Last updated 2026-07-25
TL;DR
There's no single national Medicaid NEMT rate. Each state Medicaid agency sets or negotiates its own NEMT reimbursement, often through a broker like Modivcare or MTM, and rates typically combine a trip base fee ($10 to $30ish) plus a per-mile rate ($0.90 to $2+), sometimes with wheelchair or wait-time add-ons. You have to check your specific state Medicaid transportation page or broker contract for real numbers.
How much does Medicaid actually pay for non-emergency transportation?
There's no single answer, and anyone who gives you one flat number for the whole country is guessing. Medicaid is a federal-state program, and each state runs its own NEMT reimbursement structure under its Medicaid State Plan. Some states pay providers directly. Most contract the whole benefit out to a broker like Modivcare, MTM, Access2Care, or SafeRide, and the broker sets (or negotiates) the per-trip and per-mile rates you actually get paid. What's consistent across states is the general shape of the payment: a base trip rate, plus a per-mile rate once you're past a certain mileage threshold, sometimes with add-ons for wheelchair loading, stretcher service, or wait time. Federal Medicaid regulation requires states to "ensure necessary transportation for beneficiaries to and from providers" under 42 CFR 431.53, but it does not set the dollar amount [1]. That's left entirely to the state. So the honest answer to "how much does Medicaid pay near me" is: pull up your state Medicaid transportation unit's fee schedule or your broker's provider rate sheet. Those are the only two documents that matter. Everything else, including anything you read on a forum or in a Facebook group claiming "$2.50 a mile in my state," is anecdotal and probably stale. For background on the benefit itself before you get into rates, see medical transportation and nemt.
What is NEMT and why does Medicaid cover it?
NEMT stands for non-emergency medical transportation. It's the Medicaid benefit that gets a member to and from covered medical appointments, dialysis, physical therapy, or the pharmacy, when they have no other way to get there and don't need an ambulance. It's not for emergencies; that's a separate benefit covered under emergency ambulance rules. Medicaid has covered NEMT since the earliest years of the program because federal rules require states to guarantee access to care, and access means nothing if a member can't physically get to the appointment. The Centers for Medicare & Medicaid Services describes NEMT explicitly as assuring "transportation to and from providers" for Medicaid beneficiaries who need it and have no other means of getting there [2]. Modes covered vary by state and by rider need: ambulatory sedan or van, wheelchair van, and in some states stretcher van or even bus passes and mileage reimbursement for a friend or family member who drives the member. Wheelchair van work tends to pay a higher base rate than ambulatory sedan work because of the loading time, ramp or lift equipment, and securement requirements, but exactly how much higher depends entirely on your state's fee schedule. For a plain-language rundown of the benefit category itself, see non emergency medical transportation and non emergency medical transportation services.
Does Medicaid cover ambulance rides?
Yes, but that's a different benefit than NEMT, and it pays differently. Medicaid covers ambulance transportation when a member's condition requires emergency care or when a non-emergency ambulance (not wheelchair van) is medically necessary, for example a bed-confined patient who needs monitoring en route. States set their own ambulance fee schedules too, often referencing base rates plus mileage, similar in structure to NEMT but usually reimbursed at higher amounts because of the clinical staffing and equipment on board. CMS guidance separates "emergency" ambulance transport from "non-emergency ambulance" transport, and both are billed and reimbursed differently from wheelchair van or ambulatory NEMT trips run through a broker [2]. If you're building a wheelchair-van business, you're generally not in the ambulance reimbursement lane at all; you're in the broker-managed NEMT lane. Don't confuse the two when you're reading rate sheets, because ambulance CPT and HCPCS codes (like A0425 for ground mileage) are a completely separate billing world from broker trip rates. For a look at how ambulance-level transport differs operationally from wheelchair van NEMT, see emergency medical transport.
Does Medicare cover medical transportation?
Mostly no, and this trips up a lot of new operators. Original Medicare covers ambulance transportation when medically necessary, under Medicare Part B, but it does not generally cover routine non-emergency wheelchair van or ambulatory rides to a doctor's appointment. CMS says Medicare Part B covers ground ambulance transportation when other transportation "could endanger your health" and no alternative is safe, which is a much narrower standard than Medicaid's NEMT benefit [3]. Some Medicare Advantage plans offer limited non-emergency transportation as a supplemental benefit, but that's plan-specific, not a guaranteed Medicare benefit, and the trip counts and mileage caps vary widely by plan and by year. If you're planning your business around Medicare Advantage rides, you need to check each plan's specific supplemental benefit summary, not assume coverage. Bottom line: if your business model depends on non-emergency transportation reimbursement, Medicaid (and Medicare Advantage supplemental benefits, where they exist) is where the volume is, not traditional Medicare Part B.
