NEMT Scheduling in 2027: How to Build Next-Day Runs That Keep Vans Full

Most of a NEMT trip is fixed before it reaches you: who rides, when, and in what kind of vehicle. What you control is how the trips fit together: which van takes each trip leg, in what order, and how much room sits between legs. That fit decides whether vans stay full and riders arrive on time.

A good schedule is built the day before, around the rules your brokers publish. This guide walks through the method in order, with the rule behind each step. For what happens once the vans roll, see NEMT dispatch.

Who sets what on a NEMT trip

Here is how the work splits on a typical broker trip.

Set by the broker or health plan	Set by you
Who rides, and whether the trip is covered	Which driver and van take each leg
The pickup and appointment times the rider is told	The order of legs on each run
The mode and level of assistance, such as wheelchair van, door to door	How much time you leave between legs
Shared-ride limits and return-trip rules	Which trips you accept, and which you turn back by the deadline
Any change to times, addresses, or vehicle type	When each driver starts and ends the day

Three programs show how firm those times are:

• Georgia Medicaid (July 1, 2026). The broker tells members their pickup time when they request the ride.
• MAS, New York (October 1, 2023). Providers keep to all times and addresses on each trip. Changes are requested through MAS in advance, and changes asked for after the ride may not be approved.
• CareOregon (February 2024). Changes to pickup times, appointment times, and addresses need brokerage approval. Trips not provided as authorized are not paid.

For private pay riders and facility contracts, you set the times yourself. The same method below works for them. See private pay NEMT.

When trips arrive and how much changes

Riders book days ahead, so most of tomorrow is known before today starts.

Program	How far ahead riders book	Source date
Georgia Medicaid	At least 3 business days before a non-urgent appointment	July 1, 2026
Modivcare, Kansas	3 business days (72 hours). Bookings taken up to 30 days ahead.	September 2026
Louisiana Medicaid	At least 48 hours, except urgent trips and hospital discharges	July 14, 2025
Rhode Island (state contract with MTM Health)	Requests made at least 48 hours ahead must be accepted. Advance booking is required except for urgent care and follow-up visits too soon to book ahead.	July 1, 2025

Brokers then hand trips out on their own clock. MTM Health’s Virginia handbook (approved August 10, 2026) sends trips to eligible providers 7 days before the appointment. The Marketplace shows open trips 5 days before, and MTM dispatchers call providers 4 to 5 days out about trips not yet offered or still pending.

Virginia matches trips to providers by capacity, hours of operation, trip distance, and credentialing status. So the settings in your broker profile shape what you are offered. MAS asks providers to keep holidays and closures current in their Transportation Provider Profile.

Wisconsin’s statewide report for May 2026 shows how much of a month is predictable:

Wisconsin NEMT, May 2026	Trip legs
Scheduled, including cancellations and no-shows	406,006
Canceled	104,602
Completed	301,246
Completed legs tied to a recurring appointment	203,022
Completed legs booked with less than 24 hours’ notice	36,143

The completed count includes 87,582 legs where members drove themselves and were paid mileage.

About two in three completed legs came from recurring appointments, and about one in eight came with less than a day’s notice. About one scheduled leg in four was canceled. That points to a two-pass schedule: a weekly frame built from standing orders, then a next-day pass for new trips, changes, and cancellations.

The timing rules your schedule must meet

Every run has to fit the payer’s clock. These are the published rules for pickups and arrivals.

Program	Pickup rule	Arrival at the appointment
MTM Health, Virginia (August 10, 2026)	15 minutes before to 15 minutes after the scheduled pickup, first leg only	No later than the appointment time, with time to check in
MTM Health, Rhode Island (July 1, 2026)	Within 15 minutes of the stated time	On time for the appointment
Georgia Medicaid (July 1, 2026)	Within 15 minutes of the stated pickup time	On time for the appointment
MAS, New York (October 1, 2023)	At the scheduled time or up to 15 minutes before or after	On time for the appointment
Texas Medicaid health plans (August 1, 2021)	Driver waits at least 10 minutes after the pickup time	At least 15 minutes and no more than one hour early, unless the member asks
CareOregon (February 2024)	Never before the scheduled pickup time, unless the member chooses. Driver waits at least 15 minutes.	No drop-off more than 15 minutes before the facility opens, unless the member asks

Louisiana’s manual (July 14, 2025) has riders arrive at least 15 minutes and no more than two hours before their appointments.

