Last updated 2026-07-25
TL;DR
Virginia Medicaid doesn't pay a flat statewide NEMT rate. Payment flows through the state's contracted broker, and rates are set by mode (ambulatory, wheelchair van, stretcher) with mileage add-ons. Owner-operators get paid whatever the broker's contracted rate is, not a rate they negotiate directly with DMAS. Confirm current figures with your broker and Virginia's Department of Medical Assistance Services.
What is non-emergency medical transportation (NEMT)?
Non-emergency medical transportation is the Medicaid-funded ride to and from covered health care, for people who don't have another way to get there and don't need an ambulance. Think dialysis three times a week, physical therapy, a psychiatrist appointment, a prenatal visit. The person isn't in medical crisis. They just can't drive themselves or ride the bus, often because of a wheelchair, a walker, dementia, or no working vehicle at all. Federal Medicaid rules require states to make sure eligible people can actually get to and from covered services. The regulation is blunt about it: states must "ensure necessary transportation for recipients to and from providers" and may do this directly, through contracts, or through a broker [1]. That single sentence in federal code is why NEMT exists as an industry at all. Virginia, like most states, handles this through a broker system rather than paying every transportation provider directly. NEMT vehicles range from a regular sedan for someone who just needs a ride, up through wheelchair-accessible vans and stretcher vans for people who can't transfer into a car seat. It is not an ambulance and it does not carry emergency medical equipment or lights and sirens. That distinction matters a lot for licensing, insurance, and reimbursement, which we'll get into below. For a broader look at how NEMT fits into the Medicaid transportation system nationally, see medical transportation and nemt.
How does Virginia Medicaid pay for NEMT rides?
Virginia's Department of Medical Assistance Services (DMAS) manages NEMT through a statewide broker contract, not through direct fee-for-service billing to every driver. CMS's national NEMT overview confirms this broker model is standard practice: states may arrange transportation "directly, through contracts with transportation providers, or through a broker" that manages trip scheduling and payment on the state's behalf [2]. That matters because the number you actually get paid as an owner-operator isn't a number DMAS sets and publishes for you to look up. It's a rate negotiated in your provider agreement with whichever broker manages your region's contract. Virginia has moved through different broker structures over the years and regions can be split between vendors. So the practical answer to "what does Virginia pay for NEMT" is: it depends which broker holds your area's contract right now and what your signed agreement says. Rates typically break down into a base trip rate (sometimes called a "loaded mile" rate or a flat pickup fee) plus a per-mile rate once you're past a certain radius. Wheelchair or stretcher trips usually pay more than ambulatory sedan trips because of the extra equipment, ramp or lift, and often a second person to help with securement. Some brokers pay a no-show or "dry run" fee if the member isn't there when you arrive, though the amount and the rules for qualifying (call-in windows, wait times, documentation) vary broker to broker. Because these figures shift with contract renewals and broker changes, don't build a business plan around a number you read somewhere online, including this article. Confirm current per-mile and per-trip rates directly with your broker and with DMAS before you sign anything or buy a vehicle.
Does Medicaid cover ambulance rides in Virginia?
Yes, but that's a separate benefit from NEMT and it's billed differently. Medicaid covers ambulance transportation when it's medically necessary, meaning the person's condition requires the vehicle itself and the medical monitoring or equipment during transport, more than a ride [1]. Ambulance trips are typically billed fee-for-service by licensed EMS agencies under their own provider agreements and rate structures, separate from the broker-managed NEMT network. NEMT wheelchair van and stretcher van trips are not ambulance transports. A stretcher van moves someone lying down, but it's not staffed or equipped for emergency medical intervention, and it bills through the NEMT broker rather than as an ambulance claim. If a member's condition changes mid-trip and they need actual emergency care, the NEMT driver calls 911. They don't attempt to render care themselves. If you're deciding what kind of company to start, understand this distinction early. Ambulance companies need EMS licensure, medically trained staff, and a whole different regulatory relationship with the state health department. NEMT wheelchair van companies need a driver, a properly equipped vehicle, and broker credentialing. They are not interchangeable businesses and the reimbursement rules aren't either.
Does Medicare cover medical transportation?
Original Medicare's coverage of non-emergency transportation is much thinner than Medicaid's. Medicare Part B covers ambulance transportation when other transportation could endanger the person's health, generally for emergencies or when the person's condition requires it [3]. Medicare does not have a broad NEMT benefit the way Medicaid does for the general fee-for-service population. There is a narrower path. Some Medicare Advantage plans offer non-emergency transportation as a supplemental benefit, and CMS has allowed this for years under expanded Advantage supplemental benefit rules. But it's plan-specific, not a guaranteed Medicare benefit, and the trip limits and covered destinations vary by plan. Practically, this means most of your NEMT revenue as a new operator is going to come from Medicaid members, not Medicare beneficiaries, unless you also credential with specific Medicare Advantage plans that have added a transportation benefit in your area. Don't assume a Medicare card guarantees a paid ride the way a Medicaid card generally does for eligible non-emergency trips.
