The steps every state shares
- 1
Decide who you will carry
Ambulatory riders only, or wheelchair and stretcher too. Each level of service needs different vehicles, equipment and training.
- 2
Form the business
Register the company with your Secretary of State, get an EIN from the IRS and open a business bank account.
- 3
Get vehicles and insurance
Brokers and states set minimum liability cover and vehicle standards; wheelchair vans need a lift or ramp and wheelchair securement.
- 4
Check and train drivers
Background and driving-record checks, drug testing, and passenger-assistance, CPR and first-aid training are common contract requirements.
- 5
Enrol with Medicaid
Brokers and health plans usually need you enrolled as a Medicaid provider before they can pay you, and many states ask for an NPI number.
- 6
Get credentialed by the broker or plans
The broker or managed-care plans that run NEMT in your state inspect vehicles, review documents and add you to their network.
- 7
Set up dispatch and trip records
Trips arrive with times, levels of service and rider details; you must prove each one with logs, signatures and mileage.
How does Medicaid NEMT work?
Medicaid must assure necessary transportation to covered care for members who have no other way to get there. Many states use a broker or managed-care plans to book the trips and pay a network of local transportation providers, so a new provider's first customer is often that broker or plan.[1][2]
Can you start without Medicaid?
Yes. Private-pay riders, dialysis and therapy centres, care homes and hospitals can pay you directly, so that work can start while Medicaid enrolment and broker credentialing are pending.
Why does the state matter so much?
Each state runs Medicaid transportation its own way: one statewide broker, regional brokers, managed-care plans or county programmes. That decides who credentials you, what they pay and which documents they audit, so check your state Medicaid agency's transportation page and the broker's provider requirements before you buy vehicles.
All guides in this section
Running a NEMT business
- How to become a NEMT provider with a brokerWhat a NEMT broker is, what it checks, conflict-of-interest rules and keeping the account.
- NEMT driver certification: what drivers needWho sets NEMT driver requirements, the federal duty, and keeping training records.
- How to start a wheelchair transportation businessLift and ramp standards, securement training, payers and dispatching accessible vans.
- How to start a medical transportation business with one vanThe van, enrolment and credentialing, first customers, trip paperwork, second van.
- How much does it cost to start a NEMT business?A NEMT start-up cost sheet and where margin is made or lost.
- How to start a transportation business for the elderlyWhat NEMT covers, private-pay and care-home customers, licences and regular trips.
Frequently asked questions
Do I need a special licence to run a NEMT business?
It depends on the state. Some require a specific transportation permit or registration, others rely on Medicaid enrolment plus broker credentialing and local business licences. Each state guide lists what applies.
Can I start a NEMT business with one van?
Yes. Many providers start with one vehicle and one driver, often the owner. The one-van guide covers the smallest setup that brokers will credential.
How do NEMT providers get paid?
By the broker, health plan or state under the rates in their contract, usually per completed trip, or directly by private-pay riders and facilities.
Sources
Fees and rules change. Each source is the official page we read, with the date we read it; check it before you apply or pay.
- [1] Medicaid.gov: Assurance of Transportation (federal NEMT requirement and coverage guide) (read 2 Nov 2026)
- [2] CMS: Non-Emergency Medical Transportation (provider booklet, driver and vehicle criteria) (read 2 Nov 2026)