# Group Home Transportation in 2027: Who Pays for Each Ride and How to Win the Work

Canonical URL: https://nemtguide.com/guides/group-home-transportation/ · Updated 2026-10-02

Group home transportation is rides for people living in group homes, most often adults with developmental disabilities. Who pays depends on the home and the trip. Intermediate care facilities often pay for medical rides from their daily rate. In waiver group homes, outings come from the home's rate, job and day program rides may be waiver services, and doctor visits go through Medicaid NEMT or the home, by state.

- Ask who pays before you quote. The same resident's rides can be billed to the broker, to a waiver, or to the home.
- Intermediate care facilities usually pay for residents' medical rides themselves, as in Louisiana, Maine, and New York.
- Waiver group home rates often include outings and errands, so the home pays you from its own budget, as in Pennsylvania and Missouri.
- Homes expect your drivers to meet the clearance, training, and incident reporting rules their own staff follow.
- Starting July 9, 2027, states must require waiver providers to report critical incidents, such as abuse, neglect, and serious medication errors, within state deadlines.

A group home can hand you steady, repeat work: the same residents, the same addresses, and the same day program or job every weekday. It can also hand you a billing mistake, because one resident's rides may be paid by three different payers. Sort out who pays before you quote.

## What group homes are and why they hire ride companies

This guide covers homes for people with intellectual or developmental disabilities, which Medicaid pays for in one of two ways:

- **Waiver group homes.** Under a home and community-based services waiver, the home is paid for a residential service. CMS's technical guide for 1915(c) waivers (version 3.6, January 2019) calls it residential habilitation and lists transportation among its supports. When the rate covers rides between the home and other service sites or places in the community, the state's service definition must say so.
- **Intermediate care facilities (ICF/IIDs).** These are licensed facilities that Medicaid pays a daily rate, often called a per diem.

Two pressures push homes to hire outside drivers. First, the federal settings rule requires waiver homes to support full access to the community, including work and community life, to the same degree as people not receiving these services. In a home the provider owns or controls, residents must have the freedom and support to control their own schedules and activities ([42 CFR 441.301(c)(4)](https://www.ecfr.gov/current/title-42/section-441.301)). Residents go to different places at different times, so a single weekly group outing rarely fits everyone's plans.

Second, staff are spread thin. Missouri's developmental disabilities waiver manual, posted September 2026, sets daytime staffing for its lowest-need group homes at one staff member for every eight residents. A staff member who leaves to drive one resident to a store takes that coverage away from the other seven.

## Who pays for each ride

The answer depends on the kind of home and the purpose of the trip. These are the patterns in the state rules below:

| Ride | Who usually pays | Example rules |
|---|---|---|
| Medical visit, ICF/IID resident | The facility, from its daily rate | Louisiana, Maine, New York |
| Medical visit, waiver group home resident | Medicaid NEMT in some states, the home in others | Missouri (NEMT), New York (the home) |
| Outings, errands, worship, visits | The group home, from its own rate | Pennsylvania, Missouri |
| Job | A waiver ride service you bill | Pennsylvania, Missouri, Ohio |
| Day program | The waiver, the day program, or the home | Missouri, Ohio, Florida |

### Intermediate care facilities

In these three states, ICF/IIDs pay for residents' medical rides themselves, which makes the facility your customer.

- **Louisiana.** The Medicaid Services Manual (Section 10.0, issued July 14, 2025) lists non-ambulance NEMT for children and adults in ICF/IIDs, and for nursing home residents, as "included in facility per diem."
- **Maine.** MaineCare's non-emergency transportation rule, in the version effective April 5, 2015 that the state still posts, excludes rides for residents of nursing facilities and ICF-IIDs. The exception is a written request from the facility, approved by the Department in advance, saying it cannot supply a ride to a medically necessary service for good cause.
- **New York.** The Medicaid Transportation Policy Manual (effective August 25, 2023) says ICFs, supervised community residences, and supervised and supportive Individualized Residential Alternatives certified by OPWDD must provide or pay for all resident transportation to medical and clinical appointments, at no added cost to Medicaid. See [OPWDD transportation](https://nemtguide.com/guides/opwdd-transportation/).

