NEMT broker commission percentage: what owner-operators pay

Last updated 2026-07-25

What is NEMT and why does a broker sit between Medicaid and the driver?

Non-emergency medical transportation (NEMT) is transportation to and from Medicaid-covered medical appointments for people who don't need an ambulance but can't get there on their own, whether that's because of a wheelchair, a walker, dialysis fatigue, or just not having a car. Federal Medicaid rules require states to make sure eligible people can get to covered services, and NEMT is how most states fulfill that duty. The federal regulation at 42 CFR 431.53 says states must "ensure necessary transportation for recipients to and from providers" ^[1]. Most states don't pay individual drivers directly. Instead they hire a transportation broker, a company like Modivcare, MTM, Access2Care, or SafeRide, under a statewide or regional contract. The broker takes ride requests from Medicaid members, dispatches them to a network of contracted transportation providers, and pays those providers out of the rate the state pays the broker. That's the whole reason "broker commission" is a real cost in this business, even though it rarely shows up as a labeled line item on your contract. If you're new to the industry, read what NEMT actually is and how it fits into the larger medical transportation landscape before you start pricing anything, because the broker layer changes almost every business decision that follows.

Is there a standard NEMT broker commission percentage?

No. There is no published national standard, and no state Medicaid agency sets a public "broker commission percentage" that applies across the industry. Broker margins are proprietary business terms buried inside state procurement contracts and provider agreements, and they differ by state, region, trip type, and even by individual broker-provider contract. What you can say with confidence: the broker is paid one rate by the state (often a capitated per-member-per-month rate, sometimes fee-for-service), and the broker pays contracted transportation providers a different, lower rate. The gap between those two numbers is effectively the broker's margin, but it's not expressed anywhere as a clean "20% commission" figure you can look up. Some state Medicaid transportation pages publish the state-to-broker contract rate or the RFP terms, which is the closest thing to public data. For example, several states post their NEMT broker procurement documents through their Medicaid transportation unit, and those documents show the capitation or administrative fee paid to the broker, not what the broker in turn pays drivers. If you want that number for your state, the honest move is to pull your state's Medicaid transportation unit contract page directly and read the rate schedule yourself, because a broker's sales rep isn't always the best source for that history.

How do NEMT brokers actually pay owner-operators?

Brokers pay owner-operators one of a few ways, and understanding which model you're in determines your real margin far more than any "percentage" framing would. Per-trip flat rate. The broker pays a set dollar amount per completed trip, sometimes tiered by ambulatory versus wheelchair versus stretcher level of service. This is the most common structure reported by owner-operators in industry forums and trade publications, though exact figures are broker- and region-specific and change often. Per-mile plus a base or loaded-mile rate. Some broker contracts pay a base pickup fee plus a per-mile rate once the passenger is in the vehicle, with lower or no pay for deadhead miles driven to reach the pickup. Percentage-of-fee-schedule. In a few states, the broker pays providers a percentage of the state's fee-for-service Medicaid transportation rate (the rate the state would pay if there were no broker at all), which is the closest thing to an actual "commission percentage," but even here the percentage isn't public across the industry and it varies by broker and by year. Because of this variation, ask every broker you're considering for their current, written rate card and any per-trip deductions (fuel surcharges, no-show handling, dispatch fees) before you sign a provider agreement. Confirm with your broker and state Medicaid agency, since rates are renegotiated on procurement cycles that typically run several years and can change mid-contract.

How do I start a non-emergency medical transportation business?

