Are NEMT drivers covered by DOT drug testing?

Only some. Part 382 of the federal motor carrier rules tests CDL holders, and a passenger van calls for a CDL once it is built to seat at least 16, counting the driver, or carries a weight rating of 26,001 pounds or higher. Part 655 tests everyone who operates revenue service vehicles for certain FTA grant recipients and their contractors, with or without a CDL. The typical minivan or wheelchair van driver is outside both, so company policy, broker contracts, and state law set the rules.

Did the 2026 marijuana rescheduling change DOT testing?

No. The April 28, 2026 order moved FDA-approved marijuana drugs and marijuana subject to a state medical marijuana license to Schedule III, and all other marijuana stayed in Schedule I. DOT's drug and alcohol office answered in May 2026 that a medical review officer still cannot report a marijuana positive as negative because the employee used a state-licensed product, because rescheduling gave marijuana sold under state programs no FDA approval, and without that approval no valid prescription exists.

May a company turn down an applicant over a positive marijuana test?

State law and the job decide. California forbids decisions based on a test showing nothing but nonpsychoactive metabolites, and Washington applies the same limit to hiring. Nevada bars refusing to hire over a marijuana result, but exempts jobs that require driving where law requires testing and jobs the employer decides could affect others' safety. Minnesota bars cannabis testing of applicants unless the law requires it or the job falls under an exception, such as safety-sensitive work or face-to-face care of vulnerable adults or patients.

Is a medical marijuana card holder allowed to drive NEMT vans?

For company-tested drivers, state law answers that, and no state protects impaired driving. Arizona forbids penalizing a registered patient for a positive test, except where the use, possession, or impairment happened on the job site or on the clock, and an employer whose testing policy follows the state's testing law may remove anyone from a safety-sensitive job, including driving, on a good-faith belief of current impairing drug use. For CDL or FTA-covered drivers, a card is not an acceptable medical explanation.

Do brokers have their own marijuana rules?

Yes. MTM's provider agreement requires drug screens covering marijuana, forbids drug use or influence at any time while serving MTM members, and takes a driver with a positive screen off MTM trips. Louisiana's Medicaid manual bans marijuana use or influence for NEMT drivers who are driving or physically controlling a vehicle, medical marijuana included.

What does federal Medicaid law require about drivers and drugs?

Federal law makes every state keep a mechanism, which may be an attestation, ensuring each NEMT provider has "a process to address any violation of a State drug law." It also requires that providers and drivers not be excluded, that drivers hold valid licenses, and that providers can disclose drivers' driving histories to the state.

Compliance

Marijuana laws and NEMT drivers: testing, off-duty use, and safety-sensitive jobs

Updated September 30, 20269 min read

A NEMT company can bar drivers from using marijuana on duty everywhere. Federal testing reaches CDL holders and drivers on FTA-funded service, and it still rejects medical use as an explanation for a positive result, although the April 28, 2026 order put state-licensed medical marijuana in Schedule III. Off-duty use and hiring tests follow state law, and several states exempt safety-sensitive driving jobs.

On this page

Every NEMT company can keep marijuana out of the driver’s seat. The harder questions are about testing and off-duty use: which drivers fall under federal testing, whether a positive pre-employment test can cost someone the job, and what to do with a driver who holds a medical card. The answers depend on the vehicle, the funding, the broker, and the state. This guide sorts them out as of September 30, 2026, including the federal rescheduling order that took effect April 28, 2026.

What changed federally in 2026

On April 28, 2026, a final order took effect placing two kinds of marijuana in Schedule III of the Controlled Substances Act: drug products approved by the FDA, and marijuana subject to a state-issued medical marijuana license (91 FR 22714). The order says every other form of marijuana remains in Schedule I, which leaves adult-use products sold under state recreational licenses where they were. The broader proposal, which would place all marijuana in Schedule III, was set for a DEA hearing starting June 29, 2026, and no final rule on it had been published by September 30, 2026.

