NEMT Cost per Trip in 2027: Find Your Real Cost and the Rides That Lose Money

The rate sheet tells you what a trip pays. What it costs is harder to see. The gap between the two decides whether a busy month makes money, and it is different for every trip: a short ride with a long drive to the pickup can cost more than a long ride next door.

This page builds a cost per trip from your own bills, works one full example with official prices in effect in September 2026, and then shows how to spot the trips that lose money.

What goes into your cost per trip

Every dollar you spend running a van lands in one of three groups. Keeping them apart is what lets you price a single trip later.

Cost group	What it includes	How it behaves
Fixed costs per van	Van payment or its cost spread over its life, commercial auto insurance, registration, permits, office, dispatch, phones, admin pay	The same every month, however many trips you run
Driver time	Wages, employer Social Security and Medicare, workers’ compensation, unemployment tax, paid time off	Grows with every hour the van is on the road or waiting
Running cost per mile	Fuel, tires, oil, brakes, repairs, ramp or lift upkeep	Grows with every mile, loaded or empty

Empty miles belong in the running cost. CMS says miles with no member on board, including the drive back after a no-show, generally cannot be paid, though a state may build their cost into its rate (SMD 23-006, September 28, 2023). You pay for every mile, so you count every mile. See deadhead miles and loaded miles.

How to figure your cost per trip in five steps

Use one calendar month and one van. Once the method works for one van, repeat it for each.

Step 1: Add up a month of fixed costs for the van

Take the van payment, or the price divided by the months you expect to keep it. Add the monthly insurance premium and the van’s share of office, dispatch, phone, and admin costs. Leave fuel and repairs out, because they go in Step 3.

Step 2: Find what an hour of driver time costs

Start with the hourly wage. Add the employer’s share of Social Security and Medicare, 7.65 percent of wages in 2026 (6.2 percent plus 1.45 percent, IRS Publication 15). Then add workers’ compensation, unemployment tax, and paid time off from your own bills, per hour paid. Multiply by the hours you paid the driver that month.

Step 3: Find your running cost per mile

Fuel per mile is the price of a gallon divided by your van’s miles per gallon. Add tires, oil, brakes, and repairs over the last few months, divided by the miles driven. Multiply by every mile on the odometer for the month.

Step 4: Count trips, miles, and busy minutes

Count paid one-way trips from your trip logs. Take miles from the odometer, not from the claims, so empty miles are in. Busy minutes are the minutes the van spends on trips: driving to the pickup, loading, riding, unloading, and waiting.

Step 5: Divide

Cost per trip = (fixed costs + driver cost + running cost for all miles) ÷ trips

Cost per busy minute = (fixed costs + driver cost) ÷ busy minutes

The first number tells you whether the month works. The second, with your cost per mile, prices any single trip. The cost per mile calculator and the driver cost calculator do parts of this math for you.

Worked example: one wheelchair van, 8 trips a day

Here is one ramp minivan for one month. The van price, useful life, fuel price, fuel economy, wage, and payroll tax come from official sources. The insurance, overhead, repair, and schedule figures are example numbers, so replace them with your own.

Input	Example	Where it comes from
Van	$69,476 ÷ 60 months = $1,157.93 a month	Florida DOT’s state contract price for the base ADA ramp minivan, a Chrysler Voyager (order form effective February 20, 2025), spread over the 5-year, 200,000-mile life Florida DOT uses for modified minivans (2026 benchmarks)
Insurance	$900 a month	Example. See NEMT insurance cost.
Office, dispatch, phones, admin	$600 a month	Example
Driver wage	$18.09 an hour	BLS median for shuttle drivers and chauffeurs in other transit and ground passenger transportation, May 2025
Employer Social Security and Medicare	$1.38 an hour	7.65 percent of $18.09 (IRS Publication 15, 2026)
Workers’ comp, unemployment tax, paid time off	$1.53 an hour	Example
Fuel	$4.478 ÷ 19 = $0.24 a mile	EIA U.S. regular gasoline, week of September 21, 2026, and the EPA city rating of 19 mpg for the 2026 Chrysler Voyager before conversion
Tires, oil, brakes, repairs	$0.15 a mile	Example
Schedule	8 one-way trips a day, 22 days, 8 paid hours a day	Example
Miles per trip	10 loaded + 5 empty	Example
Busy minutes per trip	45	Example: 12 to the pickup, 8 to load and secure, 20 riding, 5 to unload

The driver wage is for the federal job group that includes nonemergency medical transporters (SOC 53-3053). Across all industries, the May 2025 median for the same job was $17.93 an hour. See NEMT driver pay for wages by state.