How do you start a medical transportation business?
Start with the vehicle and licensing requirements, then the business entity, then Medicaid enrollment, then broker credentialing. Skipping the order costs people money, because plenty of new operators buy a van first and discover mid-application that the vehicle doesn't meet a broker's ADA lift specifications or the state's inspection requirements for wheelchair securement. Here's the realistic sequence: 1. Form your business entity (LLC is standard) and get an EIN. 2. Get commercial auto insurance quotes before you buy the vehicle, not after. Wheelchair van insurance for livery/NEMT use runs meaningfully higher than personal auto and some insurers won't write it at all in certain states. 3. Confirm Virginia's vehicle inspection and driver requirements for NEMT with DMAS or your regional broker, since these can include annual vehicle inspections, wheelchair securement checks, and driver background checks. 4. Apply for a Virginia Medicaid provider number as a transportation provider, per DMAS enrollment procedures. 5. Apply for broker credentialing with whichever broker(s) hold your service area's contract. This is a separate application from Medicaid enrollment, with its own paperwork, insurance minimums, and sometimes a vehicle inspection visit. 6. Get your driver(s) any required training (defensive driving, passenger assistance, sometimes CPR/First Aid depending on broker rules). Most new owner-operators underestimate step 5. Broker credentialing (with Modivcare, MTM, Access2Care, or whichever vendor is active in your Virginia region) is its own gate separate from Medicaid enrollment, and you generally need both before you can bill for rides. For a walkthrough of broker-specific requirements, see nemt transportation.
How to start a NEMT business with just one van
One van is a completely normal way to start, and plenty of Virginia operators run exactly one wheelchair van for years before adding a second vehicle. The paperwork burden is the same whether you own one van or ten; it's not scaled down for small operators. So budget real time (often 60 to 120 days, sometimes longer depending on the broker's current application backlog) for enrollment and credentialing before your first paid trip. With one vehicle, your biggest operational risk is downtime. If that van is in the shop, you have zero capacity, so a maintenance reserve matters more to a one-van operator than a ten-van fleet where breakdowns average out. Buy a wheelchair van with a documented maintenance history and get a pre-purchase inspection from a mechanic who knows accessible vehicle conversions, more than a general mechanic, since the ramp or lift system and floor reinforcement are the expensive parts to repair. One-van operators should also confirm whether their target broker requires a certain fleet size or service area coverage commitment before credentialing. Some brokers are fine with single-vehicle owner-operators; others prioritize applicants who can cover a wider geographic radius or guarantee same-day availability. Ask directly rather than assuming. A one-time reference tool like the $199 State + Broker NEMT Launch Kit can help you track which state Medicaid enrollment steps and broker credentialing steps apply to your specific situation, since the checklist differs by state and by which broker runs your region. It's not a guarantee of approval and it doesn't replace confirming details directly with DMAS and your broker, but it saves the time of piecing the sequence together from scratch.
What does the wheelchair van itself need to meet for Virginia NEMT?
Expect requirements around ADA-compliant wheelchair lifts or ramps, working wheelchair securement systems (tie-downs rated for the load), and a vehicle age or mileage ceiling that some brokers enforce even if the state itself doesn't set one explicitly. Insurance minimums for commercial/livery use are typically higher than personal auto minimums, and brokers often require you to name them or list specific coverage types on your certificate of insurance. Drivers typically need a clean driving record check, sometimes a specific license class or endorsement depending on vehicle size, and background checks including sex offender registry and criminal history screening, since drivers are transporting a vulnerable population that includes elderly and disabled Medicaid members. All of this is broker- and program-specific, and Virginia's exact current requirements should be confirmed directly with DMAS and the broker for your service region before you buy a vehicle or sign a lease. Requirements change, and a van that qualified last year in one region may not automatically qualify under an updated broker contract.
