Staffing agency drivers for NEMT: joint employment, insurance, and broker approval

Staffing agency drivers can fill a NEMT schedule, but only after they clear the same broker credentialing, insurer approval and screening as your own drivers, and your company will likely share legal responsibility for them as a joint employer. The broker credentialing guide covers the approval steps every driver goes through, whoever employs them.

Where agency drivers fit and where they do not

A staffing agency can put a licensed driver in your van next week. It cannot make that driver approved for your broker trips next week, and that gap decides most of the question.

Broker work runs on credentials. Under the 2023 MTM provider agreement that Pennsylvania publishes, a driver or attendant may not do any work under the contract before being fully credentialed. In Virginia, MTM Health’s handbook approved in August 2026 puts the required state and MTM courses ahead of a driver’s first NEMT trip, and warns that trips by unapproved drivers can go unpaid. A day-labor model, where whoever the agency sends shows up and drives, does not work for broker trips.

Agency drivers fit best when the gap is predictable and lasts weeks, not days:

• A planned absence, such as a driver’s medical leave, filled by one agency driver who goes through your full credentialing once.
• A new contract ramp, while you recruit permanent drivers for a facility or broker region you just won.
• Private-pay and facility work that no broker credentials, where your own screening and your insurer’s approval are the gates.

For call-outs that come up the same morning, the answer is usually your own bench of credentialed part-time drivers, sized with the drivers-per-van guide and covered in the last section.

Are you a joint employer of agency drivers?

Probably, under labor and safety law, and possibly under wage law. The agency signs the paycheck, but your dispatchers set the driver’s schedule, assign every trip, and direct the work all day. That is what joint employer tests look at.

Wage and hour law

The Labor Department has had no joint employer regulation for the Fair Labor Standards Act since a rule published July 30, 2021 rescinded its 2020 version. On April 23, 2026 it proposed a new one, and it remained a proposal in October 2026, with comments closed since June 22, 2026. For the usual staffing situation, which the proposal calls vertical joint employment, it names four factors: whether the company hires or fires the employee, supervises and controls the work schedule or conditions of employment to a substantial degree, determines the rate and method of pay, and maintains the employment records. No single factor decides it.

A NEMT company that dispatches an agency driver meets the second factor on the first day. The proposal also states the consequence plainly: it makes every joint employer jointly and severally liable, alongside the others, for each FLSA obligation, overtime included, covering all the hours the employee worked that week. If the agency underpays overtime, you can be on the hook for it. Check the agency’s overtime practice, and watch the total if the same person also drives for you directly.

Labor relations law

The National Labor Relations Board’s 2020 joint employer rule is the one in force. The Board’s 2023 replacement was vacated by a federal court in Texas on March 8, 2024, and on February 27, 2026 the Board formally put the 2020 text back in its rules (29 CFR 103.40). Under it, a company is a joint employer of another employer’s workers only if it has and actually uses substantial direct and immediate control over one or more essential terms: wages, benefits, hours of work, hiring, discharge, discipline, supervision, and direction. The rule counts assigning a worker’s individual schedule and tasks as direction, and deciding the worker’s shifts and overtime as control of hours, which describes dispatch. Telling a driver only where and when to go is not supervision under the rule; instructing them how to do the job is.

Safety law

OSHA treats a staffing agency and its client, the host employer, as joint employers of temporary workers, jointly responsible for a safe workplace and for meeting OSHA’s rules on training, hazard communication and recordkeeping. Its guidance gives the example of the agency providing general safety training and the host training on its own equipment and hazards, which in NEMT means the wheelchair lift, securement, stretcher handling and backing a long van. If you keep the OSHA injury log, 29 CFR 1904.31 requires you to record injuries to temporary workers you supervise day to day.

Workers’ comp and the staffing contract

In the usual setup the agency, as the employer of record, carries workers’ compensation. Get its certificate, naming the right state, before the first shift, and make the contract say whose policy responds.

State law can shift the cost back to you. Illinois is a useful example:

• Agencies must register. Under the Day and Temporary Labor Services Act (820 ILCS 175/45), an agency doing business in Illinois must be registered with the Illinois labor department, showing workers’ comp that covers all its employees.
• Clients must check. Section 85 makes it a violation for a client to contract with an unregistered agency, and requires the client to verify the agency’s status before contracting and again every March 1 and September 1.
• Liability can come back to you. The Workers’ Compensation Act (820 ILCS 305/1(a)4) makes the loaning and borrowing employers jointly and severally liable for a loaned worker’s benefits when the borrowing employer does not pay, and unless the parties agree otherwise, the loaning employer can recover everything it paid from the borrowing employer.

Your broker contract has its own workers’ comp terms. MTM’s standard agreement requires statutory workers’ comp, and a provider that lacks it must show the state-law exemption that excuses it. Ask the broker whether the agency’s policy satisfies that requirement for agency-employed drivers. The workers’ comp guide covers class codes and pricing.

