Last updated 2026-07-23
TL;DR
MTM (Medical Transportation Management) is a broker that many state Medicaid agencies hire to manage non-emergency medical transportation. To drive for MTM you first enroll as a Medicaid transportation provider with your state, then apply to MTM's provider network separately. Requirements vary by state, so confirm specifics with your broker and state Medicaid agency before you buy a van.
What is MTM medical transportation?
MTM, short for Medical Transportation Management, Inc., is a private company that states hire to run their Medicaid non-emergency medical transportation (NEMT) programs. It is not a government agency and it does not pay Medicaid claims directly out of federal funds. Instead, a state Medicaid agency signs a contract with MTM, MTM builds a network of transportation providers (that's you, the wheelchair-van owner-operator), and MTM dispatches trips, sets rates, and handles billing on the state's behalf. MTM is one of several large NEMT brokers operating across the country, alongside Modivcare and others. Which broker runs NEMT in your state depends entirely on that state's current contract. Some states run NEMT in-house through managed care organizations instead of a statewide broker. So the very first thing to figure out isn't "how do I sign up with MTM," it's "who actually manages NEMT in my state right now." That answer changes when contracts turn over, sometimes every few years. For background on how the broker model fits into the bigger Medicaid transportation picture, see medical transportation and nemt. A quick clarifying point people often miss: enrolling with MTM does not replace enrolling with your state Medicaid agency. Those are two separate steps, and skipping the state one is the single most common reason new owner-operators get stuck for weeks.
What is non emergency medical transportation (NEMT)?
Non-emergency medical transportation is transportation to and from Medicaid-covered medical appointments for people who don't have another way to get there and don't need an ambulance. Think dialysis three times a week, chemotherapy, physical therapy, prenatal visits, or a psychiatric appointment. The ride itself isn't an emergency; the medical need is real, but nobody is calling 911. Federal Medicaid rules require states to make sure eligible enrollees can actually get to and from covered care. The regulation at 42 CFR 431.53 requires state Medicaid plans to "specify that the Medicaid agency will ensure necessary transportation for recipients to and from providers" [1]. States can meet that obligation directly, through managed care plans, or by contracting with a broker like MTM. That's the legal root of the entire NEMT industry: a compliance requirement, not a nice-to-have. NEMT covers a range of vehicle types: ambulatory sedans and minivans for people who can walk and sit unassisted, wheelchair vans for people who use a wheelchair or scooter, and in some states stretcher vans for people who must travel lying down. Most new owner-operators start with a wheelchair van because reimbursement rates for wheelchair-accessible trips tend to run higher than ambulatory sedan trips. Exact rate schedules vary by state and by broker contract, though, so confirm current rates with your broker and state Medicaid agency before you commit to a vehicle purchase. For a broader look at how NEMT programs are structured state by state, see non emergency medical transportation and nemt transportation.
Does Medicaid cover ambulance rides?
Yes, but it's a different benefit than NEMT. Medicaid covers ambulance transportation when a beneficiary's condition requires emergency medical response or medically necessary ambulance-level care during transport, such as continuous monitoring or the possibility of needing emergency intervention en route. Medicaid.gov describes non-emergency medical transportation as an assurance requirement tied to enrollee access, distinct from the emergency ambulance benefit covered under separate Medicaid rules [2]. The distinction matters because it determines which credential you need. Ambulance services generally require state EMS licensure, certified EMTs or paramedics, and a different enrollment pathway through your state's EMS regulatory office, not through an NEMT broker. If you're planning to run wheelchair vans, you are in the NEMT lane, not the ambulance lane, and you won't need EMT certification for most non-emergency wheelchair transport work. Some states do require a first aid or CPR card, so confirm with your state Medicaid agency. So when someone asks "does Medicaid cover ambulance," the honest answer is: yes for medically necessary emergency or ambulance-level transport, and separately, yes for non-emergency transportation to Medicaid-covered appointments, through the NEMT benefit. Two different systems, two different enrollment paths, two different vehicle types.
Does Medicare cover medical transportation?
