Can a Medicaid member choose the transportation company? Broker assignment and same-driver requests

In most states, a Medicaid member does not get to pick the company that drives them. A broker or health plan books the ride and passes it to one of the companies it contracts with. Choosing a doctor works differently, and a handful of states still give members a real say over the ride, from a free pick in Alabama to a written right to ask in Colorado.

Why the broker usually picks the company

Federal law lets a state set aside free choice of provider for rides once it hires a broker. The authority is section 1902(a)(70) of the Social Security Act, which Congress created in section 6083 of the Deficit Reduction Act of 2005. It allows a state to run a NEMT brokerage program “notwithstanding” three other parts of the law: statewideness, comparability, and section 1902(a)(23), the free choice of provider rule.

Before that change, a state that paid for rides as a medical service could not limit members’ choice by contracting selectively with a broker unless it held a section 1915(b) waiver. The final rule putting the broker option into regulation, published December 19, 2008 and effective January 20, 2009, explains the reason: setting aside free choice lets a state pick the most cost-effective broker through competitive bidding.

The trade-off sits in 42 CFR 440.170(a)(4): the broker must monitor member access and complaints and make sure rides are timely and drivers are licensed, qualified, competent, and courteous. That duty is why a written complaint carries weight. The other broker conditions, from competitive bidding to the ban on self-dealing, are covered in how states run NEMT.

Brokers are not the only route around free choice. CMS’s 2023 transportation coverage guide, SMD 23-006, says free choice does not apply when a state claims rides as an administrative cost, and that managed care authorities can waive it too. Free choice binds only when a state pays for rides as a medical service without a broker or waiver. In that setup, a member may use any qualified Medicaid provider willing to serve them. Health plans, for their part, send rides through the transportation vendor they contract with.

Choosing the doctor is a separate right

Losing the choice of ride company does not take away the choice of doctor. Section 1902(a)(23) still lets a member get care from any qualified provider who agrees to serve them, subject to the plan’s rules.

Rides can strain that right. States generally pay to reach the closest qualified provider, and a longer trip usually needs a medical justification. CMS addresses the conflict directly in SMD 23-006:

• If a ride to the member’s chosen doctor costs the same as a ride to a closer one, or only a minimal amount more, refusing it could violate free choice.
• If leaving a distant doctor would harm the member, or that doctor has special capabilities the member’s care needs, refusing the ride may also violate free choice.
• When a state does refuse a ride over distance, it should help the member find closer providers and offer a review process for trips beyond its usual zone.

Washington writes both halves into one rule. Under WAC 182-546-5000, clients “may not select the transportation provider or the mode of transportation,” and their free choice of doctor does not require the state to pay unusual or exceptional transportation costs.

Where members get a say

States split three ways: the member chooses, the member may ask, or the member has no say. These six policies show the range.

A few details matter for the people booking:

• Alabama’s Medicaid agency runs NET itself, through its own coordinators. A member calls the Recipient Call Center (1-800-362-1504, option 4) five or more days ahead of the appointment, or no later than 24 hours after an urgent visit. Alabama’s procedures say a county may have no transporter at all, and then the member has to arrange the trip some other way.
• Louisiana also steers trips toward local companies. When several companies tie on cost, the broker should favor a company that lists the member’s home region as its primary area of operation. A company from outside the region can get the trip only if the broker keeps records showing that no willing local company could keep to the timing rules, or that the outsider was cheaper.
• Kentucky uses Type 07 for a specialty carrier serving disoriented riders who can walk, and Type 08 for lift or ramp vehicles serving riders who cannot. A written recommendation from the rider’s physician or another clinician named in the statute sets the level, and the broker may not change it. A rider who names a company still books through the broker, and if they name no one, the broker assigns the trip and must share these trips fairly among its subcontractors.
• Colorado’s broker, MediDrive, began with the nine Denver metro counties in July 2026, and the whole state follows on January 1, 2027. HCPF says a preferred-provider request does not guarantee future assignments. A 2026 state law, House Bill 26-1328, goes further: the broker must let members ask for a company, or a different one, before a trip, may not steer them away from the company they prefer, and must keep every request on file for audits. Two limits apply. Requests for a specific company open only after every service region is running, and a company under trip caps in a corrective action plan can be passed over.
• Missouri’s FAQ also lets a member ask that a particular company not be sent again. The broker investigates the incident that prompted the request.

