Last updated 2026-07-23
TL;DR
NEMT rates are set by each state Medicaid program or its contracted broker, not by a national fee schedule. Wheelchair van trips typically pay a base rate plus per-mile or per-loaded-mile add-ons. There is no single national number; you have to confirm current rates with your state Medicaid transportation unit and each broker you credential with.
What is NEMT and why do rates vary so much?
Non-emergency medical transportation (NEMT) is transportation to and from Medicaid-covered medical appointments for people who have no other way to get there and don't need an ambulance. Federal Medicaid regulations require states to ensure necessary transportation for beneficiaries to and from providers, and NEMT is how most states meet that duty for non-emergency rides. The core requirement lives at 42 CFR 431.53, which says states must "ensure necessary transportation for beneficiaries to and from providers" [1]. Rates vary because Medicaid is a joint federal-state program. States design and administer their own NEMT benefit within federal rules, and most states hand the day-to-day work to a transportation broker like Modivcare, MTM, Access2Care, or a regional player like SafeRide [2]. Each state signs its own contract with its own rate schedule. A state that pays brokers on a capitated basis (a flat amount per eligible member per month) sets things up very differently than a state paying brokers per trip, and that filters down into what a wheelchair van owner-operator actually sees on a settlement statement. So when someone asks 'what's the NEMT rate,' the honest answer is: it depends on the state, the broker, the vehicle type, the mileage, and sometimes the specific Medicaid managed care plan involved. There is no CMS fee schedule for NEMT the way there is for physician services. You have to go get the number from the source. For general background on the benefit itself, see medical transportation and nemt.
What is non emergency medical transportation, exactly?
Non emergency medical transportation covers rides to Medicaid-covered appointments (dialysis, physical therapy, primary care, behavioral health, pharmacy pickups in some states) for members who have no other transportation option and don't need emergency medical care during transport. It is distinct from ambulance transport, which is for emergencies or cases requiring medical monitoring in transit. Medicaid.gov describes NEMT as part of the assurance of transportation states must provide so beneficiaries can get to and from providers [2]. Modes covered typically include ambulatory sedan or livery rides, wheelchair-accessible van rides, and in rural or long-distance cases, non-emergency stretcher transport or even bus passes and mileage reimbursement for a friend or family member driving the member. States decide the exact mix of modes and the medical necessity documentation required for each. A member who cannot transfer independently into a standard vehicle typically needs a wheelchair van, and that's the vehicle type most new owner-operators are financing and insuring. See non emergency medical transportation and non emergency medical transportation services for more on how states classify trip levels.
How is a NEMT rate actually structured?
| Base/pickup rate | Flat amount for accepting and starting a trip | Paid once per trip or per leg | |
|---|---|---|---|
| Per-mile rate | Amount per loaded mile (member in vehicle) | Often tiered by distance band | |
| Wait time | Compensation for waiting during appointment or return | Sometimes capped or excluded | |
| Deadhead/no-load miles | Miles driving to pickup with no passenger | Rarely paid, varies by broker | |
| Wheelchair/stretcher differential | Higher rate for accessible or stretcher vehicles | Add-on to base ambulatory rate | |
| No-show/cancellation fee | Partial payment when member cancels late or no-shows | Broker-specific, often limited | Because states set Medicaid fee-for-service rates independently, and brokers often negotiate their own contracted rates with individual transportation providers on top of that, the actual dollar figures in each cell above can differ by a wide margin state to state. A state Medicaid agency's published fee schedule (where one exists) is the only authoritative number for fee-for-service claims; broker-negotiated rates for managed transportation networks are usually disclosed only in the provider contract you sign, not on a public webpage. Confirm both with your state Medicaid transportation unit and the specific broker before you build a business plan around any number you've seen quoted online. |
Most state and broker NEMT rate schedules use some combination of these pieces, though the exact mix and dollar amounts differ by state and change over time: | Component | What it means | Typical structure |
Does Medicaid cover ambulance rides?
Yes. Medicaid covers medically necessary ambulance transportation when a member's condition requires emergency care or medical monitoring during transport, under a separate benefit and separate rate structure from NEMT [2][3]. Ambulance transport (ground, air, or water) is billed and rated differently than a wheelchair van trip because it requires licensed medical staff and emergency equipment. Ambulance rates are typically set through the state's Medicaid fee schedule for ambulance services, and many states reference CMS's ambulance fee schedule methodology used in Medicare as a benchmark, adapting it to their own program [3]. This is a completely different world from NEMT wheelchair van rates: different licensing, different vehicle standards, different reimbursement source. If you're buying a wheelchair van and planning to enroll with an NEMT broker, ambulance rates aren't relevant to your business model, but it's a common point of confusion for new operators researching 'Medicaid transportation' broadly, so it's worth being clear on the distinction. See emergency medical transport for more on how that benefit works.
