What Is Ryan White Medical Transportation? HIV Program Rides and How Ride Companies Get the Work

The Ryan White HIV/AIDS Program is the federal safety net for low-income people with HIV. HRSA says more than half of everyone diagnosed with HIV, over 600,000 people, get services through it each year. Rides are a small line in each local budget, and each area decides what kind of ride to buy. This page shows who holds the money, what two big areas and one state buy, and how a ride company asks for the work.

What Ryan White medical transportation pays for

Federal law lists medical transportation among the support services Ryan White grants can fund, next to outreach, language services, and referrals (42 U.S.C. 300ff-14). HRSA’s policy notice 16-02 (revised January 28, 2026) defines it as non-emergency transportation that lets an eligible client reach or stay in core medical and support services.

That reaches past the doctor’s office. Los Angeles County’s contracts name trips to HIV care, dental care, food programs, and legal services. Texas lists outpatient care, case management, substance use and mental health services, and pharmacies.

HRSA lets grant holders provide rides five ways:

1. Contracts with transportation providers. This is where a ride company fits.
2. Vouchers or tokens, such as transit passes or taxi vouchers.
3. Mileage repayment through a non-cash system, such as the gas card Texas’s standard names, at no more than federal travel rates.
4. Volunteer drivers, once insurance and liability are addressed.
5. The agency’s own vehicles, with prior approval to buy one.

The program never pays cash to clients, the upkeep, loan, insurance, or registration costs of a client’s own car, or emergency transport. Texas also bars recreational trips.

Who holds the money and buys the rides

HRSA splits the program into parts, and each part pays different buyers:

• Part A goes to the chief elected official of 52 metro areas that HRSA lists as most affected by HIV (reviewed February 2026), including Los Angeles, Miami, Houston, and Minneapolis-St. Paul. The official picks a lead agency to manage it, and a local planning council or planning body sets service priorities and how the money is split.
• Part B goes to the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and six other territories.
• Parts C and D go straight to local community-based groups.

Los Angeles County and Miami-Dade County pass their Part A money to clinics, hospitals, and HIV agencies, and those agencies buy the rides. That is where the for-profit limit matters. Federal law lets a Part A area fund a for-profit only when it is the only available provider of quality HIV care in the area. HRSA’s policy notice 11-02 applies that to contracts for core medical and support services, and medical transportation is a support service. The notice also bars a nonprofit from passing its award on to a for-profit.

A ride company can still be paid as a contractor. 2 CFR 200.331 lists the marks of a contractor: it sells similar services to many buyers, operates in a competitive market, and provides the service within its normal business. The grant holder makes that call case by case, so the answer differs by area. Ask it, in writing, how it classifies ride vendors.

What local Ryan White ride contracts look like

Three examples show how differently areas spend it:

• Los Angeles County. On February 4, 2025, the Board of Supervisors approved 16 transportation contracts worth $753,586 a year, or $2,260,758 from March 1, 2025 to February 29, 2028, all Part A money, with authority to extend to February 28, 2031. The 16 contractors are clinics, hospitals, a city health department, and social service agencies. Each arranges rides by transit, local van or shuttle, taxi, rideshare, rail, or its own vehicles, and buys taxi and rideshare rides through purchase agreements and payment accounts with the companies that provide them. Taxis and rideshares are only for clients who cannot use transit because of their health, extreme travel times, or no nearby stop, and the agencies must arrange wheelchair accessible vehicles when needed.
• Miami-Dade County. Its Part A bid for contracts starting March 1, 2027 (RFP RW-DS-0327, due September 28, 2026) gives medical transportation 1 percent of Part A funds, $206,326, plus $18,746 of Minority AIDS Initiative funds. The county limits the service to discounted transit tickets, with app-based rides only when it approves them. The bid also asks for-profit subcontractors that serve clients to show they are the only available provider of quality HIV care or that nonprofits lack capacity.
• Texas. The state’s Part B standard (revised April 30, 2025) counts service by the one-way trip and allows contracts with transportation providers, including rideshare. Clients must be able to confirm a vehicle or rideshare trip at least two business days ahead. Agency and volunteer drivers need a valid Texas license, and agencies must make sure each driver is covered by auto liability insurance and each vehicle has a current Texas registration.

So in Los Angeles the buyer of your van rides is one of the 16 agencies, while Miami-Dade’s plan names transit tickets and approved ride-share, not vans. Read the local plan before you pitch.

Ryan White pays after Medicaid

Ryan White is the payer of last resort. Grant money cannot pay for any item or service that has been paid, or can reasonably be expected to be paid, by insurance or a federal or state health program, the Indian Health Service excepted (42 U.S.C. 300ff-15(a)(6) for Part A and 300ff-27(b)(7)(F) for Part B). HRSA’s policy notice 21-02 (revised March 13, 2025) tells agencies to make reasonable efforts to find other payers and to document how they help clients enroll in coverage, and Los Angeles County’s ride contracts tell agencies to bill any third-party payer that is available. That is the flip side of the rule on the third party liability page: Medicaid bills first, Ryan White fills the gaps.

A dispatch and billing example

Say you sign a vendor agreement with an HIV clinic that holds Los Angeles County’s Ryan White transportation money. On Tuesday the clinic sends two requests.

The first rider has Medi-Cal and needs a wheelchair van to her HIV doctor. Her Medi-Cal plan’s ride benefit covers that trip, so it goes to the plan, not to your Ryan White agreement. If you are in the plan’s network, you may still drive it, and you bill the plan or its broker.

The second rider is not on Medicaid and needs a ride to the clinic’s food program and back. No other payer covers that trip, so the clinic books both legs with you and pays from its Ryan White funds. You invoice the clinic per one-way trip, the unit Texas’s standard counts. Ask which trip records it needs. Los Angeles County’s trip log for agency-run vehicles lists the date, time, and place of departure, the destination, the arrival time, odometer readings, and the number of clients, and Texas asks agencies to document the reason for each trip, its origin and destination, and its cost.

Keeping a rider’s HIV status private

Almost every Ryan White rider has HIV, so any manifest, text, or invoice that names the program reveals a diagnosis. Under HIPAA, a ride company that receives that information from a clinic is usually a business associate and must sign an agreement; see HIPAA for NEMT and the business associate agreement. Los Angeles County’s ride contracts include a business associate agreement and require every activity to follow HIPAA.

Some states go further. New York’s Public Health Law section 2782 bars anyone who obtains confidential HIV-related information while providing a health or social service from disclosing it except to the parties the law lists. Ask the agency what to call these trips on manifests, texts, and invoices, and keep the program name off anything a driver sees.

How a ride company gets Ryan White work

1. Find the grant holder. Check HRSA’s Part A list for your metro area, and your state health department’s HIV care program for Part B.
2. Ask who holds medical transportation. The grant holder can tell you which clinics and agencies are funded for it and share the local service standard.
3. Read the local plan. It shows the budget for rides and whether vans, taxis, or only transit passes are allowed.
4. Ask how for-profit companies are treated. Some areas want proof that no nonprofit can do the work. Get the answer in writing before you spend time on a proposal.
5. Watch for bids. Los Angeles County can reopen its transportation application to add contractors, and Miami-Dade runs its bids in rounds, with the latest closing on September 28, 2026. The government contracts guide shows where local bids are posted.
6. Pitch the funded clinics. Quote a per-trip or per-mile price, your wheelchair capacity, how much notice you need, and the trip records you keep. The health center transportation guide covers the federal purchasing and kickback rules health centers follow.
7. Sign a business associate agreement before you get any rider’s name.
8. Invoice per trip with the records the contract names, and keep them for the retention period in your agreement.