Last updated 2026-07-25
TL;DR
A non-emergency medical transportation contract is an agreement, usually with a state Medicaid broker like Modivcare or MTM, that lets you get paid to drive Medicaid members to medical appointments. Getting one requires business licensing, vehicle inspection, driver background checks, insurance minimums, and a completed broker credentialing application on top of state Medicaid enrollment.
What is non-emergency medical transportation, exactly?
Non-emergency medical transportation (NEMT) is transport for people who need to get to a medical appointment but don't need an ambulance or emergency response. Think dialysis three times a week, physical therapy, a prenatal visit, a psychiatric outpatient session. The ride itself is routine. The passenger's ability to get there without help is the problem, whether that's because they use a wheelchair, don't drive, or have no other way to the clinic. Federal Medicaid rules require states to make sure eligible people can actually get to covered care. The regulation at 42 CFR 431.53 says states must "ensure necessary transportation for beneficiaries to and from providers" and may do that directly, through contracts, or through a broker arrangement [1]. That single sentence is the legal reason the entire NEMT brokered industry exists. States don't want to run dispatch centers and credential thousands of drivers themselves, so nearly every state now hires a transportation broker (Modivcare, MTM, Access2Care, SafeRide, or a regional equivalent) to do it for them. A "NEMT contract," in practice, almost always means a subcontractor agreement with one of these brokers, not a direct contract with the state Medicaid agency. You're not signing anything with the state health department. You're signing with the broker who holds the state contract, and you agree to their rates, their trip assignment system, and their compliance rules. For background on how that layered system works, see medical transportation and nemt transportation.
How do NEMT broker contracts actually work?
The broker holds a multi-year contract with the state Medicaid agency to manage all non-emergency rides for that state's Medicaid population. Your contract is one level down: a transportation provider agreement between you (an LLC, usually) and the broker. Once you're approved, the broker's software assigns you trips based on your service area, vehicle type, and availability. You bill the broker, not Medicaid directly, for completed trips. Rates are usually a base rate plus mileage, and they vary a lot by state and by vehicle type (ambulatory sedan versus wheelchair van versus stretcher van). Brokers typically don't publish rate sheets publicly; you'll see the actual numbers only after you're credentialed and get your provider packet, so budget time to confirm rates with your specific broker before buying a vehicle. Most broker contracts include a trip acceptance requirement or a minimum on-time percentage, a no-show and cancellation policy, GPS or telematics reporting, and an audit clause letting the broker (or the state) review your trip logs and vehicle maintenance records. Read the termination section closely. Many broker agreements allow termination without cause on 30 to 90 days' notice, which means the contract protects the broker's flexibility more than your revenue stability. That's normal in this industry, not a red flag specific to any one broker.
How to start a NEMT business, step by step
Here's the order that actually works, based on how state Medicaid enrollment and broker credentialing are structured almost everywhere: 1. Form your business entity (LLC in most states) and get an EIN. 2. Get commercial auto insurance and general liability coverage that meets your state's minimums for for-hire passenger vehicles carrying people with disabilities. 3. Buy or lease your vehicle. If you're starting with one wheelchair van, make sure it has a certified wheelchair lift or ramp and tie-down restraints that meet ADA and state Department of Transportation standards. 4. Enroll as a Medicaid provider with your state Medicaid agency. Many states require this before a broker will even look at your application, since some brokers only credential providers who are already active Medicaid providers in that state. 5. Apply for broker credentialing with whichever broker(s) hold the NEMT contract in your service region. Some states use one broker statewide; others split by region or run multiple brokers. 6. Complete driver background checks, drug screening, and any state-required NEMT driver training or certification. 7. Pass the vehicle inspection (broker-required, sometimes annual, sometimes more frequent). 8. Sign the provider agreement and go live in the dispatch system. This whole process commonly takes anywhere from six weeks to four months, depending on how backed up the state's provider enrollment unit is and how many rounds of corrections your application needs. Confirm current timelines with your state Medicaid agency, since backlogs shift constantly. See non emergency medical transportation for a fuller breakdown of the enrollment sequence.
How do you start a medical transportation business with one wheelchair van?
One van is a completely viable way to start. Most successful owner-operators in this space begin exactly this way, not with a fleet. The practical constraints are different from running a fleet, though. With one van, you have zero redundancy: if it breaks down or fails an inspection, you have no trips to give the broker until it's fixed, and repeated no-shows because of vehicle downtime can get your contract flagged or suspended. Buy a vehicle with a strong maintenance history and budget for a spare tie-down set and a backup driver you can call on short notice. With one van you also can't say yes to every trip type. If a broker's request queue is heavy on stretcher trips and you only have a wheelchair-accessible vehicle, you'll be leaving volume on the table. That's fine; it just means you should ask the broker directly, before signing anything, what trip mix they're seeing in your specific county so you know whether a single wheelchair van fits demand or whether ambulatory sedan trips would fill more of your week. Licensing and insurance costs don't scale down much just because you have one vehicle. You'll still need the same commercial auto policy tier, the same driver background check process, and the same vehicle inspection as a ten-van company. Factor that into your first-year budget rather than assuming a solo operation is proportionally cheaper across the board.