For transportation testing, nothing moved. In a May 2026 answer, the Department of Transportation’s drug and alcohol office said a medical review officer cannot downgrade a lab-confirmed marijuana positive to negative on the claim that it came from a state-licensed product. Rescheduling did not give state-dispensed marijuana FDA approval, and without that approval there is no valid prescription. Medical cards, physician certifications, and dispensary receipts therefore do not qualify as a legitimate medical explanation. The same answer states that using marijuana does not fit with safety-sensitive duties (ODAPC Part 40 Q&A). Part 40 separately forbids accepting hemp or other non-prescription marijuana products as an explanation (49 CFR 40.151).

Which drivers fall under federal rules

Most NEMT drivers are outside federal testing. Four situations bring federal rules in.

Driver situation	Federal rule	Effect on marijuana use
Holds a CDL because the van is built to seat at least 16 counting the driver, or weighs in at a 26,001-pound rating or higher	49 CFR Part 382	The full DOT testing program; no duty while using a Schedule I drug, and other controlled substances only with a practitioner’s advice that driving is safe (49 CFR 382.213)
Operates revenue vehicles for a recipient of FTA grants under 49 U.S.C. 5307, 5309, or 5311, or for its contractor	49 CFR Part 655	FTA testing for everyone operating a revenue service vehicle, CDL or not, plus dispatchers who control vehicle movement (49 CFR 655.4)
Drives a 9 to 15 passenger van on paid interstate trips	49 CFR Part 391, unless the trip falls under the sick and injured persons exception	No federal drug testing without a CDL, but a qualified driver may not use any Schedule I drug (49 CFR 391.41(b)(12))
Everyone else	None	Company policy, broker rules, and state law decide

The CDL line is set in 49 CFR 383.5, and the CDL guide walks through it. The DOT number guide explains the sick and injured persons exception and why FMCSA applies it trip by trip. Part 382 also applies to an owner who drives: an employer whose only driver is itself must run random testing through a selection pool of two or more covered employees (49 CFR 382.103).

Medicaid and broker rules

Federal Medicaid law does not set a marijuana rule for NEMT drivers, but it makes each state confirm, by attestation or another mechanism, that every NEMT provider has “a process to address any violation of a State drug law” (42 U.S.C. 1396a(a)(87)). States and brokers fill in the details.

Louisiana. The Medicaid transportation manual forbids a driver to use marijuana, or be under its influence, while driving or in physical control of a vehicle, and it names therapeutic or medical marijuana that state law permits as covered by that ban. It separately prohibits taking medical marijuana across state lines and any unlawful possession or use of marijuana at work.
MTM. Under the MTM provider agreement that Pennsylvania’s Department of Human Services publishes, a drug screen means a urine-based test built to HHS or DOT standards, and its minimum panel includes marijuana along with cocaine, amphetamines, opioids, and PCP. The provider must keep a written substance-free workplace policy that includes pre-hire and random testing, and a refusal to test counts as a positive. Drug use, or being under the influence, is off limits at any time a driver serves MTM members. A driver under reasonable suspicion comes off service at once and is tested at the provider’s cost, a positive result ends that driver’s MTM work, and anyone with a positive screen or addiction treatment in the past five years is ineligible.

Check each broker manual you work under. Broker contract terms sit on top of state employment law, so a driver policy has to satisfy both.

State laws on off-duty use and hiring tests

State employment law decides what a company may do about off-duty use and pre-employment tests for drivers outside federal testing. These examples come from the statutes themselves.

