How much does medicaid pay for NEMT rides in 2025

Last updated 2026-07-25

How much does Medicaid actually pay for non-emergency medical transportation?

There's no federal NEMT rate card. Medicaid is a joint federal-state program, and each state Medicaid agency either sets its own NEMT fee schedule or hands the job to a transportation broker who negotiates rates with drivers and transportation companies. That means a wheelchair van trip in Ohio can pay differently than the same trip in Texas, and the difference isn't small. Federal law requires states to guarantee "necessary transportation for beneficiaries to and from providers" under 42 CFR 431.53, but it does not set the dollar amount ^[1]. States decide whether to pay per trip, per mile, per loaded mile, or some mix of a base rate plus mileage. Some states publish these rates in public fee schedules; broker-managed states often keep the actual per-mile or per-trip payment to contracted providers confidential, folded into a private contract. As a rough range based on published state fee schedules and broker rate sheets that are publicly available, ambulatory (sedan/minivan) NEMT trips tend to pay somewhere between $0.75 and $2.50 per loaded mile plus a base or "pickup" fee of $8 to $20. Wheelchair van trips usually pay more per mile, often $1.25 to $3.00, plus a higher base fee, sometimes $15 to $35, to account for the extra time loading and securing a chair. Stretcher van trips pay the most of the non-ambulance categories. Those numbers are illustrative, not a guarantee for any specific state or broker. You need to confirm current rates with your state Medicaid transportation unit or your broker's provider relations department before you buy a vehicle or sign a contract.

What is NEMT, exactly?

NEMT stands for non-emergency medical transportation. It's transportation for Medicaid (and sometimes Medicare Advantage) beneficiaries who need a ride to a covered medical appointment, dialysis, or pharmacy pickup, but who don't need an ambulance or emergency response. Medicaid.gov describes NEMT as a benefit that helps beneficiaries "who need to get to and from medical services but have no means of transportation" ^[2]. It covers a spectrum of vehicle types: ambulatory sedans and minivans for people who can walk and transfer themselves, wheelchair-accessible vans for people who use a wheelchair or scooter, and stretcher vans for people who must stay lying down but don't need clinical monitoring. NEMT is different from ambulance transport in a legal and clinical sense. Ambulance transport involves emergency medical technicians, is billed under different codes, and is used when a patient needs medical monitoring or intervention during the ride. NEMT drivers are not medical providers; they're trained in safe passenger handling, wheelchair securement, and (in most states) basic first aid, but they don't administer care. For a broader look at how the benefit works state by state, see non emergency medical transportation and NEMT transportation.

Does Medicaid cover ambulance rides?

Yes, but that's a separate benefit from NEMT with its own billing codes and rate structure. Medicaid covers ambulance transportation when a beneficiary's condition requires emergency response or medical monitoring en route, under the same federal transportation guarantee found at 42 CFR 431.53 ^[1]. Ambulance services are billed through a different fee schedule than NEMT, usually tied to base rate plus mileage (using CPT/HCPCS codes like A0426, A0428, A0429 for ground ambulance) and reimbursed at rates each state sets in its Medicaid state plan. These rates are generally higher than NEMT van rates because they include EMT-level staffing and equipment costs. The short version: if a patient needs a wheelchair van or ambulatory sedan to get to a dialysis appointment, that's NEMT. If a patient needs paramedics and monitoring during transport, that's ambulance transport, and it's reimbursed differently. If you're building a wheelchair-van business, you're almost certainly operating in the NEMT lane, not the ambulance lane, unless you also hold separate EMS licensure.

Does Medicare cover medical transportation?

Medicare's coverage of non-emergency transportation is much narrower than Medicaid's. Original Medicare (Part B) covers ambulance services only when other transportation would endanger the patient's health, and CMS states this coverage condition directly in its Medicare Benefit Policy Manual, Chapter 10 ^[3]. It generally does not cover routine rides to a doctor's office or dialysis via wheelchair van the way Medicaid does. Some Medicare Advantage (Part C) plans offer NEMT-style transportation as a supplemental benefit, but this is plan-specific, not a guaranteed Medicare benefit. If you want to contract with a Medicare Advantage plan for rides, you'd typically go through the same brokers (Modivcare, MTM, or similar) that manage Medicaid NEMT networks in your state, since many of these brokers also hold Medicare Advantage transportation contracts. If your business plan depends heavily on the assumption that "Medicare pays for this too," don't assume it. Confirm directly with the specific Medicare Advantage plan or broker whether transportation benefits exist and what they pay, because it varies plan by plan and is not standardized the way Medicaid's federal transportation guarantee is.

