Last updated 2026-07-24
TL;DR
Non emergency medical transportation rates are set by each state Medicaid agency or its broker, not by a national fee schedule. Most models pay a base/pickup fee plus a per-mile or per-loaded-mile rate, often somewhere between $0.50 and $3+ per mile depending on the state and vehicle type. There is no single national NEMT rate; you have to check your specific state Medicaid transportation unit and broker contract.
What is non emergency medical transportation (NEMT)?
Non emergency medical transportation, usually shortened to NEMT, is transportation to and from medical appointments for people who don't need an ambulance but can't get there on their own. Think dialysis three times a week, chemo infusions, physical therapy, or a wheelchair user going to a primary care visit. It's a covered Medicaid benefit in every state, though the details of how it's delivered vary a lot. Federal law is actually pretty direct about this. Medicaid regulations at 42 CFR 431.53 require states to "ensure necessary transportation for beneficiaries to and from providers" and to describe in their state plan how they meet that requirement [1]. States can run NEMT themselves, contract with a broker (Modivcare, MTM, Access2Care, and others are the big national names), or do some mix of both, often county by county. NEMT vehicles range from sedans for ambulatory riders to wheelchair vans with lifts or ramps to stretcher vans for people who must stay lying down. Rates differ by vehicle type because the cost of running a wheelchair van (lift maintenance, tie-down inspections, extra loading time) is higher than running a sedan. For a broader look at how the whole system fits together, see nemt and non emergency medical transportation.
How are NEMT rates actually set?
There's no federal NEMT fee schedule. Rates come from whoever manages transportation in your state: sometimes the state Medicaid agency directly, more often a regional or statewide broker under contract to the state. That means two owner-operators in neighboring states, or even neighboring counties under different broker contracts, can be paid very differently for the identical trip. Most payment structures use a base rate (sometimes called a pickup fee, flag drop, or trip fee) plus a per-mile rate once you're past a certain number of miles, sometimes called "loaded miles" (miles with the passenger in the vehicle, as opposed to deadhead miles getting to the pickup). Some states or brokers add a per-mile rate from mile one; others build in a flat rate for the first several miles and then bill incrementally. A useful real example: Wisconsin's Medicaid fee schedule for non-emergency medical transportation lists specific procedure codes and rates, for instance wheelchair van base and per-mile rates that are published publicly by the state's Medicaid program and updated periodically [2]. Rates like these are public record in most states because Medicaid fee schedules are state plan documents subject to public disclosure, even when day-to-day trip assignment runs through a private broker. Because rates are contract-driven and change over time, the only reliable way to know what you'll be paid is to pull the current fee schedule from your state Medicaid transportation unit's website or ask your broker's provider relations department directly, and to confirm whether the number you're quoted is gross (before any broker administrative fee) or net.
What's a typical per-mile NEMT rate?
| Ambulatory sedan | $8 to $25 | $0.50 to $1.50 | |
|---|---|---|---|
| Wheelchair van | $15 to $45 | $1.00 to $2.50 | |
| Stretcher van | $25 to $75+ | $1.50 to $3.00+ | Treat that table as directional, not a quote. Your actual numbers come from your state's published fee schedule or your broker's rate sheet, and you should get that in writing before you commit to buying a vehicle. |
Rates commonly land somewhere between $0.50 and roughly $3.00 or more per loaded mile, with base/pickup fees typically in the $10 to $50 range, but this spread is wide on purpose because states genuinely pay very differently. Rural states with long trip distances sometimes pay a lower per-mile rate but a higher base fee to make short urban-style pricing unworkable; dense urban markets sometimes do the reverse. Vehicle type matters too. Ambulatory sedan trips usually pay the least. Wheelchair van trips pay more per mile and often carry a separate, higher base fee because of loading time, lift use, and tie-down requirements. Stretcher van trips, which need two crew members in many states, typically pay the most. Here's a general (not state-specific) illustration of how the pricing structure tends to break down by vehicle type, based on publicly posted Medicaid transportation fee schedules across several states: | Vehicle type | Typical base/pickup fee | Typical per-mile add-on |
Does Medicaid cover ambulance rides?