### Waiver group homes

Waiver homes split rides between their own rate and separate waiver ride services, and each state draws the line in a different place.

- **Pennsylvania.** Under the Consolidated Waiver as of January 1, 2026, the residential habilitation provider is responsible for rides to activities related to health, community involvement, and the service plan, except rides another provider is responsible for. A resident in residential habilitation can get Transportation as a separate waiver service only to and from a competitive integrated job. See [Pennsylvania ODP transportation](https://nemtguide.com/guides/pennsylvania-odp-transportation/).
- **Missouri.** The September 2026 waiver manual says group home services include non-medical transportation to the community as part of the rate. A separate waiver ride may be authorized when a resident goes to work or day habilitation. If the home is equipped to routinely drive residents to day habilitation, those rides are in its rate. Staff must make sure residents get to medical appointments, and those costs are billed to the Medicaid state plan.
- **Florida.** The iBudget handbook (May 2023) pays a residential habilitation provider separately for rides only if it is enrolled as a waiver transportation provider, and only between the home and another waiver service. Rides that are part of residential habilitation are in its rate. A private ride company outside the coordinated transportation system is paid with waiver funds only when the community transportation coordinator cannot provide or arrange the ride. See [APD transportation provider](https://nemtguide.com/guides/florida-apd-transportation-provider/).
- **Ohio.** Non-medical transportation under rule 5123-9-18 (effective January 2, 2025) covers rides to jobs, day and employment services, volunteer work, and post-secondary education, billed by a certified provider. The same rule lets a homemaker/personal care provider drive residents to those places and bill its own service plus transportation under rule 5123-9-24. In Ohio, your competition for a route can be the home's own van. See [DODD non-medical transportation](https://nemtguide.com/guides/ohio-dodd-non-medical-transportation/).

For enrolling in these waiver services, see [how to become a waiver transportation provider](https://nemtguide.com/guides/waiver-transportation-provider/).

### Medical rides for waiver residents

Who pays for a waiver resident's doctor visit depends on the state. Missouri bills those rides to the Medicaid state plan. New York makes its OPWDD-certified group homes provide or pay for them, and Pennsylvania's waiver makes the home responsible for rides to activities related to health. Ask the home which rule applies before you take a booking.

CMS's waiver guide says a ride to medical care covered by the state plan must be billed as state plan transportation or an administrative expense, not as waiver transportation. When a resident's medical ride goes through Medicaid NEMT, home staff book it with the broker or health plan like any other member. Recurring visits, such as therapy, suit a [standing order](https://nemtguide.com/guides/nemt-standing-orders/). If a staff member rides along, the broker's escort rules apply. See [escorts and caregivers](https://nemtguide.com/guides/escorts-and-caregivers/).

Never send the home a bill for a ride Medicaid paid. A Medicaid provider must accept the agency's payment, plus any cost sharing the state sets, as payment in full ([42 CFR 447.15](https://www.ecfr.gov/current/title-42/section-447.15)).

## What group homes expect from a ride company

A home's own rules reach the people it hires to be alone with its residents, including your drivers. Expect it to ask for proof of these.