Starting an NEMT business generally means clearing five layers before you ever take a Medicaid trip: business formation, vehicle and insurance, state Medicaid enrollment, broker credentialing, and driver compliance. First, form your business entity (LLC is common) and get an EIN from the IRS, then set up commercial auto insurance for the vehicle class you're running. Wheelchair-accessible vans typically need higher liability limits than standard sedans because the vehicle carries a passenger who cannot self-evacuate in an emergency, and several state Medicaid transportation units specify minimum coverage amounts in their provider manuals. Second, enroll as a Medicaid provider in your state. Some states let transportation providers enroll directly with the state Medicaid agency; many now route enrollment entirely through the regional broker instead. The Centers for Medicare & Medicaid Services (CMS) requires state Medicaid agencies to screen and enroll providers under 42 CFR Part 455, Subpart E, which covers provider screening levels (limited, moderate, high) ^[2]. NEMT providers are commonly screened at the "moderate" categorical risk level, which typically requires a site visit in addition to license verification, though states set the specific category. Third, apply for broker credentialing separately from state enrollment. Modivcare, MTM, Access2Care, and SafeRide each run their own provider application, vehicle inspection, and driver background check process on top of whatever the state requires. Expect to submit vehicle registration, insurance certificates, driver MVR (motor vehicle record) checks, and often proof of a wheelchair lift or ramp inspection. Fourth, get your vehicle compliant. Wheelchair vans generally need a working lift or ramp, functioning tie-downs, and in most states a passenger vehicle inspection specific to accessible transport, on top of standard state vehicle inspection. Fifth, complete driver training. Most brokers require defensive driving certification and passenger assistance training (sometimes CPR/First Aid) before a driver is activated in their system. Read how NEMT transportation programs are structured state by state, and check our guide to non-emergency medical transportation services for the service categories brokers typically credential separately (ambulatory, wheelchair, stretcher).

How do I start a medical transportation business with just one van?

Starting with a single wheelchair van is common and workable, but it means you're both the owner and the driver on day one, so your credentialing timeline and your income depend entirely on one vehicle passing inspection and one person clearing background checks. Realistically, plan for these steps in rough order: business entity and EIN, commercial auto and general liability insurance quotes (get these early, because insurers sometimes take one to two weeks to underwrite a wheelchair-van policy), state Medicaid provider enrollment application, broker credentialing application with your target broker(s), vehicle inspection scheduling, and driver background check and training completion. With one van, you can typically only serve one broker's dispatch queue efficiently at a time, though nothing stops you from being credentialed with multiple brokers (Modivcare and MTM both operate in many overlapping states) and choosing which rides to accept based on which broker's dispatch pings you first. Some owner-operators intentionally credential with two or three brokers precisely because commission structures and trip volume differ by contract, and having options lets you decline a low per-trip offer from one broker in favor of a better one from another. Don't skip the insurance step to save time. A commercial auto policy written for a personal vehicle almost never covers Medicaid passenger transport, and brokers require proof of commercial coverage with specific liability minimums before activation, not after.

Does Medicaid cover ambulance rides, and how is that different from NEMT?

Yes, Medicaid covers ambulance transportation, but it's a separate benefit category from NEMT and it's billed and reimbursed differently. Ambulance transport (emergency or non-emergency) requires a licensed ambulance service, ALS or BLS-equipped vehicles, and EMT or paramedic staffing, and it's billed under Medicaid's ambulance fee schedule rather than through most NEMT broker contracts. NEMT, by contrast, covers rides for people who don't need medical care during transport, just an accessible or non-accessible vehicle to get to and from a covered appointment. A wheelchair van driver is not delivering medical care in transit; an ambulance crew is licensed and equipped to do so. If you're planning to buy a wheelchair van, you are entering the NEMT market, not the ambulance market, and the two have almost no overlap in licensing, broker relationships, or reimbursement mechanics. CMS's guidance on non-emergency medical transportation confirms that states must provide NEMT "to ensure that eligible individuals have transportation to and from providers," separate from the ambulance benefit ^[3]. If you're weighing whether wheelchair-van NEMT or ambulance transport fits your business plan, our guide to emergency medical transport breaks down the licensing gap in more detail.

Does Medicare cover medical transportation the same way Medicaid does?