And these are the rules for the ride home and for shared rides.

Program	Will-call return	Extra ride time on a shared ride
MTM Health, Virginia	Within 45 minutes of the call	45 minutes over the average direct trip
MTM Health, Rhode Island	Within 45 minutes of the call	45 minutes over the average direct trip
Georgia Medicaid	Within 1 hour of the call	45 minutes over the average direct trip
MAS, New York	Within 1 hour of the ready call	Any ride under one hour, with some exceptions
Texas Medicaid health plans	Within 1 hour of the request	1 hour over the average direct trip
Louisiana Medicaid	Within 2 hours of the call, inside the facility’s business hours	Any ride: 1 hour beyond the estimated travel time

Early arrival at the door does not buy you time. Virginia, Rhode Island, Georgia, and MAS all say a member never has to board before the scheduled pickup time. See pickup window and maximum ride time.

How to set a pickup time

When you set the time yourself, or check one the broker gave you, work back from the appointment:

Pickup time = appointment time, minus the arrival cushion, minus drive time, minus boarding time

• Arrival cushion. Time to get inside and check in. It must fit the program: at least 15 minutes and no more than one hour early in Texas, 15 minutes to two hours in Louisiana, and no later than the appointment time in Virginia.
• Drive time. The drive for that hour of that day, not a late-night estimate.
• Boarding time. How long your drivers really take to load and secure each kind of rider. Time a week of trips and use your own numbers.

Here is an example with hypothetical numbers. A wheelchair rider has a 10:00 a.m. appointment. The drive takes 30 minutes at that hour, loading and securement take 10 minutes, and you want a 20-minute arrival cushion.

Step	Minutes	Time
Appointment		10:00 a.m.
Arrival cushion	20	9:40 a.m.
Drive time	30	9:10 a.m.
Boarding and securement	10	9:00 a.m.
Pickup time		9:00 a.m.

If a second rider shares the van, add the drive to that stop and that rider’s boarding time. Then check that the first rider’s time on board stays inside the shared-ride limit.

If a broker’s pickup time is tighter than your numbers, call the broker the day before. CareOregon and MAS, for example, do not let you move it yourself.

First and last appointments of the day

Facility hours matter as much as the appointment:

• Texas. For the first or last appointment of a provider’s day, the member must not be dropped off more than 15 minutes before opening or picked up more than 15 minutes after closing.
• Louisiana. If you arrive before the facility opens, the driver stays with the rider until it opens. An early arrival costs you the van, not just the minutes.
• CareOregon. No drop-off more than 15 minutes before the facility opens unless the member asks, and drivers try to pick members up within 15 minutes of the facility closing.

Match every trip to a vehicle that fits

The level of service on the trip decides which vans can take it and how long each stop takes.

Mode or level on the trip	What it means	What it needs	Scheduling note
Ambulatory, curb to curb	The rider walks with little help. The driver stays at or near the vehicle.	A sedan, passenger car, or minivan	Time your own stops for each level
Door to door	The driver helps the rider between the building door and the vehicle	Any vehicle that fits the mode	Add time at both ends for the walk to the door
Hand to hand	The rider passes from one responsible person to another, such as facility staff	Any vehicle that fits the mode	Add time to find the person at the destination
Wheelchair	The rider stays in a wheelchair, sitting upright	A wheelchair van with a certified ramp or lift and securements, and a trained driver	Leave time to load and secure the chair
Stretcher	The rider travels lying down, with no medical monitoring	A stretcher van with an approved stretcher and trained staff, sometimes an attendant	Georgia dialysis trips need a bed or chair ready on arrival

The level definitions come from MTM Health’s Virginia handbook (August 10, 2026). Its vehicle rules shape the schedule too:

• Use the authorized mode exactly. An unapproved mode or vehicle swap can mean no payment.
• Count seats, not riders. Total occupants, including the driver, must not exceed the manufacturer’s designed seating capacity.
• Check every wheelchair station. Each needs four working securements and a lap and shoulder belt.
• Check weight against the lift. The manifest lists the member’s weight with any mobility device, and you document each lift’s rated capacity.
• Carry a spare wheelchair for discharges. Providers who accept hospital discharges carry one on board, with a seat at least 20 inches wide.