Does Medicare cover medical transportation?
Medicare's coverage of transportation is narrower than Medicaid's. Medicare Part B covers ground ambulance services when other transportation would endanger the person's health, subject to medical necessity rules, and Medicare generally does not cover routine non-emergency transportation like a wheelchair van ride to a doctor's appointment [4]. There are limited exceptions. Some Medicare Advantage plans offer non-emergency transportation as a supplemental benefit, since CMS has clarified that Medicare Advantage plans may offer expanded supplemental benefits, including transportation, for chronically ill enrollees whose plans meet the requirements of the Bipartisan Budget Act of 2018 [5]. Some states also run Medicare-Medicaid dual-eligible programs that layer NEMT coverage in through the Medicaid side. If you're planning to build a business around Medicare-only riders, understand upfront that fee-for-service Medicare is not your NEMT payer; your real market is Medicaid members and any Medicare Advantage plans in your state that specifically contract for non-emergency rides. Confirm any Medicare Advantage transportation contracting directly with the plan, since this isn't run through the state Medicaid broker network at all.
How to start a medical transportation business (the sequence that actually works)
Most people who ask 'how to start a medical transportation business' really mean starting an NEMT company with one or two wheelchair vans, so here's the realistic order of operations, not the idealized one. 1. Pick your state and confirm the rules first. NEMT is state-regulated on top of Medicaid rules, so your state's requirements (business licensing, vehicle permits, driver background check standards) shape everything downstream. 2. Form the business entity and get your EIN, general liability and commercial auto insurance, and any required state transportation or livery permit. 3. Buy or lease a wheelchair-accessible van that meets your state's accessibility and safety inspection standards; ADA-compliant lifts or ramps and tie-down systems are usually non-negotiable for broker credentialing. 4. Enroll as a Medicaid provider with your state Medicaid agency. This is separate from broker credentialing and is often required before a broker will even review your application. 5. Apply for credentialing with the NEMT broker(s) operating in your region, since most states have handed day-to-day trip dispatch to a broker rather than paying providers directly. 6. Get your drivers trained (defensive driving, passenger assistance, sometimes CPR/first aid depending on state and broker rules) and background-checked. 7. Set up your dispatch, GPS/telematics, and documentation workflow, since brokers audit trip logs and on-time performance closely. See nemt transportation for a broader walkthrough of the operational side.
How do you start a NEMT business step by step, including paperwork?
The paperwork burden is the part new owner-operators consistently underestimate. Expect to assemble, in some combination depending on your state: articles of incorporation or LLC formation documents, EIN confirmation letter, commercial auto insurance certificate naming required parties, a vehicle inspection certificate, driver background check results (often through a state-specified vendor), driver training certificates, a copy of your Medicaid provider agreement, and broker-specific application forms that ask for all of the above again in their own format. A realistic timeline from 'I have a van' to 'I'm running paid trips' is commonly 60 to 120 days once you account for Medicaid provider enrollment processing time plus separate broker credentialing review, though states publish their own enrollment processing targets and these can run longer during high-volume periods. Federal rule requires state Medicaid agencies to make an enrollment determination within 15 business days of a complete application for most provider types, per 42 CFR 455.410 and related screening provisions, but broker credentialing on top of that runs on its own separate timeline [6]. Confirm current processing timelines with your state Medicaid agency, since they vary and change. One thing that trips people up: Medicaid provider enrollment and broker credentialing are two separate approvals, and passing one does not guarantee the other. You need both before you can legally bill for trips in most states. Nobody can promise you'll get approved by a specific broker; each one runs its own review against its own network needs and standards.
How to start a non-emergency medical transportation business with just one van
Starting with a single wheelchair van is common and workable, but it changes your economics and your risk profile compared to running a small fleet. With one van, you have no backup vehicle if it breaks down or fails inspection, so a maintenance reserve matters more than it would with three vans. You're also more exposed to a single broker's trip volume and rate structure since you can't diversify across contracts as easily. Some owner-operators start as an independent contractor for an existing NEMT provider or broker network before buying their own authority, which lets you learn dispatch and documentation requirements with less capital at risk. If you do go straight to owning and operating your own single-van business, prioritize getting the vehicle accessibility standards right the first time (lift/ramp certification, tie-downs, interior clearance) because a van that fails a broker's vehicle inspection means a redo and a delay, more than a fix. Confirm your state's specific wheelchair van equipment standards with your state Medicaid transportation unit before you buy, not after.