How does Virginia's NEMT rate structure compare to other states?
| Who sets the rate | State Medicaid agency, published fee schedule | Broker, via individual provider contract | |
|---|---|---|---|
| Rate transparency | Usually public on Medicaid transportation unit site | Not typically published; confirm with broker | |
| Billing party | Provider bills Medicaid directly | Provider bills the broker, broker bills the state | |
| Rate consistency | Same rate statewide | Can vary by broker/region within the state | If you're comparing markets before deciding where to operate, look at non emergency medical transportation and non emergency medical transportation services for how other states structure their programs. |
There's no national standard NEMT rate. Each state Medicaid program either sets its own fee schedule or lets its contracted broker negotiate rates directly with providers, and Virginia falls into the broker-negotiated category. That means comparing "Virginia's NEMT rate" to another state's isn't really an apples-to-apples exercise, because the underlying payment model differs. States that run pure fee-for-service NEMT often publish a rate schedule on the Medicaid transportation unit's website (a fixed per-mile rate, a base trip rate, sometimes a wheelchair loading fee listed as a specific dollar amount). Broker-model states like Virginia generally don't publish that number publicly because it's a negotiated term in each provider's contract with the broker, not a public fee schedule. Here's a general comparison of how the two models typically work, without attaching specific dollar figures since Virginia's aren't publicly fixed: | Feature | Fee-for-service state model | Broker-negotiated model (Virginia) |
What paperwork does Virginia Medicaid enrollment actually require?
DMAS enrolls NEMT providers through its standard Medicaid provider enrollment process, which generally requires a completed provider agreement, National Provider Identifier (NPI) where applicable, business licensing documentation, proof of insurance, and disclosure of ownership and control information as required under federal Medicaid provider screening rules [4]. Federal regulation requires state Medicaid agencies to screen providers based on a categorical risk level (limited, moderate, or high), and transportation providers are commonly placed at a level requiring background checks or site visits depending on the state's designation [4]. Expect this to take real time. Provider enrollment backlogs are common across state Medicaid programs, and DMAS processing time isn't something you should assume will match a broker's separate timeline. Submit your Medicaid enrollment application and your broker credentialing application in parallel where the broker allows it, rather than waiting for one to finish before starting the other, since both processes commonly run 30 to 90-plus days depending on current volume. Keep copies of everything: your provider agreement, insurance certificates, vehicle inspection records, and driver background check results. Brokers periodically re-verify credentials, and having your file organized saves you from a scramble when a re-credentialing request lands with a short deadline.
How do broker credentialing rates differ from state Medicaid rates?
This is where a lot of new operators get confused, so it's worth separating clearly. Virginia Medicaid (DMAS) sets the overall program rules and contracts with a broker to manage day-to-day trip assignment and payment. The broker, not DMAS directly, is who cuts your check for each completed trip, and the broker's contracted rate with you is the number that actually lands in your account. Different brokers operating in different Virginia regions, or different broker contracts over time as the state re-bids its transportation broker contract, can result in different rates for functionally identical trips. A wheelchair van trip in one region might pay differently than the same type of trip in another region, simply because a different broker holds that contract with different negotiated terms. This is also why credentialing with a broker is a separate step from Medicaid enrollment. You can be a fully enrolled Virginia Medicaid transportation provider and still not be able to accept trips until you're separately credentialed and contracted with the specific broker managing your area. If Virginia changes brokers (as many states periodically do through competitive re-bid), previously credentialed providers sometimes need to re-apply under the new vendor's process.
What should a new owner-operator realistically budget for beyond the vehicle?
The van itself, whether new or a used conversion, is usually the largest single cost, but it's far from the only one. Commercial/livery insurance for a wheelchair van running Medicaid trips is a recurring cost that's meaningfully higher than personal auto coverage, and rates vary a lot by driving record, vehicle type, and state. Other recurring costs to plan for: vehicle maintenance specific to the ramp/lift system, driver background check fees, any required driver training or certification renewal, business insurance beyond auto (general liability, sometimes workers' comp if you hire drivers as employees rather than contractors), and dispatch or scheduling software if you're not using a broker's own dispatch app exclusively. There's also the gap period to plan for. It's the weeks or months between finishing enrollment/credentialing and actually receiving your first trip assignments and first payment. Broker payment cycles (net 15, net 30, sometimes longer) mean cash doesn't start flowing the day you're approved. Build a cash cushion for that gap rather than assuming payment starts immediately.
Frequently asked questions
What is non-emergency medical transportation (NEMT)?
NEMT is Medicaid-funded transportation to and from covered health care for people who don't need an ambulance but can't get there on their own, often because of a wheelchair, mobility limits, or lacking a vehicle. Federal Medicaid rules require states to ensure this access, generally through a state broker system rather than direct billing by every driver [1].
Does Medicaid cover ambulance rides?
Yes, Medicaid covers medically necessary ambulance transportation, but this is billed separately from NEMT through licensed EMS providers, not through the NEMT broker network. Ambulance coverage requires that the person's medical condition needs the vehicle and staff during transport, more than a ride to an appointment [1].
