NEMT delivery models: statewide brokers, managed care, regional brokers, and direct billing

Four ways a state buys rides

Every state has to get Medicaid members to covered care, and each decides how. For a transportation company, the choice settles three practical matters: which door you apply through, where your payments come from, and whose rate sheet you work under.

Many states use two or more of these at the same time. The Pennsylvania Department of Human Services report of June 25, 2026 explains why: states often design NEMT around groups of members, such as plan enrollees and everyone else, so a single state can run a plan model and a broker or state program side by side.

The federal rules behind every model

The federal duty is short. 42 CFR 431.53 requires each state plan to commit the Medicaid agency to ensuring necessary transportation and to describe its methods. CMS guidance SMD 23-006 sets out the choices, and each one changes something for providers.

State-hired brokers carry extra obligations under 42 CFR 440.170(a)(4). The state has to choose the broker through competitive bidding and audit it on a regular schedule. The broker must track member access and complaints and ensure transport personnel are “licensed, qualified, competent, and courteous.” It generally may not drive trips itself or refer them to a company it has a financial relationship with, apart from documented exceptions such as a rural area where no other qualified company is available. Transportation companies, for their part, may not give the broker anything of value to win referrals.

One statewide broker

One company takes every Medicaid ride request in the state, builds the provider network, and oversees it. For a provider, that means a single contract, a single credentialing process, and a single provider relations team.

New York shows how it works in practice. Medical Answering Services replaced the regional transportation managers in 2023, with Nassau and Suffolk counties moving last, on December 1, 2023. The state’s manual says the broker has no vehicles, contracts directly with transportation companies, and negotiates rates that take the place of the state fee schedule. Billing runs differently from most broker states: the broker authorizes each trip, and you submit the claim to Medicaid through eMedNY using the prior authorization number the broker issued. Getting in starts with the broker, since eMedNY rejects new non-medical transportation applications filed after April 15, 2024 without its letter of support. According to eMedNY, the broker assigns trips by the member’s choice of network vendor, then the medical practitioner’s choice, then rotation.

Wisconsin gives the state’s side of the argument. Its Department of Health Services says one statewide vendor gives members and transportation providers one contact and one process for eligibility, scheduling, credentialing, billing, and complaints, and gives the state one company to hold to its standards. State law requires the department to rebid the contract on a regular schedule. On May 21, 2026, it announced its intent to select Verida to replace MTM, and its August 25, 2026 update still set no transition date.

Montana is moving into this group. A July 9, 2026 state notice says Modivcare takes over NEMT enrollment and billing under a new broker contract, and the state expects the new program to start October 1, 2026.

The trade-off: one application covers the whole state, and one company controls your trip volume everywhere. If that broker stops adding companies, every county closes at once. See what to do when a broker network is full.

Regional brokers

Here the state is split into regions, each with its own broker, and one company can hold several regions. Every region you drive in takes its own broker contract, and a county line can divide two networks.

Georgia has five regions: North, Atlanta, Central, East, and Southwest. Since Modivcare left Central, East, and Southwest on April 1, 2026, Verida has held all five. Georgia pays by capitation: a fixed monthly amount for every eligible member who lives in the broker’s regions. The broker’s listed duties include signing and paying transportation companies, gatekeeping each member’s request, and reserving and assigning trips.

Kentucky publishes the provider steps. First you obtain state motor carrier operating authority. Then you call the regional broker for your county, such as FTSB around Louisville, Lexington, and Northern Kentucky. The broker goes over its contract, looks at each vehicle, and takes copies of your insurance, registrations, and workers’ compensation proof. You file a separate Medicaid enrollment application for each service type, and the broker signs each one. The Transportation Cabinet reminds new companies that their contract is with the broker rather than the Commonwealth, that the broker pays their invoices, and that a new company needs a minimum of three approved drivers matched to three operating passenger vehicles.

Washington’s Health Care Authority contracts with six regional brokers and lists them by county. Hopelink covers King and Snohomish, People for People covers Yakima, and Special Mobility Services covers Spokane, among others.

Before you buy vehicles in a regional state, lay your intended service area over the region map. A garage close to a boundary may need two broker contracts to keep its vans busy.

Managed care: rides inside the health plans

When rides are carved in, the ride benefit belongs to the health plans, and each one is responsible for getting its enrollees to care. The Pennsylvania report describes two routes a plan can take. It can arrange trips and contract with transportation companies itself, or it can hand daily operations to a broker that runs the call center and the provider network. Either way, members start the request with the plan.