Your auto insurer decides who drives your vans

Do not count on the agency’s insurance for your vans. Your commercial auto policy covers them, on its own terms. Carriers often set their own NEMT guidelines, and a driver’s age and experience can affect whether you qualify and what you pay.

Before an agency driver takes a van out:

1. Send the driver’s motor vehicle record to your agent and get written approval.
2. Add the driver to the policy’s driver list if your policy keeps one.
3. Confirm the driver meets the broker’s driving record rules as well. MTM’s standard agreement, for example, rules out a driver convicted of at least three at-fault moving violations, or convicted after citations in at least two at-fault crashes that hurt someone or damaged property, in the last 36 months.

The guide to getting drivers approved by your insurer covers declined candidates and named driver exclusions.

Screening has to match the broker’s rules

Brokers credential the driver, not the employer. Every requirement in your broker contract applies to an agency driver exactly as it applies to your own:

• The driver file. MTM’s agreement expects, for each driver, the license, a criminal history check when hired and annually, an annual driving record covering three years back, drug and alcohol results from hiring, accidents, suspicion and random draws, and training certificates.
• Drug testing. MTM’s agreement calls for a written substance-free workplace policy that tests drivers at hire and at random, counts a refusal as a positive, and bars drivers with a positive screen in the past five years. If the agency’s program lacks random testing, enroll the driver in yours.
• Exclusion checks. Federal Medicaid law (42 U.S.C. 1396a(a)(87)) requires each state to ensure that NEMT drivers hold a valid license and are not excluded. Under the OIG’s exclusion bulletin, an excluded person cannot furnish program-paid services, whether they are on the payroll, under contract, or volunteering. The bulletin’s own example is a hospital that faces overpayment liability when an excluded nurse from a staffing agency treats its patients, and it notes that a client can reduce its exposure to civil penalties by showing it reasonably relied on an agency that agreed by contract to run the check, and that it made sure the agency was doing so. Put the check in the contract, then search every agency driver on the exclusions list yourself and keep the result.
• Training. PASS, HIPAA, defensive driving, first aid and securement, whatever your broker lists, done before the first trip and paid for by someone. Settle who pays in the contract.

Then ask the broker. MTM’s agreement defines a driver as an individual directly retained or employed by the transportation provider, and it bars assigning or subcontracting work unless MTM agrees in writing. A driver on an agency’s payroll does not fit that definition on its face, so get the broker’s written answer before an agency driver runs a single trip.

What the staffing contract should say

A staffing agreement for drivers should answer these questions in writing:

• Screening standards, spelled out to match the broker: background scope and lookback, driving record rules, drug panel, and random pool.
• Records access. The agency hands over the full driver file on request, fast enough for a broker audit.
• Insurance and indemnity. Workers’ comp and liability certificates, and who indemnifies whom for a crash or an injury.
• Removal. You can pull a driver from your work immediately for a safety concern, and the agency replaces the driver.
• Training time and cost, including broker-required courses.
• The conversion fee if you hire the driver directly, and when it drops to zero.

The conversion fee is worth negotiating, and some states cap it. Illinois bars an agency from restricting a temporary worker from accepting a permanent job with the client, and limits the placement fee for non-skilled labor to the agency’s daily commission over 60 days, minus one day’s commission for each day the worker already worked for the agency in the past 12 months (820 ILCS 175/40). The cap does not apply to skilled labor, meaning placements where the agency ran an advanced application, a screening process and a job interview, so an agency that screens and interviews its drivers may charge more. Get the fee in writing either way. Illinois also has an equal pay rule for long assignments (820 ILCS 175/42). Once a temporary worker has worked more than 720 hours at the same client within 12 months, the agency must pay at least what the client pays its lowest-paid comparable direct hire, or, if the client chooses, at least the area’s median wage for that job in federal wage data. The agency must also provide substantially similar benefits or their hourly cash value. On request, the client must give the agency the pay and benefit details it needs to comply.

When a PEO or your own bench fits better

Three other arrangements solve some of the same problems:

• A part-time bench. Credentialed drivers on your own payroll who take two or three shifts a week and cover call-outs. They are already approved with your brokers and know your vans.
• A PEO. A professional employer organization co-employs your own drivers. According to the IRS, PEOs run payroll and tax reporting for client businesses, usually for a fee figured on payroll costs. Hiring, dispatch and broker compliance stay with you, and a PEO does not supply drivers. See the guide to using a PEO.
• Independent contractors. Rarely a fit for drivers you schedule and direct. The 1099 or W-2 guide explains why.

Tracking agency hours in HealthRide

An agency invoice is only as good as the hours behind it. Agency drivers can punch in and out on the HealthRide driver app like anyone else, so their timecards in the reports give you a check on the agency’s weekly bill. Their license and training expirations sit in fleet and credentials beside your own drivers’, with reminders ahead of each date and a warning if you go to assign a trip after one has passed, which matters most for drivers whose files are kept by someone else.