Medicaid provider application fee: the 2026 amount and when a transportation company pays it
Overview
The Medicaid provider application fee is a federal charge on institutional providers each time a state screens them: first enrollment, revalidation, a new location, or a new owner. For applications filed in 2026 it is $750, reset each January for inflation. States decide whether a NEMT company counts as institutional. A company with an existing Medicare enrollment, or one in another state's Medicaid program, does not pay it again.
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How the amount is set
Any application filed during calendar year 2026 pays $750, from a first Medicaid enrollment to a revalidation. It is the same fee Medicare charges, set under 42 CFR 424.514: $500 in 2010, then raised each year by the change in the consumer price index for all urban consumers over the 12 months ending in June of the year before. For 2026, CMS took the 2025 fee of $730, added the 2.7 percent increase from July 2024 to June 2025, and rounded $749.71 to $750.
The amount that applies is the one in effect when you submit, so an application sent in December 2026 pays the 2026 fee. CMS estimated that about 30,000 Medicaid and CHIP institutional providers would pay it in 2026, 9,000 of them new and 21,000 revalidating.
| Calendar year | Fee | Federal Register notice |
|---|---|---|
| 2022 | $631 | October 25, 2021 |
| 2023 | $688 | December 5, 2022 |
| 2024 | $709 | November 7, 2023 |
| 2025 | $730 | December 2, 2024 |
| 2026 | $750 | December 3, 2025 |
The fee is one line in a startup budget, and our startup cost guide covers the rest.
Does a transportation company count as institutional?
That is each state’s call. The federal rule (42 CFR 455.460) names individual physicians and nonphysician practitioners as exempt, and CMS’s enrollment compendium (section 1.8.1, updated November 17, 2025) extends that to other non-institutional providers such as group practices. The compendium explains how states sort everyone else:
- Medicare’s list carries over. Anything Medicare treats as institutional, including ambulance service suppliers, is institutional in Medicaid too.
- Medicaid-only types are the state’s decision. A state that classes a provider type as institutional has to apply that to every provider of the type.
- Transportation is named. CMS’s February 2011 rule said states must charge institutional entities billing fee-for-service Medicaid, and listed non-emergency transportation providers as an example.
Published state rules show how this plays out for ride companies.
| State | NEMT applicants pay? | What the state’s rule or list says |
|---|---|---|
| North Carolina | Yes | Federal fee on NEMT van, taxi, bus, and private vehicle enrollments, plus a $100 state fee |
| Ohio | Yes, for wheelchair vans | Rule appendix marks wheelchair van as fee-paying, high risk at first screening |
| New York | Yes | $750 on non-medical transportation enrollments: ambulette, taxi, livery, and TNC |
| Texas | Yes | Required for demand response and TNC applicants in the enrollment system |
| Kentucky | Not listed | Fee list names ambulance (provider type 55), not non-emergency transportation (56) |
North Carolina’s extra $100 comes from G.S. 108C-2.1 and applies to every enrollment and revalidation application, whatever the provider type. Check your own state’s list before you budget, and see the risk levels entry for the screening that the fee pays for.
When the fee is charged
The fee follows the screening. CMS lists four triggers: a new enrollment, a revalidation, an added practice location, and an added owner. Texas also names reenrollment applications. One application covering several locations pays one fee, while a company enrolling as two institutional provider types pays twice.
Routine updates are free. A new phone number, bank account, billing address, or business name does not carry the fee. Adding an owner does, and so does a sale that the state handles as a new enrollment, which the change of ownership entry covers. The revalidation guide covers the five-year cycle that brings the fee back.
Who is exempt
You owe nothing if you are enrolled in Medicare or in another state’s Medicaid program, or if Medicare or another state has already collected the fee from you. States check the claim before they waive it:
- Kentucky matches provider type and risk category, practice location, FEIN, and 5 percent owners against the earlier enrollment.
- North Carolina asks whether you paid the federal fee for the same site within the past 12 months and wants the confirmation attached.
- Texas wants proof of payment with the application.
A hardship exception is the other way out, and only CMS can grant one. You send the state a letter that explains the hardship and makes the case for an exception. For proof, CMS’s compendium suggests the company’s latest tax return, a profit and loss export from the accounting system, and three or more bank statements. The state may turn the request down without CMS, but only CMS can approve it, and it has 60 days to decide. Ohio’s rule also lets the state waive the fee, with CMS approval, when charging it would hurt beneficiaries’ access to services.
Paying it
Pay with the application, or the clock does not start. NCTracks will not begin processing until both the federal and North Carolina fees are paid. Texas will not process a fee-paying application that comes in unpaid, and Ohio rejects one without proof of payment as incomplete. Keep the receipt, because it is your proof if you later enroll in a second state.
Frequently asked questions
- Do we pay the fee again when we revalidate?
- Yes, if your provider type pays it at all. CMS lists revalidation with new enrollment, new practice locations, and new owners as events that carry the fee, and Texas and North Carolina both collect it on revalidation applications. The revalidation guide covers the rest of that process.
- We are already enrolled in another state. Do we pay twice?
- No. If Medicare or another state's Medicaid program already enrolled you, or already took your fee, federal rules bar the new state from charging it. Expect to prove it. Texas wants proof of payment with the application, and North Carolina asks you to attach the payment or site visit confirmation from the earlier application.
- Is the fee refunded if the application is denied?
- Usually not. Ohio's rule keeps the fee when enrollment is denied because the provider failed screening. The federal Medicare rule refunds it only for an approved hardship request, an application rejected before screening began, or a denial caused by a temporary moratorium.
- What will the fee be in 2027?
- CMS had not announced it as of October 6, 2026. The formula is fixed: take the $750 for 2026 and apply the rise in urban consumer prices from July 2025 through June 2026. CMS publishes it in a Federal Register notice, and the last five notices appeared between late October and early December.
