Where to start a NEMT company: comparing states on rates, rules, and open networks
No state is best for everyone. Compare five things: whether new companies can enroll, who pays for rides, what the published rates are, what license the state requires, and what changes are coming. For example, Utah accepts no new NEMT provider applications, Minnesota enrolls no new Twin Cities metro companies until January 27, 2027, and South Dakota pays wheelchair vans from its own fee schedule with no broker.
On this page
Many owners never really choose a state. They start where they live, because that is where their insurance history, their drivers, and their contacts at dialysis centers are. Still, the gap between states is wide enough to matter if you live near a state line, plan to move, or want to open a second location. Five questions decide whether a state is a good place to start: can you get in, who pays, what does it pay, what does it take to be legal, and what is about to change.
The five things to compare
- An open door. Some states or brokers are not adding companies, either by law or because their network is full.
- Who pays for rides. One statewide broker, several health plan brokers, county programs, or the state itself. Each means a different number of contracts and manuals.
- The rate. Some states publish a fee schedule. In broker and health plan states, your rate is set in your own agreement.
- Operating authority. Ranges from nothing beyond Medicaid enrollment to a certificate with a bond or a public hearing.
- Coming changes. Broker handovers, new licenses, and freezes all change the math for a company starting now.
The state guides cover each of these in detail for all 50 states and the District of Columbia.
Eleven states side by side
The table pulls the main points from eleven state guides. It shows how different the starting conditions are, not a ranking.
| State | Who pays for most rides | Authority to plan for | Door for new companies | Dated change |
|---|---|---|---|---|
| Colorado | The state directly outside the nine-county Denver metro; MediDrive in the metro | Medicaid enrollment, then credentialing, then a MediDrive contract | Open to new companies from October 1, 2026, after a moratorium that lasted through September 30 | MediDrive schedules and pays trips in every county from January 1, 2027 |
| Florida | Medicaid health plans, each through a ride vendor such as Modivcare, MTM, Alivi, or Ride2MD | No statewide license; counties may license vehicles for hire | Vendor by vendor | |
| Georgia | One broker, Verida, in all five regions | Department of Public Safety authority as a passenger carrier | Verida contracts where a region needs more capacity | Verida took over three regions from Modivcare on April 1, 2026 |
| North Carolina | Medicaid health plans and the brokers they hire | NC Medicaid enrollment through NCTracks | Plans and brokers may not require exclusivity or non-compete terms | |
| Ohio | County agencies, health plans (Anthem uses MTM, for example), and a state fee schedule for wheelchair vans | Ambulette service license and vehicle permits for wheelchair vans | Varies by payer | New payment appendix enacted July 10, 2026 |
| Pennsylvania | County programs in all 67 counties | PUC certificate, $350 per class of service, open to protest | County by county | A June 2026 state study found the county model more effective than a statewide broker |
| Rhode Island | MTM Health, statewide | NEMT certificate after a public hearing, $125, renewed yearly | Through MTM | |
| South Dakota | The state; no broker | $1 million liability coverage and a safety check every week or 1,000 miles for wheelchair and stretcher vans | Direct Medicaid enrollment | New fee schedule effective July 1, 2026 |
| Texas | Medicaid health plans, each through a ride vendor | State vehicle standards in 1 TAC chapter 380 | Vendor by vendor | For trips on or after October 1, 2026, MTM Health is Blue Cross and Blue Shield of Texas’s ride vendor in place of Modivcare |
| Utah | The state, with Modivcare as statewide broker | No Medicaid enrollment for new NEMT companies | Only by contracting with Modivcare | |
| Virginia | Health plan brokers, plus a state broker for fee-for-service members | DMV NEMT carrier certificate, $25,000 surety bond, NEMT plates | Broker by broker | For trips on or after October 1, 2026, MTM Health is the fee-for-service broker in place of Modivcare |
A blank cell means the guide lists no dated change for that column. Check the linked guide before you commit, since broker contracts change often.
