HRSN Transportation: Medicaid Rides to Social Care Services Under 1115 Waivers

Picture a Medicaid managed care member in New York with no car and a care plan that lists a housing court date to prevent an eviction. A ride to that hearing is the kind of trip New York’s HRSN protocol describes. It is not a ride to a doctor, so it is not NEMT, and the protocol says it is “not tied” to Medicaid transportation “in any way.”

What HRSN transportation is

HRSN stands for health-related social needs. Washington’s Health Care Authority describes them as unmet, adverse social conditions that contribute to poor health, such as food insecurity, housing instability, unemployment, and lack of reliable transportation. A state can ask CMS to pay for services that address those needs through a section 1115 waiver. HRSN transportation is the ride that gets a member to one of those services.

The destination makes the trip an HRSN trip. New York’s protocol lists housing appointments, housing court, local social services and motor vehicle offices, a pharmacy, court and probation appointments, parenting classes, and food pharmacies and farmer’s markets. A medical visit is NEMT, which every state must assure under the federal rules in assurance of transportation.

Some states draw the line in their own NEMT rules. Oregon’s rule for its coordinated care organizations says NEMT must not be provided for HRSN services (OAR 410-141-3920, effective July 1, 2026).

Where approvals name a ride to HRSN services

As of October 6, 2026, these section 1115 approvals on Medicaid.gov name a ride service. Another state’s terms may too, so search yours for the word transportation.

State	What the approval covers	Approval runs through
Arizona	Non-medical transportation to and from HRSN services	September 30, 2027
Illinois	Non-medical transportation to and from HRSN services	June 30, 2029
Massachusetts	Transportation to HRSN services for housing supports and nutrition supports	December 31, 2027
New York	Public and private transportation to covered HRSN services and case management	March 31, 2027
North Carolina	Non-medical transportation to and from Healthy Opportunities Pilots HRSN services	December 9, 2029
Washington	Non-emergency, non-medical transportation, listed under community transition services	June 30, 2028

An approval is permission, not an open program. Washington’s lists the service, but the Health Care Authority’s September 2026 overview names it only among services run with a partner agency in the Department of Social and Health Services, with no start date, and its page of services available now does not list it. North Carolina’s Healthy Opportunities Pilots suspended operations when the legislature did not fund them after July 1, 2025. As of October 6, 2026, the state’s page says the legislature has since approved $9 million for state fiscal year 2027 to restart services for a subset of members, with details still being finalized.

CMS rescinded its November 2023 and December 2024 HRSN guidance bulletins on March 4, 2025 and said it will consider state applications case by case. The bulletin says nothing about approvals already granted, and the posted terms for each state above still list the ride service.

How a company gets these trips in New York

New York runs HRSN services through nine regional lead entities, each running a social care network, that cover 13 regions. Their state contracts run from August 1, 2024 to March 31, 2027. Managed care plans contract with the networks, and each network builds its own group of providers. A van company contracts with the network, not with a NEMT broker.

Who qualifies has three parts:

• Plan and group. The member must be in Medicaid managed care and in one of the listed groups, such as high users of emergency or hospital care, Health Home members, people with a serious mental illness or substance use disorder, pregnant people up to 12 months postpartum, and children under six.
• Need. The member screens as unable to get to HRSN services without help, for example with no license, no working vehicle in the household, or a physical, cognitive, mental, or developmental limitation.
• Care plan. The need for the ride is documented in the member’s care plan.

The protocol says a trip can be a public or private ride, such as a taxi, a ride app, a bus pass, or a train pass, and may carry a caregiver or guardian for the member’s benefit. It puts nonprofit community organizations first and allows a for-profit company at the network’s discretion when no nonprofit is available. The network pays under code T2025 at actual cost, within a regional cap, and sets its own rates. The protocol counts a bus pass or a ride app as the same service, so a van company is one option among several.

New York’s approval ends March 31, 2027, and CMS’s September 25, 2026 letter says its authorities expire then unless renewed or amended. The terms say the state will move HRSN services into risk-based managed care payment rates no later than April 1, 2027. As of October 6, 2026, the Medicaid.gov page for the demonstration lists two amendment requests among its pending applications and no extension request. Check New York’s health department for the renewal status before you sign a contract that runs past that date.

What to do now

1. Read your state’s approval. Open it on the State Waivers List and search the special terms for “transportation” and “HRSN,” as section 1115 waiver explains.
2. In New York, ask the lead entity for your region, listed in the Social Care Network manual, how it contracts transportation providers. The New York state guide covers the rest of the state’s ride programs.
3. In Massachusetts, ask the accountable care organizations and health plans near you, since the approval lets them contract HRSN providers. In Arizona, Illinois, North Carolina, and Washington, ask the state Medicaid agency whether the ride service has started.
4. Keep HRSN trips apart from NEMT in dispatch and billing. Different payers, different rules.
5. Treat dates as open. Read the contract’s end date against the approval’s end date. For how public buyers award transportation work, see government NEMT contracts.