Does Medicaid cover ambulance transportation the same way it covers NEMT?
No. Ambulance transport is fee-for-service billing by a licensed EMS agency for medically necessary emergency-capable transport. NEMT wheelchair and stretcher van trips go through a state's contracted broker and cover non-emergency rides to routine covered care like dialysis or therapy appointments.
Does Medicare cover medical transportation?
Original Medicare Part B covers ambulance transportation when medically necessary, but it doesn't have a broad routine NEMT benefit like Medicaid does. Some Medicare Advantage plans offer non-emergency transportation as a supplemental benefit, but that's plan-specific, not guaranteed under standard Medicare [3].
How do you start a medical transportation business?
Form your business entity, secure commercial insurance quotes, confirm your state's vehicle and driver requirements, apply for state Medicaid provider enrollment, and separately apply for broker credentialing with whichever broker covers your service area. Both enrollment and credentialing can run 30 to 90-plus days, so start the paperwork before you're financially dependent on trips flowing.
How to start a NEMT business with one van?
One van is normal for a first-time operator. Focus on vehicle reliability (a broken-down single van means zero capacity), get a pre-purchase inspection focused on the ramp/lift and securement system, and confirm your target broker doesn't require a minimum fleet size or geographic coverage commitment before you buy.
How to start a non-emergency medical transportation business in Virginia specifically?
Confirm Virginia DMAS's current transportation provider enrollment steps, identify which broker currently holds the contract for your service region, and apply for both Medicaid enrollment and broker credentialing in parallel. Rates and requirements are set at the broker level, so contact them directly for current figures rather than relying on older published numbers.
What is the current Virginia NEMT per-mile rate?
Virginia doesn't publish a single statewide per-mile NEMT rate, because DMAS manages transportation through a contracted broker whose negotiated rates can vary by region and by provider agreement. Confirm the current base trip rate and per-mile rate directly with your broker before signing a provider agreement.
Do wheelchair van trips pay more than ambulatory sedan trips in Virginia?
Generally yes, since wheelchair and stretcher trips require ramp/lift equipment, securement time, and sometimes a second staff member to assist, brokers typically build a higher rate or added fee into these trip types compared to standard ambulatory sedan trips. Exact differentials are set in each broker's contract.
How long does Virginia Medicaid NEMT provider enrollment take?
There's no fixed statutory timeline, and processing time depends on DMAS's current application volume and whether your submission is complete. Many providers report 30 to 90-plus days between enrollment and broker credentialing combined; plan your cash flow assuming the slower end of that range.
Is broker credentialing the same as Virginia Medicaid enrollment?
No, they're separate processes. Medicaid enrollment through DMAS establishes you as a recognized provider type in the state's system; broker credentialing is a separate application, insurance verification, and sometimes vehicle inspection required by the specific broker (such as Modivcare or MTM) managing trip assignment in your region.
What insurance do I need for a Virginia NEMT wheelchair van?
You'll generally need commercial or livery auto insurance meeting minimums set by your broker's contract, which are usually higher than standard personal auto minimums. Some brokers also require you to list them on your certificate of insurance or carry specific liability coverage types; confirm exact minimums with your broker before purchasing a policy.
Can I run NEMT for both Medicaid and Medicare Advantage members in Virginia?
Potentially, but they require separate arrangements. Medicaid NEMT runs through the state's broker contract; Medicare Advantage transportation benefits are set plan by plan as a supplemental benefit, so you'd need to contract separately with any Advantage plan offering that benefit in your area.
Sources
- 42 CFR § 431.53, Assurance of transportation: Federal Medicaid regulation requires states to ensure necessary transportation for recipients to and from providers, directly, by contract, or through a broker
- 42 CFR § 440.170, Transportation: Federal regulation defines transportation as a Medicaid service state plans may cover, including expenses for transportation and other related travel expenses necessary to secure medical examinations and treatment
- Medicare.gov, Ambulance Services coverage: Medicare Part B covers ambulance transportation when other transportation could endanger health, and does not have a broad routine NEMT benefit
- 42 CFR § 455.450, Screening levels for Medicaid providers: Federal regulation requires state Medicaid agencies to screen providers at limited, moderate, or high risk levels, affecting background check and site visit requirements for transportation providers
- Medicaid.gov, Non-Emergency Medical Transportation: CMS overview describing NEMT as a required Medicaid benefit ensuring access to covered health care services for eligible beneficiaries, arranged directly, through contracts, or through a broker
- 42 CFR § 431.107, Required provider agreement: Federal regulation requires state Medicaid agencies to have a written provider agreement in place before a provider can be paid, underpinning the requirement for a completed provider agreement during enrollment