No, and this trips up a lot of new owner-operators. Medicare's coverage of transportation is much narrower than Medicaid's. Medicare Part B covers ambulance services when other transportation "could endanger the person's health" ^[4], but original Medicare generally does not cover routine non-emergency transportation to doctor's appointments the way state Medicaid NEMT benefits do. Some Medicare Advantage (Part C) plans have added NEMT-style transportation as a supplemental benefit in recent years. CMS's 2019 final rule expanded the definition of "primarily health-related" supplemental benefits for Medicare Advantage plans, and the rule's preamble specifically discusses transportation as an example of a benefit plans could offer under that expanded flexibility, published at 83 Fed. Reg. 16440 (April 16, 2018) with the final policy adopted for contract year 2019 ^[5]. But that's plan-by-plan, not a guaranteed benefit, and it's a completely separate contracting relationship from state Medicaid broker networks. If your business plan assumes steady Medicare-funded rides, confirm with each specific Medicare Advantage plan or its contracted transportation vendor, because there's no federal mandate comparable to the Medicaid transportation rule at 42 CFR 431.53 that applies to Medicare.

How do you start a medical transportation business step by step?

Here's the realistic sequence, laid out as a checklist you can actually follow, though the order can shift depending on your state's specific requirements. 1. Decide on service type: ambulatory sedan, wheelchair van, or stretcher van. Wheelchair vans require a lift/ramp and tie-down system and cost more upfront (used ADA-compliant vans commonly run in the high five figures to low six figures depending on age and mileage, though prices vary widely by market and condition). 2. Form your business entity and get an EIN. 3. Get commercial insurance quotes early. Coverage requirements for wheelchair-accessible vehicles are typically higher than standard livery insurance because of the wheelchair passenger risk profile. 4. Apply for state Medicaid provider enrollment. Some states enroll transportation providers directly; many require enrollment through the regional broker instead. CMS requires state agencies to verify licensure, run OIG/SAM exclusion checks, and in many cases conduct an on-site visit under the provider screening rules at 42 CFR 455.450 ^[2]. 5. Apply for broker credentialing with each broker operating in your region (Modivcare, MTM, Access2Care, SafeRide, or a regional broker specific to your state). 6. Pass vehicle inspection, including lift/ramp function tests and tie-down checks. 7. Complete driver background checks, MVR review, and required training (defensive driving, passenger assistance, sometimes CPR/First Aid). 8. Get your provider agreement and rate card in writing before you accept your first dispatched trip. Putting together every state Medicaid enrollment form and every broker application packet from scratch is the single biggest time sink new owner-operators report, since each state and each broker uses different forms, different required attachments, and different renewal cycles. This is the exact gap our $199 State + Broker NEMT Launch Kit is built to close: a one-time packet of the state enrollment and broker credentialing paperwork organized by state, so you're not hunting down six different portals on your own. It doesn't replace state or broker approval and it doesn't guarantee credentialing outcomes, but it does save you the research time.

What does a wheelchair van owner-operator actually net after broker pay structures?

Because commission percentages aren't standardized or published, the more useful question for your own math is: what per-trip rate am I being offered, and what does that rate need to cover? Your costs per trip include fuel (wheelchair vans generally get worse mileage than sedans due to weight and lift equipment), vehicle maintenance and depreciation on lift/ramp hardware, commercial insurance premiums allocated per trip, driver time including wait time at appointments (which brokers often don't pay for), and deadhead miles to reach pickups. Before accepting a provider agreement, ask the broker directly: what is the per-trip or per-mile rate for wheelchair-level service versus ambulatory, is there a separate rate for loaded versus deadhead miles, is wait time compensated after a grace period, and how often does the rate get renegotiated. Get the answer in writing, because verbal quotes from a credentialing rep don't always match what shows up in your remittance statements once you're active. No one publishes reliable trip-volume or income data broken out by broker and state, and any number claiming to tell you what a new wheelchair-van owner-operator nets per month is a guess dressed up as a fact. Build your break-even math from your own fixed and variable costs, not from someone else's projection.