Can you get in
The first filter is whether anyone will add a new company in your area.
- Enrollment freezes. Under 42 CFR 455.470, a state can stop enrolling a provider type it considers high risk, for six months at a time, with federal approval. Minnesota’s freeze keeps out new NEMT companies based in the seven metro counties around Minneapolis and Saint Paul through January 27, 2027, while companies based in other Minnesota counties can still enroll. Colorado’s freeze lasted through September 30, 2026, and new companies can enroll from October 1. See enrollment moratorium.
- Closed state enrollment. Utah’s transportation manual is blunt: “Medicaid does not accept applications for additional NEMT providers.” New companies reach Utah Medicaid riders only through a contract with Modivcare.
- Capacity-based contracting. Georgia’s broker invites qualified companies in areas where it needs transportation. You submit a request for qualifications, and a full region can mean a long wait. Our guide to full broker networks covers the options.
Who pays shapes your first year
The payment model decides how many relationships you manage and how exposed you are to one decision.
- One statewide broker (Georgia, Rhode Island). One contract, one manual, one payment schedule. If that broker cuts your volume, you have no second Medicaid source in the state.
- Health plan brokers (Florida, North Carolina, Texas, Virginia). Each plan picks a ride vendor, so reaching most members can take two or three contracts. North Carolina’s managed care policy bars plans and their brokers from putting exclusivity or non-compete provisions in transportation provider contracts.
- County programs (Pennsylvania, and part of Ohio). Pennsylvania funds its medical assistance transportation program in all 67 counties, and 53 counties run it in-house. In Ohio, county agencies contract with ride vendors on the state’s behalf, while the state pays wheelchair van trips from its own schedule. You market to each county program separately.
- The state itself (South Dakota). No broker stands between you and the payer. Enrollment is with South Dakota Medicaid itself, and each trip is billed to it.
Timing can move a state from one model to another. Colorado’s trips outside the Denver metro are billed to the state until January 1, 2027, when MediDrive takes over every county. How states run NEMT explains each model in depth.
What the rates look like
Only some states publish what they pay, and published rates mostly apply to fee-for-service trips. Two published wheelchair van schedules show how far apart states can be:
| Wheelchair van, 10 loaded miles outside city limits (example) | Ohio | South Dakota |
|---|---|---|
| Base rate (A0130) | $31.00 | $43.39 |
| Mileage (S0209) | $1.30 a mile | $2.61 a mile |
| Example trip total | $44.00 | $69.49 |
| Schedule | OAC 5160-15-28 appendix, enacted July 10, 2026 (rates last changed January 1, 2024) | Effective July 1, 2026 |
Ohio’s figures are maximum payments. South Dakota’s schedule calls the wheelchair van a secure van, and it pays S0209 mileage only for the part of a trip outside city limits, so an in-town trip earns the base rate alone. A higher rate does not mean a better business on its own. South Dakota requires $1 million in liability coverage for secure medical transportation and a safety inspection every week or every 1,000 miles, whichever comes first.
In broker and health plan states, rates come from each broker. MTM Health says its Texas rates are worked out company by company, while its Virginia handbook prices trips from a Schedule A rate sheet for the state. Ask every broker for its rate sheet before you plan a budget. The Ohio rate guide, South Dakota rate guide, and how much Medicaid pays for NEMT go further.
What it takes to be legal
Licensing ranges from light to demanding, and the cost is time as much as money.