How does the broker system affect what I get paid?
Most states have moved to a "brokerage model," where the state Medicaid agency contracts with a single company (or a few regional companies) to manage all NEMT trip assignment, credentialing, and payment. Modivcare, MTM, Access2Care, and SafeRide are the largest national players, though which one holds the contract in your state, and for how long, changes over time as contracts get rebid. Under this model, you don't bill Medicaid directly. You enroll as a Medicaid transportation provider with the state, then separately credential as a transportation provider with whichever broker holds the contract in your region. The broker dispatches trips to you and pays you according to its own rate schedule, which the broker typically negotiates or sets under the terms of its state contract. This matters for the rate question because two operators in neighboring counties of the same state can be paid differently if different brokers or different regional contracts apply. It also means rates can change mid-contract or when a state rebids the broker contract, sometimes with very little notice to providers. Always confirm current per-mile and base rates directly with your broker's provider relations team and cross-check against your state Medicaid transportation unit's published fee guidance, since brokers don't always keep public rate sheets current. For a broader look at how brokers operate, see nemt transportation.
How to start a NEMT business (the real checklist)
Starting a non-emergency medical transportation business has a fairly fixed sequence, even though the specific forms and fees differ by state. Skipping steps or doing them out of order is the single biggest cause of delay new operators run into. 1. Form your business entity (LLC is standard) and get an EIN from the IRS. 2. Get your state or local operating authority, which might be a state DOT permit, a for-hire vehicle permit, or a county passenger transport license depending on where you are. 3. Buy or lease your wheelchair-accessible vehicle and get it built out to spec (ramp or lift, tie-downs meeting ADA and manufacturer standards, wheelchair securement per SAE J2249 where required). 4. Get commercial auto insurance with livery or NEMT-specific coverage; personal auto policies won't cover paid passenger transport. 5. Enroll as a Medicaid transportation provider with your state Medicaid agency (this is separate from broker credentialing). 6. Credential with the broker(s) operating in your service area, which usually means a separate application, vehicle inspection, driver background checks, and sometimes a signed transportation agreement. 7. Get your drivers trained (defensive driving, wheelchair securement, sometimes CPR/First Aid depending on your state), and background-checked to Medicaid provider standards. 8. Start accepting dispatched trips once both state enrollment and broker credentialing are approved. Every one of these steps has its own paperwork trail, and states genuinely differ on order and requirements, so confirm the specific sequence with your broker and state Medicaid agency before you spend money on a vehicle build-out you can't get credentialed.
How do you start a medical transportation business with one van?
One van is a completely normal way to start, and plenty of successful NEMT operators began exactly this way. The mechanics don't really change with fleet size at the start; you still need the entity, the insurance, the state enrollment, and the broker credentialing regardless of whether you run one van or ten. What does change with a one-van operation is your risk tolerance around downtime. If your single vehicle is in the shop, you have zero capacity that day, so budget for that in your insurance and maintenance planning from day one. A lot of new owner-operators underestimate how much of their working capital needs to sit in reserve for a transmission repair or a lift motor replacement, since there's no second van to lean on. On the credentialing side, brokers generally don't have a minimum fleet size to get approved; they care about vehicle age, inspection status, driver background checks, and insurance limits, not how many vans you own. Confirm your specific broker's minimum vehicle standards (some have age caps, like 7 or 10 years, on vehicles used for wheelchair transport) before you buy a used van assuming it'll pass inspection.
How to start a non-emergency medical transportation business, state by state
Every state Medicaid agency runs its own transportation unit, and each publishes (or should publish) its own provider enrollment page, fee schedule, or broker contact list. There is genuinely no shortcut around reading your specific state's page, because requirements range from a simple provider agreement to a full competitive bid process depending on the state. What's fairly universal: you'll need a National Provider Identifier (NPI) in most states even for transportation-only enrollment, a completed provider enrollment application through the state's Medicaid Management Information System (MMIS) portal, proof of insurance, vehicle registration and inspection documentation, and often a signed provider agreement specifying you'll follow the state's NEMT policy manual. The federal floor for all of this sits in 42 CFR 431.53, which requires states to "specify that the Medicaid agency will ensure necessary transportation for recipients to and from providers," and lets states either provide it directly, arrange it, or require managed care and brokers to arrange it [1]. States have wide discretion on how they build that assurance, which is exactly why enrollment paperwork looks so different from Texas to Ohio to California. A practical starting point: search "[your state] Medicaid non-emergency transportation provider enrollment" and look specifically for a .gov page from your state's Medicaid or Health and Human Services department, not a broker marketing page. That state page will tell you whether the state itself enrolls providers, whether a broker handles all provider enrollment, or both.
