Contracting with Medicaid health plans that manage their own rides
Most Medicaid plans that cover rides pay a broker, so your contract is with that broker. A smaller group arranges NEMT itself, including IEHP, Central California Alliance for Health, and Partnership HealthPlan of California. To work for one, enroll with state Medicaid, apply through the plan's credentialing department, and negotiate rates, trip approval rules, claim deadlines, and payment timing.
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Plan or broker: find out who actually buys the rides
When a state puts NEMT inside its Medicaid plan contracts, each plan becomes responsible for its own members’ rides. CMS guidance SMD 23-006 names the legal routes for that (a section 1115 demonstration, a 1915(b) waiver, or a 1932(a) state plan amendment) and confirms a state may instead keep rides outside its plan contracts. See managed care organization for the term.
A plan that holds the benefit then picks one of two ways to run it. Pennsylvania’s Department of Human Services laid both out in a June 25, 2026 study of NEMT in every state. The plan can manage trips itself and sign transportation companies directly. Or it can pay a broker to run the call center, schedule rides, and build and oversee the provider network. Members book through the plan’s contact information in both cases.
| Setup | Who takes the booking | Who signs you | Who pays you |
|---|---|---|---|
| Plan manages rides itself | Plan transportation staff | The plan | The plan |
| Plan pays a broker | Broker call center | Broker | Broker |
| Rides kept outside the plans | A broker the state hires, or the Medicaid program | The state’s broker, or the state | The state’s broker, or the state |
The quickest test is the phone number members call to book. Texas publishes a contact list for its 14 Medicaid plans, and every one routes rides to a broker (three different brokers between them). Tennessee’s four plans split between Verida and Tennessee Carriers. In markets like those, the path runs through broker contracts. The delivery models guide shows which states carve rides into their plans.
Plans that run their own ride programs
A minority of plans keep NEMT in house. These examples come from each plan’s own materials as of September 2026.
| Plan | Where | How members get rides | First contact for a transportation company |
|---|---|---|---|
| Central California Alliance for Health | Mariposa, Merced, Monterey, San Benito, and Santa Cruz counties | Members phone the Alliance no later than 5 business days before the visit, and the Alliance arranges the trip | The Alliance’s credentialing team, using the application written for transportation companies |
| Partnership HealthPlan of California | California | Partnership’s own transportation department books NEMT and non-medical rides. It arranges NEMT only after a clinician signs a Provider Certification Statement. | Partnership’s provider relations team |
| IEHP | California | IEHP has managed NEMT trips itself since May 12, 2026. Its former vendor, Call the Car, still handles non-medical rides. | The IEHP Provider Call Center |
| Arizona Complete Health | Arizona (AHCCCS) | Its provider manual includes NEMT vendors among the organizations it credentials | Its potential provider request form |
Plans change setups in both directions. IEHP took NEMT in house in May 2026. Two Blue Cross and Blue Shield plans are swapping brokers instead: the Texas plan hands its Medicaid rides to MTM Health on October 1, 2026, and the New Mexico plan follows on November 1, both leaving Modivcare.
From first call to signed agreement
Plan credentialing reviews a transportation company much the way a plan reviews any organization in its network. Federal rules set the outline. Each state sets one credentialing and recredentialing policy that all its plans follow, each plan must document its own process, and no plan may contract with a provider excluded from federal health programs (42 CFR 438.214).
- Enroll with state Medicaid. Any company in a plan’s network is a network provider under 42 CFR 438.2, and the state must screen and enroll it even if it never carries a fee-for-service member (42 CFR 438.602(b)). A plan can sign you while enrollment is pending for up to 120 days, then must end the agreement if the state refuses you or the 120 days pass. The Alliance’s packet makes Medi-Cal fee-for-service enrollment a condition for every contracted provider. See becoming a Medicaid transportation provider.
- Find the contract language and a named contact. The state must post each plan’s contract and provider directory online (42 CFR 438.602(g)). Search the contract and the plan’s provider manual for “transportation.” Then call provider services and ask whether the plan signs transportation companies directly, where it is short, and who handles applications.
- Clear any pre-screen. Arizona Complete Health does not start formal credentialing until its Potential Provider Committee approves your request.
- Submit the full credentialing file. Plan packets center on the company rather than on each driver. The Alliance’s transportation packet asks for:
- Your NPI and taxonomy code, a W-9, a business license, and a fictitious business name statement
- Commercial liability coverage of $1,000,000 per claim and $3,000,000 in aggregate, plus commercial vehicle liability coverage
- A copy of a California driver’s license, and first aid and CPR certificates where they apply
- A signed confidentiality declaration and a debarment certification
- Answers to attestation questions about sanctions, license actions, and program history
- Wait for the committee. The Alliance’s Peer Review and Credentialing Committee or a medical director reviews every application. Arizona Complete Health decides within 60 calendar days of a complete application and verifies credentials through the Arizona Association of Health Plans’ credentialing verification organization. It also requires your AHCCCS ID and NPI.
