To Drive or Not to Drive, that IS the Question!
A family calls. Mom can't drive anymore, and she needs to get to her doctor's appointments, the pharmacy, and church on Sunday. You tell them, "Sorry, we don't drive."
What happens next? They call the next agency on the list.
Over the last year, more and more agencies have asked me whether they're even allowed to drive clients. A few have stopped offering transportation altogether. Here's what I want you to learn: for private pay, driving is often a deal breaker. Let's make sure a misunderstanding doesn't cost you a client.
Is Driving a PAS Task?
No. Driving isn't on the list of PAS services in Chapter 558 of the Texas Administrative Code.
But you run a business. Can you choose to drive your clients anyway? Yes. And for private pay, I think you should.
Medicaid Is a Different Story
If you serve Medicaid clients, the answer is no. Medicaid attendants can't transport clients.
Medicaid doesn't reimburse for transportation, so the agency can't reimburse attendants for it. That's also why most Medicaid agencies don't carry insurance that covers it. Know where that line is, and keep your team on the right side of it.
Private Pay and Long-Term Care Insurance: Put It in Writing
Nothing prevents you from driving private pay clients. Long-term care insurance clients fall in the same category. For VA contracts, check what your contract says before you offer it.
If you're going to drive, your client agreement needs to say so. Spell out:
Whether caregivers will drive the client's vehicle, their own, or both
That driving the client's car is included in the hourly rate
The mileage rate when a caregiver uses their own vehicle
Then screen for it. Caregivers who drive need a valid driver's license. Check driving records, too. Your liability carrier may require it.
Their Car or Yours?
The client's own vehicle is usually the better option.
The client already knows how to get in and out of their car. Your caregiver doesn't have to manage a lifted pickup, a running board, a broken air conditioner, or a cracked windshield. And you aren't limited to staffing only the caregivers whose cars are nice enough for client outings.
Many caregivers have a license but no car, so they carry no auto insurance of their own. In many cases, a client's full-coverage policy covers a driver the client has given permission to use the car. Ask the family to confirm that with their insurer.
Permission has limits, too. A caregiver who takes the car for a spin while the client naps is a very different situation. Talk with your team about what responsible use of a client's vehicle looks like.
Of course, many clients no longer have a car. Often there's dementia involved, or an accident led the family to take the keys. Many of those families say, "We're not buying Mom another car, but we will get her a caregiver so she can still get out." That's where your agency comes in.
The Insurance Piece You Can't Skip
If your staff drive for work, your agency needs non-owned auto coverage, often sold as hired and non-owned auto (HNOA). It covers your staff driving any vehicle your agency doesn't own. That includes the client's car and the caregiver's own car.
It isn't expensive enough to be a deal breaker. Ask your broker about it, and don't let the cost talk you out of offering transportation.
Setting Your Mileage Rate
When caregivers use their own vehicles, pay them mileage. Most agencies use the IRS standard rate. The business rate is 76 cents per mile for miles driven on or after July 1, 2026, up from 72.5 cents earlier this year (IRS; PayrollOrg). It changes, so look it up each year.
No law says you have to pay exactly that rate. You can pay more or less. But here's what I recommend:
Pay caregivers the IRS rate.
Bill clients 10 to 15 cents a mile above it.
At 76 cents, that means billing about 86 to 91 cents a mile. The more miles your caregivers drive, the more liability you carry. That difference helps cover your insurance.
Families occasionally ask whether you really pay caregivers the full amount. Be honest: you pay the IRS rate, and the difference covers your added insurance. In my experience, most families understand. If mileage is a sticking point, there's another option. The client can provide an insured, reliable vehicle, and mileage doesn't come up at all.
What About Ride Shares?
Some agencies skip driving and bill clients for rides through a ride-share account instead. It works, but it usually costs families more than mileage. If you go that route, you may need to offer something else to make up for it.
My recommendation? If you serve private pay clients, find a way to drive.
The Bottom Line
Errands, outings, church, and doctor's appointments are a big part of care. For private pay clients, transportation helps keep them independent and connected. With the right agreement language, the right insurance, and a clear mileage policy, you can say yes with confidence.
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Did you miss our last blog post on When Staffing Shortages Hit, What's Your Plan? Watch what I have to say on that topic here.
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