Last updated 2026-07-25
TL;DR
Texas doesn't set one statewide NEMT rate. HHSC contracts regional brokers (MTP) who pay drivers per trip or per mile, with wheelchair-van runs paid more than ambulatory sedan trips. Ambulatory mileage reimbursement for individual/gas-card drivers is set by HHSC; wheelchair-van rates are negotiated between the broker and the transportation provider, so you confirm actual numbers with your specific broker contract.
What is non-emergency medical transportation (NEMT)?
Non-emergency medical transportation, usually shortened to NEMT, is transportation to and from covered medical appointments for people who have no other way to get there and don't need an ambulance. Think dialysis three times a week, chemotherapy, physical therapy, or a routine OB visit for someone who doesn't drive and has no family nearby. Federal Medicaid rules require states to make sure eligible people can get to and from providers. The regulation says state Medicaid plans "must ensure necessary transportation for beneficiaries to and from providers" and may do this directly, through a broker, or through contracts with transportation companies [1]. That's the legal hook that created the entire NEMT brokerage industry, including the four names most new operators in Texas run into: Modivcare, MTM, Access2Care, and (in some regions) SafeRide. NEMT is different from an ambulance. NEMT vehicles are wheelchair vans, ambulatory sedans, and stretcher cars driven by contracted drivers, not EMS crews. There's no siren, no IV, no clinical intervention. If a rider needs a paramedic during the ride, that's an emergency transport, a completely different Medicaid benefit with completely different billing rules.
Does Medicaid cover ambulance rides in Texas?
Yes. Texas Medicaid covers medically necessary ambulance transportation, both emergency and some non-emergency ambulance trips, as a separate benefit from the NEMT program described above. Ambulance providers bill Texas Medicaid directly through the fee schedule administered by HHSC, not through the regional NEMT brokers. The distinction matters if you're cross-shopping business models. An ambulance service needs EMS licensure through the Texas Department of State Health Services, a whole different regulatory track than a wheelchair-van NEMT company, governed under Texas Health and Safety Code Chapter 773 [2]. If you're buying a wheelchair van and don't hold EMS certifications, you're in the NEMT lane, not the ambulance lane, and that's the lane this article covers. Does Medicare cover medical transportation the same way? Not really. Medicare covers ambulance transportation when other transport would endanger the person's health, under Medicare Part B, but traditional Medicare generally does not cover routine non-emergency rides to a dialysis chair or a follow-up appointment [3]. Some Medicare Advantage plans have added NEMT as a supplemental benefit in recent years, but that's plan-specific, not a guaranteed Medicare benefit, so always confirm with the specific plan before you count on that revenue.
How does Texas price NEMT trips? (MTP and the regional broker model)
Texas Health and Human Services Commission runs Medicaid NEMT through the Medical Transportation Program (MTP). HHSC divides the state into service regions and contracts a managed transportation broker for each region to schedule and pay for trips [4]. As of the last several contract cycles, that broker has largely been MTM, Inc., though HHSC re-bids these contracts periodically and the assigned broker can change by region and date, so confirm the current broker for your specific counties directly with HHSC's MTP page before you sign anything [4]. There is no single "Texas NEMT rate." What exists instead is a patchwork: HHSC sets reimbursement policy and mileage rates for individual transportation participants (friends, family, or self-arranged drivers using their own car and a gas card), while the regional broker separately negotiates contracted per-trip or per-mile rates with commercial transportation providers like wheelchair-van companies [5]. Those two rate structures are not the same number, and mixing them up is one of the most common mistakes new owner-operators make when estimating what a broker will actually pay them. HHSC's mileage reimbursement rate for individual (self-arranged) transportation is published in HHSC's MTP provider guidance and is periodically updated; it has historically tracked close to (though not identical to) the federal mileage rate used for other state reimbursement purposes [5]. That rate is not what a commercial wheelchair-van contractor gets paid per trip. Your contracted rate as a provider is whatever you negotiate with the broker, and it typically varies by vehicle type, trip mileage band, and whether the rider needs a lift or ties down a wheelchair.
What determines your actual per-trip pay as a wheelchair-van provider?