State	Protection	Exceptions that matter for NEMT
California	No discrimination for cannabis use off the job and away from work, or for a result showing only nonpsychoactive metabolites; no questions to applicants about prior use (Gov. Code 12954)	Testing required by state or federal law, including as a condition of federal funding or a federal contract; on-the-job use or impairment is never protected
New York	Legal cannabis use outside work hours, off premises, and without employer equipment or property is protected (Labor Law 201-D)	Action required by law; specific, articulable symptoms of impairment while working; action needed to avoid violating federal law or losing a federal contract or funding
New Jersey	No adverse action for cannabis use or solely for metabolites; testing is allowed, but a lab result has to be combined with a physical exam by a certified Workplace Impairment Recognition Evaluator (N.J.S.A. 24:6I-52, as amended by P.L.2025, c.325)	Drug- and alcohol-free workplace policies; federal contract impact; the statute expressly leaves impaired-driving laws untouched
Washington	No hiring discrimination for off-duty use or metabolite-only tests (RCW 49.44.240)	Post-accident and suspicion testing; tests required by law; safety-sensitive positions where impairment presents a substantial risk of death, named before the applicant applies
Nevada	No refusing to hire over a marijuana result on a screening test (NRS 613.132)	Jobs requiring driving where law requires testing; jobs that could affect others’ safety, in the employer’s judgment; federally funded positions
Minnesota	Cannabis counts as a lawful consumable product, so off-duty use away from work is protected (181.938); applicants cannot be cannabis-tested as a hiring condition unless a state or federal law calls for it (181.951)	Cannabis is treated as a drug under the testing law for safety-sensitive positions, positions providing face-to-face care or medical assistance to patients or vulnerable adults, and positions where law requires a test; random testing is limited to safety-sensitive positions
Illinois	Using products that are legal under state law, off the employer’s premises and outside work and on-call time, is protected (820 ILCS 55/5)	The cannabis act preserves reasonable zero-tolerance and drug-free workplace policies, including testing, and action on specific, articulable symptoms, with a chance for the employee to contest (410 ILCS 705/10-50)
Connecticut	Without a written policy that says otherwise, off-duty use cannot lead to discipline, and a test positive only for the THC metabolite cannot by itself justify rejecting or penalizing someone (21a-422p, 21a-422q)	Exempted employers include companies whose main business is transportation or health care and social assistance; exempted positions include driving jobs where law requires testing, jobs involving care or supervision of medical patients and vulnerable people, and jobs the employer decides could affect public safety
Arizona	A registered patient’s card, or a positive marijuana test, cannot be held against them unless they used, possessed, or were impaired by marijuana on the job site or on the clock (36-2813)	An employer with a testing policy that follows Arizona’s testing law may pull an employee from a safety-sensitive position, a term that covers driving a motor vehicle, on a good-faith belief of current use of a drug that could impair (23-493.06)
Virginia	No firing, discipline, or discrimination for lawful medical cannabis oil use that a practitioner has certified in writing (40.1-27.4)	Action for work impairment; banning possession during work hours; federal law, contracts, and funding
Florida	No employment protection: the medical marijuana law does not limit drug-free workplace programs or require accommodating medical use at work (381.986)	Not applicable

The exceptions that usually reach drivers

Driving jobs often fit the exceptions these laws carve out, but not always, so read the words of your state’s law.

Federally required testing continues everywhere. Most of these statutes say so expressly, and FTA’s rule preempts any state law that makes compliance with it impossible or stands in its way (49 CFR 655.6).
Safety-sensitive definitions differ. Arizona names operating a motor vehicle. Minnesota uses any job where drug or cannabis impairment would endanger someone’s health or safety. Nevada and Connecticut let the employer judge which jobs could affect other people’s safety. Washington requires a substantial risk of death and identification of the position before anyone applies, and its whole law covers only hiring.
Patient care exceptions may help. Minnesota’s reaches jobs that give face-to-face care or medical assistance to patients and vulnerable adults, and Connecticut’s reaches jobs that involve the care or supervision of medical patients and vulnerable people. Whether a driving job qualifies depends on its actual duties.
Industry exemptions apply in Connecticut, where transportation and health care employers are exempted employers.
Impairment is never protected. None of these laws protects using marijuana, or being impaired by it, while driving for work.

New Jersey has no general safety-sensitive exception. There, a company acting on a driver’s test needs the physical impairment evaluation along with the lab result.

Writing the policy

A driver policy should work for both federally covered and company-tested drivers.