Medicare's coverage of transportation is much narrower than Medicaid's. Original Medicare Part B covers ambulance services only when other transportation would endanger the beneficiary's health and the transport is medically necessary. The statutory basis sits at 42 U.S.C. 1395x(s)(7), which defines covered ambulance service, and CMS spells out the medical necessity standard in the Medicare Benefit Policy Manual, Chapter 10 [3]. Medicare does not have a general non-emergency medical transportation benefit the way Medicaid does in most states. Some Medicare Advantage plans offer NEMT as a supplemental benefit, meaning a private Medicare Advantage insurer chooses to add rides to medical appointments as an extra perk beyond what Original Medicare requires. If you want to work with Medicare Advantage transportation, that's usually arranged through the plan's own transportation vendor or a broker contract specific to that plan, not through the Medicaid broker relationship with MTM. Confirm directly with each Medicare Advantage plan or its transportation vendor what credentialing they require, because it is not standardized the way Medicaid NEMT enrollment tends to be within a state. Bottom line: if your business plan leans on Medicare non-emergency rides, don't assume Medicare works like Medicaid. Verify plan by plan.
How to start a medical transportation business
Starting a medical transportation business (specifically an NEMT business, since that's the market wheelchair-van owner-operators actually enter) comes down to five things happening roughly in order, though some can overlap: 1. Form your business entity (LLC is common) and get an EIN from the IRS. 2. Get commercial auto insurance and any state-required NEMT-specific coverage. 3. Buy or convert a vehicle that meets your state's wheelchair-accessible vehicle standards. 4. Enroll as a Medicaid transportation provider with your state Medicaid agency. 5. Apply for broker network credentialing with whichever broker (MTM, Modivcare, Access2Care, SafeRide, or another) manages NEMT in your state. Most states also require a background check for drivers, a vehicle inspection, and proof of a driving record clean of certain disqualifying offenses within a lookback period the state sets. Some states additionally require a Certificate of Need or a separate NEMT operating permit before you can even apply for Medicaid enrollment. None of this is standardized nationally; it is genuinely state-by-state, and it's the reason so many new owner-operators get the sequence wrong and lose weeks waiting on a step they did out of order. A realistic planning note: paperwork alone (state enrollment plus broker credentialing) commonly takes somewhere between four and twelve weeks from a clean application, depending on the state's current backlog and how complete your first submission is. Nobody publishes a national average because every state agency and broker runs its own queue, so treat any specific timeline you hear as one program's experience, not a guarantee for yours.
How to start a NEMT business (the credentialing sequence in detail)
Here's the sequence broken out with the traps that actually cost people time. First, confirm which broker (if any) manages NEMT in your target state and county right now. NEMT broker contracts get rebid, and a state that used MTM last year might use a different broker this year, or might have carved NEMT back into managed care plans. Call your state Medicaid transportation unit and ask directly; don't rely on old blog posts (including this one, eventually). Second, complete state Medicaid provider enrollment. This usually means an application through the state's Medicaid Management Information System (MMIS) portal, an NPI number in many states, proof of insurance, vehicle registration and inspection documents, and driver background checks. Some states require this before broker credentialing; a few let you run the applications in parallel. Confirm the order with your state Medicaid agency because doing it backwards can mean resubmitting documents. Third, apply to the broker's provider network. MTM, like other brokers, has its own vehicle and driver standards that sit on top of, not instead of, the state's Medicaid requirements. Expect the broker to ask for your Medicaid provider number, proof of insurance naming the broker or state as required, vehicle photos, and a signed provider agreement covering rates, service areas, and performance standards (on-time pickup percentages, complaint thresholds, and so on). Fourth, expect an onboarding or orientation step, sometimes online, sometimes in person, before you get load into their dispatch system. For an overview of how brokers compare on process and requirements, see nemt and non emergency medical transportation services.
How do you start a medical transportation business with one van?