Where do you actually find current NEMT rates for your state?
There is no single national database of NEMT rates you can look up like a price sheet. You have to go to two places: First, your state Medicaid agency's transportation or NEMT unit, which publishes (or will provide on request) the fee-for-service rate schedule if your state pays providers directly, or explains its capitated broker model if it doesn't. Medicaid.gov's Non-Emergency Medical Transportation page and each state's Medicaid agency site are the starting points for finding the right unit [2][7]. Second, the broker(s) operating in your region (Modivcare, MTM, Access2Care, SafeRide, or a regional broker) directly, since broker-negotiated rates for their contracted transportation providers are usually disclosed only during or after the credentialing application process, not published publicly. Ask specifically for the current wheelchair van base rate, per-mile rate, and any wait-time or no-show policy in writing before you sign a provider agreement. Rates get renegotiated periodically and can change with state budget cycles, so treat any number you hear secondhand (including anything in an online forum) as unverified until you've confirmed it with the actual payer for your service area.
What's the difference between broker rates and state fee-for-service rates?
In states that still run pure fee-for-service NEMT, the state Medicaid agency sets the rate and pays enrolled providers directly for each trip, following its published fee schedule [1][2]. In states that use a capitated broker model (the more common setup today), the state pays the broker a set amount per eligible member per month, and the broker then negotiates its own rates with the transportation providers in its network. This means two providers running the same trip type in the same state, but under contract with two different brokers, can legally be paid different amounts. It also means the broker, not the state, controls day-to-day rate negotiation, dispute resolution, and no-show policy, even though the state Medicaid agency retains oversight of the broker's contract performance under the state's Medicaid managed care oversight rules . This distinction matters for a wheelchair van owner-operator because it tells you who to call with a rate dispute. If your state is fee-for-service, that's the state Medicaid agency. If it's brokered, that's your contracted broker first, with the state Medicaid transportation unit as the oversight body if the broker isn't meeting its contractual obligations to the state.
What does it cost to start, and how does that compare to expected NEMT rates?
A wheelchair-accessible van purchase (new or good used, retrofitted with a lift or ramp) commonly runs from roughly $25,000 to $60,000-plus depending on condition and conversion type, though prices vary widely by market and by whether you're buying new or used. On top of the vehicle, budget for commercial auto insurance, general liability insurance, state business licensing fees, driver background checks, and any state-required training courses. This article deliberately does not project trip volume or revenue, because no state or broker publishes guaranteed trip counts, and any 'you'll make $X per month' claim you see online is not something anyone can back up with real data. What you can do is build your rate assumptions from the actual, confirmed numbers you get from your state Medicaid transportation unit and your target broker(s), then run your own cost math (fuel, maintenance, insurance, driver pay, loan payments) against those confirmed per-trip and per-mile figures before you commit capital. For a structured way to organize the state enrollment and broker credentialing paperwork described above, this is exactly the gap the $199 one-time State + Broker NEMT Launch Kit is built to close: it doesn't get you approved (nobody can guarantee that) but it organizes the document checklist so you're not discovering missing paperwork mid-application.
What should you ask a broker before you sign a provider agreement?
Get these answered in writing before you commit a vehicle and driver to a broker network: What is the current base rate and per-mile (or per-loaded-mile) rate for wheelchair van trips in this service area? Is there a wait-time payment, and is it capped? What is the no-show and late-cancellation payment policy? How often are rates reviewed or renegotiated, and were they changed in the last 12 months? What is the payment cycle (weekly, biweekly, net-30) and what triggers a payment hold or claim denial? What vehicle inspection standard and driver training documentation does this specific broker require, separate from the state's minimum? Different brokers (Modivcare, MTM, Access2Care, SafeRide, or regional ones) structure these terms differently even within the same state, so don't assume one broker's answer applies to another. Get the specific broker's current policy in writing, not a verbal summary from a recruiter.
Frequently asked questions
What is NEMT?
NEMT stands for non-emergency medical transportation: rides to and from Medicaid-covered medical appointments for people who have no other transportation option and don't need ambulance-level care in transit. It's a required part of most state Medicaid programs, typically arranged through a state agency or a contracted transportation broker.
Does Medicaid cover ambulance rides?
Yes, Medicaid covers medically necessary ambulance transportation, but under a separate benefit with a separate rate schedule from routine NEMT wheelchair van or sedan trips. Ambulance transport requires licensed medical staff and is billed differently. Confirm your state's specific ambulance fee schedule with your state Medicaid agency.
