Assisted Living Transportation Requirements in 2027: What Facilities Must Arrange and How to Win the Rides

What state rules require of assisted living facilities

Assisted living is licensed by each state, not by a federal program, so the duty to get residents to the doctor changes at every state line. The CDC counted 32,200 residential care communities with 988,800 residents in 2022, and 81.5% of the communities were for-profit.

State rules come in two strengths. The stronger ones say the facility must provide rides or arrange them. The lighter ones say it must help residents arrange them. Under the stronger rules, a facility without its own van needs a company like yours.

State and rule	What the facility must do	Rides it covers
Florida, 59A-36.007	Provide or arrange	Medical, dental, nursing, and mental health care
North Carolina, 13F .0906	Assure rides, no extra fee	Health care, social services, shopping, recreation, worship
California, 22 CCR 87465	Provide directly or arrange	Medical and dental care, may be the nearest facility
Louisiana, 48:I.6847	Provide or arrange for residents who cannot manage rides	Medical care, personal services, errands, outings
Oregon, 411-054-0030	Provide or arrange	Medical and social purposes
Minnesota, 144G.41	Help arrange, on request	Medical and social service visits, shopping, recreation
Virginia, 22VAC40-73-790	Help the resident make arrangements	As necessary

A few details change how you pitch:

• Florida. The rule (effective June 11, 2025) lists the ways a facility can arrange rides: family and friends, volunteers, taxi cabs, public buses, and agencies providing transportation. You are the last item on that list. The facility must also help residents make appointments and remind them, and it may not require residents to use a particular health care provider, so expect trips to many different offices.
• North Carolina. The rule covers adult care homes with seven or more beds. It names community resources, public systems, volunteer programs, family members, and facility vehicles as ride sources. Because residents cannot be charged extra, the home pays for any ride it buys from you.
• California. Residential care facilities for the elderly may limit the ride to the nearest medical or dental facility that meets the resident’s need, and may provide it directly or arrange it.
• Louisiana. Adult residential care providers must provide or coordinate transportation as a required service, to the extent each resident needs or wants it (LAC 48:I.6841). The transportation rule’s list of rides applies to residents who cannot manage their own transportation. Its vehicle and driver rules are below.
• Minnesota. On a resident’s request, the facility must give direct or reasonable help arranging rides and tell the resident who is responsible for that help.

Who pays for an assisted living resident’s ride

Three payers cover most assisted living rides, and the one you bill depends on the ride and the resident.

• The resident or family. Florida’s admission package must state the availability of transportation and any additional cost to the resident (rule 59A-36.006, amended November 27, 2025). Florida resident contracts must also give at least 30 days’ written notice of a rate increase (section 429.24, 2026 Statutes). In Texas, the state’s disclosure statement (Form 3647, November 2022) asks whether transportation is in the base rate and lists transportation to doctor visits as a service residents can buy. These are private pay rides, priced like the ones in the private pay guide.
• The facility. Where the rule bars a charge, as in North Carolina, the facility pays your invoice out of its own rate. Facilities paid through a Medicaid waiver may also owe rides as part of that service, as in Texas below.
• Medicaid. Federal rule 42 CFR 431.53 requires every state to ensure necessary transportation for its Medicaid members, including members who live in assisted living. A covered medical ride for a Medicaid resident usually goes through the state’s broker or health plan, and the facility pays nothing. Florida’s long-term care plans, which pay for assisted living services, also cover transportation to and from long-term care program services.

Bill one payer for each ride. If the facility’s own rate already covers a trip, do not also send it to Medicaid.

Texas: ask the plan before you bill Medicaid

Texas facilities that serve STAR+PLUS home and community-based members must provide or arrange transportation and escort to local shopping, recreational trips, and the nearest available medical provider (STAR+PLUS Handbook section 7220, revision 19-1, June 3, 2019). The same section says those members are entitled to Medicaid medical transportation for covered appointments, and facility staff schedule it. A member who wants to go to an outside activity that is not a facility group outing pays for that ride, which is private pay work.

The managed care ride handbook (UMCM 16.4, version 2.0.1, August 1, 2021) points the other way. Section 3120 lists transportation to or from an assisted living facility among the limits on NEMT, next to services whose rate already includes transportation. Before you carry a Texas assisted living resident on a Medicaid ride, confirm with the member’s health plan that the trip is covered. The Texas guide lists the plans and their ride vendors.

What a facility will check before it uses your company

Louisiana’s rule (LAC 48:I.6847, amended October 2021) shows what a careful facility looks for. Whether an adult residential care provider drives residents itself or contracts the rides out, it must document that:

1. Every vehicle carrying residents is inspected and licensed under state law.
2. Drivers hold a valid driver’s license, plus a chauffeur’s license or a CDL with a passenger endorsement when one applies.

The facility must also carry its own current commercial liability insurance, and the vehicles must be handicapped accessible or equipped for the residents served. When the facility runs rides itself, it must also train drivers in CPR, first aid, and each resident’s needs, and keep a safe driving record from the state motor vehicle office at hire and every year.

The rule then exempts the facility from the vehicle and driver verifications if it uses a third-party company that the state health department has authorized as a NEMT provider. If you are enrolled in Louisiana Medicaid, say so in your first email, because it saves the facility a file of paperwork. Elsewhere, expect the same questions and have the answers ready: see CPR rules for drivers, driver background checks, and insurance limits.

Evacuation plans need vehicles

Emergency plans are a second door. Texas requires each assisted living facility’s plan to identify current arrangements for access to enough vehicles to safely evacuate all residents (26 TAC 553.275, amended January 24, 2023). The plan must also say how the facility will notify each driver carrying residents, and the employer of any driver who is not facility staff. Florida’s emergency rule for assisted living (59A-36.019) requires plans to cover evacuation transportation and transportation after a disaster. The facility submits its plan every year to the county emergency management agency, which has the final say, and a changed contract or agreement that alters how the plan works must be filed within 30 days.

A wheelchair van company that signs a written evacuation agreement fills that part of the plan. Agree on how the facility reaches you after hours, how many seats and wheelchair spaces you can send, and how you will be paid. The evacuation transportation agreements guide covers the clauses.

How to win assisted living ride work, step by step

1. Pull the licensed facility list. Florida Health Finder, the Texas long-term care provider search, and California’s care facility search let you look up licensed facilities near you. Start with the ones closest to your garage.
2. Read the facility’s disclosure first. In Florida, ask for the admission package. In Texas, ask for Form 3647. You will learn whether rides are in the base rate, sold as an extra, or not offered.
3. Ask who books rides now. Usually it is the administrator or an activities or transportation coordinator. Ask how many trips a week they cannot cover and what happens to those residents today.
4. Split the trips by payer. Book covered rides for Medicaid residents through the state’s broker or plan, which you must be enrolled with. Quote everything else as facility-paid or private pay.
5. Offer what the rule asks for. In Florida, that is medical, dental, nursing, and mental health visits. In North Carolina, add shopping, recreation, and worship, and remember the home pays because residents cannot be charged extra.
6. Price it safely. When the facility pays, price by distance, time, or a fixed run, never per resident, and never discount private work to win Medicaid trips. The facility contracts guide explains the kickback rules behind this.
7. Put it in writing. Use the free facility transportation agreement to set rates, booking, cancellations, insurance, privacy, and how either side can end the deal.
8. Add the evacuation agreement in Texas and Florida, and ask the facility to name you in its plan.

Assisted living residents also need rides to the bank, the store, and family events, which Medicaid medical ride benefits do not cover. Some waiver members get those trips through a separate waiver transportation benefit. For the rest, the senior transportation guide covers the permits and insurance private rides take.