NEMT broker payment models compared

Payment model	How it works	What to ask the broker
Per-trip flat rate	Fixed dollar amount per completed trip, often tiered by ambulatory/wheelchair/stretcher	Is the rate the same for all trip lengths, or tiered by distance too?
Per-mile (loaded)	Base pickup fee plus a per-mile rate once passenger is aboard	Are deadhead miles to the pickup paid at all?
Percentage of fee schedule	Broker pays providers a percentage of the state's underlying Medicaid transportation fee schedule	What percentage, and is it published in the provider agreement?
Capitated broker contract (state-to-broker only)	State pays broker a fixed per-member-per-month amount; broker manages provider pay internally	Not directly relevant to your pay, but explains why broker margins vary by state caseload	This table reflects commonly reported structures in the industry, not a guarantee of what any specific broker currently offers in your state. Rate cards change on contract renewal cycles, so treat any number you hear from a recruiter as a starting point for negotiation, not a locked figure.

How is a state's NEMT broker contract different from your provider agreement?

These are two separate documents, and confusing them is one of the most common mistakes new owner-operators make. The state Medicaid agency signs a procurement contract with the broker (Modivcare, MTM, Access2Care, SafeRide, or a regional company) that sets the broker's payment terms, performance standards, and complaint-resolution requirements. That contract is a matter of public record in most states because it went through a competitive bid (RFP) process, and you can often find the awarded contract and its rate terms on your state Medicaid transportation unit's website or your state's procurement portal. Your provider agreement is a separate, private contract between you and the broker. It sets your per-trip or per-mile pay rate, your credentialing requirements, and your performance obligations (on-time percentage, no-show handling, complaint thresholds). This document is not public, and its terms are not derived directly from the state contract in any way you can calculate from the outside. Because the state contract and your provider agreement are negotiated separately, a broker's margin (the gap between what the state pays the broker and what the broker pays you) is not something you can reverse-engineer from public records alone. If you want to understand the broker layer better before signing anything, review our overview of NEMT and non emergency medical transportation programs, which explain how the broker model fits into each state's Medicaid transportation structure.

What should I check before signing a broker provider agreement?

Read the rate schedule attachment, more than the body of the agreement, since pay rates are often buried in an appendix that gets updated separately from the main contract. Confirm whether rates are locked for a set term or subject to change with notice, and how much notice you get. Ask specifically about no-show and late-cancellation pay, since these are common disputes. Ask whether wait time beyond a grace period (commonly 15 to 30 minutes, though this varies by broker) is compensated. Ask how disputes over trip completion or GPS verification are resolved, since some brokers use app-based mileage tracking that can undercount actual miles driven if the driver forgets to close out a trip properly. Finally, confirm current requirements directly with your broker and your state Medicaid agency before you finalize anything. Broker rate cards, credentialing checklists, and state provider manuals all change, sometimes mid-year, and a contract term that was accurate last quarter may not be accurate when you apply. This article is a reference to help you ask the right questions, not legal advice and not a promise of any particular pay rate or approval outcome.

Frequently asked questions

What percentage commission do NEMT brokers like Modivcare or MTM take?

There's no published industry-standard percentage. Brokers negotiate a rate with the state Medicaid agency, then pay providers a separate, lower per-trip or per-mile rate under a private provider agreement. That gap functions like a commission but isn't disclosed as a set percentage anywhere. Ask the specific broker in your state for their current rate card before signing.

How do I start a NEMT business from scratch?

Form a business entity, get commercial auto insurance for your vehicle class, enroll as a Medicaid provider in your state (directly or through the broker, depending on the state), get credentialed with your regional broker (Modivcare, MTM, Access2Care, or SafeRide), pass vehicle inspection, and complete driver background checks and training. Requirements and order vary by state.

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 can't get there on their own. Federal rule 42 CFR 431.53 requires state Medicaid agencies to ensure this transportation is available to eligible members, which is why most states contract with brokers to manage rides.