- Sign the provider agreement. Negotiate first, using the terms in the next section.
- Put recredentialing on the calendar. Both plans recredential every 36 months. The Alliance mails the renewal packet about 5 months before the due date and may end network status at once if you miss it. Arizona Complete Health gives notice 180 days ahead, and a provider that misses the deadline goes back through initial credentialing.
Broker credentialing works differently, with more weight on each driver and vehicle. The broker credentialing guide covers that side.
Terms to settle before you sign
Rates can legally differ by specialty, and between two providers of the same specialty (42 CFR 438.12(b)(2)). The first offer is where negotiation starts.
| Area | What the agreement should spell out |
|---|---|
| Rates | A payment for each code and modifier at each level of service, checked against the state’s fee schedule. The billing codes guide lists the usual codes. |
| Extras | How loaded miles are measured, and whether waiting time, no-shows, attendants, and after-hours trips pay anything |
| Trip approval | The approvals and forms that must be on file before a trip. Partnership books NEMT only once a certification statement is signed, and IEHP reminds medical offices to keep the physician certification statement on file. |
| Claims | The claim format, the address or portal, the filing deadline, and the steps to correct or appeal a denial |
| Payment timing | The number of days from a clean claim to payment. The federal prompt-pay standard in plan contracts (30 days for 90 percent of clean claims, 90 days for 99 percent) is written for practitioners’ claims, and a plan and provider may agree to a different schedule in writing (42 CFR 447.46, 447.45). Write your own payment deadline into the contract. |
| Member billing | None. Members may not be billed for covered services the plan fails to pay (42 CFR 438.106), so the plan is your only source of payment. |
| Coverage | The counties and hours you commit to, and what happens when you cannot cover a trip |
| Exit | Notice periods for each side. Arizona Complete Health asks for 60 days’ written notice and may impose a 12-month wait before a departing provider can reapply, depending on the agreement. |
The broker rates guide shows how to check any offer against your own cost per trip. Run a plan’s rate sheet through the same math.
When a plan turns you down
Meeting every requirement does not oblige a plan to add you. Under 42 CFR 438.12, it may limit its network to the providers its members need. It may not refuse you solely because of your type of license or certification, and it has to put its reason in writing. That letter is your to-do list for the next application.
A few rules still work in your favor:
- Uncovered care must be bought out of network. If its network cannot provide a covered service to a member, the plan must cover it out of network, adequately and on time, for as long as the gap lasts (42 CFR 438.206(b)(4)). Ask the plan how it books the rides its network misses.
- Some plans reconsider. Arizona Complete Health accepts a written request within 30 calendar days of a denial issued over quality of care, credential thresholds, or liability claims. A provider denied initial participation there can reapply one year after the committee’s final decision.
Other plans in the county, the fee-for-service program, and local facilities are separate buyers with their own doors. The guide to a full broker network lists them.
Tracking each plan’s money in HealthRide
Every plan you sign adds its own rate sheet and its own payment schedule. In HealthRide, each finished trip becomes an invoice priced from that payer’s rates, and checks, broker payments, insurance payments, and card payments land in one list matched to trips and invoices, so each plan’s unpaid balance is easy to see. See invoicing.
Frequently asked questions
- Will a Medicaid plan sign a transportation company with no broker in between?
- Some will, when they run rides themselves. Central California Alliance for Health has a transportation application that goes to its credentialing department, and NEMT vendors appear on Arizona Complete Health's list of organization types it credentials. Where the plan hands rides to a broker, as every Texas Medicaid plan does, you sign with the broker instead.
- Which plans in my area use a broker?
- Look up the number a member calls to book a ride. Texas and Tennessee publish each Medicaid plan's ride vendor, and elsewhere the plan's member handbook lists it. A broker's number means you apply to that broker. If members reach the plan's own transportation staff, as Alliance and Partnership members do, the plan is the buyer.
- Is state Medicaid enrollment required for plan work?
- Yes. 42 CFR 438.602(b) makes the state screen and enroll each company in a Medicaid plan's network, including companies that never carry a fee-for-service member. A plan can contract with you before enrollment is final, with a 120-day limit on that pending period. The Alliance requires Medi-Cal fee-for-service enrollment from every provider it contracts with.
- How long does credentialing with a health plan take?
- It varies by plan. Arizona Complete Health first needs its Potential Provider Committee to approve your request, then decides within 60 calendar days of a complete application. Add time for state enrollment, which the plan needs before it can finish.
- What happens if a plan turns my company down?
- A plan may keep its network no larger than its members require, so a refusal can be lawful. It still owes you a written reason, and it may not refuse you only because of the type of license you hold (42 CFR 438.12). Arizona Complete Health lets applicants declined over quality, credentials, or liability claims ask for reconsideration in writing within 30 calendar days.
- If a plan never pays for a trip, can the rider be billed?
- No. 42 CFR 438.106 requires the plan to protect its Medicaid members from charges for covered services it fails to pay a provider for, and from its own debts if it becomes insolvent. Your remedy is the plan's dispute or appeal process.