Yes, Medicaid covers ambulance transportation, but that's a separate benefit from NEMT and it's billed and rated completely differently. Ambulance transport (emergency and some non-emergency ambulance runs, like a hospital-to-hospital transfer requiring medical monitoring) is covered under emergency medical services rules, generally billed with HCPCS ambulance codes and paid at rates set by the state's ambulance fee schedule, not the NEMT vehicle fee schedule [3]. NEMT, by contrast, covers trips where the rider doesn't need medical care in transit; they need a ride, possibly with mobility assistance getting in and out of the vehicle. If you're comparing your options as an owner-operator, running an ambulance requires EMS licensure, medical staffing, and state EMS agency certification, an entirely different (and far more expensive) business than wheelchair van NEMT. For background on the distinction, see emergency medical transport.
Does Medicare cover medical transportation?
Medicare's coverage of transportation is narrower than Medicaid's and it does not generally cover routine non-emergency van rides to appointments. Original Medicare covers ambulance services when other transportation could endanger the person's health, under Medicare Part B rules, and it covers non-emergency ambulance transport only in limited circumstances, such as when a doctor certifies it's medically necessary because the beneficiary can't be transported safely any other way [4]. Some Medicare Advantage plans offer supplemental non-emergency transportation benefits (a set number of one-way trips per year to medical appointments) as an extra plan benefit, but this varies enormously by plan and by year and is not guaranteed by Medicare itself. If you're planning your business around a payer mix, don't assume Medicare fee-for-service is a reliable NEMT income source; Medicaid and Medicare Advantage supplemental benefits are the more realistic lanes, and even those depend entirely on your state and the specific plans operating there.
How do brokers like Modivcare, MTM, and Access2Care affect what you get paid?
In most states, you don't bill Medicaid directly for NEMT trips; you get credentialed as a network provider with the broker the state has contracted with, and the broker assigns trips and pays you according to its own rate sheet. That rate sheet is negotiated between the state and the broker, and then the broker sets what it pays its network of owner-operators and small fleets, which is not always identical to what the state pays the broker. This is the part new owner-operators get wrong most often. They assume the state's published Medicaid fee schedule is what they'll personally receive. Sometimes it roughly is; sometimes the broker keeps a spread and pays providers a different (usually lower) contracted rate for administering the network, driver vetting, scheduling software, and claims processing. Neither approach is inherently wrong, but you need the actual number from the actual broker, in writing, before buying a van. Rates and contract terms differ by broker and by state and change over time, so confirm current pay rates directly with your broker and your state Medicaid transportation unit before finalizing any purchase decision. For details on getting into these networks in the first place, see nemt transportation and non emergency medical transportation services.
How to start a medical transportation business, step by step
The order of operations matters more than people expect, because some steps (like state Medicaid enrollment) can take weeks to months, and buying a vehicle before you know you'll be approved is how people end up with an expensive van sitting in a driveway. 1. Research your state's NEMT delivery model. Some states manage NEMT directly through Medicaid; most use a broker. Find your state Medicaid transportation unit's page and read the current provider manual. 2. Form your business entity (LLC is common) and get an EIN from the IRS. 3. Get commercial auto insurance for a passenger vehicle used for hire; personal auto policies exclude this. Confirm minimum liability limits with your state and broker, since NEMT often requires higher limits than a standard livery policy. 4. Complete state-level requirements: this usually includes a business license, vehicle permits or inspections, and driver background checks (many states require FBI/state fingerprint checks for anyone transporting Medicaid beneficiaries). 5. Enroll as a Medicaid provider with your state (a distinct process from broker credentialing) if your state requires direct enrollment in addition to broker network status; some states require both. 6. Apply for broker credentialing with the broker(s) operating in your service area (Modivcare, MTM, Access2Care, SafeRide, or a regional broker). This typically includes vehicle inspection, driver certification (defensive driving, passenger assistance, sometimes CPR/first aid), and proof of insurance. 7. Get your vehicle inspection-ready: working wheelchair lift or ramp, functioning tie-downs meeting the broker's specified standard (often referencing SAE or ADA-related securement guidance), first aid kit, fire extinguisher, and any state-required NEMT vehicle markings or lack thereof (some states restrict signage). 8. Start with trip volume expectations grounded in reality, not guesswork; broker trip assignment volume depends on regional demand and how many providers are already in network, and no broker guarantees a minimum trip count.
