Caregivers can get paid back for the miles they drive through three main channels: Medicaid (for care recipients on Medicaid), the Department of Veterans Affairs (for veterans and their caregivers), and an employer (for professional home health aides). Mileage reimbursement for caregivers is not a single national program with one rate. The VA currently pays 41.5 cents per mile for approved health-related travel. The IRS 2026 benchmarks that many other programs follow are 72.5 cents per mile for business use and 20.5 cents per mile for medical use.1Internal Revenue Service. IRS Sets 2026 Business Standard Mileage Rate at 72.5 Cents Per Mile, Up 2.5 Cents If no program covers you, unreimbursed medical driving may still be deductible on your tax return.
If the Care Recipient Is on Medicaid
Federal law requires every state Medicaid plan to guarantee transportation for beneficiaries to and from medical providers.2eCFR. 42 CFR 431.53 – Assurance of Transportation This is called non-emergency medical transportation, or NEMT. States meet the obligation in different ways: some contract with transportation brokers, some reimburse family members directly, and others use a combination of both.3Medicaid. Assurance of Transportation
Home and Community-Based Services (HCBS) waivers add another layer. States use these waivers to design programs that keep people out of institutional care, and many of them cover transportation as a service.4Medicaid. Home and Community-Based Services 1915(c) Under waivers, states set their own mileage rates and eligibility rules, so what a family caregiver earns per mile varies from state to state.
Many states also offer self-directed programs (sometimes called consumer-directed or participant-directed), which let the care recipient manage a budget and hire the caregiver of their choosing, including relatives. Through self-direction, the care recipient effectively becomes the employer, and mileage can be built into the caregiver’s compensation. More than 30 states allow spouses or other relatives to serve as paid caregivers through some form of self-directed Medicaid program. The forms, rate schedule, and enrollment process are set locally, so call your state Medicaid office or the managed care organization that handles the beneficiary’s coverage.
If You Are Caring for a Veteran
Veterans and their caregivers use a separate path: the VA Beneficiary Travel program. The current reimbursement rate is 41.5 cents per mile for approved health-related travel. Eligible expenses also include tolls, parking, public transit fares, and in some cases lodging and meals.5Veterans Affairs. Reimbursed VA Travel Expenses and Mileage Rate
A small deductible applies before payment kicks in: $3 each way, or $6 round-trip, per appointment, capped at $18 per month. Once you reach the $18 cap, the VA covers your full approved travel costs for the rest of that month.5Veterans Affairs. Reimbursed VA Travel Expenses and Mileage Rate
Non-veteran caregivers qualify for travel reimbursement in two situations: as a family caregiver enrolled in the VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC), traveling for caregiver training or to support the veteran’s care, or as a medically required attendant traveling with the veteran.6Veterans Affairs. File and Manage Travel Reimbursement Claims File within 30 days of the appointment. Submissions go through the Beneficiary Travel Self-Service System (BTSSS) online, by mail using VA Form 10-3542, or in person at a VA facility. If you use direct deposit, VA travel pay requires its own deposit setup separate from other VA benefits.
If You Are a Paid Home Health Aide
Agency-employed aides don’t file with a government program for mileage. Reimbursement is set in the employment agreement, often pegged to the IRS business rate (72.5 cents per mile for 2026). The legal floor comes from the Fair Labor Standards Act: if your employer doesn’t reimburse driving expenses and those unreimbursed costs push your effective hourly pay below the federal minimum wage, your employer is violating the law.7U.S. Department of Labor. Wage and Hour Division Opinion Letter FLSA2020-12 The reimbursement only has to “reasonably approximate” your actual expense, but it must keep you above the minimum wage.
Travel between clients during your workday is a separate issue from mileage. That time is compensable work time, not just reimbursable driving. If you see three clients in a day, the drive from client one to client two and from client two to client three counts as hours worked that your employer must pay for.8U.S. Department of Labor. Domestic Service Final Rule Frequently Asked Questions Your commute from home to the first client and from the last client back home is ordinary commuting and doesn’t need to be paid. Agencies that treat all travel as commuting are shortchanging their workers.