- **Clearances like its own staff.** For waiver transportation, Pennsylvania requires every driver, aide, or volunteer who will be alone with a participant to be at least 18 and hold a valid license. Each needs a state police criminal history check before hire, an FBI check if they have lived in Pennsylvania less than two years, and a child abuse clearance when the rider is under 18. See [NEMT driver background checks](https://nemtguide.com/guides/nemt-driver-background-check/).
- **Yearly training.** In Pennsylvania, contractors paid by the provider who work alone with individuals must complete 12 hours of training a year (55 Pa. Code 6100.143, code current through August 8, 2026). It covers person-centered practices, preventing and reporting abuse, individual rights, recognizing and reporting incidents, and safe use of behavior supports.
- **Drivers who know each rider.** Pennsylvania's waiver also requires transportation agencies to train their staff in each participant's needs, such as communication, mobility, and behavior. Ask for each resident's relevant support plan notes before the first ride. See [transporting riders with autism](https://nemtguide.com/guides/transporting-riders-with-autism/) for calm-trip practices.
- **An aide on bigger loads.** Pennsylvania requires an aide on the vehicle when a provider carries more than 6 participants on a per-trip ride.
- **A phone call right away when something goes wrong.** In Pennsylvania, the home must report a death, a hospital admission, abuse, neglect, a missing person, law enforcement activity, or an injury needing more than first aid within 24 hours of discovery (55 Pa. Code 6100.401). Starting July 9, 2027, or with the first managed care contract period that begins on or after that date, every state must require waiver providers to report critical incidents within state deadlines ([42 CFR 441.302(a)(6)](https://www.ecfr.gov/current/title-42/section-441.302)). The list includes abuse, neglect, exploitation, misuse of restrictive interventions, and medication errors that lead to a poison control call, an emergency or urgent care visit, a hospital stay, or a death. Your driver's call is how the home meets its clock.
- **Vehicle checks and trip records.** Ohio's waiver ride rule requires the first driver of the day to check a wheelchair vehicle's fasteners, belts, and ramp or lift and record it. Its trip records include the plate number, start and stop times, the driver's signature, and the names of everyone in the vehicle. The [trip log template](https://nemtguide.com/templates/nemt-trip-log-template/) covers most of these.
- **Insurance that answers abuse claims.** Oregon's state risk management office tells state agencies to require abuse and molestation coverage from contractors who have care over clients, and lists group homes among them. The coverage can be a separate policy or an endorsement, with limits reserved for it and defense costs outside the limit. Ask your agent whether your policies cover these claims before a home asks you. See [NEMT insurance requirements](https://nemtguide.com/guides/nemt-insurance-requirements/).

## How to price group home routes

Price the home's own rides from your costs, not from a guess. Find your hourly and per-trip cost with the [cost per trip guide](https://nemtguide.com/guides/nemt-cost-per-trip/), then use the pricing models in [NEMT facility contracts](https://nemtguide.com/guides/how-to-get-nemt-facility-contracts/): by distance, per hour, per route, or a monthly minimum.

Group home work comes in three shapes, and each prices differently:

1. **Daily runs to a job or day program.** The same stops every weekday. Price per route, or per one-way trip by distance zone, and reset the price when the stops change.
2. **Outings and errands.** The van waits while residents shop or attend an event. Price per hour with a minimum, because waiting time is your cost.
3. **Appointments the home pays for.** For ICF/IID residents, price per trip by distance plus a wait rate, the same way you would for a nursing home.

Check the waiver rate before you quote a ride the waiver could pay for. It shows what the state pays for the same trip. Pennsylvania's statewide fee schedule, for agencies without a cost-based rate, pays $36.54 for a one-way trip up to 10 miles, $65.78 for over 10 to 30 miles, and $74.73 for over 30 miles, rates in effect since July 1, 2024 and repeated in the schedule posted for January 1, 2027. Ohio pays $26.91 to $28.85 per rider for each one-way trip between home and a day service or other listed place, depending on the county, and higher special rates for one rider at a time to a competitive job. Ohio pays each rider's fare no matter how many ride together, so a van carrying four residents to the same day program earns four fares.

Shared runs need a clear rule in a private contract. Decide whether you charge per rider or per run, and how many stops a run includes. Missouri also caps waiver per-trip rides at two units per participant per day.

Never bill one ride twice. CMS's technical guide says that when another waiver service's rate already includes transportation, the state must have ways to prevent duplicate billing of the ride. Ohio bars billing day services or the driver's homemaker/personal care for the same time as a per-trip ride. Put in writing which rides the home pays for, which you bill to the waiver, and which go through the broker. Never lower the home's price in exchange for residents' Medicaid trips. See [anti-kickback rules for NEMT](https://nemtguide.com/guides/anti-kickback-rules-for-nemt/).