What does a typical NEMT rate structure actually look like?
| Base/pickup rate | roughly $10 to $30 per trip | |
|---|---|---|
| Per-mile rate (after included miles) | roughly $0.90 to $2.00+ per mile | |
| Wheelchair van differential | added flat amount or higher base than ambulatory | |
| Wait time | per 15-minute increment, if offered | |
| Deadhead/no-show | sometimes a reduced flat fee, varies heavily by broker | Don't treat this table as your state's numbers. Treat it as a map of what categories to look for on your actual rate sheet so you know what questions to ask your broker's provider relations contact. Ask specifically: what's my base rate, what's my per-mile rate, at what mileage does per-mile kick in, is there a wheelchair differential, and how is wait time billed. Get the answer in writing, ideally as part of your signed transportation agreement, not a verbal promise from a recruiter. |
Most state and broker rate schedules share a similar structure even though the numbers differ: a flat "base" or "pickup" rate for the trip, plus a per-mile rate once you exceed a free-mileage threshold (commonly the first 5 to 10 miles included in the base rate), plus sometimes a wait-time rate charged in per-quarter-hour increments, and sometimes a wheelchair or stretcher differential added to the base. Here's a representative structure pattern (illustrative only, not a specific state's actual numbers, since real numbers require pulling your state/broker rate sheet): | Component | Typical range seen across states |
What paperwork actually gets you paid (state enrollment vs. broker credentialing)
These are two separate approvals, and mixing them up is the most common early mistake. State Medicaid provider enrollment is your legal authorization to bill Medicaid (directly or through a broker) as a transportation provider at all. Broker credentialing is the operational approval from Modivcare, MTM, Access2Care, or SafeRide (whichever holds your state or region's contract) that actually gets trips dispatched to your vehicles. You generally need both, in most states, before you can accept a single paid trip. Order varies: some states want Medicaid enrollment first, then broker credentialing; some brokers will start your file while state enrollment is pending, then hold live dispatch until state approval clears. Confirm the required order and any grace periods with your broker and your state Medicaid transportation unit directly, since guessing wrong can mean weeks of a van sitting idle. This two-step system is exactly the paperwork stack that a state and broker launch kit is built to organize; something like the RideCredential $199 Launch Kit is meant to walk a new owner-operator through both tracks side by side so nothing gets filed out of order. That's a starting checklist, not a guarantee of approval; final decisions always rest with the state agency and the broker.
What actually moves your rate up or down over time?
Rates aren't fixed forever. States rebid broker contracts on cycles that typically run three to five years, and new contracts can bring new rate schedules, sometimes better, sometimes worse, for existing providers. Fuel cost adjustments show up in some states as a periodic per-mile rate review, though this is far from universal. Vehicle type also matters more than most new operators expect. A wheelchair van credentialed and equipped to spec (functioning ramp or lift, compliant securement points, appropriate vehicle age per your broker's standards) typically qualifies for the wheelchair differential rate. A van that's technically wheelchair-capable but fails inspection on securement equipment gets bumped down to ambulatory rates, or gets rejected from credentialing outright, so keeping your vehicle inspection-ready isn't just a safety issue, it's a revenue issue. On-time performance and complaint history can affect your standing with a broker too; most brokers reserve the right to reduce trip volume or terminate a provider agreement for repeated late pickups or no-shows, which functionally caps your earning capacity even if your contracted rate never changes on paper.
Where do I find my state's actual current rate?
Two places, and you need both. First, your state Medicaid agency's transportation unit page, usually under the Medicaid or Health and Human Services department website, which sometimes publishes a fee schedule directly and sometimes just names the broker(s) responsible for rate-setting in your region. Second, your broker's provider relations department, which is who actually sends you a signed rate agreement once you're credentialed. CMS's own Medicaid NEMT overview is a decent starting point for understanding the federal framework before you drop into state specifics [2], but CMS does not publish state-by-state rates; that's genuinely a state-level document you have to find directly. If a broker recruiter quotes you a rate verbally before you've signed anything, get it in writing before you commit to a vehicle purchase or lease based on that number. Recruiters aren't always wrong, but verbal quotes aren't binding, and rates you hear about from other drivers in a Facebook group may reflect an old contract, a different region, or a different vehicle class than yours.
Frequently asked questions
How much does Medicaid pay for non-emergency transportation per mile?
It depends entirely on your state and broker. Rate structures generally combine a base trip fee (roughly $10 to $30) with a per-mile rate after an included mileage threshold, often in the $0.90 to $2.00+ per mile range, but the exact number is set by your state Medicaid agency or its contracted broker (Modivcare, MTM, Access2Care, SafeRide), not by a national standard.
What is NEMT?