One van is a completely normal way to start, and plenty of owner-operators run exactly one wheelchair van for years before adding a second. The credentialing process doesn't care how many vehicles you have; a fleet of one goes through the same state enrollment and broker application as a fleet of twenty. What changes with one van is your operating math, not your paperwork. With a single vehicle, any downtime (an accident, a mechanical failure, a driver who's sick) means zero revenue that day, because you have no backup. Some owner-operators solve this by driving the van themselves and hiring a second driver only for overflow, others keep a maintenance reserve fund specifically so an unexpected repair doesn't take the business offline for two weeks. On the vehicle side, make sure whatever van you buy or convert actually meets your state's wheelchair-accessible vehicle standard before you finalize the purchase. That typically means a certified conversion (ramp or lift, tie-down and securement points meeting an accepted standard, adequate interior clearance), not a van you modified yourself in a driveway. Buying first and asking the state second is a common and expensive mistake; a van that doesn't meet the standard for wheelchair securement or clearance can fail inspection outright. One more thing worth planning for with a single-van operation: broker contracts often specify service area and expected trip volume commitments. Ask the broker upfront what performance standards apply, and whether a one-van operation is even something they'll credential in your area, before you sign a lease or buy a vehicle.
How to start a non-emergency medical transportation business (state and broker checklist)
| Business entity | LLC or corporation, EIN | Your state's Secretary of State office | |
|---|---|---|---|
| Commercial insurance | Auto liability, often broker-specified minimums | Your insurance agent + broker contract | |
| Vehicle standard | Certified wheelchair conversion, ADA-style securement | State Medicaid transportation unit | |
| Driver background check | State and sometimes federal criminal history check | State Medicaid agency | |
| Medicaid provider enrollment | MMIS application, NPI in many states | State Medicaid transportation unit | |
| Broker credentialing | Separate application with MTM, Modivcare, etc. | The specific broker | |
| Ongoing compliance | Vehicle re-inspections, insurance renewal, driver re-checks | Broker + state, on their schedule | A federal rule worth knowing: 42 CFR 440.170(a) defines transportation as a Medicaid service states may cover, and CMS's State Medicaid Manual guidance describes how states must assure necessary transportation is available under their state plan [4]. That's the document trail underneath every state's specific enrollment form, even though the form itself will look completely different state to state. If you want a structured way to organize all these documents before you approach a state or broker, a state-and-broker launch packet like the $199 Launch Kit exists to organize exactly this checklist so you're not assembling it from scratch during your first application cycle. It doesn't replace confirming requirements with your state and broker directly, but it saves you from re-learning the sequence. |
Requirements genuinely differ by state, so treat the table below as a planning checklist, not a promise of what your state requires. Confirm every line item with your state Medicaid agency and the broker operating in your area. | Step | Typical requirement | Who to confirm with |
What documents does MTM (or any broker) usually require from owner-operators?
Every broker publishes its own provider manual, and MTM's specific requirements can change without much public notice, so this section is a general shape, not MTM's current checklist. Confirm exact current requirements directly with MTM's provider enrollment team for your state. Generally, brokers ask for proof of your state Medicaid provider enrollment (sometimes a Medicaid provider number is a prerequisite to even applying), a signed transportation provider agreement outlining rates and service area, current commercial auto insurance meeting the broker's minimum limits, vehicle registration and inspection records, driver rosters with background check clearance, and often a W-9 or business tax documentation for billing setup. Brokers also typically set ongoing performance standards after you're credentialed: on-time pickup rates, no-show and cancellation handling procedures, complaint resolution timelines, and sometimes minimum trip acceptance rates. Falling below those standards repeatedly can lead to reduced trip assignments or removal from the network, so read the provider agreement's performance section closely before signing, not after your first bad month. One practical tip: keep a single folder (physical or digital) with every document you submit to both the state and the broker, dated. When broker contracts change hands, which happens, you may need to re-submit much of the same paperwork to a new broker, and having it organized saves real time.
How is MTM different from Modivcare or other NEMT brokers?
MTM and Modivcare (formerly known as LogistiCare) are the two largest NEMT brokers in the country, and between them they manage NEMT contracts in a large share of states, though the exact count shifts as contracts get rebid. Access2Care and SafeRide operate in fewer states or specific regional and managed-care contracts. From an owner-operator's perspective, the practical differences that matter are: which broker holds the current contract in your specific state and county, what rate schedule that broker pays for wheelchair versus ambulatory trips, what dispatch technology or app the broker uses, and how responsive their provider support line actually is. These are things you learn by talking to other operators already credentialed with that broker in your area and by reading the specific provider agreement, not from general comparisons. Don't assume your experience with one broker in one state predicts anything about a different broker in a different state, or even the same broker in a different state. Contract terms, rate schedules, and credentialing steps are negotiated state by state. For a side-by-side look at how brokers differ on structure, see nemt transportation and emergency medical transport for how the emergency and non-emergency systems interact when a ride needs to be reclassified mid-trip.