Now the month:

Line	Math	Month	Per trip
Fixed costs	$1,157.93 + $900 + $600	$2,657.93	$15.10
Driver	176 hours × $21.00	$3,696.00	$21.00
Running cost	2,640 miles × $0.39	$1,029.60	$5.85
Total	176 trips	$7,383.53	$41.95

The van spends 45 minutes on each of 8 trips, so it is busy 6 of its 8 paid hours. That gives a cost per busy minute of $6,353.93 ÷ 7,920 minutes, or about $0.8023. Every trip in this example costs busy minutes × $0.8023 + miles × $0.39.

Two checks keep the example honest. At 2,640 miles a month, the van reaches 158,400 miles in 5 years, inside Florida’s 200,000-mile benchmark, so the 5-year life is the one that applies. And the price is a base price: Florida’s order form adds two required items for $1,295, and other options, taxes, and loan interest raise it further, so use your own payment if you financed.

What the same trip pays in three states

A cost means little until you set it next to a rate. Here is what three state fee-for-service schedules pay for the average trip in the example: one wheelchair van trip with 10 loaded miles.

Program	Base rate (A0130)	Per loaded mile (S0209)	10-mile trip pays	Against $41.95
Arizona, Phoenix and Tucson metro, from October 1, 2026	$11.15	$1.54	$26.55	Loses $15.40
Ohio, rates last changed January 1, 2024	$31.00	$1.30	$44.00	Keeps $2.05
Nebraska, from July 1, 2026	$46.12	$1.85 after the first 5 loaded miles	$55.37	Keeps $13.42

• Nebraska includes the first five loaded miles, all unloaded miles, and usual waiting time in the base rate, so a 10-mile trip is paid mileage for 5 miles. Its July 1, 2026 schedule notes that rates did not rise because no increase was funded.
• Ohio pays the lesser of your charge or the maximum in the appendix to rule 5160-15-28, whose current version took effect August 1, 2026.
• Arizona pays higher rates, billed with the TN modifier, for trips starting outside the Phoenix and Tucson metro areas: $12.21 plus $1.66 a mile from October 1, 2026.

Broker and health plan trips pay whatever your contract says, which can be higher or lower. The state schedule is still a fair yardstick when a broker offers you a rate. See NEMT reimbursement rates for other states.

Which trips lose money

The average hides the trips that sink you. Price each kind of trip with the formula from the example, busy minutes × $0.8023 plus miles × $0.39, and set it against the same three rates. The trip shapes below are examples.

Trip	Busy minutes	Miles driven	Cost	Arizona metro	Ohio	Nebraska
Short ride, pickup nearby: 3 loaded, 2 empty	26	5	$22.81	Loses $7.04	Keeps $12.09	Keeps $23.31
Average ride: 10 loaded, 5 empty	45	15	$41.95	Loses $15.40	Keeps $2.05	Keeps $13.42
Short ride, far pickup: 3 loaded, 15 empty	51	18	$47.94	Loses $32.17	Loses $13.04	Loses $1.82
Long ride: 30 loaded, 5 empty	75	35	$73.82	Loses $16.47	Loses $3.82	Keeps $18.55
Return after a 60-minute wait: 10 loaded	90	10	$76.11	Loses $49.56	Loses $32.11	Loses $20.74
No-show: 5 empty, 10-minute wait	22	5	$19.60	Loses $19.60	Loses $19.60	Loses $19.60

Arizona also pays waiting time (T2007, $4.59 per half hour from October 1, 2026), but only when the driver waits at the appointment because going back is not practical, the wait is at least 30 minutes, and the appointment is more than 10 miles away (AHCCCS billing manual, chapter 14, July 31, 2026). The 10-mile return above does not qualify, so the table leaves wait pay out. Four patterns stand out:

• Far pickups for short rides. The base rate is the same for a 3-mile ride whether the van drove 2 miles or 15 to get there. The empty drive is pure cost.
• Waiting. An hour of waiting costs $48.14 of van and driver time in the example. Unless your state pays wait time or the driver fills that hour with other trips, the return leg loses money. See NEMT wait time billing.
• No-shows. The drive out and the wait cost the same as for a real trip, and nothing is paid. CMS says neither states nor providers may charge the member for a no-show (SMD 23-006). See billing for no-shows.
• Long rides where the mile rate is low. Once the base rate is used up, each extra mile has to pay for itself. The next table shows when it does.

