# Adult Day Care Transportation in 2027: Who Pays and How to Price Center Routes

Canonical URL: https://nemtguide.com/guides/adult-day-care-transportation/ · Updated 2026-09-29

Adult day care transportation is the daily ride between a participant's home and an adult day center. About three in four centers provide it. Medicaid pays for it in one of three ways: inside the center's own rate, as a separate per-trip rate the center bills, or as a regular Medicaid ride. A NEMT company gets this work by contracting to run a center's morning and afternoon routes.

- About three in four U.S. adult day centers provide daily round-trip rides, with their own staff or through outside transportation companies.
- Medicaid pays for the ride inside the center's rate, as a separate ride rate the center bills, or as a regular Medicaid ride, depending on the state.
- When the ride is in the center's rate or ride code, your customer is the center, so you work as its subcontractor under the state's rules for center transportation.
- Late vans cost centers money, because Ohio and Illinois count attendance without ride time.
- Price routes so absences cannot sink you: a per-route price or a daily minimum beats a pure per-rider rate.

An adult day center needs its participants at the door every morning and home every afternoon, on every day it is open. Many centers run their own vans. Many others hire a transportation company to run the routes. For a NEMT company, that is steady, scheduled work between the medical trips, paid by a customer you can meet in person.

## Who pays for adult day care transportation

CDC's 2025 National Post-acute and Long-term Care Study counted 4,448 adult day services centers in the United States, serving about 227,169 participants. In that study, 73.7 percent of centers provided daily round-trip rides to and from the center, either with their own paid staff or through outside providers. Another 12.9 percent only referred families to someone else.

Medicaid pays for at least part of the care of most participants. In the same study, 75.9 percent of centers were set up to take Medicaid or were part of a PACE program, and 64.5 percent of all participants had some or all of their center services paid by Medicaid in the last 30 days.

The money reaches you by several routes:

| Who pays | How the ride is paid | Who you contract with |
|---|---|---|
| Medicaid, with rides inside the center's rate | The center's rate covers transportation, and the center pays for the ride | The center |
| Medicaid, with a separate ride rate | The center bills a per-trip or per-mile ride code | The center, as its subcontractor |
| Medicaid NEMT or waiver transportation | The ride is billed as a regular Medicaid trip where the center's rate does not cover it | The state, its broker, or the waiver agency |
| PACE | The PACE organization runs transportation for its participants | The PACE organization |
| VA | Veterans may get help with rides to VA-paid adult day health care, varying by location | Ask the day center or the local VA medical center |
| Older Americans Act | Area agencies on aging can fund both transportation and adult day care | The area agency on aging or its provider |
| Private pay | The family pays the center or you | The family or the center |

## Three ways Medicaid pays for the ride

States cover adult day services through 1915(c) waivers, state plan benefits, and managed care. CMS's technical guide for 1915(c) waivers (version 3.6, January 2019) defines adult day health as health and social services, generally four or more hours a day on a regular schedule, in a community setting. It tells states to say so in the waiver when the ride between home and center is part of the service and its cost is in the center's rate. It also says that when another service's rate includes rides, the state must prevent double billing of waiver transportation.

### 1. The center pays for the ride itself

**Texas.** The Day Activity and Health Services (DAHS) program lists transportation among its services. Its rate effective September 1, 2025 is $18.59 per unit, with 3 to 5 hours counting as 1 unit and 6 or more hours as 2 units. The rate sheet shows a $5.06 administration and transportation cost inside that total.

**New York.** The Medicaid Transportation Policy Manual (effective August 25, 2023) says many adult day health care programs contract with Medicaid-enrolled transportation providers or own vehicles. In those cases the program, not Medicaid, pays the transportation provider directly. Medicaid will not authorize rides to and from those programs, except for a separate medical appointment on the same day.

In both states the center pays you from its own budget. Your price has to fit inside what Medicaid pays the center for the day.

### 2. The center bills a separate ride rate

**Ohio.** Under the PASSPORT waiver, a certified adult day center must transport each participant to and from the center. It may subcontract with a transportation provider that meets Ohio's non-medical transportation rule, 173-39-02.18, or the caregiver may drive (rule 173-39-02.1, effective December 1, 2023). The ride is billed as a round trip, a one-way trip, or by the mile, using a distance the case manager sets in advance.

