Enrollment broker vs transportation broker: two different Medicaid contractors
Overview
An enrollment broker is the contractor a state Medicaid program hires to help members choose and join a health plan, through choice counseling and taking enrollments by phone, in person, or online. It does not book or pay for rides. Under 42 CFR 438.810, it must be independent of every plan and provider in the state. A transportation broker is the one that arranges trips.
On this page
Medicaid uses two contractors with “broker” in the name, and they do unrelated jobs. The enrollment broker helps a member pick a health plan. The NEMT broker books the member’s rides and pays the companies that drive them. Ride companies deal with the second one every day and almost never with the first. Where each fits in a state’s ride program is laid out in how states run NEMT.
What an enrollment broker does
An enrollment broker does choice counseling, enrollment work, or both, under 42 CFR 438.810. Enrollment work means sending out and processing enrollment materials and taking enrollments by phone, in person, or online. Choice counseling, defined in 42 CFR 438.2, means answering members’ questions and pointing out what to weigh when choosing a plan and a primary care provider. It stops short of recommending one plan over another.
States must offer choice counseling to every member who is about to enroll in a plan. Whoever does that work for the state under contract counts as an enrollment broker and falls under the same rules, per 42 CFR 438.71(c)(2). Section 1915(b)(2) of the Social Security Act allows a waiver under which a locality serves as the “central broker” for plan selection, and 42 CFR 431.55(d) lets the locality hire any public or private agent for the job.
Who a rider calls for what
The split shows up plainly in the phone numbers states publish.
| Question | Texas | North Carolina |
|---|---|---|
| Choose or change a health plan | Enrollment Broker, 800-964-2777 | NC Medicaid Enrollment Broker, 1-833-870-5500 |
| Book a ride as a plan member | The member’s health plan | The ride line listed for each plan |
| Book a ride without a health plan | Medical Transportation Program, 1-877-633-8747 | County Department of Social Services (Medicaid Direct and the EBCI Tribal Option) |
North Carolina’s NEMT page, last updated September 28, 2026, gives every plan its own ride number, such as 855-397-3602 for Healthy Blue and 800-349-1855 for UnitedHealthcare Community Plan. For rides, the page points members to the enrollment broker only when they are not sure which plan or program they are in.
Why a plan change matters to a ride company
In states where rides are part of managed care, the member’s plan decides who arranges and pays for the trip. Changing plans moves future rides to another plan, and possibly another transportation vendor. In Texas, every plan change goes through the Enrollment Broker. A request that arrives before mid-month takes effect when the following month begins; anything later waits one more month. Pregnant women in Texas’s expedited enrollment group are covered fee-for-service until their plan starts. The manual tells providers to call the Enrollment Broker for the plan name and still confirm coverage when the service happens. Managed care organizations explains how rides work once a member is in a plan.
Independence rules
Federal money pays for an enrollment broker only if the broker and its subcontractors meet two tests in 438.810(b):
- Independence. It may not be a health plan or health care provider in the state, be owned or controlled by one, or own or control one.
- No conflict of interest. No owner, employee, consultant, or contractor of the broker may hold a direct or indirect financial interest in any entity or provider that furnishes services in the state. None may be excluded from Medicare or Medicaid, debarred by a federal agency, or under civil money penalties.
CMS also reviews and approves the broker’s initial contract. State plan transportation brokers answer to a different conflict rule, the ban on sending trips to companies they have a financial relationship with, which how states run NEMT covers along with the other broker conditions.
Frequently asked questions
- May a ride company enroll a rider in a health plan?
- Not in Texas. Its provider manual lets providers tell clients they can enroll by phone with the enrollment broker, but the call must be made by the client, not by the provider or the provider's agent. Providers also may not handle enrollment forms or steer a client toward a plan based on what it pays. In another state, read its managed care marketing rules before offering to help.
- Does the enrollment broker recommend the best plan for rides?
- No. Federal rules define choice counseling as answering questions and pointing out the factors to weigh when choosing among plans and primary care providers. It expressly excludes recommending for or against a particular plan. A member who cares about rides can ask which company handles each plan's transportation and decide from there.
- Is the enrollment broker the same company in every state?
- No. Each state that uses one hires its own contractor, and CMS must review and approve the first contract or memorandum of agreement before federal money can pay for it. The state Medicaid agency names its broker and phone number. In North Carolina, for example, it is the NC Medicaid Enrollment Broker at 1-833-870-5500.
