What Is Door-to-Door Service in NEMT? Driver Duties and When It Is Required

What door-to-door service means

Door-to-door service is a level of help where the driver walks with the rider between the building and the vehicle at both ends of the ride. MTM Health’s Virginia handbook (approved August 10, 2026) defines it as transportation for riders who need help to move safely between the vehicle and the door of the pickup point or destination. The driver leaves the vehicle, helps the rider from the door of the pickup location, walks them to the vehicle, and helps them in.

It sits one step above curb-to-curb service, where the rider reaches the curb alone, and one step below door-through-door service, where the driver goes inside. Programs word it a little differently:

Source	What door-to-door covers
MTM Health, Virginia handbook (approved August 10, 2026)	Help between the vehicle and the door at both ends. No lifting, and drivers other than ambulance or stretcher van crews should not enter a residence.
CareOregon NEMT manual (version 1.3, February 2024)	The driver escorts the rider from the door or front desk at pickup, then to the waiting area of the appointment. No check-in, and no handoff to a specific person.
Louisiana Medicaid manual (section 10.3, issued July 14, 2025)	Help to and from the main entrance of the pickup and drop-off locations, given when a rider who needs it asks.
New York Medicaid, ambulettes (manual effective August 25, 2023)	Staff take the rider from their front door, including an apartment door or nursing home room, to the door of the medical office, with no limit on stairs or floors.

What the driver does on a door-to-door trip

1. Park safely near the entrance. Keep the vehicle and any other riders in view as much as you can.
2. Go to the door and identify yourself. Virginia and Rhode Island drivers identify themselves, show identification, and announce their presence at the entrance of the home or facility. Rhode Island also asks drivers to respect facility staff and follow facility rules.
3. Walk with the rider to the vehicle. Offer an arm, guide them over steps, ramps, and curbs, and move obstacles out of the way. New York defines this personal assistance as touching the rider, or, if they prefer not to be touched, staying close enough to catch a sudden loss of balance.
4. Help them in and secure them. Help the rider sit, fasten the seat belt, secure any wheelchair, and store the walker or other device.
5. At the destination, walk them to the door. Some brokers go a little further: CareOregon’s manual asks drivers to take the rider to the appointment’s waiting area.
6. Write it down. Record the pickup and drop-off times and anything unusual on your trip log.

What door-to-door service does not include

• Lifting or carrying the rider. Virginia’s definition excludes lifting. New York says moving a wheelchair user onto an examination table is the job of the rider’s aide or the medical practitioner, not the driver, and drivers do not have to enter an exam room or stay through the appointment.
• Going into the home. Virginia drivers, other than ambulance or stretcher van crews, should not enter a residence.
• Checking the rider in or handing them to a person. CareOregon does not ask this of door-to-door drivers. Riders who must be handed to a caregiver get hand-to-hand service.

Stairs are where rules differ most. New York ambulette staff must help riders climb or go down stairs, with no limit on the number of floors. CareOregon’s manual has drivers help riders with stairs when needed or asked, but they may not physically assist or carry a rider up or down, and they tell the NEMT manager when that is the case. If a pickup involves stairs, read your broker’s rule before the ride, and ask whether the rider needs a stair chair crew instead.

When door-to-door service is required

CMS sets the principle. Its Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) says riders with disabilities in many cases need more than curb-to-curb service, and states must consider each rider’s support needs when they choose the mode. Programs turn that into rules:

• Pennsylvania MATP. As of September 2026, DHS says MATP must provide door-to-door service when a rider’s disability or limitation keeps them from getting to the curb and the need is medically verified.
• MTM Health trips. MTM Health’s provider agreement (January 1, 2023) makes curb-to-curb the standard and requires MTM’s prior approval for door-to-door, based on medical necessity.
• Louisiana. The broker must make sure providers give door-to-door help on request to riders who may need more help (section 10.3, issued July 14, 2025).
• Georgia dialysis trips. Wheelchair riders ride door to door, but the NEMT provider does not lift them into the dialysis chair. The dialysis team takes over on arrival (manual version July 1, 2026). See dialysis transportation.
• New York ambulettes. Every ambulette ride includes door-to-door personal assistance at no extra charge. New York’s Office of the Medicaid Inspector General has found ambulette companies that did not provide it, and a company that bills an ambulette ride without it may face financial or other sanctions.
• Hospital discharges. These often need more. CareOregon sends the driver to the nurses’ station on the rider’s unit with a full escort. See hospital discharge transportation.

A rider’s needs can change on the same day. DOT’s paratransit examples (Appendix E to 49 CFR Part 37) describe a dialysis rider who waits at the curb on the way in but needs help to the door on the way home. If you know it will happen, ask the broker to set door-to-door on that trip leg in advance.

How door-to-door service changes dispatch and pay

Time. Each door-to-door stop takes longer than a curbside pickup, so build minutes into the schedule at both ends to stay inside the pickup window.

Other riders. DOT’s examples say help should generally be given even when other riders stay aboard, as long as the vehicle is not left unattended or out of sight for a long time. The driver is not a personal care attendant for the riders who wait.

Training. Virginia requires PASS passenger assistance training, and taxi drivers who do door-to-door or hand-to-hand trips need it too. Ohio ambulette drivers repeat passenger assistance training at least every three years. See PASS certification and NEMT driver training.

Pay. It depends on the payer:

Payer	How door-to-door help is paid
Minnesota Medicaid statute (256B.0625, subd. 17, as of September 2026)	Assisted transport base rate of $14.30, against $12.10 for unassisted transport by a NEMT company
New York Medicaid ambulettes	Included in the ambulette rate, with no extra or enhanced charge
MTM Health provider agreement (January 1, 2023)	Drivers may not charge riders for general help such as opening doors, offering an arm, or holding a bag

Missing the level. Virginia warns that carrying a rider in a way that does not match the authorized level of assistance may lead to nonpayment or corrective action. See NEMT level of service for how brokers assign levels and what a mismatch costs.