Ryan White medical transportation: how HIV program rides are funded and who drives them
Overview
Ryan White medical transportation is a support service under the federal HIV/AIDS program run by HRSA: nonemergency rides that get an eligible client to core medical and support services. Funded agencies can pay for it through contracts with transportation companies, vouchers or tokens, non-cash mileage reimbursement, volunteer drivers, or their own vehicles. Ryan White pays last, after Medicaid or any other coverage.
On this page
The Ryan White HIV/AIDS Program, run by the Health Resources and Services Administration (HRSA), pays for care and support for people with HIV after any other coverage has paid. Rides are one of its support services. For a transportation company, it is a contract funder much like the others described under human service transportation: the program pays an agency, and the agency buys rides. It is not a Medicaid benefit.
What the program will pay for
Federal law lists medical transportation among the support services Ryan White can fund, meaning services people with HIV need to achieve their medical outcomes (42 U.S.C. 300ff-14(d)). HRSA’s Policy Clarification Notice 16-02 defines it as nonemergency transportation that lets an eligible client get to core medical and support services. It allows five methods:
- Contracts with providers of transportation services.
- Mileage reimbursement through a non-cash system, capped at federal travel rates.
- Buying or leasing agency vehicles, with the funder’s prior approval for any purchase.
- Volunteer driver programs that have dealt with insurance and liability.
- Voucher or token systems.
Money is tight by design. In Part A, at least 75 percent of the grant left after certain set-asides must go to core medical services unless HRSA grants a waiver. Rides compete with the other support services for what remains.
Medicaid and insurance pay first
Ryan White is the payer of last resort. Part A funds may not pay for any item or service to the extent another program has paid or can reasonably be expected to pay, including insurance, state compensation programs, and federal or state health benefit programs (42 U.S.C. 300ff-15(a)(6)). A rider with Medicaid should book covered trips through the state’s NEMT program first. Ryan White can still reach trips Medicaid does not cover. Texas’s standard lists destinations that include case management, substance use and mental health services, and pharmacies, as well as outpatient medical care.
How a ride company gets the work
For a ride company, the way in is a contract with an agency that holds Ryan White funds, the first method HRSA lists. Under 2 CFR 200.331, the agency decides case by case whether an outside party is a subrecipient carrying out part of the program or a contractor selling it goods or services. Most contractor traits describe an ordinary ride business: it provides rides in its normal course of business, sells to many buyers, and competes for the work. In Part A, federal law also limits direct financial assistance to public and nonprofit entities, and to for-profits only when they are the sole available provider of quality HIV care in the area.
The funded agency answers to its state or local standards, and those shape what it asks of you. The Texas Department of State Health Services standard for Part B and state services, revised April 30, 2025, is a good example:
- Unit. Service is counted per one-way trip, and contracts with transportation providers may include ride-share companies.
- Records. For each trip, the agency keeps the reason and how it connects to care, the origin and destination, the method used, and the cost per trip.
- Booking. Clients riding in an agency vehicle or ride-share must be able to confirm their trip at least two business days ahead.
- Drivers. Agency and volunteer drivers need a valid Texas license, liability insurance on the vehicle, and current Texas registration.
- Conduct. Riders sign a statement agreeing to safe conduct in the vehicle, including what happens if they break it.
Keeping the trip file ready
Agencies that buy rides need each trip’s details for their own monitoring. HealthRide keeps every trip’s pickup and drop-off addresses, times, and GPS-recorded miles, and the trip log exports as a CSV or PDF the agency can keep on file.
Frequently asked questions
- Can Ryan White pay a rider cash for gas or a cab?
- No. HRSA bars cash payments and cash reimbursements to clients. Mileage reimbursement has to run through a non-cash system, such as a gas card, at no more than federal travel rates. The program also will not pay for repairs, tires, loans, insurance, or registration on a client's own car.
- Does a Ryan White rider also need to be on Medicaid?
- No, but if the rider has Medicaid, the Medicaid ride benefit comes first. For Part A grants, for example, federal law bars the money from paying for any item or service that another program or insurance has paid for or can reasonably be expected to pay for.
- Can Ryan White pay for an emergency trip?
- No. The service covers nonemergency rides only. Texas's standard, for example, bars agencies from using it to move a client who needs emergency medical care, and rules out trips that do not lead to medical or support services, such as recreational outings.