NEMT is non-emergency medical transportation, the Medicaid benefit that covers rides to and from covered medical appointments for members who have no other way to get there and don't need an ambulance. It includes ambulatory sedan, wheelchair van, and in some states stretcher van transport, arranged directly by the state or through a contracted broker.
Does Medicaid cover ambulance rides?
Yes. Medicaid covers ambulance transportation for emergencies and for non-emergency situations where an ambulance level of care is medically necessary, but this is a separate benefit from NEMT with its own fee schedule, billing codes, and provider enrollment path. Wheelchair van and ambulatory NEMT are billed through a different system than ambulance transport.
Does Medicare cover medical transportation?
Original Medicare Part B covers ambulance transportation when medically necessary and no safer alternative exists, but it does not generally cover routine non-emergency wheelchair van or sedan rides to appointments. Some Medicare Advantage plans offer limited non-emergency transportation as a supplemental benefit, but coverage and trip limits vary by plan and must be confirmed directly with the plan.
How do I start a NEMT business?
Form a business entity, secure any required state or local operating authority, get a wheelchair-accessible vehicle inspected and built to spec, carry commercial auto insurance for paid passenger transport, enroll as a Medicaid transportation provider with your state, and then credential separately with the broker(s) operating in your area before you can accept dispatched trips.
How do I start a medical transportation business with just one van?
One van is a common and legitimate way to start; the enrollment and credentialing steps are identical regardless of fleet size. The main difference is operational risk: with a single vehicle, any breakdown means zero capacity that day, so build extra reserve into your budget for repairs and keep your insurance and inspection status current at all times.
What's the difference between state Medicaid enrollment and broker credentialing?
State enrollment is your legal authorization to bill Medicaid as a transportation provider. Broker credentialing is a separate operational approval from the company (Modivcare, MTM, Access2Care, SafeRide, or others) that actually dispatches trips in your area. Most states require both before you can be paid for a ride.
Do all states use a broker for NEMT?
Most states have moved to a brokerage model where a contracted company manages trip assignment and provider payment, but the specific broker, contract terms, and whether the state also enrolls providers directly all vary. Confirm your state's specific setup with its Medicaid transportation unit rather than assuming a national standard applies.
Why do wheelchair van rates differ from ambulatory sedan rates?
Wheelchair van trips generally involve longer loading times, ramp or lift equipment, and wheelchair securement requirements, so many states and brokers pay a higher base rate or add a wheelchair differential compared to ambulatory sedan trips. The exact differential amount is set state by state or broker by broker.
Can my Medicaid NEMT rate change after I'm credentialed?
Yes. Rates can change when a state rebids its broker contract (commonly every three to five years), when a broker updates its provider rate schedule, or in some states through periodic fuel or cost adjustments. There's no guarantee your initial contracted rate stays fixed indefinitely, so check your provider agreement for any rate-change terms.
Where do I find the real NEMT rate for my state?
Check your state Medicaid agency's transportation unit page (a .gov site) for a published fee schedule or the name of the broker responsible for your region, then contact that broker's provider relations department directly for the current signed rate agreement. Don't rely on secondhand numbers from other drivers, since rates vary by region and change over time.
Does a launch kit or checklist guarantee Medicaid or broker approval?
No. No checklist, guide, or paid kit, including RideCredential's Launch Kit, can guarantee state Medicaid enrollment or broker credentialing approval; those decisions rest entirely with the state agency and the broker based on their own requirements. A good checklist just helps you avoid missing steps or filing paperwork out of order.
Sources
- eCFR, 42 CFR 431.53 (Assurance of transportation): Federal regulation requiring state Medicaid agencies to ensure necessary transportation to and from providers
- Medicaid.gov, Non-Emergency Medical Transportation: CMS description of the NEMT benefit and its purpose within Medicaid
- Medicare.gov, Ambulance Services coverage: Medicare Part B ambulance coverage standard and its limits compared to Medicaid NEMT
- CMS, 42 CFR 440.170 (Transportation): Federal definition of transportation as an optional Medicaid benefit category states may cover
- U.S. Government Accountability Office: GAO report on Medicaid non-emergency medical transportation program oversight and broker arrangements
- Medicaid.gov CMS Informational Bulletin: CMS guidance clarifying Medicaid NEMT coverage requirements and broker/transportation provider arrangements
- Centers for Medicare & Medicaid Services: Medicare ambulance fee schedule details used to compare Medicare vs Medicaid transportation reimbursement
- eCFR: Federal regulation defining Medicare coverage conditions for ambulance services
- Medicaid.gov: CMS toolkit outlining state options for administering and structuring NEMT programs, including broker models
- U.S. Small Business Administration: Federal guidance on registering a new business, relevant to starting an NEMT company