**Illinois.** Under the Persons who are Elderly waiver, the adult day provider bills its own ride code. A unit is one one-way trip between the participant's home and the center, with no more than two a day, and outings, doctor visits, and shopping trips do not count (89 Ill. Adm. Code 240.230 and 240.1950). A center that subcontracts its rides must write its safety procedures into the service agreement (section 240.1550), and it needs the Department on Aging's written approval before subcontracting any Community Care Program service (section 240.1607).

| | Ohio PASSPORT | Illinois Community Care Program |
|---|---|---|
| Ride rate | Billing maximums of $23.21 one way, $28.61 round trip, or $3.12 a mile | $12.44 per one-way ride, code T2003 |
| Effective | April 17, 2026 | January 1, 2026 |
| Shared rides | 75 percent of the rate for riders from the same home, in the same vehicle, to the same place | Each rider is a unit, up to two a day |
| Center attendance rate | $80.94 a day or $40.48 a half day (enhanced level) | $16.84 per hour, code S5100 |
| Ride time counted as attendance | No | No |

See [T2003](https://nemtguide.com/glossary/t2003/) for how the per-trip code works elsewhere.

### 3. The rider uses a regular Medicaid ride

Where the center's rate and codes do not cover rides, a Medicaid member may get to the center through NEMT or waiver transportation, depending on the state. CMS's waiver guide limits waiver transportation to rides that reach waiver services and other places in the member's service plan. It cannot replace the state's duty to ensure necessary rides to and from providers under [42 CFR 431.53](https://www.ecfr.gov/current/title-42/section-431.53), so a ride to medical care the state plan covers is billed as NEMT.

Virginia shows the NEMT version for a related kind of day program. MTM Health's handbook for Virginia fee-for-service NEMT (May 2026) lists day support programs among covered trips and says many trips recur daily or weekly to day support or dialysis. To bill these rides yourself, you enroll with the broker or the waiver agency. See [how to become a waiver transportation provider](https://nemtguide.com/guides/waiver-transportation-provider/) and [NEMT broker contracts](https://nemtguide.com/guides/how-to-get-nemt-broker-contracts/).

## PACE, VA, and Older Americans Act programs

**PACE.** PACE programs deliver care at a PACE center, as well as at home and in inpatient facilities ([42 CFR 460.98](https://www.ecfr.gov/current/title-42/section-460.98)), and they run transportation for their participants. In September 2026, CMS counted 208 PACE contracts with 81,439 participants. A PACE organization that uses a contractor must make sure the vehicles are maintained to the manufacturer's recommendations and can communicate with the PACE center. It must train all transportation staff, contractors included, to manage participants' special needs and handle emergencies, and tell drivers about relevant care plan changes ([42 CFR 460.76](https://www.ecfr.gov/current/title-42/section-460.76)). See [PACE transportation contracts](https://nemtguide.com/guides/pace-transportation-contracts/).

**VA.** Enrolled veterans who qualify for community care and meet the clinical criteria can use VA's Adult Day Health Care where it is available. A copay may apply, based on the veteran's service-connected status and finances, and VA Form 10-10EC is used to figure it. VA says veterans may be able to get help with transportation to and from the center, and that services vary by location. See [VA transportation contracts](https://nemtguide.com/guides/va-transportation-contracts/).

**Older Americans Act.** Title III supportive services include transportation to supportive and nutrition services ([42 U.S.C. 3030d(a)(2)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section3030d&num=0&edition=prelim)). The act also counts adult day care as a respite service for families ([42 U.S.C. 3002(30)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title42-section3002&num=0&edition=prelim)). Ask your area agency on aging whether it funds rides for local day programs. See area agency on aging transportation.

**Private pay.** Participants without any of these programs pay privately. Quote the family or the center a clear price per ride or per week. See [private pay NEMT](https://nemtguide.com/guides/private-pay-nemt/).

## How adult day center routes run

An adult day route is a shared ride on a fixed schedule. The van leaves early, picks up several participants, and arrives before the program starts. In the afternoon it runs the same loop in reverse. Each participant attends on set days, so the manifest barely changes week to week. See [NEMT standing orders](https://nemtguide.com/guides/nemt-standing-orders/) and NEMT multiloading.

Being on time is money for the center. Ohio and Illinois both count attendance without ride time. In Ohio, less than four hours of attendance is a half day. A participant who arrives late and ends up with three and a half hours drops from the $80.94 enhanced day rate to $40.48. In Illinois, the center bills $16.84 for each hour of programming, and time on the van does not count toward those hours.