How are NEMT rates actually set: state fee schedule vs. broker contract?

States run their NEMT benefit one of three main ways: a state-managed fee-for-service system where the Medicaid agency pays providers directly off a published fee schedule, a broker model where a private company (Modivcare, MTM, Access2Care, SafeRide, or a regional broker) manages the network and pays contracted providers, or managed care where health plans handle transportation, often subcontracting to the same brokers. In a state-managed system, rates are usually public. You can often find the exact per-mile and base rates in the state Medicaid provider manual or fee schedule PDF. In a broker system, the rate you get is whatever you negotiate (or accept) in your provider services agreement, and brokers don't typically publish these rates publicly. That's the biggest practical difference for a new owner-operator: in a state-run system you know your rate before you enroll; in a broker system you often don't know your real per-mile rate until you're deep into credentialing. This is also why two drivers doing the identical wheelchair-van trip in the same city can be paid differently. One might be contracted directly with the state at the published rate, another might work under a broker's negotiated rate, and a third might be a subcontractor of a subcontractor, taking a cut below the broker's own rate with the transportation company. Ask directly, in writing, what your per-mile and base rate will be before you sign anything. For a rundown on how the major national brokers structure their networks, see medical transportation.

How does Medicaid NEMT pay compare across trip types?

Trip type	Typical base/pickup fee	Typical per-mile rate	Notes
Ambulatory sedan/minivan	$8-$20	$0.75-$2.00/loaded mile	Lowest tier; patient can walk/transfer
Wheelchair van	$15-$35	$1.25-$3.00/loaded mile	Higher due to securement time and lift equipment
Stretcher van	$25-$50+	$2.00-$4.00/loaded mile	Requires stretcher securement, sometimes two staff
Ambulance (BLS/ALS)	Separate fee schedule, base rate + mileage	Varies by state Medicaid ambulance rate	Billed under different codes, not NEMT	These ranges are drawn from a mix of publicly posted state Medicaid transportation fee schedules and are meant to show relative scale, not a rate you should plug into a business plan. Every one of these numbers can and does shift by state, by broker, and by contract renewal. Some states also pay a per-trip flat rate instead of base-plus-mileage, especially for very short urban trips. Don't build your budget around the midpoint of any range here. Pull your actual state's current fee schedule (search "[your state] Medicaid NEMT fee schedule" or check the state Medicaid transportation unit page) or get your broker's rate sheet in writing before you commit to buying a van.

How do you start a medical transportation business (the basic sequence)?

Starting an NEMT business is mostly a paperwork and sequencing problem before it's a driving problem. The rough order that avoids the most costly mistakes: form your business entity, get your commercial auto and livery/NEMT insurance in place, buy or lease a compliant wheelchair-accessible vehicle, get your state Medicaid provider enrollment (or your broker credentialing, or both) started, and pass any state-required vehicle inspection and driver background checks before you take your first ride. The order matters because some states require proof of insurance and vehicle registration before they'll issue provider enrollment, while brokers often require an active state Medicaid enrollment number before they'll credential you into their network. Buying the van first, before you know your state's vehicle age limits, ADA lift specs, or required signage, is one of the most common expensive mistakes new owner-operators make. Almost every state Medicaid agency publishes an NEMT provider manual through its transportation unit; that document is the single best source for your state's specific enrollment steps, required forms, and vehicle standards. Search "[your state] Medicaid non-emergency transportation provider manual" to find it, or look for a link from your state Medicaid agency's transportation or managed care page.

How do you start an NEMT business step by step?

Break it into five concrete phases. First, business setup: LLC or corporation formation, EIN, and a business bank account, since almost every state and broker requires you to enroll as a business entity, not an individual. Second, insurance and licensing: commercial auto liability (often $1 million combined single limit is required by brokers), workers' comp if you'll have employees, and any state-specific NEMT operating permit or Certificate of Public Convenience and Necessity some states require. Third, the vehicle: a wheelchair-accessible van that meets your state's ADA lift, tie-down, and age/mileage standards. Fourth, driver qualifications: a valid driver's license (CDL is rarely required for a single wheelchair van under most state weight thresholds, but confirm with your state), a clean MVR, drug testing, background check clearance, and CPR/first aid certification are common requirements across states and brokers. Fifth, and this is the step people rush, is dual enrollment: getting your state Medicaid provider number (often through the state's Medicaid Management Information System portal) and separately getting credentialed with whichever broker (Modivcare, MTM, Access2Care, SafeRide, or a regional broker) manages NEMT in your specific state and region. These are two different applications with two different timelines, and in most states you need both before you can bill for a ride.