What goes wrong most often during MTM or broker credentialing?
The most common failure point is sequence: applying to the broker before state Medicaid enrollment is finished, or buying a vehicle before confirming the state's exact wheelchair-accessible vehicle standard. Both cost weeks of rework. The second most common issue is insurance gaps. Broker contracts frequently specify minimum liability limits or require the broker (or state) be named on the policy in a specific way. A generic commercial auto policy that doesn't match the broker's required language can bounce your application back, sometimes more than once if the corrections aren't caught the first time. Third, driver background check timing. Background checks expire or need to be within a certain look-back window by the time you submit, so starting this process too early (months before you're ready to submit everything else) can mean redoing it. Fourth, and this one is underrated: not confirming which broker currently holds the contract. Because broker contracts turn over, a new owner-operator who spends weeks preparing an application for the "wrong" broker (one that just lost the state contract) wastes real time. A five-minute phone call to your state Medicaid transportation unit before you start any paperwork prevents this entirely.
What should I check before I buy a wheelchair van for NEMT work?
Before you spend money on a vehicle, confirm three things directly with your state Medicaid agency and, if known, your target broker: the specific wheelchair securement and clearance standard the state requires, whether the state requires a particular vehicle inspection or certification before enrollment, and whether the broker you'll apply to has additional vehicle-age or mileage limits beyond the state's requirements. A common mistake is buying a used van and adding an aftermarket wheelchair lift without checking whether that specific conversion meets the accepted securement standard in your state. Many states reference SAE or WC19 wheelchair tie-down and occupant restraint standards for wheelchair securement systems; ask your state Medicaid transportation unit which standard applies and whether they require documentation from the conversion company showing compliance. Also ask about vehicle age limits. Some broker contracts won't credential a vehicle over a certain age (commonly somewhere in the 5 to 10 year range, though this varies widely and isn't standardized), so a great deal on an older van could turn out to be ineligible.
How long does it take to get credentialed and start driving?
There's no single national timeline, because state Medicaid enrollment speed and broker onboarding speed both vary by workload and by how complete your first submission is. Anecdotally across states, owner-operators report anywhere from a few weeks to a few months for the combined state-plus-broker process, but that's a range reported informally, not a published statistic, so don't treat it as a guarantee for your state. What you can control: submitting complete documentation the first time cuts out the resubmission cycle, which is the single biggest source of delay. Missing insurance endorsements, expired background checks, and incomplete vehicle documentation account for most of the back-and-forth that stretches a four-week process into a twelve-week one. Call both your state Medicaid transportation unit and the broker's provider relations line before you submit anything, and ask for their current checklist in writing. Verbal answers from a call center can differ from what a supervisor or the actual provider manual says, so get it in writing where you can.
Frequently asked questions
What is MTM in medical transportation?
MTM (Medical Transportation Management, Inc.) is a private company that many state Medicaid agencies contract with to manage non-emergency medical transportation (NEMT). MTM builds and dispatches a network of transportation providers, sets rates under its state contract, and handles ride scheduling and billing on the state's behalf. It is not a government agency itself.
What is non emergency medical transportation (NEMT)?
NEMT is transportation to and from Medicaid-covered medical appointments for people who don't need an ambulance but lack another way to get there, such as dialysis, chemotherapy, or physical therapy visits. Federal rule 42 CFR 431.53 requires state Medicaid programs to ensure this kind of transportation is available to eligible enrollees.
Does Medicaid cover ambulance rides?
Yes. Medicaid covers ambulance transportation when a beneficiary's medical condition requires emergency response or ambulance-level monitoring during transport. This is a separate benefit from NEMT, with separate licensure (EMS/EMT credentials) and a different enrollment path than the NEMT broker system that MTM and similar companies manage.
Does Medicare cover medical transportation?
