What Is a Missed Trip in NEMT? Definitions, Limits, and Penalties

What counts as a missed trip

A missed trip is a scheduled ride your company was assigned and did not run. The vehicle never arrived for the pickup, or for the ride home. Programs call it different things, but the definitions line up closely:

Program	Term	Definition
Florida Medicaid plans (contract update July 1, 2026)	Missed trip	“A scheduled trip for which the transportation provider failed to pick up the enrollee.”
Texas Medicaid health plans (NEMT Services Handbook, version 2.0.1)	Provider no-show	“A trip when the DRTS provider fails to show up to pick up a Member for a scheduled pick-up or return.”
North Carolina (managed care NEMT policy, amended January 1, 2025)	NEMT provider no-show	“Any instance where the transportation provider does not arrive for pick-up of member to scheduled trip.”
MTM Health, Virginia (handbook approved August 10, 2026)	Vendor no-show	“Failure or refusal to complete assigned trips.”
CareOregon, Oregon (provider manual version 1.3, February 2024)	Provider no-show	A verified report from a member, caregiver, facility staff, or others that the provider failed to arrive at the pickup

Two things follow. The return counts: Texas names the return pickup, and each trip leg is its own pickup. And MTM’s wording, “failure or refusal,” means a trip you accepted and then chose not to run counts the same as one you forgot.

Missed trip, no-show, late trip, or turnback

Brokers score each of these differently, so your records need to show which one happened.

What happened	What it is called	Whose miss
Your vehicle arrived on time and waited, and the rider was not there	Rider no-show	The rider’s
The rider canceled after the notice deadline	Late cancellation	The rider’s
Your vehicle arrived after the pickup window	Late trip	Yours, counted against on-time performance
You handed the trip back before the broker’s deadline	Turnback or reroute	Yours, counted as a turnback
Your vehicle never arrived	Missed trip or provider no-show	Yours

The line between a rider no-show and a missed trip is your paperwork. CareOregon’s manual says brokerages must tell member no-shows apart from provider no-shows, and providers are not held accountable for member no-shows. A rider no-show with no arrival time and no call attempt on record can look like a missed trip.

How states and brokers count missed trips

Missed trips are measured as a share of trips, and the limits are small.

Program	Limit	How it is measured
MTM Health, Virginia (handbook approved August 10, 2026)	Vendor no-shows under 0.25% of trips	Reviewed with your assigned field monitor
North Carolina vendor contracts (MA-2910, revised March 16, 2026, and the managed care policy)	No more than one quarter of one percent of all trips	Per contract year
MTM Health, Rhode Island (handbook last updated July 1, 2026)	Green under 0.29%, yellow 0.3% to 0.49%, red 0.5% or more	Provider scorecard
MediTrans, Louisiana (provider page, as of September 2026)	Provider-caused no-shows under 1%, with 98% or more of trips completed	Monitored performance
Texas Medicaid health plans (NEMT Services Handbook)	99% of assigned and accepted trips completed, not counting member cancellations and no-shows	Health plan standard
Florida Medicaid plans (contract update July 1, 2026)	No more than 0.2% of transportation requests end in a missed trip	Monthly, for each plan

Run the numbers for your own volume. Under MTM Virginia’s standard, a company that runs 2,000 trips in a quarter must stay under 5 missed trips (2,000 × 0.25% = 5). One broken van on a morning with no backup can use that up.

Florida’s limit binds the health plan, and the contract requires plans to monitor their network providers and take corrective action when they fall short. The same contract says no rider with a standing order, such as dialysis, cancer treatment, or methadone, may miss an appointment because of a late pickup, a missed trip, or a cancellation by the transporter. See NEMT broker scorecards for how each measure is scored.

What a missed trip costs you

No payment. CMS says federal Medicaid funds are not available for payments to no-show providers, because no covered service is delivered (SMD 23-006, September 28, 2023). The same guidance tells states to monitor provider no-shows and to arrange replacement rides on short notice.