What Trips Qualify
Most programs cover trips tied directly to the care recipient’s health: visits to primary care physicians, specialists, physical therapy, and mental health providers. Pharmacy runs and trips to medical supply stores for equipment like wheelchairs or oxygen supplies are generally covered too, though programs don’t always treat these the same as doctor visits.
Some HCBS waiver programs extend coverage to non-medical trips like grocery shopping, but usually only when the trip is done solely for the care recipient and documented in the care plan. Transporting the patient is almost always covered; running errands on their behalf while they stay home gets more scrutiny. Driving a care recipient to a social outing or family event rarely qualifies unless the care plan specifically includes community integration as a therapeutic objective.
Records You Need to Keep
Sloppy records are the most common reason claims get denied. Every trip log should capture:
- The exact date of the trip
- Starting and ending odometer readings
- The full destination address
- A clear purpose, such as “cardiology follow-up” or “prescription pickup”
Record this right after the trip. Estimating later is where errors creep in. A dedicated notebook works, but a mileage-tracking app captures GPS data automatically, and some programs will accept GPS-verified logs as supporting documentation.
If you provide Medicaid-funded home health services, your visits are likely captured by an Electronic Visit Verification (EVV) system, which logs date, time, location, and service type using GPS or telephony.9Medicaid. Electronic Visit Verification EVV is primarily a care verification tool, but the location data can support mileage claims by showing exactly where and when you were.
How to File a Claim
Most Medicaid programs and the VA now accept claims through digital portals. The VA’s BTSSS lets caregivers file online right after an appointment.6Veterans Affairs. File and Manage Travel Reimbursement Claims Medicaid claims often route through a transportation broker or the managed care organization handling the beneficiary. Some programs still accept mailed paper forms.
Expect a review of roughly two to four weeks. Payment comes by direct deposit or paper check. If a claim is denied, the notice should explain why, and most programs allow you to correct and resubmit. Common denial triggers are mismatched addresses, missing purpose descriptions, and claims filed outside the allowed window. The VA’s 30-day deadline is firm.
If No Program Pays You: The Tax Deduction
Miles you drive for a care recipient’s medical needs that no program reimburses may still save you money at tax time. The IRS allows a medical transportation deduction on Schedule A, but only for the portion of your total medical expenses that exceeds 7.5% of your adjusted gross income.10Internal Revenue Service. Topic No. 502, Medical and Dental Expenses That threshold is steep, so this deduction typically helps only households with substantial medical costs overall.
You can claim either actual out-of-pocket costs (gas, oil, tolls, parking) or the IRS standard medical mileage rate of 20.5 cents per mile for 2026. Depreciation, insurance, and general maintenance are not deductible under this method.11Internal Revenue Service. Publication 502 (2025), Medical and Dental Expenses Parking fees and tolls can be added on top of the standard rate. The travel must be “primarily for and essential to medical care,” so driving your parent to a doctor’s appointment qualifies; picking up their dry cleaning on the way does not. You can deduct medical transportation costs you pay for yourself, a spouse, or a dependent.
Is the Reimbursement Taxable?
For professional aides, employer reimbursements paid under an accountable plan are not taxable and don’t appear on your W-2. An accountable plan requires you to substantiate expenses with adequate records (your mileage logs) and return any excess reimbursement. If your employer simply adds a flat mileage payment to your paycheck without requiring documentation, that’s a non-accountable arrangement and the full amount is taxable wages.
For family caregivers reimbursed through Medicaid or another government program, payments that cover documented out-of-pocket costs are generally not treated as taxable income: if you spent the money and got paid back, you didn’t have a net gain. Keep receipts and mileage logs to support the payment; without documentation, the IRS could reclassify it as income.
Fraud Risk
Inflating mileage, logging trips that never happened, or billing personal errands as care-related travel is fraud. Under the False Claims Act, penalties include fines of up to three times the program’s loss plus a per-claim penalty for each fraudulent submission.12U.S. Department of Health and Human Services. Fraud and Abuse Laws Criminal prosecution under 18 U.S.C. ยง 287 can result in imprisonment. Even “reckless disregard” for the truth of a claim can trigger civil liability, so careless record-keeping that produces inaccurate claims is not much safer than deliberate falsification. Log each trip accurately, don’t round up, and never claim a trip you didn’t make. Programs increasingly cross-check submitted claims against GPS and EVV data.