How do you start a non-emergency medical transportation business with just one van?

One van is enough to start, and plenty of owner-operators do exactly this. The trade-off is that with a single vehicle you have zero backup capacity, so a breakdown or driver illness means zero revenue for however long the fix takes. With one van, focus your energy in three places: get the vehicle right the first time (a used wheelchair van with a well-maintained lift and low enough mileage to pass your state's inspection standards, not the cheapest van you can find), get your insurance and both enrollments (state Medicaid plus broker) moving in parallel rather than sequentially where the state allows it, and build a simple maintenance and backup plan (a relationship with a local mobility equipment shop, at minimum) before you need it. Many states and brokers do not require a minimum fleet size to enroll a small NEMT provider, but they do require the vehicle to pass inspection and the driver(s) to pass background and drug screening regardless of fleet size. A one-van operation faces the exact same credentialing bar as a twenty-van company; you just have less room for error operationally. If you want a structured way to track every document a state and broker will ask for, in the order they typically ask for it, that's the entire point of the $199 RideCredential State + Broker NEMT Launch Kit, built specifically for owner-operators doing this with their first van, not a fleet department.

What documents does state Medicaid enrollment actually require?

Every state's Medicaid provider enrollment application for NEMT is different in its exact form numbers, but the categories of documents required are consistent enough to plan around. Expect to submit: your business formation documents (articles of organization, EIN letter), proof of commercial auto insurance meeting your state's minimum liability limits, vehicle registration and inspection certificates, driver license and background check clearance for every driver, and often a signed provider agreement or Medicaid provider participation agreement. Many states process NEMT enrollment through the same Medicaid Management Information System (MMIS) portal used for medical providers, even though you're not billing medical claims. Some states also require a surety bond or specific NEMT operating authority separate from general Medicaid enrollment. Processing time varies enormously by state, from a few weeks to several months, and there is no federal standard timeline for NEMT-specific enrollment. Call your state Medicaid transportation unit directly and ask for their current processing time; published estimates go stale fast and phone confirmation beats a webpage that hasn't been updated in a year.

What does broker credentialing add on top of state enrollment?

Broker credentialing is a separate process from state Medicaid provider enrollment, and in most states you need both. The broker (Modivcare, MTM, Access2Care, SafeRide, or a regional company depending on your state's contract) manages the day-to-day trip assignment and payment, even though the state Medicaid agency is the ultimate funder. Broker applications typically ask for the same insurance and vehicle documentation as the state, plus broker-specific items: a signed provider services agreement (which is where your actual per-mile and base rate lives, and which is rarely public), proof of a certain number of years in business or a certain fleet size (this varies by broker and by state contract), driver onboarding through the broker's own training or orientation program, and sometimes a dispatch/GPS technology requirement so the broker can track trips in real time. Because broker rate sheets are contract-specific and not federally standardized, the honest answer to "what will I get paid per mile" is: ask the broker directly, in writing, before you sign, and ask what happens to your rate at contract renewal. Rates have been renegotiated downward in some state broker contracts over the years as states rebid contracts, so don't assume today's rate is locked in forever. For more on how brokers structure credentialing across different states, see NEMT and non emergency medical transportation services.

How is this different from starting an ambulance or emergency transport business?

NEMT and emergency medical transport are regulated, licensed, and reimbursed differently, and conflating them is a common early mistake. Emergency transport (ambulance service) requires state EMS licensure, certified EMT or paramedic staff, specific vehicle equipment standards set by state EMS agencies (not Medicaid transportation units), and a different Medicaid billing pathway using ambulance-specific codes. NEMT wheelchair van operators do not need EMT certification for their drivers in the vast majority of states; drivers typically need passenger assistance training, wheelchair securement training, CPR/first aid, and a clean background check, which is a meaningfully lower licensing bar than EMS certification. If your business plan involves both wheelchair van NEMT and ambulance-level transport, you're really running two separate regulated businesses under one roof, each with its own state agency oversight. If you're deciding which lane to enter, read up on how emergency medical transport is licensed separately before assuming your NEMT credentialing covers you for ambulance-level work. It doesn't.

Frequently asked questions

How much does Medicaid pay per mile for NEMT?

There's no national per-mile rate. Published state fee schedules and broker rate sheets show ambulatory trips commonly paying $0.75-$2.00 per loaded mile and wheelchair van trips paying roughly $1.25-$3.00 per loaded mile, often plus a base fee. Your actual rate depends on your specific state or broker contract, so confirm current numbers with your state Medicaid transportation unit or broker directly.

Does Medicaid cover ambulance rides?

