from the program’s services, by bus, taxi, accessible van, or other vehicle. Each state writes its own waiver, so the rides covered, the rates, and the enrollment steps differ. Our glossary entry on waiver transportation explains the basics.
Federal rules also push waiver residents toward community life. HCBS settings must support full access to the greater community, including chances to work, take part in community life, and receive services in the community, to the same degree as people not on Medicaid (42 CFR 441.301(c)(4)(i)). That gives communities serving waiver residents a reason to offer rides beyond doctor visits.
Appointments and outings are different work
Appointment rides and outings need different vehicles, schedules, and prices. Put them in separate sections of the agreement.
| Appointment rides | Outings | |
|---|---|---|
| Riders | One resident, sometimes with an escort | A group |
| Schedule | Set by the doctor’s office, often with an uncertain return time | Set by the community’s activity calendar |
| Vehicle | Sedan, wheelchair van, or stretcher van | Larger van, ideally with wheelchair positions |
| Who pays | Resident, community, Medicaid, or plan | Usually the community or residents directly, since Medicaid ride programs cover trips to medical providers |
| Pricing | Per trip plus wait time after a grace period | Hourly with a minimum |
Activities are a licensing requirement in some states, and outings are one way to meet it. Florida requires scheduled activities at least 6 days a week for at least 12 hours a week, and an outing that residents help plan can count for up to 3 of those hours. An activities director who needs a reliable vehicle for the weekly trip is a buyer.
For appointment rides, match the service level to the resident. A resident with memory loss may need door-through-door help or an escort, and the agreement should say who provides it.
What the partnership agreement should cover
| Term | What to settle |
|---|---|
| Who can book | Residents, families, community staff, or all three, and how each books |
| Notice | How far ahead appointment rides and outings must be booked, and same-day terms |
| Service levels | Ambulatory, wheelchair, stretcher, escort or door-through-door help |
| Handoff | Where drivers meet residents, who signs them out and back in, what to do if nobody is at the front desk |
| Billing | Which rides the community pays, which the resident pays, and how residents pay (card on file or monthly statement) |
| Outing rates | Hourly rate, minimum hours, and extra charges for long distances or late returns |
| Cancellations | Notice required and the fee for late cancellations and no-shows |
| Backup | What happens when a vehicle breaks down or a driver calls out, and how fast staff hear about it |
| Insurance | Your coverage and a certificate on request |
| Term | Start date, renewal, notice to end, and notice of rate changes |
Use the facility transportation agreement template as the base and add an outing section. For private-pay rates and collections, see our private pay guide.
Starting the relationship
- Meet two people. The executive director signs, and the resident services or activities director books. Ask each what goes wrong with rides today.
- Offer a standing appointment day. Residents of one community may share the same nearby clinics. A regular pickup schedule is easier for staff to plan around and fills your vehicle’s day. Keep the same drivers on standing runs where you can, so staff and residents know who is coming.
- Make it easy for families. Adult children may book and pay. Give them a booking method and a way to know when their parent is on the way back.
- Report monthly. Send the community a list of completed rides, on-time pickups, and any incidents.
If the community also has a skilled nursing wing, the payer rules change for those residents. See our guide to skilled nursing facility transportation.
Serving senior communities with HealthRide
Residents and their families can book rides online, get a text link to follow the driver live, and pay by card with a saved card or a pay link. Standing weekly appointments are set up once and keep repeating, and rides the community covers go on its monthly invoice. See payments.
Frequently asked questions
- Do assisted living communities have to provide transportation?
- In some states, yes, for health care. Florida requires assisted living facilities to provide transportation to medical, dental, nursing, or mental health services, or to arrange it through family, volunteers, taxis, public buses, or transportation agencies. California requires its residential care facilities for the elderly to provide or arrange transportation to medical and dental care. Check your own state's licensing rules.
- Does Medicaid pay for rides from assisted living?
- For some residents. Each state Medicaid agency must see that members can get to their medical providers, so eligible residents can use that benefit for appointments. Some home and community-based waiver programs also pay for assisted living services and for rides to waiver services. Florida's Long-Term Care program, for example, lists both. Waiver money generally cannot pay for room and board.
- Does a community's own shuttle have to be wheelchair accessible?
- Not every vehicle, but the service has to be equivalent. Under federal ADA rules, a private business that is not mainly in the transportation business and runs a demand-response service must give riders with disabilities, including wheelchair users, equivalent service, judged on response time, fares, service area, hours, and other factors. The Department of Transportation notes this may mean coordinating with other providers that have accessible vehicles.
- Should I charge a community per trip or by the hour?
- Per trip for appointments and by the hour for outings. An appointment is one rider, one pickup, a wait, and a return, so a per-trip rate with wait time after a grace period fits. An outing ties up a vehicle and driver for a block of hours regardless of distance, so an hourly rate with a minimum fits better.
- Who should get the bill, the resident or the community?
- Whoever the agreement names, and it should name one for each type of ride. Some communities include certain rides in their fees and pay you monthly. Others pass the charge to residents or let residents pay you directly by card. If the community passes charges through, state rules may require notice to residents before rates rise; Florida requires at least 30 days' written notice of a rate increase in the resident contract.