What does Medicaid actually cover, and does it cover ambulance rides?
Medicaid covers both emergency ambulance transport and non-emergency transportation, but they're different benefits with different rules and different reimbursement structures. Emergency ambulance transport, the kind dispatched through 911 for a medical emergency, is billed as an ambulance service under each state's Medicaid ambulance fee schedule, separate from NEMT. States set their own ambulance rates, and CMS has also finalized a federal Medicaid Emergency Triage, Treat, and Transport (ET3) style framework for ambulance payment in specific circumstances; check your state Medicaid ambulance fee schedule for current rates [2]. If you're planning to run an ambulance company rather than a wheelchair van business, that's a different licensing track entirely, usually through your state's EMS office, not the NEMT broker. Non-emergency transportation, the category this article covers, is what gets a Medicaid member to a scheduled appointment when an ambulance isn't medically necessary. CMS's own guidance describes NEMT as helping "beneficiaries who need assistance getting to and from providers" get to covered Medicaid services when they have no other means of transportation [2]. States must cover it for Medicaid enrollees as an assurance of access to care, though the exact covered trip types (dialysis, mental health, WIC visits, etc.) vary by state plan. So to answer both questions directly: yes, Medicaid does cover ambulance rides when they're medically necessary and billed under the state's ambulance program, and yes, Medicaid covers non-emergency transportation too, but through the broker system described here rather than through an ambulance provider agreement.
Does Medicare cover medical transportation?
Medicare's coverage is much narrower than Medicaid's. Medicare Part B covers ambulance transportation when it's medically necessary and other transportation would endanger the person's health, per CMS's Medicare Benefit Policy Manual [3]. It does not have a general non-emergency medical transportation benefit the way Medicaid does. Some Medicare Advantage (Part C) plans have started offering limited NEMT as a supplemental benefit, since CMS expanded the definition of allowable supplemental benefits for Medicare Advantage plans starting in 2019 to include transportation for health-related services [4]. Coverage, trip limits, and vendor networks for these supplemental rides vary entirely by plan, so if you want to contract with a Medicare Advantage plan's transportation vendor, you'll need to confirm eligibility and enrollment separately from your Medicaid credentialing, plan by plan. Bottom line for a new operator: your primary revenue path is Medicaid NEMT broker contracts. Medicare Advantage supplemental transportation is a smaller, plan-specific add-on worth pursuing later, not a starting point.
What do I need before a broker will credential me?
| Business entity | LLC or corporation, active state registration | |
|---|---|---|
| Commercial auto insurance | State-set minimum liability, often $1 million combined single limit for accessible vehicles | |
| General liability insurance | Broker-set minimum, confirm exact figure with your broker | |
| Vehicle inspection | Annual or semi-annual, DOT and ADA lift/ramp and tie-down compliance | |
| Driver background check | State and federal criminal history check | |
| Driver drug screening | Pre-employment and often random testing | |
| Driver training | State-specific NEMT or passenger assistance training, hours vary | |
| Medicaid enrollment | Active provider number with the state Medicaid agency, required before or alongside broker credentialing in most states | Because every one of these figures shifts by state and by broker cycle, treat this table as a starting checklist, not a final answer. Confirm the current insurance minimums and inspection frequency with your broker and your state Medicaid agency before you buy insurance or schedule an inspection, since paying for the wrong coverage tier is a common and expensive mistake new operators make. |
Every broker's checklist differs in small ways, but the core requirements repeat across Modivcare, MTM, Access2Care, and SafeRide provider applications: | Requirement | Typical standard |
How long does NEMT provider enrollment and credentialing take?
There isn't one federal timeline for this because each state runs its own Medicaid provider enrollment unit and each broker runs its own credentialing queue on top of that. What's consistent is that it's a two-stage process, and both stages have to clear before you can accept trips. State Medicaid enrollment alone, for a straightforward NEMT provider application with clean paperwork, commonly takes a few weeks to two months in states with active processing. Broker credentialing, once your Medicaid enrollment is active, often runs another few weeks to a couple months depending on how backed up the broker's document review queue is and how many corrections your submission needs on the first pass. The most common delay isn't the review itself, it's incomplete submissions: missing insurance certificates with the correct coverage language, vehicle registration that doesn't match the applicant's business name, or driver background checks that expired before the broker finished reviewing the file. Get every document in the exact format the broker's checklist specifies before you submit, and call the broker's provider relations line to confirm your application is complete rather than assuming silence means it's fine.