For providers, this usually means more contracts per county. Texas publishes its 14 Medicaid plans with the ride vendor for each, and the vendors are MTM, SafeRide, and Modivcare. Vendors change, too: from October 1, 2026, Blue Cross and Blue Shield of Texas members book with MTM Health rather than Modivcare. Tennessee splits its plans between two vendors. Verida carries BlueCare and TennCare Select members, and Tennessee Carriers carries UnitedHealthcare and Wellpoint members.

Members outside the plans take a different route. In Texas, the state’s Medical Transportation Program handles fee-for-service members and must prior authorize every trip. Its claims administrator, TMHP, enrolls demand response companies and transportation network companies directly. The health plans approve trips for their own members.

A few plans skip brokers and run rides themselves. The guide to contracting with Medicaid health plans names examples and explains their credentialing.

The practical effect: serving all the Medicaid members in a single county can take two or three contracts, and any plan can switch vendors, as Blue Cross and Blue Shield of Texas is doing.

Direct billing: a public office runs the rides

In this model, no broker stands between your company and the program. Your Medicaid enrollment or a county contract is the agreement, a public office approves the trips, and the program pays your claims. The Pennsylvania study notes that under this in-house approach, trips are generally preauthorized and providers are paid under the state’s fee-for-service schedule.

• North Dakota. You enroll with ND Medicaid itself. Before each trip, except trips leaving a hospital, the local human services zone or a tribal office must approve it on form SFN 1507 and give the provider a copy. You bill on the CMS 1500 form or the 837P electronic format within 180 days of service. Payment is capped at your usual and customary charge or the state’s calculated amount, whichever is lower.
• Alabama. Members request rides through the Medicaid Recipient Call Center, 5 or more days before a scheduled visit. Payments to transporters are set up twice a month, on the 1st and the 16th, and the agency cautions that certain counties may lack any transporter.
• Pennsylvania. The Medical Assistance Transportation Program runs county by county. The 2026 study counts 8 counties acting as the sole provider, 38 using a vendor, 7 using a hybrid, 13 under direct agreements between the state and transit agencies, and Philadelphia under a state broker since 2005. The transit authority rabbittransit, for example, runs the program for York, Dauphin, and 11 other counties.

What this means for you: Medicaid enrollment is your contract, the fee schedule is your rate, and each claim is your invoice. The Medicaid billing guide covers the claim itself.

Which states use which model

The Pennsylvania report placed every state and DC in a group, drawing on a profile of each state’s program funded by the Federal Transit Administration. Below is where each state landed, plus changes announced since.

The report’s totals: 11 states use one statewide broker only, 9 use regional brokers only, 20 states and DC combine health plans with other arrangements, 7 leave rides entirely to the state or counties, and 3 pair state or county programs with regional brokers.

Group labels hide a lot of variety. A regional state can end up with one company in every region, as Georgia has, and a plan state can include plans that arrange rides themselves. Confirm the current setup on the state’s own pages, starting from your state guide or the broker directory.

How the model changes your paperwork and your pay

Colorado shows what a model change does to a provider’s paperwork. The state’s September 2026 bulletin says that from January 1, 2027, every trip must be scheduled and approved through MediDrive and every payment will come from MediDrive. Companies outside the Denver metro that have billed the state directly will stop doing so for trips on or after that date, and can still bill the state for earlier trips within the 365-day filing limit.

Finding your state’s model in four steps

1. Start with the Medicaid agency’s transportation page. It will name the broker, the regions, or the health plans that handle rides.
2. Check the state plan’s transportation attachment. SMD 23-006 says Attachment 3.1-D, the assurance of transportation, must describe the state’s methods. Medicaid.gov posts approved state plan amendments.
3. If rides are carved in, match each plan to its ride vendor, and ask how members outside the plans get rides.
4. Call each broker’s or plan’s provider line and ask whether it is adding companies in your counties.

Expect change. Montana and Colorado are switching models between October 2026 and January 2027, Wisconsin has named a new broker without a start date, and plans switch vendors regularly. The broker transition guide explains how to keep trips and payments flowing through a changeover.

Working any model in HealthRide

Most companies end up serving more than one model at once. Because HealthRide connects with brokers like MTM, Alivi and Sentry, their trips arrive on the dispatch board without anyone retyping them, alongside the facility and private-pay rides you book yourself. Every ride keeps its own signatures, GPS miles, and on-time record, whichever payer it belongs to. See broker connections.