Some programs allow an upgrade. CareOregon’s manual lets you use a different vehicle without asking when it still meets the member’s needs, such as a wheelchair van with ambulatory seats for a member booked for a sedan. Ask each broker before you swap.

In Georgia, dialysis trips follow set levels: ambulatory is curb to curb, wheelchair is door to door with no lift to the dialysis chair, and stretcher is bed to bed or treatment chair. Every stretcher standing order request for dialysis needs a letter of medical necessity. See level of service and the NEMT vehicle requirements guide.

The next-day scheduling method, step by step

Run these steps at the same time every afternoon. The order matters: fixed trips first, flexible ones last.

1. Pull tomorrow’s trips at a set time

Pick one cutoff, such as 2 p.m., and pull every accepted trip, standing order, and facility booking for tomorrow. Anything that comes in later goes on as a change, not a rebuild.

2. Count trips by level of service and hour

Count wheelchair, stretcher, and ambulatory legs in each hour of the day. Compare that with the vans and drivers you have for each hour. A shortage at 7 a.m. shows up here, while there is still time to fix it.

3. Place the fixed-time trips first

These trips cannot move, so they anchor each run:

• Dialysis and other treatment chairs. Group riders by center and chair time. See dialysis transportation.
• First appointments of the day, which cannot arrive before the facility opens.
• Known hospital discharges, which carry their own clock.
• Hand-to-hand riders, who need a person waiting at the destination.

MTM Health’s Virginia handbook asks providers to make a best-faith effort to use the same driver for recurring trips when they can, and to document when they cannot. Keep regular riders with their regular driver.

4. Group the rest by area and time

Sort the remaining trips into zones, then into time blocks inside each zone. A run works when each drop-off lands near the next pickup, just before its time.

Keep local trips even when long ones pay more. Louisiana’s manual (July 14, 2025) has brokers watch for providers who turn down local trips in favor of long ones, and a pattern can bring trip reductions or other sanctions. NEMT route planning covers building zones and cutting empty miles.

5. Chain legs with slack

Between one drop-off and the next pickup, leave enough time for three things:

1. The drive to the next pickup, at that hour.
2. The full wait at the next door. Georgia and Rhode Island let drivers leave after 10 minutes. Texas requires at least 10, New York and CareOregon at least 15, and MediTrans in Louisiana 15 at a home or 20 at a facility.
3. Boarding time for that rider’s level of service.

A run with no room for a full wait turns one slow rider into several late pickups. The guide to on-time performance shows how that shows up in your broker scores.

6. Add shared rides where the rules allow

Pair riders going the same way at about the same time, then check the first rider’s time on board against the limit. See the shared-ride section below.

7. Place return legs and hold room for will-calls

Put every scheduled return on a run. Then hold capacity near the clinics where will-call returns come from. The section on returns below shows how.

8. Check drivers, vehicles, and credentials

Put each run on a driver whose shift covers it, with breaks that fit between legs. Then check every driver and van against the broker’s credential list. MTM Health’s Rhode Island handbook (July 1, 2026) wants renewals uploaded 10 business days before they expire, and trips can come off the manifest if a credential is not in at least 5 days before it expires. NEMT driver schedules covers shift patterns.

9. Turn back what does not fit, before the deadline

A trip you cannot run belongs back with the broker while it still has time to place it.

Broker	Deadline to hand a trip back
MTM Health, Virginia	At least 24 hours before the scheduled pickup
MTM Health, Rhode Island	At least 24 hours before the appointment. No same-day turnbacks, and trips taken from the Marketplace cannot be turned back.
MediTrans, Louisiana	Decline a trip offer within 30 minutes if you cannot complete it. A timely decline carries no penalty.