Liquidated damages. Many broker agreements set a fixed charge for each miss and take it out of what the broker owes you. WellTrans’s Indiana agreement (revised October 16, 2025) lists these:

What happened	Charge
Vehicle no-show	$100 each time
A trip assigned at least 36 hours ahead and rerouted less than 12 hours before pickup	The extra cost of the replacement ride, or $100 if no ride is found
Reroutes above 15% of your trips in a month	$200 for each percent over
A late arrival at a dialysis appointment	$150, plus $50 for each hour or part of an hour past the first
A trip billed that was not performed	$50 per trip, unless it was a clerical error

WellTrans gives written notice at least 10 days before it imposes a charge, so you can contest it.

Charges passed down. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, lets MTM pass on any sum its client or a government agency charges MTM for your performance. WellTrans’s agreement passes client charges down the same way. Those charges can be large. Florida’s Medicaid agency may charge a health plan $2,500 each time a late ride makes an enrollee miss a pre-scheduled appointment, and $5,000 for each failure to meet its transportation timeliness standards (contract update July 1, 2026).

Fewer trips. MTM’s Virginia and Rhode Island handbooks say missing the standards can bring a performance improvement plan, liquidated damages, or removal from the network. CareOregon may put a provider with a repeated pattern of no-shows on a corrective action plan. WellTrans reserves suspension, reduced trip volume, and termination. The broker penalties guide compares more contracts.

Never bill a trip you did not run. A claim for a ride that did not happen is a claim for a service that was not delivered, and the NEMT fraud guide covers where that leads.

When a missed trip can be excused

Some agreements excuse a miss you could not control, if you report it in time.

• CareOregon may excuse a provider no-show after an accident or an unforeseen vehicle problem, and decides other causes case by case. Unusual weather or traffic that holds up all vehicles does not count as noncompliance.
• WellTrans does not charge its late pickup damages when the cause was beyond your control and you told WellTrans before the scheduled pickup time. Its 12-hour reroute rule does not apply to a documented emergency.

Both depend on a record made at the time. A call to dispatch, logged with the time, is what turns a breakdown into an excused delay.

What to do when you cannot make a trip

1. Hand it back early. MTM Health’s Virginia handbook expects a turnback at least 24 hours before the pickup time. Its Rhode Island handbook allows no same-day turnbacks, and none at all for trips taken from its marketplace. WellTrans wants reroutes at least 12 hours before pickup.
2. On the day, call dispatch right away. CareOregon requires providers to report to dispatch immediately when they cannot perform a trip, so the brokerage can reassign it. Texas health plans must arrange a backup vehicle when told a pickup is more than 30 minutes late. Georgia’s broker may use a rideshare company as a backup when a provider does not show, for riders who need no physical help (manual version July 1, 2026).
3. Tell the rider or the facility. MTM’s Virginia handbook asks providers to contact affected members or facilities with the delay and a new arrival time, and to notify MTM.
4. Write it up. After a provider no-show, CareOregon asks for a complete incident report: whether the rider was harmed, whether the appointment had to be rescheduled, and what retraining or correction followed. The incident report form covers those points.
5. Fix the cause. Look for the pattern: one driver, one time of day, one van, or one facility.

If the problem is a driver running behind rather than a trip you cannot cover, see what to do when a driver is running late.

How to keep missed trips near zero

• Put every trip on a manifest. MTM’s Rhode Island handbook warns that trips sent to you unassigned must be moved onto a manifest so that none get missed. Check tomorrow’s daily manifest against the broker’s list each afternoon.
• Protect standing orders first. Florida’s contract singles out dialysis, cancer treatment, and methadone riders, and WellTrans charges $150 for a late dialysis arrival. Keep a backup driver or van for those runs. See NEMT standing orders.
• Accept only what you can run. A trip you accept and then drop becomes a turnback at best and a missed trip at worst.
• Plan the rides home. Will-call returns are easy to lose late in the day. See managing will-call trips.
• Track your own rate every week. Divide missed trips by trips assigned and compare the result with each broker’s limit before the broker does. The on-time performance guide covers the rest of the scorecard.