Health plans can set aside free choice as well, so a member in managed care usually rides with whichever company the plan’s vendor assigns.

Asking for the same company or driver

Families of riders with dementia or autism often ask for the same company or driver every time. No program promises a specific driver, but several give you something to work with. The broker assigns the company and the company assigns the driver, so the request has to reach both.

1. Book the trips as a standing order. Repeat appointments such as dialysis, therapy, or day treatment can usually be booked one time as a standing order. When several companies tie on cost, Louisiana’s manual has the broker keep the standing order with one company “to ensure continuity of care and to prevent missed treatments.”
2. Name the company you want on the order. In Colorado and Missouri, ask the broker to record a preferred provider. In Kentucky, a rider with a Type 07 or 08 certificate can name the company outright. In Virginia’s fee-for-service program, MTM Health’s provider handbook says that when a standing order names a provider, its trips go straight to that company.
3. Ask the company for the same driver. Once you know which company has the trips, call its dispatcher. The same Virginia handbook (May 2026) asks companies to make a good-faith attempt to use one driver for a rider’s recurring and standing order trips whenever operations allow, particularly when a rider has cognitive, mobility, or medical needs. It does not promise a driver, and companies are told to note in the record each time a substitute covers.
4. Put the reason in writing. CMS’s coverage guide lists steps a state can take when a rider’s needs make the match with drivers hard: limiting the rider to one company that can handle those needs when no other willing company exists, requiring specialized transport, and consulting the rider’s treating practitioners. A short letter from the doctor, therapist, or case manager explaining why a change of driver causes harm gives the broker something concrete to act on.
5. Arrange an escort if the rider needs one. A family member or aide who rides along can bridge a new driver. Rules on escorts and attendants differ by state. Kentucky, for example, does not require an escort for riders 13 and older unless a clinician recommends one for specific safety reasons.
6. Consider a family driver. Where mileage reimbursement is offered, a relative or friend the rider trusts can drive and be reimbursed. Our mileage reimbursement page covers the usual rules.

One practical detail for Missouri: rideshare trips require the member to send and receive text messages. If the rider cannot, call the broker at (866) 269-5927 and ask to have rideshare excluded from their file. For the van side of consistency, see our guide for drivers on transporting riders with dementia.

When the assigned company keeps failing

A member without a choice of company still has ways to end a bad match. Work through them in order.

1. Get today’s ride first. Call the broker’s number for late or missing rides. CMS expects members to know how to report a driver who never came and ask for another ride, and expects states to let substitute companies step in quickly.
2. Keep a record of each failure. Write down the date, the scheduled time, the confirmation number, the time the van showed up (or that it never did), and who you spoke with.
3. Ask the broker not to use that company. Missouri states this option in writing. Elsewhere, ask anyway and have the request noted on the member’s record.
4. File a complaint. Brokers must monitor complaints under 42 CFR 440.170(a)(4), and a written pattern is harder to set aside than one bad day. Our guide to filing a Medicaid transportation complaint covers where to send it and what to include.
5. Go to the state if nothing changes. The state Medicaid agency answers for the broker. If rides are denied or cut back rather than just late, that is an appeal, covered in when a Medicaid ride is denied.

Watch the other direction too. CMS lets a state answer a member’s repeated no-shows by assigning one company and making every trip depend on the member confirming it shortly beforehand. Answering confirmation calls protects the member’s rides.

If you run the company members ask for

A request for your company by name is a request for the same dependable driver, trip after trip. With HealthRide, the company schedules a standing appointment once and HealthRide keeps it going, so the dispatcher only has to assign the rider’s usual driver, one motion per trip on the board. Riders and families follow their driver live from a text link. See recurring trips.