What should I look for in the actual contract language?
Read the whole provider agreement before you sign it, more than the rate sheet. A few sections matter more than people expect: Termination clause: most broker contracts allow termination without cause on short notice (commonly 30 to 90 days). This is standard in the industry, but it means you shouldn't take out a large vehicle loan assuming guaranteed long-term trip volume from any single broker. Exclusivity and non-compete language: some contracts restrict you from running non-Medicaid private-pay trips in the same service area, or require the broker's approval before you contract with a second broker. Check this before you assume you can stack multiple broker contracts freely. Payment terms: find the actual number of days the broker has to pay a clean claim. Some state Medicaid managed care contracts require the broker to pay clean claims within a set number of days (often 30), but that requirement flows from the state's contract with the broker, not automatically into your subcontractor agreement, so confirm your specific payment terms in writing. Audit and recoupment rights: brokers typically reserve the right to audit your trip records and claw back payment for trips that don't meet documentation standards. Keep your own trip logs, signed passenger manifests, and GPS records independent of the broker's system so you have your own copy if a dispute comes up. Insurance and indemnification: confirm whether the contract requires you to name the broker as an additional insured on your policy, which is common and just means an extra line item with your insurance agent, not a red flag.
Do I need to enroll in Medicaid separately, or does the broker handle that?
In most states, yes, you need your own active state Medicaid provider enrollment before or during broker credentialing. The broker relationship and the Medicaid provider relationship are legally separate even though they feel like one process from the applicant's side. CMS requires state Medicaid agencies to screen and enroll providers under 42 CFR Part 455, Subpart E, including the risk-level screening and background check requirements that apply to transportation providers [4]. Your state Medicaid agency's provider enrollment portal is where this happens, and it's usually a different login system entirely from the broker's provider portal. Some states let the broker submit enrollment paperwork on your behalf as part of a streamlined process; others require you to complete Medicaid enrollment entirely on your own before the broker will even open your credentialing file. There's real variation here, so the first call you make should be to your state Medicaid transportation unit to ask which order they require, not to the broker.
What ongoing compliance does a NEMT contract require?
Getting the contract signed is the easy part. Keeping it active requires ongoing paperwork that trips up new operators more than the initial application does. Most brokers require annual or semi-annual vehicle re-inspection, current insurance certificates on file at all times (a lapse of even a few days can trigger automatic deactivation in some broker systems), updated driver background checks on a schedule the broker sets, and continued completion of any required driver training modules. States also periodically revalidate Medicaid provider enrollment, a process CMS requires at least every five years under federal regulation, though states can set shorter cycles [5]. Miss a revalidation deadline and your Medicaid provider number can be deactivated, which cascades into your broker credentialing being suspended too, even if your broker paperwork is otherwise current. Set calendar reminders well ahead of both your state revalidation date and your broker's insurance and inspection renewal dates; this is the single most common reason active NEMT operators suddenly stop getting trip assignments.
Where do I go to compare brokers and start the paperwork?
Start with your state Medicaid transportation unit's website. Nearly every state publishes which broker (or brokers) hold the current NEMT contract for each region, along with a provider enrollment page. Search "[your state] Medicaid non-emergency transportation broker" and you'll usually land directly on the right page; if you can't find it, your state Medicaid agency's provider services phone line can tell you in one call. From there, each broker (Modivcare, MTM, Access2Care, SafeRide, or a regional broker) has its own provider network application on its own site. Expect separate logins, separate document uploads, and sometimes separate insurance certificate formats for each broker if your state uses more than one. Because the checklist (entity formation, insurance, vehicle inspection, driver files, Medicaid enrollment, broker application) repeats across every state with only the specific numbers changing, some new operators use a structured checklist product to keep the paperwork organized instead of tracking it across a dozen browser tabs. RideCredential's $199 one-time Launch Kit is built around exactly this sequence: state Medicaid enrollment plus broker credentialing paperwork organized into one packet, so you're not guessing which document goes to which portal. It doesn't replace your state's forms or guarantee approval; it's an organizing tool for a process that's genuinely repetitive across states. Whatever tool or checklist you use, the two calls that matter most before you spend money on a vehicle are: your state Medicaid transportation unit (to confirm the current broker and enrollment order) and that broker's provider relations line (to confirm current insurance minimums and rate structure for your vehicle type). For more on how state-by-state rules differ, see non emergency medical transportation services and nemt.
Frequently asked questions
What is NEMT?
NEMT stands for non-emergency medical transportation. It's transport for Medicaid (and some Medicare Advantage) members getting to routine medical appointments, like dialysis or physical therapy, who don't need an ambulance but can't get there on their own. States must ensure this access under 42 CFR 431.53, usually through a contracted broker like Modivcare or MTM.