Four things drive the number on your settlement statement: vehicle type, mileage, load/unload time, and your region's broker contract terms. Wheelchair-van and stretcher trips almost always pay more per trip than ambulatory sedan trips because of the extra time, the lift maintenance, and the liability of securing a wheelchair. Most brokers use a base rate plus a per-mile rate beyond a certain loaded-mile threshold, similar to how taxi and paratransit contracts are structured elsewhere. Some contracts pay a flat rate for trips under a set mileage (common thresholds in broker contracts nationally run 0 to 10 or 0 to 15 miles) and then a per-mile add-on beyond that. Whether Texas MTP brokers use exactly that structure in your region, and what the specific numbers are, is something only your broker's provider manual or contract will tell you. A few real variables to ask about before you sign a provider agreement: - Is there a separate, higher rate for wheelchair versus ambulatory versus stretcher?
- Is there a no-show or wait-time fee if the rider isn't ready?
- Is deadhead mileage (driving to pick up the rider, or driving back empty) paid at all, and at what rate?
- How often are you paid (weekly, biweekly) and is there a minimum trip volume to stay active in the network? None of these numbers are standardized statewide, and they change when HHSC re-bids a regional contract. Get the current provider rate sheet in writing from the broker for your specific service area before you commit.
What is NEMT, exactly, and how is it billed?
NEMT is trip-based transportation, not medical billing in the CPT-code sense most clinics use. A wheelchair-van driver doesn't submit a claim to Medicaid directly in most Texas regions; the broker handles scheduling, verifies Medicaid eligibility for the ride, dispatches you the trip, and pays you according to your provider contract, then the broker bills HHSC on the back end [4]. That's a meaningfully different business model from, say, a home health agency billing Medicaid directly per visit. As a wheelchair-van owner-operator, your customer relationship is with the broker, not with Texas Medicaid itself. You still have to enroll as a Texas Medicaid provider in most cases (Texas uses the TMHP provider enrollment portal for this), and then separately credential with the broker to actually receive trip dispatches . Both steps matter. Skipping Medicaid provider enrollment and only credentialing with the broker can get you flagged during an audit. Skipping broker credentialing and only enrolling with Medicaid means you'll never get dispatched a trip, because the broker (not HHSC) controls day-to-day trip assignment in the MTP model.
How to start a NEMT business in Texas (the real sequence)
Most people get this backwards by buying the van first. Do the paperwork first, then buy the van that matches what your region's broker actually needs. 1. Form your business entity (LLC is standard) and get an EIN from the IRS. 2. Get commercial auto insurance quotes for wheelchair-accessible vehicles; this alone will reshape your budget, since NEMT liability coverage runs well above personal auto rates. 3. Check Texas Department of Motor Vehicles requirements for any for-hire or passenger transportation permitting that applies to your vehicle class and county. 4. Enroll as a Texas Medicaid provider through TMHP if you intend to bill or be reimbursed through the state program . 5. Apply for credentialing with the regional broker(s) covering the counties you want to serve. Confirm the current broker for your region directly on the HHSC MTP page, since assignments change [4]. 6. Buy or convert your wheelchair van only after you know the broker's minimum vehicle-age, lift-certification, and inspection standards, because those specs vary by broker and can rule out an older used van you already had your eye on. 7. Get drivers background-checked and trained to the broker's standard (defensive driving, passenger assistance, wheelchair securement) before your first dispatch. Skipping ahead to buy a van before you've read a broker's actual vehicle standards is the single most expensive mistake new owner-operators make in this business.
How to start a medical transportation business with just one van
One van is a completely normal way to start, and plenty of owner-operators run exactly this way for years before adding a second vehicle. The one-van model changes your priorities: you need the van to almost never be down for repair, and you need a real backup plan (a rental agreement, a second driver, or a relationship with another local provider) for the days it is. With one van, your credentialing math is simple: one vehicle inspection, one insurance policy, one driver file (or two, if you drive some shifts and hire backup for others). Brokers generally don't require a minimum fleet size to credential you; a solo wheelchair van is a legitimate provider type in the MTP network, subject to whatever vehicle and driver standards the broker sets [4]. The practical constraint with one van isn't credentialing, it's capacity. You can only be dispatched trips your one vehicle and schedule can actually cover, and brokers track no-shows and cancellations closely. A single missed pickup on a dialysis run (a rider who needs three trips a week, every week) is the kind of reliability failure that gets providers deactivated from a broker's network, so build slack into your schedule rather than booking back-to-back trips with zero buffer.
How do you start a medical transportation business, step by step, if you have zero experience?