Does Medicare cover medical transportation?
Medicare Part B covers ambulance transport when other transportation would endanger the person's health, but fee-for-service Medicare generally does not cover routine non-emergency rides like a wheelchair van trip to a doctor's office. Some Medicare Advantage plans offer non-emergency transportation as a supplemental benefit; confirm directly with the plan.
How much does an NEMT wheelchair van rate typically pay?
There's no single national rate. Wheelchair van trips are paid through a combination of a base/pickup rate plus a per-mile or per-loaded-mile rate, and the actual dollar amounts differ by state and by broker. Confirm the current published fee schedule with your state Medicaid transportation unit and get broker-specific rates in writing before signing a provider agreement.
How do I start a NEMT business?
Form your business entity, get commercial auto and liability insurance, buy a wheelchair-accessible van meeting your state's accessibility standards, enroll as a Medicaid provider with your state agency, get credentialed with the NEMT broker(s) in your area, and get drivers trained and background-checked. Medicaid enrollment and broker credentialing are separate approvals, both usually required.
Can I start an NEMT business with just one van?
Yes, many owner-operators start with a single wheelchair van. It's workable but leaves you with no backup vehicle if it breaks down and less flexibility to diversify across multiple broker contracts. Some new operators start as a contractor for an existing provider first to learn dispatch and documentation before buying their own vehicle.
How long does it take to get NEMT credentialed?
A realistic range is 60 to 120 days from having your vehicle and insurance ready to running paid trips, once you account for separate Medicaid provider enrollment processing and broker credentialing review. Federal rule (42 CFR 455.410) sets a 15-business-day target for state enrollment determinations on complete applications, but broker credentialing runs separately and can extend the total timeline. Confirm current processing times directly with your state Medicaid agency and target broker.
Who sets NEMT rates, the state or the broker?
It depends on the state's model. In fee-for-service states, the state Medicaid agency sets and pays the rate directly. In states using a capitated broker model, the state pays the broker a set monthly amount, and the broker negotiates its own rates with individual transportation providers in its network.
Do all NEMT brokers pay the same rate for wheelchair van trips?
No. Even within the same state, different brokers (Modivcare, MTM, Access2Care, SafeRide, regional brokers) can pay different rates because each negotiates its own provider contracts. Get the specific rate schedule from each broker you're credentialing with in writing rather than assuming one broker's terms apply to another.
What documents do I need for Medicaid NEMT provider enrollment?
Commonly required: business formation documents, EIN, commercial auto and general liability insurance certificates, vehicle inspection certification, driver background checks, driver training records, and a completed state Medicaid provider enrollment application. Exact requirements vary by state, so confirm the current checklist with your state Medicaid transportation unit.
Is NEMT provider enrollment the same as broker credentialing?
No, they're two separate approvals. Medicaid provider enrollment is with the state Medicaid agency and establishes you as an approved Medicaid provider. Broker credentialing is a separate application with the specific broker(s) operating in your region, and passing one doesn't guarantee the other.
What vehicle equipment do wheelchair vans need for NEMT?
Requirements vary by state, but typically include a certified wheelchair lift or ramp, secure wheelchair tie-down and occupant restraint systems, adequate interior clearance, and passing a state or broker vehicle inspection. Confirm your state's specific ADA-related equipment standards with your state Medicaid transportation unit before purchasing a van.
Sources
- 42 CFR 431.53, Assurance of Transportation: States must ensure necessary transportation for Medicaid beneficiaries to and from providers
- Medicaid.gov, Non-Emergency Medical Transportation: NEMT is part of states' assurance of transportation to Medicaid-covered services and is typically administered by states or contracted brokers
- Medicare.gov, Ambulance Fee Schedule methodology (CMS): Ambulance transportation is a separate Medicaid benefit from NEMT, and many states reference CMS's ambulance fee schedule methodology
- Medicare.gov, Ambulance Services coverage: Medicare Part B covers ambulance services when other transportation would endanger health, and does not generally cover routine non-emergency transportation
- CMS, Medicare Advantage and Part D Final Rule (CMS-4182-F), 83 Fed. Reg. 16440 (Apr. 16, 2018): CMS rules allow Medicare Advantage plans to offer expanded supplemental benefits, including non-emergency transportation, for chronically ill enrollees
- 42 CFR 455.410, Enrollment and screening of providers: State Medicaid agencies must require enrollment and screening of all providers, with enrollment determination timelines set in federal regulation
- 42 CFR Part 438, Medicaid Managed Care: States retain oversight responsibility over Medicaid managed care contractors, including transportation brokers operating under managed care arrangements