Yes. Medicaid covers ambulance transportation when a beneficiary's condition requires emergency response or medical monitoring, under the federal transportation guarantee in 42 CFR 431.53. Ambulance rides are billed under separate codes and a separate fee schedule than NEMT wheelchair van or sedan trips, and are generally reimbursed at higher rates to cover EMT staffing.

What is NEMT?

NEMT (non-emergency medical transportation) is Medicaid-covered transportation to medical appointments for beneficiaries who need a ride but don't need an ambulance. It covers ambulatory sedans/minivans, wheelchair-accessible vans, and stretcher vans, driven by trained but non-medical drivers, and is described by Medicaid.gov as helping beneficiaries who otherwise have no means of getting to covered services.

Does Medicare cover medical transportation?

Original Medicare Part B covers ambulance transport only when other transportation would endanger the patient's health; it generally does not cover routine wheelchair van or sedan rides to appointments. Some Medicare Advantage plans offer NEMT-style benefits as a supplemental extra, but this varies by plan, so confirm directly with the specific plan or broker rather than assuming coverage.

How do I start a medical transportation business?

Form your business entity, secure commercial auto and NEMT insurance, buy a compliant wheelchair-accessible vehicle, and pursue both state Medicaid provider enrollment and broker credentialing (Modivcare, MTM, Access2Care, SafeRide, or your state's contracted broker). Most states require both before you can be paid for a trip. Check your state Medicaid transportation unit's provider manual for the exact sequence and required forms.

How do I start an NEMT business?

Sequence it as: business entity and insurance first, then a compliant wheelchair or ambulatory vehicle, then driver qualification (background check, drug test, CPR/first aid), then state Medicaid enrollment and broker credentialing in parallel where your state allows it. Skipping the sequence, especially buying a vehicle before confirming your state's vehicle standards, is the most common expensive mistake.

Can I start an NEMT business with just one van?

Yes, plenty of owner-operators start with a single wheelchair van. The credentialing bar (insurance, vehicle inspection, driver background checks, state and broker enrollment) is the same regardless of fleet size. The main trade-off is zero backup capacity if that one vehicle breaks down or its driver is unavailable.

What is non-emergency medical transportation?

Non-emergency medical transportation is a Medicaid benefit that provides rides to and from covered medical services for beneficiaries who don't need ambulance-level care. It includes ambulatory sedans, wheelchair-accessible vans, and stretcher vans, and is required under federal Medicaid regulation 42 CFR 431.53, though states and their contracted brokers administer the specifics differently.

Do NEMT drivers need to be EMTs?

No. In the vast majority of states, NEMT drivers need passenger assistance and wheelchair securement training, CPR/first aid certification, and a clean background check and driving record, but not EMT or paramedic licensure. EMT certification is required for ambulance/emergency transport, which is a separate regulatory category from NEMT.

How long does Medicaid NEMT provider enrollment take?

There's no federal standard timeline; it varies by state from a few weeks to several months depending on the volume of applications and whether your documentation is complete on first submission. Call your state Medicaid transportation unit directly and ask for their current processing estimate rather than relying on an older published figure.

What's the difference between state Medicaid enrollment and broker credentialing?

State Medicaid enrollment gives you a provider number recognized by the state's Medicaid program. Broker credentialing is a separate process with a private company (like Modivcare or MTM) that the state contracts to manage day-to-day trip dispatch and payment. In most broker-model states you need both, and they have separate applications, documents, and timelines.

Why do wheelchair van trips pay more than ambulatory sedan trips?

Wheelchair van trips typically involve a higher base fee and higher per-mile rate because of the additional time and equipment needed for lift operation and wheelchair securement, plus the higher vehicle cost. Published state fee schedules commonly show wheelchair van base fees roughly $5-$15 higher than ambulatory sedan base fees, though exact figures vary by state.

Sources

1. eCFR, 42 CFR 431.53 (Assurance of transportation): States must ensure necessary transportation for Medicaid beneficiaries to and from providers
2. Medicaid.gov, Non-Emergency Medical Transportation: Definition and description of the NEMT benefit for beneficiaries with no means of transportation
3. CMS Medicare Benefit Policy Manual, Chapter 10 (Ambulance Services): Medicare Part B ambulance coverage rules requiring that other transportation would endanger the patient's health
4. CMS, Medicaid State Plan Amendments (SPA) process overview: States document their NEMT payment methodology through Medicaid state plan amendments filed with CMS
5. 42 CFR 440.170 (Transportation as a Medicaid benefit): Federal regulation defining transportation as an optional Medicaid benefit category states may cover under their state plan