Original Medicare covers ambulance transport only when medically necessary and when other transportation would endanger the beneficiary's health, under the standard in 42 U.S.C. 1395x(s)(7). Medicare generally doesn't cover routine non-emergency rides to appointments, though some Medicare Advantage plans offer NEMT as a supplemental benefit through their own vendor arrangements, separate from Medicaid NEMT.
How do I start a NEMT business from scratch?
Form a business entity, get commercial insurance, buy a vehicle meeting your state's wheelchair-accessible standard, enroll as a Medicaid transportation provider with your state, then apply separately for broker network credentialing (MTM, Modivcare, or whichever broker holds your state's contract). Confirm the exact sequence and requirements with your state Medicaid agency first.
How do you start a medical transportation business with just one van?
One van is a normal starting point; the credentialing process is the same regardless of fleet size. The main risk with a single vehicle is downtime: any accident or repair takes your whole operation offline, so many one-van operators keep a maintenance reserve fund and a plan for backup coverage during outages.
Do I need an EMT certification to drive NEMT wheelchair vans?
Generally no. Non-emergency wheelchair transport isn't the same as ambulance service, so most states don't require EMT certification for NEMT drivers. Some states do require a first aid card, CPR certification, or passenger assistance training. Confirm the exact driver qualification list with your state Medicaid agency before hiring.
How is MTM different from Modivcare?
MTM and Modivcare (formerly LogistiCare) are the two largest NEMT brokers nationally, but which one manages NEMT in your state depends on that state's current contract, and contracts get rebid periodically. Rate schedules, dispatch technology, and provider support differ by broker and by state, so compare based on your specific state's current contract, not general reputation.
How long does MTM credentialing take?
There's no published national average. Combined state Medicaid enrollment plus broker credentialing has been reported anywhere from a few weeks to a few months depending on the state's backlog and how complete your first submission is. Missing insurance documentation and background check timing are the most common causes of delay.
What vehicle standards does a wheelchair van need to meet for NEMT?
States typically require a certified wheelchair conversion with proper securement and tie-down points, adequate interior clearance, and passing a state vehicle inspection. Standards aren't identical nationwide, and some broker contracts add their own vehicle age limits on top of state requirements. Confirm the specific standard with your state Medicaid transportation unit before buying a vehicle.
Can I get credentialed with MTM before enrolling with my state Medicaid agency?
Usually no. Most states require Medicaid provider enrollment first, since brokers like MTM typically ask for your Medicaid provider number as part of their own application. Confirm the required order directly with your state Medicaid agency and the broker, since a few states allow parallel processing.
Does every state use MTM or a similar broker for NEMT?
No. Some states run NEMT through managed care organizations instead of a single statewide broker, and some manage it directly through the state Medicaid agency. Broker contracts also change over time. Call your state Medicaid transportation unit to confirm who currently manages NEMT before starting any application.
Sources
- eCFR, 42 CFR 431.53 (Assurance of transportation): Federal rule requiring state Medicaid agencies to ensure necessary transportation for recipients to and from providers
- Medicaid.gov, Non-Emergency Medical Transportation: Medicaid's non-emergency medical transportation assurance requirement as distinct from the ambulance benefit
- CMS, Medicare Benefit Policy Manual, Chapter 10 (Ambulance Services): Medicare covers ambulance services only when medically necessary and alternative transport would endanger health
- eCFR, 42 CFR 440.170 (Transportation): Federal definition of transportation as a Medicaid-coverable service and basis for state assurance requirements
- eCFR, 42 CFR 431.53: State plan requirement to specify methods of assuring necessary transportation
- Social Security Act Section 1902(a)(4), 42 U.S.C. 1396a: Statutory basis requiring state Medicaid plans to provide methods of administration including transportation assurance
- 42 U.S.C. 1395x(s)(7), definition of ambulance service under Medicare: Statutory definition of Medicare-covered ambulance service tied to medical necessity
- CMS, State Medicaid Manual, Part 2, Section 2320 (Transportation): CMS guidance describing how states must assure necessary transportation is available under the state plan
- GAO, Medicaid Non-Emergency Medical Transportation report (GAO-16-238): Federal oversight review describing how states use brokers to manage NEMT and program integrity concerns