Cost per loaded mile against what a mile pays

A loaded mile costs the van and driver time it takes plus the running cost. With the example’s $0.8023 per busy minute and $0.39 a mile:

Average speed with the rider	Minutes per mile	Cost per loaded mile
25 mph, city streets	2.4	$2.32
30 mph, mixed	2.0	$1.99
45 mph, highway	1.33	$1.46

At city speeds, a mile costs more than any of the three states pays for it: $1.30 in Ohio, $1.54 in metro Arizona, and $1.85 in Nebraska. On the highway, Nebraska’s and Arizona’s mile rates cover the mile and Ohio’s does not. So in a state like Ohio, the base rate carries short trips and long city trips lose a little on every mile.

Why more trips per van lower your cost per trip

Fixed costs and the driver’s shift cost the same whether the van runs 6 trips or 10. Spreading them over more trips moves the cost per trip more than anything else in the example. Here is the example van with the same trip shape and the same 8-hour shift:

Trips a day	Trips a month	Cost per trip
6	132	$53.99
8	176	$41.95
10	220	$34.73

Turn it around and you get your break-even day. The van and driver cost $288.82 a day before miles. Each average trip adds $5.85 of running cost, so it contributes its pay minus $5.85:

Program	Average trip pays	Left after running cost	Trips a day to break even
Nebraska	$55.37	$49.52	6
Ohio	$44.00	$38.15	8
Arizona metro	$26.55	$20.70	14

At 45 minutes a trip, 14 trips take 10.5 hours, so with these example costs the Arizona van cannot break even inside an 8-hour shift. The break-even calculator runs the same math with your numbers.

This is also why a trip that loses money on paper can still be worth taking. If the van would otherwise sit, any trip that pays more than its running cost and any extra driver time helps pay the fixed costs. The trips to cut are the ones that crowd out better work or lose money week after week.

How to cut the cost of losing trips

1. Sort each week’s trips into winners and losers. Price every standing order with your own busy-minute and per-mile costs, and list the ones that lose.
2. Group trips by area and time. A far pickup costs less when the van is already nearby. See NEMT scheduling.
3. Decide wait or return for each long appointment. Waiting only pays where your state pays for it or the driver has nothing better to do. Otherwise, fill the gap with another trip.
4. Confirm rides the night before. For members with repeated no-shows, CMS recognizes that a state may require the member to confirm the ride the night before or the morning of (SMD 23-006). See how to reduce NEMT no-shows.
5. Hand back what you cannot cover well, early. A trip returned within your broker’s notice rules costs far less than the same trip run late or missed, which costs you the drive and your standing with the broker.
6. Take your numbers to the broker. A table of what each trip shape costs you turns a request for a better rate into numbers the broker can check. See how to negotiate NEMT broker rates.
7. Price private rides from the same costs. Riders and facilities outside Medicaid can pay a price that covers the empty miles. See how much to charge for NEMT.

Keep your numbers current

• Fuel. Check the EIA weekly price. At 19 miles per gallon, every 10 cents a gallon moves your cost by about half a cent a mile, or 8 cents on the example’s 15-mile trip. The fuel cost calculator and ways to reduce fuel costs help here.
• Insurance and wages. Rerun Steps 1 and 2 at each renewal and each raise. Both change the cost of every busy minute.
• The van. A new van, a paid-off loan, or a big repair changes the fixed line. Recheck the useful life against your real miles.
• The IRS rate is not your cost. The business standard mileage rate is 72.5 cents a mile from January 1 to June 30, 2026 and 76 cents from July 1, 2026. It comes from a yearly study of the fixed and variable costs of running a car, 35 cents of it stands for depreciation in 2026, and it has no driver in it. It is a tax number: IRS Publication 463 does not allow it for five or more cars used at the same time. See NEMT business taxes.

Run the numbers each month for each van. Within a quarter you will know your real cost per trip, which trips lose money, and which rates you can accept.