Hospice Transportation in 2027: Who Pays and How to Win Hospice Rides

Hospices buy rides on their own contracts, outside the broker system. The hospice, not Medicaid, is usually the one paying. To win the work, you need to know which rides the hospice owes, what it can afford, and what it expects from the crew at the door.

How the hospice benefit pays for rides

Medicare pays a hospice a fixed amount for each day a patient is enrolled, whatever services that day includes (42 CFR 418.302). In return, the hospice takes on the cost of all care for the terminal illness and related conditions. MedPAC reports that in 2024 about 6,700 hospices served more than 1.8 million Medicare patients, and Medicare paid them $28.3 billion. Medicare also pays for hospice care when the patient is in a Medicare Advantage plan.

The daily rate depends on the level of care. These are the national rates for fiscal year 2027, effective October 1, 2026, as corrected by CMS on September 30, 2026. Each hospice’s actual rate is adjusted for local wages, and hospices that miss quality reporting get rates about 4 percent lower.

Level of care	What it means	Daily rate
Routine home care, days 1 to 60	Care where the patient lives	$236.33
Routine home care, day 61 on	The same care after 60 days	$186.33
Continuous home care	Mostly nursing care at home during a crisis, at least 8 hours	$1,726.16 for 24 hours ($71.92 an hour)
Inpatient respite care	A short stay in a facility so the family can rest	$545.93
General inpatient care	A stay in a hospice unit, hospital, or skilled nursing facility for symptoms that cannot be managed at home	$1,231.51

Rides come out of those amounts. A hospice that spends more on transportation keeps less for nurses and aides, so a safe ride at a lower cost is an easy case to make.

Ambulance rides and van rides are treated differently

CMS draws the line in its Medicare Benefit Policy Manual (chapter 9, section 40.1.9):

• The ride home on the first day of hospice. An ambulance ride home on the date hospice starts happens before the hospice’s first assessment and care plan. Medicare pays it through the ambulance benefit, not the hospice.
• Later ambulance rides tied to the terminal illness. These are the hospice’s responsibility. CMS gives the example of a patient who becomes unstable and needs an inpatient stay: the ambulance ride becomes a covered hospice service.
• Rides for unrelated care. An ambulance company bills Medicare directly with the GW modifier, which means the service is not related to the terminal condition (Claims Processing Manual, chapter 11, section 50).

Wheelchair and stretcher vans sit outside all of this. CMS says Medicare does not cover any non-ambulance transportation under Part A or Part B, such as a wheelchair van or stretcher van (Claims Processing Manual, chapter 6). The hospice benefit covers extra services only when Medicare could otherwise pay for them (42 CFR 418.202(i)). So for a patient with Medicare alone, a van ride is not a covered hospice service. If the hospice wants one, it buys the ride and pays for it itself.

That math can favor you. On Medicare’s 2026 ambulance fee schedule, a basic non-emergency ambulance trip (A0428) has an urban base rate of $261.60 to $380.05, depending on the area, plus $9.33 a mile (A0425). A 10-mile ride each way comes to $709.80 to $946.70 for the round trip. That equals three to four days of the hospice’s routine home care rate. If the patient does not need an ambulance crew, your stretcher van price is the one to compare against it. See NEMT vs ambulance for where the line falls.

Which hospice rides you can win

Most hospice work falls into a handful of ride types. Who pays depends on timing and on whether the trip is tied to the terminal illness.

Ride	Who usually pays	What the rules say
Hospital to home on the day hospice starts	Medicare, if it is an ambulance ride. Medicare pays for no van ride, so ask the hospital and the hospice who is paying before you book.	CMS manual, chapter 9
Home to a hospice unit, hospital, or skilled nursing facility for general inpatient care	The hospice	CMS manual, chapter 9, for an ambulance ride. Mississippi Rule 1.7 makes the hospice provide rides tied to the terminal illness.
Home to a nursing facility for respite care, and back	The hospice, since respite is one of its levels of care	Medicare pays the respite rate for at most 5 days in a row (42 CFR 418.302(e)(5)), so each stay means two rides
Hospital back home during hospice care	The hospice	Mississippi Rule 1.7
Rides to treatment for comfort, tied to the terminal illness	The hospice	Michigan, Ohio, Mississippi, and Washington rules
Rides to care unrelated to the terminal illness	The state’s normal NEMT program, or Medicare for an ambulance	Missouri, Michigan, Mississippi, and Washington rules
A move to a relative’s home or a family event	The family, as private pay	Medicaid NEMT covers only rides to covered medical care

Short stays shape the work. Among patients who died in 2024, MedPAC found the median time in hospice was 19 days and the average was 99.6 days. The average was 174 days for patients in assisted living and 120 days in nursing facilities, against 100 days at home. Expect many one-time rides for patients you never see again, so the relationship that matters is with the hospice staff who book them. Patients in facilities tend to stay longer, so they are the most likely to need repeat rides.

Medicaid hospice patients: the state rules

For Medicaid patients, several states write the hospice’s duty into their own rules. That matters because a ride booked through the broker for hospice-related care may not be covered at all.