10. Confirm riders and send manifests

Call or text each rider about tomorrow’s ride. Texas requires the confirmation 24 hours before pickup for most rides, never after 9 p.m., with a record of each contact. MTM Health’s Rhode Island handbook has providers contact members 24 hours before the ride to confirm the pickup time. CMS allows states to require riders who are often late or absent to confirm the night before or the morning of (SMD 23-006, September 28, 2023).

Send each driver the final run on the daily manifest. The guide to reducing NEMT no-shows lists what to cover on each confirmation call.

A sample day for one wheelchair van

This run uses example times for a hypothetical van. Use your own drive and boarding times.

Time	What the van does	Why it goes there
6:15 a.m.	Pre-trip inspection, final manifest loaded	The first pickup cannot be late
6:45 a.m.	Pick up rider 1, wheelchair, for a 7:30 dialysis chair	Fixed time, placed first
7:15 a.m.	Drop off rider 1 at the dialysis center	15 minutes to get inside and check in
7:35 a.m.	Pick up rider 2, wheelchair, door to door, three miles away	Same zone, next time block
8:05 a.m.	Drop off rider 2 for an 8:30 appointment	25-minute arrival cushion
8:05 to 8:30 a.m.	Slack	Covers a full wait at the next door
8:40 a.m.	Pick up riders 3 and 4 at one senior residence, going to the same clinic for 9:30 and 9:45	One stop, same direction, inside the shared-ride limit
9:15 a.m.	Drop off riders 3 and 4	Both arrive before their appointments
9:15 to 11:15 a.m.	Open for will-call returns near the clinics	Returns for riders 2, 3, and 4
11:30 a.m.	Pick up rider 1 at dialysis	Fixed return from the chair time

Three things make this run work. The fixed trips went on first. Every gap covers the next drive plus a full wait. And the middle of the morning is kept open for the returns the morning’s drop-offs will create.

Shared rides: when two riders can share a van

Texas defines a shared ride as members traveling in the same direction with appointments within one hour of each other. That is a good test in any program. Then hold the extra time on board inside the limit in the tables above: 45 minutes over the average direct trip in Virginia, Rhode Island, and Georgia, and one hour in Texas and Louisiana.

Billing differs by program. New York’s Medicaid transportation manual (August 25, 2023) pays one trip, with an additional rider, when people from the same household go to the same destination. Read your broker’s rule before you plan a shared ride for the money. NEMT multiloading covers how each payer bills extra riders.

Returns and will-calls

A will-call return has no set time, so the schedule has to hold room for it. The windows in the table above run from 45 minutes after the call with MTM Health in Virginia and Rhode Island to two hours in Louisiana.

Scheduled returns have limits too. Louisiana requires pickup within the facility’s business hours and no more than two hours after a prescheduled appointment ends.

To keep returns from wrecking the afternoon:

1. List each clinic’s closing time and put the last returns from it on a run before closing.
2. Check your own records for when each facility usually calls, by weekday.
3. Keep one van free near the busiest clinics during those hours, as in the sample day.
4. Group returns from the same facility where shared rides are allowed.
5. Ask facilities to call about 30 minutes before a rider is ready, so the van is already moving.

Hospital discharges come with little notice and their own clock, often three hours. See managing will-call trips and hospital discharge transportation.

Keep the schedule current after you build it

A schedule is a plan for tomorrow, and tomorrow will change. Keep it honest:

• Send every change through the broker. New times, addresses, and vehicle types need approval, and trips run differently than authorized may not be paid.
• Refill canceled slots. When a trip cancels, check the broker’s open trips in that zone and hour before you release the driver.
• Keep your broker profile current. Service area, hours, capacity, and closures decide which trips you are offered.
• Review standing orders monthly. Louisiana’s brokers review every standing order at least once a month, and riders or facilities can change pickup times, add appointments, or change the end date of treatment.
• Compare plan with actual. Each week, compare scheduled times with the real pickup times from your trip records. Legs that run late week after week need more time on the schedule.

Scheduling is also where you add trips without adding vans. Vehicle utilization shows how to measure trips per van per day and find the idle gaps.