| State | What the state requires before you carry riders |
|---|---|
| Virginia | DMV NEMT carrier certificate, NEMT-designated plates, and a $25,000 surety bond or letter of credit that stays on file for three years |
| Rhode Island | NEMT certificate of operating authority, issued only after a public hearing; $125 to apply and $100 to renew each December 31 |
| Pennsylvania | PUC certificate filed on Form 178 with a $350 fee for each class of service; the application is published and existing carriers may protest it |
| Nebraska | From January 1, 2027, a one-year state license for intrastate Medicaid NEMT, with a fee capped at $250 |
| Minnesota | A certificate of compliance from MnDOT for special transportation service, the state’s category for these carriers |
| Ohio | A state license for the ambulette (wheelchair van) service, plus a permit on every ambulette vehicle |
| Georgia | Department of Public Safety authority; a carrier that only takes elderly or disabled riders, 10 or fewer per vehicle, is directed to yearly GIMC registration |
Florida has no statewide NEMT license, but counties may license vehicles for hire. Florida’s 2024 law letting a vehicle-for-hire license from your home county count in other counties does not apply to stretcher and wheelchair transportation, so county NEMT licenses still apply where a county requires one. See NEMT license requirements for a wider list.
Changes to watch before you commit
A state that looks good today may change in a few months. These dated changes affect companies starting now:
- Colorado. MediDrive schedules and pays every county’s trips from January 1, 2027.
- Nebraska. The new Medicaid NEMT license is required from January 1, 2027.
- Minnesota. The metro freeze runs through January 27, 2027, and the state may extend it again.
Broader Medicaid changes matter too. Medicaid work requirements and NEMT covers the national enrollment rule that begins in 2027.
Matching a state to your plan
Use your own situation to weigh the factors:
- You want one clear path. Look for states where the steps are written out, even if they cost more up front, such as Virginia’s certificate and bond or Rhode Island’s hearing.
- You want to bill the payer directly. State-paid programs like South Dakota’s let you enroll and bill without a broker.
- You want several payers from day one. Health plan states give you more than one broker to contract with, at the cost of more paperwork.
- You are near a state line. Compare both states on all five factors, then look at where your riders’ dialysis centers and hospitals actually are.
Whatever you choose, run the numbers with your real rates and costs in the startup cost calculator before you buy a van.
Running trips in any state
Every state on this list sends trips through some mix of brokers, health plans, counties, and facilities. HealthRide connects with your brokers, like MTM, Alivi and Sentry. Whatever trips they send land on your board on their own, beside the facility and private-pay rides your team books. Each trip keeps its signatures, GPS-recorded miles, and timestamps, whoever pays for it. See broker connections.
Frequently asked questions
- What is the easiest state to start a NEMT business in?
- There is no single easiest state, because the hard part changes from state to state. Some states license lightly but send you to a broker that only adds companies where it needs capacity, as in Georgia. Others ask more up front, such as Virginia's $25,000 bond or Rhode Island's public hearing, but spell out the path. Start with the state you live in, then check the five factors in this guide.
- Should I pick a state for its Medicaid rates alone?
- No. A higher published rate often comes with higher costs. South Dakota pays more per wheelchair van trip than Ohio, but it also requires $1 million in liability coverage and a vehicle safety inspection every week or every 1,000 miles for those vans. Published rates also cover mainly fee-for-service trips. Broker and health plan rates are set company by company.
- Which states pay the highest Medicaid rates for NEMT?
- Published fee schedules only cover part of the market, so a true ranking is not possible. Where schedules exist, the gap can be large: on a wheelchair van trip of 10 loaded miles, all outside city limits, South Dakota's July 2026 schedule pays $69.49 and Ohio's pays up to $44.00. In broker and health plan states, each company's rate is set in its own agreement, so request the rate sheet from every broker you apply to.
- What does an enrollment moratorium mean for a new company?
- It means the state will not enroll new providers of that type in the covered area until the freeze ends. Federal rules let a state impose one for six months at a time, with extensions. Minnesota's freeze covers new NEMT companies based in its seven metro counties through January 27, 2027. Colorado's lasted through September 30, 2026, and new companies can apply from October 1.
- Is a statewide broker better than health plan brokers for a new company?
- Each has a trade-off. One statewide broker means one contract, one set of rules, and one payer, but also one point of failure if that broker cuts your trips. Health plan states mean several contracts and several manuals, but losing one leaves the others. Many operators in plan states end up contracting with two or three brokers.