Name who is covered by which rules. List DOT-covered and FTA-covered positions separately, since DOT tests must stay completely separate from company tests, down to a separate urine collection (49 CFR 40.13).
Ban use and impairment at work in plain words, including in company vans, on breaks, and on call where state law allows.
Match testing to state law. Minnesota requires a written policy before any testing, New Jersey requires the physical evaluation, and California bars asking applicants about past use.
Define reasonable suspicion by observable signs, such as speech, coordination, and unsafe driving, and require a supervisor’s written notes.
Say what happens after a positive or a refusal, consistent with broker contracts. MTM treats a positive as disqualifying for its trips.
Address medical use honestly. State whether card holders may hold driving jobs under your state’s law, and require drivers to report medications that could affect driving.

Example wording: “No employee may use or possess marijuana in any form, medical marijuana included, or work while affected by it, when on duty, on call, or in a company vehicle. Drivers in DOT- or FTA-covered positions are tested under federal rules, and a state medical marijuana card is not an acceptable explanation for a positive result.”

The template for a driver drug and alcohol policy includes fill-in sections for test types, state terms, and the signed acknowledgment. The driver requirements guide covers the rest of driver screening.

Tracking screens with the rest of the driver file

A drug screen date is one more credential that can lapse. HealthRide tracks each driver’s credentials and their expiration dates on the fleet page, sends reminders before a date passes, and warns dispatch when a driver with a lapsed credential is about to be assigned.

Frequently asked questions

Are NEMT drivers covered by DOT drug testing?: Only some. Part 382 of the federal motor carrier rules tests CDL holders, and a passenger van calls for a CDL once it is built to seat at least 16, counting the driver, or carries a weight rating of 26,001 pounds or higher. Part 655 tests everyone who operates revenue service vehicles for certain FTA grant recipients and their contractors, with or without a CDL. The typical minivan or wheelchair van driver is outside both, so company policy, broker contracts, and state law set the rules.
Did the 2026 marijuana rescheduling change DOT testing?: No. The April 28, 2026 order moved FDA-approved marijuana drugs and marijuana subject to a state medical marijuana license to Schedule III, and all other marijuana stayed in Schedule I. DOT's drug and alcohol office answered in May 2026 that a medical review officer still cannot report a marijuana positive as negative because the employee used a state-licensed product, because rescheduling gave marijuana sold under state programs no FDA approval, and without that approval no valid prescription exists.
May a company turn down an applicant over a positive marijuana test?: State law and the job decide. California forbids decisions based on a test showing nothing but nonpsychoactive metabolites, and Washington applies the same limit to hiring. Nevada bars refusing to hire over a marijuana result, but exempts jobs that require driving where law requires testing and jobs the employer decides could affect others' safety. Minnesota bars cannabis testing of applicants unless the law requires it or the job falls under an exception, such as safety-sensitive work or face-to-face care of vulnerable adults or patients.
Is a medical marijuana card holder allowed to drive NEMT vans?: For company-tested drivers, state law answers that, and no state protects impaired driving. Arizona forbids penalizing a registered patient for a positive test, except where the use, possession, or impairment happened on the job site or on the clock, and an employer whose testing policy follows the state's testing law may remove anyone from a safety-sensitive job, including driving, on a good-faith belief of current impairing drug use. For CDL or FTA-covered drivers, a card is not an acceptable medical explanation.
Do brokers have their own marijuana rules?: Yes. MTM's provider agreement requires drug screens covering marijuana, forbids drug use or influence at any time while serving MTM members, and takes a driver with a positive screen off MTM trips. Louisiana's Medicaid manual bans marijuana use or influence for NEMT drivers who are driving or physically controlling a vehicle, medical marijuana included.
What does federal Medicaid law require about drivers and drugs?: Federal law makes every state keep a mechanism, which may be an attestation, ensuring each NEMT provider has "a process to address any violation of a State drug law." It also requires that providers and drivers not be excluded, that drivers hold valid licenses, and that providers can disclose drivers' driving histories to the state.