CHILD FOSTER CARE MILEAGE FORM
(OVER 150 MILES)
*Under the “purpose” column please indicate “E” for education (trips to and from school) and
“O” for other (visitations, sports, cultural events, etc.).
DO NOT ENTER MEDICAL MILES- Medical mileage is handled separately.
Foster Parent Signature: _________________________ Date:_____/______/______
Social Worker Authorization: _____________________ Date:____/______/_______
Please refer to the next page for mileage reimbursement instructions.
Month/Year:
Foster Home:
Child Name:
Social Worker:
DATE
TRIP DESCRIPTION
AND DESTINATION
MILES
PURPOSE
Total Miles
Rev. 02/03/2020
0
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Mileage Reimbursement:
Do not enter medical miles (i.e. doctor appointments, therapist, occupational or physical
therapy etc.) on this form. All medical mileage reimbursement is required to go through MTM
non-emergency medical transportation Services, phone # 1-844-399-9466. Please contact
your case manager or licensor if you have any questions regarding medical mileage.
The foster care MAPCY rate includes 150 miles per child (visitation, education, cultural events,
etc.). You will need to get approval from the case manager on what can be counted as
mileage. Reminder medical mileage is not included and is reimbursed separately.
If you go over 150 miles for the month per child, you can get reimbursed with permission from
the case manager.
You cannot claim mileage for multiple children on a trip. If the children both have an
appointment divide the total miles and then assign to each child.
o Example- 2 children have visits and it is 10 miles to the visit center. If foster parent
drives 10 miles to the visit and then 10 miles back home, comes back to pick up the
children 10 miles and then goes back home 10 miles. The total trip is 40 miles for that
trip. Divide 40 miles by 2 children, assign each child 20 miles. Same scenario, but the
visit was only for one of the children and the other child was in the car to tag along. The
one child who has the visit would have 40 miles and the other child would have 0.
Keep a log of your record and email/mail a copy to your social worker.
***PLEASE TURN IN YOUR TRAVEL LOG WITHIN THE
1
st
WEEK OF THE FOLLOWING MONTH.***
Additional mileage logs can be found under forms in the foster care
section of the
St. Louis County Public Health and Human Service
website:
https://www.stlouiscountymn.gov/departments-a-z/public-
health-human-services/children-family-services