State	Rule
Michigan	Non-emergency and emergency transportation related to the terminal illness is the hospice agency’s responsibility. Unrelated rides go through the local MDHHS office, or the nursing facility for its residents (Medicaid Provider Manual, Hospice, section 6.4, July 1, 2026).
Ohio	A county office may decline a ride when a Medicaid hospice provider must provide or arrange transportation for care related to the terminal illness (OAC 5160-15-10, effective July 1, 2021).
Mississippi	The hospice must provide rides for care related to the terminal illness after admission, and rides from the hospital to home or to a freestanding hospice facility when a patient is hospitalized after electing hospice. It arranges unrelated rides through the state’s NET broker (Title 23, Part 205, Rule 1.7, in the version effective August 1, 2026).
Missouri	Hospice members are not eligible for broker NEMT, except rides to covered care unrelated to the terminal illness (NEMT Manual, section 1.2, April 2026).
Washington	Brokers do not provide rides when the care is related to the client’s hospice diagnosis (WAC 182-546-5550). Medical transportation, including ambulance, is included in the hospice daily rate (WAC 182-551-1210, effective September 1, 2025).

If your state is not listed, read the hospice chapter of its Medicaid provider manual and the NEMT manual together, and see your state guide.

PACE participants follow a different path. Under 42 CFR 460.154(i), a PACE participant who elects the hospice benefit is treated as leaving PACE voluntarily. The PACE organization stops arranging their rides, and the hospice and Medicaid rules above decide who pays for each one. See PACE transportation contracts.

What hospices need from a transportation company

Build your offer around five needs.

• The right vehicles. Hospices need stretcher vans for patients who cannot sit up for the ride and wheelchair vans for patients who can. States set who a stretcher van may carry and what the crew may do on the way. Read stretcher van requirements and bariatric transportation before you promise a ride.
• Short notice. A patient moves to inpatient care when symptoms cannot be managed at home, and that happens on the patient’s schedule. Hospices must have nursing services available 24 hours a day, 7 days a week (42 CFR 418.100(c)(2)). Say plainly which hours you cover and how fast you can respond. See same-day NEMT trips and after-hours NEMT.
• Gentle handling. Offer two-person crews for stretcher rides and door-through-door service, with a hand-to-hand handoff when the patient cannot be left alone. Train crews on safe passenger transfers for fragile patients.
• Crews who know hospice. Hospices must give orientation about hospice philosophy to all contracted staff who have patient and family contact (42 CFR 418.100(g)(1)). Offer to send your drivers to it.
• Clean records. Keep a trip record for every leg with the hospice’s authorization, times, and signatures, as in any trip documentation system.

The written agreement

Federal rules require it. A hospice that arranges services through another company must support them with written agreements requiring that every service be authorized by the hospice, delivered safely by qualified staff, and carried out under the patient’s plan of care. The hospice keeps oversight of the service (42 CFR 418.100(e)). Washington adds that for a hospice to be paid its daily rate for contracted services, it must have a written agreement with the provider.

Use this checklist, and start from the free facility transportation agreement.

Term	What to settle
Scope	Ride types (inpatient transfers, respite, discharge, treatment), vehicle types, and levels of service
Ordering	Who at the hospice may order a ride, how, and what order number or authorization you record
Response times	Scheduled rides, same-day rides, and after-hours rides
Rates	Base rate by vehicle type, mileage, waiting time, after-hours and weekend rates, late cancellations
Billing	Monthly invoice to the hospice, what patient details it shows, payment terms, and that you never bill the family for rides the hospice ordered
Condition changes	What the crew does if the patient’s condition changes on the way: when to call 911 and when to call the hospice’s 24-hour line
Staff	Background checks, training, and attendance at the hospice’s orientation
Records and privacy	Trip records, how long you keep them, and a business associate agreement if the hospice asks for one. See HIPAA for NEMT.
Insurance	Limits and whether the hospice is named as an additional insured
Term	Start date, renewal, and notice to end the agreement

How to pitch hospice agencies

1. Build your list. Download the CMS Hospice General Information file from the Provider Data Catalog. The August 19, 2026 update lists 6,669 Medicare-certified hospices with addresses and phone numbers.
2. Find the people who book rides. The administrator runs the hospice day to day (42 CFR 418.100(b)). Each patient’s care is coordinated by a registered nurse on the interdisciplinary group, which also includes a doctor, a social worker or counselor, and a pastoral or other counselor (42 CFR 418.56(a)). Ask each hospice who books rides day to day, and meet that person as well as the administrator.
3. Bring a one-page offer. List your vehicles, hours, response times, and prices. The rate sheet template is a good start.
4. Lead with the numbers. Show the hospice what a stretcher van ride costs next to an ambulance ride at Medicare rates, for a patient who does not need an ambulance crew.
5. Ask for one ride. A first ride done well opens the door to the rest.
6. Report every month. Send rides completed, on-time pickups, and any complaints. See NEMT marketing for building a visit routine.

Keep the pricing clean

HHS OIG’s compliance guidance for nursing facilities (November 2024) warns against swapping: a facility accepting a low price for services it pays for out of its Medicare per diem in exchange for referring other business the supplier bills directly to a federal health care program. It names ambulance providers as prone to swapping. A hospice also pays for rides out of a fixed daily rate, so keep the same distance. Never tie a hospice price to Medicaid trips the hospice sends your way, and never price below cost to win referrals. See anti-kickback rules for NEMT.

For setting the price itself, use how much to charge for NEMT and stretcher transport cost. Hospice rides are private pay work, so you set your own price and terms.