Start by reading the actual HHSC Medical Transportation Program provider guidance before you spend a dollar. Most of what trips people up (vehicle standards, driver background check depth, insurance minimums) is written down somewhere; the mistake is guessing instead of reading. Then call your target broker's provider relations line and ask three questions directly: what's the current per-trip rate structure for wheelchair vehicles in my county, what vehicle age and inspection standard do you require, and what's your current credentialing timeline. Get the answers in writing if you can (email follow-up, more than a phone call). Parallel to that, talk to a commercial insurance agent who specifically writes NEMT or paratransit policies, not a generalist agent quoting standard livery insurance. Wheelchair lift liability and passenger assistance coverage are underwritten differently from a standard for-hire vehicle policy, and pricing swings a lot between agents who understand this niche and ones who don't. If all of that sounds like a lot of scattered paperwork across a state agency, a Medicaid enrollment portal, and a separate broker application, that's because it is. Assembling the state enrollment packet and the broker credentialing packet side by side, so you're not duplicating documents or missing something one but not the other requires, is exactly the kind of task the Launch Kit Builder at RideCredential was built to shortcut; it's a $199 one-time tool, not a guarantee of approval from any state or broker.
How much does Texas Medicaid pay for individual (self-arranged) NEMT mileage?
Individual Transportation Participant (ITP) mileage reimbursement is the rate paid to a friend, family member, or the rider themselves when they use their own vehicle instead of a contracted transportation provider. HHSC sets this rate in guidance tied to the Medical Transportation Program, and it is reviewed periodically [5]. This is not the rate a wheelchair-van contractor gets paid. ITP mileage is designed to cover gas and basic wear for a private car doing an occasional trip, not to compensate a commercial provider running a lift-equipped van with commercial insurance, driver wages, and maintenance overhead. If you're pricing a wheelchair-van business plan off the ITP mileage figure you found in a state document, you're using the wrong number; ask your broker for the commercial provider rate sheet instead. Because HHSC updates ITP mileage guidance from time to time, treat any specific cents-per-mile figure you see online (including in older blog posts) as something to verify against the current HHSC MTP publication rather than something to bake into a business plan [5].
Texas NEMT rate structure at a glance
| Rate component | Who sets it | Who it applies to | |
|---|---|---|---|
| ITP mileage reimbursement | HHSC (state) | Individual/family self-arranged drivers | |
| Contracted wheelchair-van trip rate | Regional broker (negotiated per contract) | Commercial NEMT providers | |
| Ambulatory sedan trip rate | Regional broker (negotiated per contract) | Commercial NEMT providers | |
| Stretcher-van trip rate | Regional broker (negotiated per contract) | Commercial NEMT providers | |
| Ambulance transport rate | HHSC fee schedule, billed directly | Licensed EMS/ambulance providers | The honest takeaway from this table: three of the five rows are not published in a single public rate sheet, because they're negotiated broker contracts, not state fee schedules. That's frustrating if you're trying to build a spreadsheet before you've talked to anyone, but it's the real structure of the program, and no amount of Googling will produce a statewide wheelchair-van rate that doesn't exist as a single public number. |
What licenses and insurance does Texas require before you can bill for NEMT?
There is no single statewide "NEMT license" in Texas the way there is an EMS license for ambulances. Instead you're stacking several separate requirements: business registration, vehicle permitting through TxDMV as it applies to your vehicle class, Medicaid provider enrollment through TMHP, and broker-specific credentialing (driver background checks, vehicle inspections, defensive driving certification) . Insurance minimums are set primarily by your broker contract and by general Texas financial responsibility law for motor vehicles, not by a single NEMT-specific statute. Wheelchair-van policies typically need to name the broker as a certificate holder and carry higher liability limits than a personal auto policy, given the vulnerable-passenger risk. Confirm exact limits with your broker's provider manual and your insurance agent, since brokers can and do set limits above the state's baseline financial responsibility requirements. One detail new operators miss: credentialing is per broker and per region. If HHSC's MTP contract for your area changes brokers (which has happened before across contract cycles), you may need to re-credential with the new broker even if nothing about your van or your license changed [4].
Frequently asked questions
What is non-emergency medical transportation?
Non-emergency medical transportation (NEMT) is transportation, not ambulance service, that gets Medicaid or Medicare Advantage members to and from covered medical appointments like dialysis, therapy, or check-ups when they have no other way to travel and don't need emergency medical care during the ride.
Does Medicaid cover ambulance rides in Texas?
