Volunteer driver programs for medical rides: mileage rules, insurance, and screening

Who can run a volunteer program

Volunteer drivers are a tool for nonprofits and public agencies, not for private NEMT companies. The Labor Department reads the Fair Labor Standards Act to rule out volunteering for a private employer that runs for profit. Its examples of genuine volunteering include driving vehicles for the Red Cross and helping in hospitals and nursing homes, usually done part time, for public service, religious, or humanitarian reasons, and without any expectation of pay.

That leaves three kinds of sponsors: charities such as senior centers and community action agencies, faith groups, and government agencies like counties and transit districts. Public agencies get some extra room. A public agency volunteer can receive expenses, reasonable benefits, and a nominal fee without becoming an employee, as long as the fee is not tied to productivity and is not a substitute for pay. The federal liability statute draws a similar line: someone performing services for a nonprofit or government entity stays a volunteer only if they receive no compensation beyond reasonable reimbursement for expenses actually incurred, and nothing of value in place of pay worth more than $500 a year.

Setting up the organization itself, from articles of incorporation to 501(c)(3) status and grant funding, is covered in starting a nonprofit transportation service.

Mileage: the 14-cent rule and what it means for reimbursement

The charitable mileage rate is not an IRS figure that moves with fuel prices. Section 170(i) of the Internal Revenue Code fixes it at 14 cents per mile. The IRS business rate, by contrast, is 76 cents for July through December 2026. A volunteer who is not reimbursed can deduct the cost of gas and oil for driving done for a qualified charity, or use the 14-cent rate instead, plus parking fees and tolls either way. General repairs, depreciation, registration, tires, and insurance are not deductible, and the volunteer has to keep reliable written records of the miles.

Reimbursement is where programs get tripped up. Minnesota’s revenue department explains that volunteer drivers may exclude mileage reimbursement from income only to the extent they could have deducted the expense as a charitable contribution: 14 cents a mile, or actual costs such as gas and oil tied to the charitable driving. An organization may reimburse at any rate it likes, but anything above that line can be taxable to the volunteer.

Example: a busy volunteer’s year

A volunteer drives 4,000 miles for a program that reimburses 65 cents a mile, the rate one Maine nonprofit transportation agency pays its volunteer drivers. The program pays $2,600. At 14 cents a mile, $560 of that is excludable, which leaves $2,040 that can count as income to the volunteer. Minnesota’s guidance ties the Form 1099-MISC to reimbursement above 14 cents a mile, and the federal filing floor for other income paid in 2026 is $2,000. This volunteer would get one.

Exceptions and pending changes

• Federal senior volunteer programs. IRS Publication 525 says amounts received for supportive services or out-of-pocket reimbursements from the Retired Senior Volunteer Program, the Foster Grandparent Program, and the Senior Companion Program are not included in income. A driver program run under one of them follows that rule instead.
• State relief. Minnesota lets volunteers subtract reimbursement above 14 cents a mile on the state return, up to a 2025 cap of 70 cents a mile, the IRS business rate for that year. The federal tax is unchanged.
• Congress. The Volunteer Driver Tax Appreciation Act of 2025 (H.R. 1582, introduced February 25, 2025, and S. 1177, introduced March 27, 2025) would set the charitable rate for transporting people on behalf of a charity at no less than the business rate. Both bills went to committee and were still at the introduced stage in October 2026.

Liability and insurance

Insurance has to carry the driving risk in a volunteer program, because federal liability law leaves it uncovered. The Volunteer Protection Act can spare a volunteer personal liability for ordinary negligence, but it carves out harm from driving any vehicle the state makes you license or insure, which takes in every ride on a public road. It also does nothing for the organization’s own liability. Our guide to starting a nonprofit transportation service covers the act in more detail.

That leaves two layers of coverage: the volunteer’s personal auto policy and the organization’s policy for cars it does not own, usually hired and non-owned auto. California’s insurance department warns that a typical personal auto policy excludes livery, its term for driving for hire. Before a volunteer’s first ride, have them ask their insurer in writing whether the policy responds while they carry riders for your program, and keep the answer in their file.

A few states protect volunteers’ personal policies by statute:

• Maine. An insurer may not turn down an applicant, or surcharge a policy, only because someone on it drives as a volunteer for a nonprofit or charity.
• Minnesota. Volunteer driving for a nonprofit or a unit of government is not for-hire use when an insurer weighs cancelling a policy.
• California. Insurance Code section 11580.1(f) bars a personal auto policy from carving out volunteer driving that provides social service transportation, and the protection lapses if the volunteer is paid more than mileage at the state-capped rate. Our guide to social workers driving clients explains it.

Medicaid programs may set their own floor. Virginia’s fee-for-service rules want each volunteer’s own policy to be full coverage, with no exemption for carrying passengers as a volunteer driver or for any other reimbursement.

Screening volunteers who drive Medicaid members

When a volunteer is reimbursed for Medicaid trips, the federal minimums for NEMT drivers apply. Section 1902(a)(87) of the Social Security Act reaches every individual driver the state plan pays, with public transit authorities the only exception. A volunteer has to be clear of federal health care program exclusions and licensed to drive, and the program has to have a way to respond to a state drug law violation and a way to share each driver’s driving record with the state.

States and brokers build on that, often treating volunteers exactly like employees:

• Virginia. The fee-for-service program’s volunteer, or registered, drivers clear the same credentialing and training as employed drivers and are paid gas money for the occasional long-distance or recovery trip. Each volunteer is at least 18, holds a current Virginia license, and has two years of driving experience, with a DMV point balance of -2 or better, a background check and drug screen that come back clean, and an NPI with a taxonomy code.
• Washington. The sample NEMT broker contract the Health Care Authority posts has brokers run a fingerprint-based State Patrol criminal history check on every new driver and every new volunteer. The fingerprint check is redone every third year, and a WATCH name search fills the years in between.
• One Maine agency’s standards. A Maine nonprofit transportation agency posts volunteer standards, adapted from its operations manual in 2017, that set a minimum age of 21 and at least a year of licensed driving. Volunteers disclose their medications (anything on the DEA controlled substances list needs a letter from the prescriber saying driving is safe), have no OUI conviction within 3 years and no more than 4 points on the license, and have the agency inspect their car every 12 months.

Our guides to driver requirements and background checks cover the checks in detail.

Billing and paying for volunteer trips

Medicaid has a code for this work. HCPCS A0080 bills non-emergency mileage when a volunteer supplies the vehicle, and its neighbor A0090 covers mileage when the car is provided by someone who has a vested interest in the rider, a relative for example. Arizona’s Medicaid program pays $0.44 per mile under either code for fee-for-service trips, a rate that took effect October 1, 2026. In Virginia, volunteers take trips from the fee-for-service broker in exchange for gas reimbursement. The broker coordinates the volunteer driver program and makes sure every volunteer and vehicle meets the credentialing, insurance, and inspection rules.

Volunteer hours are hard to fill at the edges of the day. The same Maine agency that pays 65 cents a mile says it needs the most help on weekends, early mornings, and late evenings, roughly 4 a.m. to 10 a.m. and 3 p.m. to 10 p.m. Plan paid backup for those windows rather than counting on volunteers to cover them.

Mileage records in HealthRide

A mileage reimbursement is only as good as the log behind it. When volunteers run trips from the HealthRide driver app, each trip record keeps the GPS-recorded miles along with pickup and drop-off times and the on-screen signature, and you can export trip logs to CSV or PDF for the bookkeeper, the auditor, or the funder. The payer summary in reports counts trips for each payer on its own, so a grant funder and Medicaid each get their own numbers.