Does Medicaid cover ambulance rides?

Yes. Medicaid covers ambulance transportation as a separate benefit from NEMT, billed through the state's ambulance fee schedule and requiring a licensed ambulance service with EMT or paramedic staffing. NEMT wheelchair vans and sedans are a different benefit category with different licensing and broker relationships.

Does Medicare cover medical transportation?

Original Medicare Part B covers ambulance transportation when other transport would endanger the patient's health, but it generally doesn't cover routine non-emergency rides to appointments. Some Medicare Advantage plans have added NEMT-style transportation as a supplemental benefit since CMS expanded supplemental benefit flexibility for contract year 2019, but it's plan-specific, not guaranteed.

Can I start an NEMT business with just one wheelchair van?

Yes, this is common. You'll handle business formation, insurance, state Medicaid enrollment, and broker credentialing yourself, and you can typically credential with more than one broker even with a single vehicle. Expect the insurance and credentialing steps to take the most time, so start those early.

How much does a wheelchair van cost for an NEMT business?

Used ADA-compliant wheelchair vans commonly range from the high five figures to low six figures depending on age, mileage, and lift/ramp condition, though prices vary widely by market. Get quotes from multiple dealers and factor in commercial insurance, which typically costs more for wheelchair-accessible vehicles than standard sedans.

Do NEMT brokers pay per trip or per mile?

Both models exist and vary by broker and state. Some brokers pay a flat per-trip rate, often tiered by ambulatory, wheelchair, or stretcher service level. Others pay a base fee plus a per-mile rate once the passenger is aboard, sometimes without compensating deadhead miles driven to reach the pickup. Ask for the specific structure in writing.

Is broker credentialing the same as state Medicaid enrollment?

No, they're separate processes. State Medicaid enrollment registers you as an approved Medicaid transportation provider under the state's rules. Broker credentialing is a private application process run by companies like Modivcare or MTM that includes vehicle inspection, driver background checks, and their own provider agreement with its own pay rates.

How long does it take to get NEMT broker credentialed?

Timelines vary widely by state and broker and aren't consistently published. Factors that add time include insurance underwriting, vehicle inspection scheduling, driver background check turnaround, and whether the state requires a site visit under federal provider screening rules. Confirm current timelines directly with your broker and state Medicaid agency.

What insurance do I need for a wheelchair van NEMT business?

You need commercial auto insurance with liability limits that meet your state's and broker's minimums, which are typically higher for wheelchair-accessible vehicles than standard sedans. Many brokers also require general liability coverage. Get quotes early since underwriting for wheelchair vans can take one to two weeks.

Can one owner-operator work with multiple NEMT brokers at once?

Often yes, if each broker operates in your area and you complete separate credentialing with each one. Some owner-operators do this deliberately so they can compare per-trip rates and dispatch volume across brokers rather than depending on a single contract's pay structure.

Sources

1. eCFR, 42 CFR 431.53 (Assurance of transportation): States must ensure necessary transportation for Medicaid recipients to and from providers
2. eCFR, 42 CFR Part 455 Subpart E (Provider Screening and Enrollment): CMS requires state Medicaid agencies to screen providers at limited, moderate, or high categorical risk levels, including site visits
3. Medicaid.gov, Non-Emergency Medical Transportation: States must provide NEMT to ensure eligible individuals have transportation to and from Medicaid providers
4. Medicare.gov, Ambulance Services coverage: Medicare Part B covers ambulance services when other transportation could endanger the person's health
5. Federal Register, Medicare Program; Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, and Medicare Prescription Drug Benefit Programs, 83 Fed. Reg. 16440 (April 16, 2018): CMS finalized expanded flexibility for Medicare Advantage supplemental benefits, discussing transportation as an example of a primarily health-related benefit, for contract year 2019
6. eCFR, 42 CFR 455.450 (Risk categories): CMS requires state agencies to verify licensure and conduct site visits for providers screened at moderate or high categorical risk