## How to win group home contracts, step by step

1. **List the residential providers near you.** Start with your state developmental disabilities agency. In Pennsylvania, an enrolled provider is added to ODP's Services and Supports Directory, which support coordinators share with participants.
2. **Credential with the NEMT broker.** Residents' medical rides still need it. See [NEMT broker credentialing](https://nemtguide.com/guides/nemt-broker-credentialing/).
3. **Enroll in the waiver ride service** where job and day program rides are billed, if your state allows outside companies.
4. **Meet the program director or house manager.** Ask which rides strain their staff: wheelchair users, weekend outings, early job shifts, or appointments on short-staffed days.
5. **Clear and train your drivers first.** Have checks, training records, and vehicle inspections done before the first ride.
6. **Offer a trial.** Take one route or one kind of trip for 30 days, and report on-time results.
7. **Sign a written agreement.** Name which rides the home pays for, the rates, incident reporting, and records. Start from the [facility transportation agreement template](https://nemtguide.com/templates/facility-transportation-agreement/) and have a lawyer review it.
8. **Report every incident at once.** A home that hears about a problem from you first, inside its deadline, is far more likely to renew.

## Frequently asked questions

### Does Medicaid pay for group home residents' doctor appointments?

Yes, but not always through the broker. Missouri's waiver manual (September 2026) says group home staff make sure residents get to medical appointments, with the cost billed to the Medicaid state plan. New York requires OPWDD-certified group homes and intermediate care facilities to provide or pay for those rides themselves. In an intermediate care facility, the daily rate usually covers them, as Louisiana and Maine rules also say.

### Can I bill Medicaid for a group home outing?

Usually not. Outings, errands, and community activities are often part of the home's own rate. Pennsylvania makes the residential habilitation provider responsible for rides to health, community, and service plan activities. Missouri builds rides into the community into its group home rate. In those cases the home pays your invoice under a private agreement.

### Do I need to be a waiver provider to drive group home residents?

Only to bill the waiver yourself, for rides such as a resident's daily trip to a job. For rides the home pays for, you sign a private agreement with the home. You still need to meet the driver rules the home must follow, which in Pennsylvania include criminal history checks and yearly training for contractors who are alone with residents.

### What do waivers pay for a group home resident's ride to work or a day program?

It depends on the state. Pennsylvania's statewide fee schedule, for agencies without a cost-based rate, pays $36.54, $65.78, or $74.73 per one-way trip by distance zone, unchanged from July 1, 2024 through the schedule posted for January 1, 2027, and allows it for group home residents only to and from a competitive job. Ohio pays $26.91 to $28.85 per rider per one-way trip to a day service, by county, under its rule effective January 2, 2025.

### Does a group home staff member have to ride along?

Sometimes. Pennsylvania's waiver requires an aide on the vehicle when a provider carries more than 6 participants on a per-trip ride, and leaves smaller loads to the provider's judgment of each rider's needs. On Medicaid NEMT trips, the broker's rules on escorts apply. Ask the home which residents need a staff member with them, and put it in writing.

### What checks do my drivers need to drive group home residents?

Follow the state's rules for the home's own staff. Pennsylvania's waiver requires drivers and aides who are alone with a participant to be at least 18, to have a state police criminal history check before hire, an FBI check if they have lived in Pennsylvania less than two years, a child abuse clearance for riders under 18, and a valid license.

## Official resources

- [CMS: Home and community-based services 1915(c) waivers](https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c)
- [eCFR: 42 CFR 441.301, home and community-based settings rule](https://www.ecfr.gov/current/title-42/section-441.301)
- [Pennsylvania ODP: Consolidated Waiver (as of January 1, 2026)](https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/services/disabilities-aging/documents/proposed-waiver-amendments/2026-01-01-consolidated-waiver-final.pdf)
- [Missouri DSS: Developmental Disabilities Waiver Manual](https://dss.mo.gov/sites/mydss/files/media/file/2026/09/DD-Waiver-Manual.docx)
- [Ohio Administrative Code 5123-9-18, Non-medical transportation](https://codes.ohio.gov/ohio-administrative-code/rule-5123-9-18)