Centers also need your times for their own records. Ohio requires each adult day session record to show the participant's arrival time, departure time, and mode of transportation. Give the center your pickup and drop-off times every day. The [daily manifest template](https://nemtguide.com/templates/nemt-daily-manifest/) has columns for them.

### What the driver must do in Ohio

Ohio's rule for certified non-medical transportation providers, 173-39-02.18 (effective February 1, 2025), applies to Ohio adult day centers whether they drive participants themselves or subcontract the rides. It is also a useful model elsewhere:

- **Hands-on help.** The driver helps each rider transfer between the pickup point and the vehicle, get in and out, and transfer from the vehicle to the destination.
- **Communication.** Every driver carries two-way communication, such as a cell phone.
- **Vehicles.** Each vehicle passes a yearly inspection by an ASE-certified or approved mechanic. Any vehicle that carries wheelchairs gets a daily check of fasteners, belts, and the ramp or lift before its first trip, with a record kept.
- **Drivers.** A driver's license held for at least two years, first aid and CPR training, a drug test, a background check, and passenger assistance training within six months of hire.
- **Trip records.** The rider's name, date, pickup point and time, drop-off point and time, driver's name, and a unique identifier for both the driver and the rider.
- **A backup plan** for when a driver or vehicle is out.

Other states set their own rules, so check your state's adult day and transportation rules on its [state guide](https://nemtguide.com/states/) page. The [wheelchair securement checklist](https://nemtguide.com/templates/wheelchair-securement-checklist/) covers the daily lift check.

## How to price an adult day route contract

Start with what the center is paid for each ride in your state. That is the ceiling on what most centers can pay you without losing money. Then pick a pricing model.

| Pricing model | How it works | Best for | Your risk |
|---|---|---|---|
| Per rider, per one-way trip | Matches how Ohio and Illinois pay centers | Centers that bill a ride code | Absences cut your pay, but your cost stays the same |
| Per route | A flat price for each morning or afternoon run | Stable routes with steady attendance | Adding riders without a price change |
| Per vehicle hour | Pay for the hours the van and driver are assigned | Long or rural routes | Pressure to shorten hours |
| Dedicated vehicle, monthly | One van and driver reserved for the center | Large centers | Center pushback if attendance drops |

### A route cost example

These are example numbers, not rates from any state. One wheelchair van runs a morning and an afternoon route for a center, carrying 10 participants each way.

| Example daily cost | Amount |
|---|---|
| Driver, 6 paid hours at $20.00, plus 10 percent payroll costs | $132.00 |
| Running cost, 70 miles at $0.75 a mile | $52.50 |
| Insurance, dispatch, and overhead share | $60.00 |
| **Daily cost** | **$244.50** |
| One-way trips at full attendance | 20 |
| **Cost per one-way trip** | **$12.23** |

Two formulas do the work:

**Cost per one-way trip = daily route cost ÷ one-way trips**

**Break-even trips = daily route cost ÷ your price per trip**

At Illinois's $12.44 ride rate, break-even is 19.7 trips, so this example covers its cost only at full attendance. If two participants are absent, 16 trips earn $199.04 against $244.50 in cost. At a per-route price of $135.00 per run, the day earns $270.00 whatever the attendance. Put your own numbers in the [trip price calculator](https://nemtguide.com/tools/nemt-trip-price-calculator/) before you quote.

### Terms to put in the contract

- **A daily minimum** or per-route price, so absences do not wipe out your margin
- **An absence deadline,** such as the evening before, for removing a rider from the route
- **Separate prices** for wheelchair riders, stretcher riders, and extra stops
- **A maximum ride time** for any participant, agreed with the center
- **Closure rules** for weather and holidays, and whether a closed day is paid
- **Who supplies escorts** for riders who cannot be left alone
- **What records you hand over** each day, such as pickup and drop-off times
- **Privacy terms.** If you receive participants' health information, the center may need a [business associate agreement](https://nemtguide.com/glossary/business-associate-agreement/) with you.

The free [facility transportation agreement](https://nemtguide.com/templates/facility-transportation-agreement/) and [rate sheet](https://nemtguide.com/templates/nemt-rate-sheet/) templates cover most of these terms.