How to start a NEMT business with just one van
You can absolutely start with a single wheelchair van, and a lot of successful owner-operators do exactly that before adding a second vehicle. The core requirements don't change based on fleet size; a one-van operation still needs the entity, insurance, driver vetting, and broker credentialing, just scaled to one vehicle and probably you as the only driver. What changes with one van is your risk exposure. If that vehicle is out of service (a lift repair, a state inspection failure, a driver who's sick), you have zero backup capacity and zero trips coming in until it's fixed. Budget for that reality: many owner-operators keep a maintenance reserve specifically because a failed wheelchair lift can take a van out of service for days. One practical tip: buy or convert the van with broker inspection standards in mind before you buy, not after. Get the specific vehicle inspection checklist from the broker(s) you plan to join (ask their provider relations line for it) so you're not retrofitting a used van to meet a lift, tie-down, or interior height standard you didn't know about.
What licenses, permits, and credentials does NEMT credentialing actually require?
Requirements are set state by state and broker by broker, so the specifics genuinely vary, but the general categories are consistent across most programs. Business level: state business registration, an EIN, and commercial auto insurance meeting the state or broker's minimum liability limits (often higher than standard commercial auto minimums; some states specify combined single limits in the $1 million range for passenger-for-hire operations, though you must confirm the exact figure with your state). Driver level: a valid driver's license (commercial license requirements vary by vehicle size and state), a clean driving record check, criminal background check (often a fingerprint-based check run through the state or a vendor like Idemia or a state police unit), and completed training modules covering defensive driving, passenger assistance techniques, and often HIPAA privacy basics since drivers handle protected health information incidentally. Vehicle level: current registration and inspection, working wheelchair securement equipment, and often a broker-specific vehicle inspection sign-off that has to be renewed annually or semi-annually. Because every one of these has state-specific and broker-specific variables, this is exactly the kind of documentation checklist worth assembling once, correctly, rather than re-researching from scratch for each state or broker application. That's the gap tools like the $199 RideCredential Launch Kit are built to close: a one-time reference package mapping state Medicaid enrollment and major broker credentialing requirements so you're not guessing which document goes to which agency.
How do you get paid once you're credentialed and running trips?
Payment mechanics differ by broker but generally follow one of two patterns: direct claims submission (you submit trip logs or electronic claims, and the broker or state pays on a set cycle, often net 15 to net 30 days) or an integrated dispatch app where completed, verified trips accumulate and get paid out on a fixed schedule, sometimes weekly. Most brokers require electronic trip verification now, meaning GPS-based pickup/drop-off confirmation or a rider signature captured on a driver app, rather than paper logs. Trips that fail verification (no-shows not properly documented, mismatched GPS data, missing signatures) commonly get denied or delayed, so learning your specific broker's verification requirements in your first week matters more than almost anything else for cash flow. Ask directly, before your first trip: what's the pay cycle length, is there a minimum payout threshold, how are denied or disputed trips resolved, and is the base/per-mile rate you were quoted gross or does it already reflect a broker administrative deduction. Get the answer in writing, not verbally from a recruiter.
What is NEMT worth to a new owner-operator, realistically?
This article won't give you a number to bank on, and you should be skeptical of anyone who does, because trip volume depends entirely on your region's Medicaid population density, how many other providers are already credentialed with the same broker, and how aggressively that broker is expanding its network in your area at the moment you apply. None of that is knowable in advance from a blog post. What is knowable and worth doing before you buy a vehicle: pull your state's current NEMT fee schedule (or ask the broker for the current provider rate sheet), calculate your per-mile operating cost (fuel, insurance, maintenance reserve for the lift, driver pay if it's more than you), and compare that against the quoted per-mile and base rates. If the math is tight before you've paid for the van, it will be tighter after.
Frequently asked questions
What is non emergency medical transportation?
Non emergency medical transportation (NEMT) is transportation to and from medical appointments, like dialysis, therapy, or check-ups, for people who don't need an ambulance but can't drive themselves or use regular transit. It's a required Medicaid benefit under 42 CFR 431.53, delivered by states directly or through contracted brokers like Modivcare, MTM, or Access2Care.
Does Medicaid cover ambulance rides?
Yes. Medicaid covers ambulance transportation, but it's billed separately from NEMT using ambulance-specific procedure codes and a distinct state fee schedule. Ambulance coverage generally applies to emergencies and certain medically necessary non-emergency transfers requiring monitoring, not routine rides to a scheduled outpatient appointment.
Does Medicare cover medical transportation?