Yes. Texas Medicaid covers medically necessary ambulance transportation as a distinct benefit, billed by licensed ambulance providers through the state fee schedule, separate from the regional NEMT broker program that dispatches wheelchair vans and ambulatory sedans.
Does Medicare cover medical transportation?
Traditional Medicare Part B covers ambulance transportation when other transport would endanger your health, but it generally doesn't cover routine non-emergency rides to appointments. Some Medicare Advantage plans add NEMT as a supplemental benefit; check the specific plan, since this isn't a guaranteed Medicare benefit.
How to start a NEMT business in Texas?
Form your business entity, get NEMT-specific commercial insurance quotes, check TxDMV vehicle requirements, enroll as a Texas Medicaid provider through TMHP, apply for broker credentialing in your service region, then buy a van that matches the broker's actual vehicle standards, not before you know them.
How to start a medical transportation business with one van?
One van is a normal way to start. Focus on reliability (backup driver or backup vehicle plan), tight scheduling with buffer time, and completing both Medicaid provider enrollment and broker credentialing before you take your first dispatch. Brokers don't require a minimum fleet size to credential a solo operator.
How do you start a medical transportation business step by step?
Read your state's Medicaid transportation program rules first, then contact your regional broker's provider relations line for current rate and vehicle standards, get NEMT-specific commercial insurance quotes, complete Medicaid provider enrollment, complete broker credentialing, and only then finalize your vehicle purchase.
What does NEMT stand for and how is it different from an ambulance?
NEMT stands for non-emergency medical transportation. Unlike an ambulance, NEMT vehicles (wheelchair vans, sedans, stretcher cars) are driven by contracted drivers with no clinical staff aboard, and they transport people who need a ride to a medical appointment but not emergency medical intervention during transit.
What are typical Texas NEMT rates for wheelchair-van trips?
There is no single published statewide rate. Wheelchair-van trip pay is set by negotiated contract between your regional Medicaid Transportation Program broker and your company, and varies by mileage band, wait time, and region. Get the current provider rate sheet directly from your broker before signing.
Who runs the Medicaid Transportation Program (MTP) in Texas?
Texas HHSC administers MTP and contracts regional brokers to schedule and pay for Medicaid NEMT trips. The assigned broker can change by region when HHSC re-bids contracts, so confirm the current broker for your specific counties on HHSC's MTP page rather than relying on older articles.
Do I need to enroll with Texas Medicaid and credential with a broker separately?
Generally yes. Texas Medicaid provider enrollment (through TMHP) and broker credentialing are two separate processes with separate paperwork. Completing only one typically means either an audit flag (enrolled but uncredentialed) or never receiving trip dispatches (credentialed but unenrolled), so plan for both.
What's the difference between ITP mileage reimbursement and a contracted provider rate?
ITP (Individual Transportation Participant) mileage is what HHSC pays a family member or friend using their own car for an occasional Medicaid trip. It's not what a commercial wheelchair-van company earns; contracted provider rates are separately negotiated with the regional broker and are typically higher per trip.
Does starting a NEMT business require an EMS license in Texas?
No. EMS licensure through the Texas Department of State Health Services is required for ambulance services, not for NEMT wheelchair-van or sedan companies, under Texas Health and Safety Code Chapter 773. NEMT requires business registration, vehicle permitting, Medicaid provider enrollment, and broker credentialing instead of an EMS license.
Sources
- 42 CFR § 431.53, Cornell LII: Federal Medicaid regulation requiring states to ensure necessary transportation for beneficiaries to and from providers
- Texas Health and Safety Code, Chapter 773 (Emergency Medical Services): Ambulance/EMS services require licensure under Texas Health and Safety Code Chapter 773, distinct from NEMT credentialing
- Medicare.gov, Ambulance Services coverage: Medicare Part B covers ambulance transportation when other transportation would endanger health, not routine non-emergency rides
- Texas HHSC, Medical Transportation Program (MTP): HHSC contracts regional brokers to schedule and pay Medicaid NEMT trips, with assignments subject to change by region
- Texas HHSC, MTP Individual Transportation Participant mileage guidance: HHSC sets and periodically updates ITP mileage reimbursement rates separate from commercial provider contract rates
- Texas Medicaid & Healthcare Partnership (TMHP), Long Term Care/Medicaid Provider Enrollment Portal (PEP): Texas Medicaid provider enrollment is administered through the TMHP Provider Enrollment Portal, separate from broker credentialing