## How to win adult day center contracts

1. **List the centers near you.** Use your state's licensing or provider directory, such as the Texas DAHS provider directory or the Illinois Department on Aging provider search.
2. **Learn how rides are paid in your state.** Is the ride inside the center's rate, a separate code the center bills, or a regular Medicaid trip? The answer decides who your customer is.
3. **Check the subcontractor rules.** Ohio centers must use a transportation provider that meets rule 173-39-02.18. Illinois centers need the Department on Aging's approval to subcontract. New York's manual describes programs that contract with Medicaid-enrolled transportation providers.
4. **Ask who runs their rides today** and what goes wrong: late arrivals, no wheelchair space, or a van that breaks down.
5. **Bring a route plan,** with pickup order, times, vehicle types, and a backup van.
6. **Quote in the center's terms,** per rider, per route, or per hour, and show the math.
7. **Start with one route** and report on-time arrivals every week. For more on selling to facilities, see [NEMT facility contracts](https://nemtguide.com/guides/how-to-get-nemt-facility-contracts/).

## Frequently asked questions

### Who pays for adult day care transportation?

Usually the adult day center, which is then paid by Medicaid, PACE, the VA, an area agency on aging, or the family. In the 2025 National Post-acute and Long-term Care Study, 73.7 percent of adult day centers provided daily round-trip rides, and 64.5 percent of participants had some or all of their center services paid by Medicaid in the last 30 days.

### Does Medicaid pay for transportation to adult day care?

Often, but the method differs by state. Texas builds transportation into its day activity and health services rate. Ohio and Illinois pay centers a separate ride rate. In New York, adult day health care programs that run or contract for rides pay the transportation company themselves, and Medicaid will not authorize those rides separately.

### How much does adult day care transportation pay?

It depends on the state. Ohio's PASSPORT waiver sets billing maximums of $23.21 for a one-way trip, $28.61 for a round trip, or $3.12 a mile (April 17, 2026). Illinois pays $12.44 per one-way ride under code T2003 (January 1, 2026). Texas pays one day activity and health services rate of $18.59 per unit, with transportation inside it (September 1, 2025).

### Can a NEMT company bill Medicaid directly for rides to an adult day center?

Usually not when the center's rate or ride code covers the trip. In Ohio the center transports or subcontracts with a transportation provider that meets the state's non-medical transportation rule, and in Illinois the center bills the ride code. CMS requires states to prevent double billing when another service's rate includes rides. Where the rate does not cover rides, the trip may go through NEMT or waiver transportation.

### How should I price an adult day center contract?

Start from your daily cost to run the route: driver hours, miles, insurance, and overhead. Divide by the one-way trips you expect, then check the result against what the center is paid per ride in your state. Add a daily minimum or a per-route price so absences do not wipe out your margin, and set separate prices for wheelchair riders and extra stops.

### What do drivers on adult day routes have to do?

It depends on the state. Ohio's rule for certified transportation providers requires drivers to help each rider transfer between the pickup point and the vehicle and to carry two-way communication, and it requires a check of wheelchair lifts and securements before the first trip each day. Drivers need a license held for two years, first aid and CPR training, a drug test, a background check, and passenger assistance training within six months.

## Official resources

- [CMS: 1915(c) waiver technical guide (core definition of adult day health)](https://wms-mmdl.cms.gov/WMS/help/35/Instructions_TechnicalGuide_V3.6.pdf)
- [CDC NCHS: National Post-acute and Long-term Care Study](https://www.cdc.gov/nchs/npals/index.html)
- [Ohio Administrative Code: Rule 173-39-02.18, non-medical transportation provider rules](https://codes.ohio.gov/ohio-administrative-code/rule-173-39-02.18)
- [Illinois Department on Aging: Community Care Program current rates](https://ilaging.illinois.gov/programs/ccp/current-rates.html)
- [Illinois Department on Aging: Provider profile search](https://webapps.illinois.gov/AGE/ProviderProfileSearch)
- [Texas HHS: DAHS provider directory (spreadsheet)](https://apps.hhs.texas.gov/providers/directories/DAHS.xlsx)
- [New York eMedNY: Medicaid Transportation Policy Manual](https://www.emedny.org/ProviderManuals/Transportation/PDFS/Transportation_Manual_Policy_Section.pdf)
- [VA: Adult Day Health Care](https://www.va.gov/geriatrics/pages/Adult_Day_Health_Care.asp)