Original Medicare covers ambulance transport only when other transport would endanger the patient's health, under Part B rules, and generally does not cover routine non-emergency van rides. Some Medicare Advantage plans offer limited supplemental non-emergency transportation benefits, but this varies by plan and isn't a guaranteed Medicare benefit.
How to start a medical transportation business?
Form a business entity, get commercial auto insurance, complete state licensing and driver background checks, enroll as a Medicaid provider if your state requires it, get credentialed with the relevant broker (Modivcare, MTM, Access2Care, etc.), and get your vehicle inspection-ready to broker standards before accepting trips.
How to start a NEMT business specifically, as opposed to general medical transport?
NEMT specifically means non-ambulance rides for Medicaid or Medicare Advantage beneficiaries, so your path runs through your state Medicaid transportation unit and the broker(s) contracted in your service area rather than through EMS licensure. Focus on broker credentialing, vehicle inspection standards, and driver background checks first.
How do you start a medical transportation business if you only have one van?
You follow the same steps as a larger fleet, just scaled to one vehicle: entity formation, commercial insurance, driver background checks, and broker credentialing. The main risk with one van is zero backup capacity if it breaks down, so budget a maintenance reserve and confirm broker inspection standards before you buy.
What is a typical NEMT rate per mile?
There's no national rate; per-mile rates commonly range from about $0.50 to $3.00 or more depending on vehicle type and state, with base or pickup fees typically between $10 and $50. Wheelchair van and stretcher rates run higher than ambulatory sedan rates. Always confirm the current figure with your state Medicaid transportation unit or broker.
Do NEMT brokers pay the same rate the state pays them?
Not necessarily. The state negotiates a rate with the broker, and the broker then sets what it pays its network of owner-operators, which may include an administrative deduction. Get the broker's actual provider pay rate in writing rather than assuming it matches the published state Medicaid fee schedule.
What credentials do NEMT drivers need?
Typically a valid driver's license, a clean driving record, a criminal background check (often fingerprint-based), and completed training in defensive driving and passenger assistance, sometimes including CPR/first aid and HIPAA basics. Exact requirements vary by state and by broker, so confirm the current list before applying.
How is a wheelchair van rate different from a sedan rate?
Wheelchair van trips usually carry a higher base/pickup fee and a higher per-mile rate than ambulatory sedan trips, reflecting longer loading times, lift maintenance costs, and tie-down requirements. Stretcher van trips, which sometimes need two crew members, typically pay the most of the three vehicle types.
How long does NEMT broker credentialing take?
Timelines vary widely by broker and by how complete your application is, ranging from a few weeks to a few months in many cases. Vehicle inspection scheduling and background check processing times are usually the biggest variables. Confirm current timelines directly with the specific broker operating in your state or region.
Can I bill Medicaid directly for NEMT trips without a broker?
In states that manage NEMT directly rather than through a broker, yes, you enroll as a Medicaid transportation provider and bill the state or its fiscal agent. In broker-managed states, you generally must be in the broker's network and are paid by the broker, not billed directly to Medicaid.
What's the biggest mistake new NEMT owner-operators make on rates?
Assuming the state's published Medicaid fee schedule is what they'll personally be paid, without confirming the broker's actual provider rate sheet, pay cycle length, and whether quoted rates are gross or net of administrative deductions. Get all of that in writing before buying a vehicle.
Sources
- eCFR, 42 CFR 431.53 (Assurance of transportation): States must ensure necessary transportation for Medicaid beneficiaries to and from providers
- Wisconsin Department of Health Services, Medicaid NEMT fee schedule: Example of a state-published NEMT fee schedule with base and per-mile rates by vehicle type
- Medicaid.gov, Ambulance and NEMT benefits overview: Medicaid covers ambulance services separately from non-emergency medical transportation, under distinct billing rules
- Medicare.gov, Ambulance Services coverage: Medicare Part B covers ambulance transport primarily when other transportation would endanger health, with limited non-emergency coverage requiring medical necessity certification
- Medicaid.gov, State Medicaid Program overview: States administer Medicaid benefits, including transportation, under federally approved state plans
- eCFR, 42 CFR 440.170 (Transportation services): Federal regulation defines transportation as a Medicaid service category distinct from medical care services
- IRS, Apply for an Employer Identification Number (EIN): New businesses, including NEMT operators, need an EIN to register as a business entity
- eCFR, 42 CFR 440.170(a) definition of transportation services: Medicaid transportation services regulation covers arranging and paying for beneficiary transportation to and from providers