How do I start a NEMT business?
Form an LLC, get commercial auto and general liability insurance, buy an inspection-ready vehicle, enroll as a Medicaid provider with your state agency, then apply for broker credentialing (background checks, driver training, vehicle inspection). Order and requirements vary by state, so confirm the sequence with your state Medicaid transportation unit before spending money on a vehicle.
How do I start a medical transportation business with just one van?
One wheelchair van is enough to start. You still need the same insurance tier, driver background checks, and broker credentialing as a larger fleet, so those costs don't shrink much. Ask your broker what trip mix (ambulatory versus wheelchair versus stretcher) is in demand in your county before assuming one van type covers enough volume.
Does Medicaid cover ambulance rides?
Yes. Medicaid covers medically necessary emergency ambulance transport under each state's ambulance fee schedule, separate from the non-emergency transportation (NEMT) benefit. Ambulance providers are usually licensed through the state EMS office, not credentialed through an NEMT broker like Modivcare or MTM.
Does Medicare cover medical transportation?
Medicare Part B covers ambulance transport when medically necessary. It does not have a general non-emergency transportation benefit like Medicaid does. Some Medicare Advantage plans offer limited NEMT as a supplemental benefit since CMS expanded allowable supplemental benefits in 2019, but coverage and vendor networks vary plan by plan.
What's the difference between a state Medicaid contract and a broker contract?
The state Medicaid agency holds the master contract with the transportation broker (Modivcare, MTM, Access2Care, SafeRide, etc.) to manage all NEMT statewide or regionally. You, as an owner-operator, sign a subcontractor provider agreement with that broker, not directly with the state. You'll also typically need separate state Medicaid provider enrollment.
How long does it take to get credentialed with a NEMT broker?
State Medicaid enrollment commonly takes a few weeks to two months, and broker credentialing on top of that often adds a few more weeks to a couple months, depending on backlog and how complete your first submission is. Incomplete insurance documents and mismatched vehicle registration are the most common causes of delay.
What insurance do I need for an NEMT contract?
You'll need commercial auto insurance meeting your state's minimum for for-hire accessible vehicles, often $1 million combined single limit territory, plus general liability coverage at whatever level your specific broker requires. Minimums vary by state and broker, so confirm exact figures with your broker and your insurance agent before purchasing a policy.
Can I work with more than one broker at the same time?
Often yes, but check your contract's exclusivity language first. Some broker agreements restrict you from certain other transportation work in the same service area without written approval. If your state uses multiple regional brokers, confirm with each one whether dual credentialing is allowed before you apply to both.
What happens if my broker terminates my contract?
Most broker provider agreements allow termination without cause on 30 to 90 days' notice, which is standard in this industry. Read the termination clause before signing so you understand your notice period, and avoid financing a vehicle purchase based on an assumption of guaranteed long-term trip volume from any single broker.
Do I need Medicaid provider enrollment even if a broker is handling my trips?
In most states, yes. Broker credentialing and state Medicaid provider enrollment are legally separate processes even though they feel connected. Federal rule 42 CFR Part 455 requires state Medicaid agencies to screen and enroll providers directly; some states let brokers assist with this, others require it done independently first.
What does it cost to become an NEMT provider?
There's no single national number; costs depend on your state's licensing fees, your insurance premiums, your vehicle purchase or lease, and any state-required driver training fees. Because these vary so widely by state and vehicle type, confirm current fee schedules with your state Medicaid agency and your chosen broker rather than relying on a flat estimate.
Is non-emergency medical transportation the same as ambulance service?
No. Non-emergency medical transportation moves people to scheduled medical appointments when an ambulance isn't medically necessary, usually in a wheelchair van, sedan, or stretcher van credentialed through a Medicaid broker. Ambulance service is emergency-capable transport licensed through a state's EMS office and billed under a separate ambulance fee schedule.
Sources
- eCFR, 42 CFR 431.53: States must ensure necessary transportation for Medicaid beneficiaries to and from providers, directly, by contract, or through a broker.
- Medicaid.gov, Non-Emergency Medical Transportation: CMS describes NEMT as assistance for beneficiaries who need help getting to and from Medicaid providers.
- CMS Medicare Benefit Policy Manual, Chapter 10 (Ambulance Services): Medicare Part B covers ambulance transportation when medically necessary and other transport would endanger the beneficiary's health.
- CMS, 2019 Medicare Advantage Supplemental Benefits Expansion: CMS expanded allowable Medicare Advantage supplemental benefits starting 2019 to include transportation for health-related services.
- eCFR, 42 CFR Part 455, Subpart E: State Medicaid agencies must screen and enroll providers, including risk-level screening and background checks.
- eCFR, 42 CFR 455.414: State Medicaid agencies must revalidate provider enrollment at least every five years.