FTSB provider guide: Kentucky Medicaid rides around Louisville, Lexington, and Northern Kentucky

FTSB at a glance

Federated Transportation Services of the Bluegrass, Inc. (FTSB) was incorporated in 1981 as a nonprofit and is based in Lexington. It does two jobs. It holds the Kentucky Transportation Cabinet’s Medicaid broker contract for 24 counties, and it operates public transit in five: Bourbon, Harrison, Lewis, Nicholas, and Rowan. Its brokerage started with Fayette County in 1998. It added Region 6 around Louisville in 2008, Region 11 in 2013, and Northern Kentucky’s Region 9 in 2017.

FTSB has also driven riders in its own vehicles since 2005. For a subcontractor, that matters more than anything else here: the organization handing out trips runs a fleet that competes for them. Kentucky’s rate and rider-choice rules, covered below, are the counterweight.

Where FTSB holds the broker contract

Kentucky has 15 HSTD regions (Human Service Transportation Delivery), and the Cabinet picks one broker for each through a request for proposals. FTSB has four regions, the most of any broker on the Cabinet’s list, and they include the state’s two biggest metro areas.

To qualify for a ride, a member needs a valid Kentucky Medicaid card, a trip to a Medicaid-covered service, and no usable vehicle. The state treats a car as unusable if it does not run, if a medical condition keeps the member from driving it, or if a relative in the same household uses it for a job, school, or a medical visit. Each region’s eligible members are assigned to its one broker. Two groups get no NEMT at all: children in KCHIP Phase III and Qualified Medicare Beneficiaries. A ride beyond the member’s own county and the ones bordering it needs a primary care referral. Every region and broker is listed in the Kentucky NEMT guide.

How money moves from Medicaid to your company

Kentucky pays its brokers by the member, not by the trip. DMS pays the Transportation Cabinet a set monthly sum for every member (capitation), and the Cabinet passes it to each region’s broker based on assigned enrollment. Statewide, those payments totaled $174,953,006 in state fiscal year 2025, a year with 3,363,272 trips. A November 2025 legislative briefing by DMS and the Cabinet listed per-member monthly rates of $11.50 in Region 6, $8.74 in Region 9, $7.76 in Region 10, and $6.88 in Region 11. A broker receives that amount whether its members ride often or rarely.

Subcontractor pay is set by the state, not negotiated with FTSB. The Cabinet sets these rates under 603 KAR 7:080, one per certificate type per region, and every eligible provider in that region gets the same rate, including FTSB’s own vans. The factors it weighs are terrain, trip length, population, where medical and employment sites sit, labor and economic conditions, and how much riders use the service. Brokers get 45 days’ notice of any rate change, unless a broker waives that notice in writing. The current rates appear in your subcontract.

The payment calendar is set by statute and regulation:

1. You bill FTSB for finished trips. An invoice dated later than the 1st is paid in the following month’s cycle.
2. FTSB files its payment reports with the Cabinet no later than the 7th.
3. If all reports are in, the Cabinet pays brokers no later than the 15th (KRS 281.875).
4. FTSB then has three business days to pay you.

FTSB must receive each invoice within six months after the trip date. Matching broker deposits to individual trips is covered in billing NEMT brokers.

Getting approved, in order

Kentucky wants motor carrier authority in place first and Medicaid enrollment last, with sign-offs from FTSB and the Cabinet in the middle.

1. Form the business. Depending on its structure, such as an LLC or corporation, the company may need a Secretary of State filing first.
2. Apply for authority. Ask the Division of Motor Carriers (502-564-1257) for an application, choosing Taxi or Disabled Persons Vehicle (DPV) authority. DPV authority requires a lift or ramp on every vehicle, and those vehicles can still carry ambulatory riders. Filing costs $250. Before the certificate issues, you need insurance on file for each vehicle: bodily injury limits of $100,000 for one person and $300,000 for all persons in an accident, and $50,000 of property damage coverage. A larger vehicle, with at least 8 regular seats, needs $600,000 for all persons instead. You must also run a nationwide criminal background check on each driver and keep it for at least three years.
3. Qualify every vehicle. The Division gives each qualifying vehicle a plate and a fee receipt card. Each Taxi or DPV vehicle license is $30 per year.
4. Contact FTSB. Let FTSB know you have your certificate and want a subcontract. It sets a time to go over the contract, inspects the vehicles, and collects copies of your insurance, vehicle registrations, workers’ compensation proof, authority certificates, and fee receipt cards.
5. Line up drug testing and training. Put all drivers and employees in Kentucky’s statewide random drug and alcohol testing pool. Safety-sensitive workers also need a background check, pre-hire drug and alcohol testing, and the required minimum training.
6. Apply for Medicaid numbers. Submit a MAP-811 for every service type you plan to run, entering 56 as the provider type in box 7 and your specialty code in box 8. Print and sign each application, send it to FTSB for the broker’s signature, then upload it to Kentucky’s Medicaid Partner Portal with the signed broker page and a copy of your operating certificate.
7. Share your Welcome Letters. When Medicaid approves you, print the Welcome Letter for each service type (it shows your Medicaid provider number) and give FTSB a copy.
8. Wait for the go-ahead. The Cabinet must approve a subcontract before it takes effect. FTSB passes your file along to the state’s Office of Transportation Delivery and holds an orientation with you before any trips. FTSB gets word once you are entered and can begin service.

The MAP-811 checklist is strict. An application with any blank question is rejected, so enter “N/A” wherever a question does not apply. Electronic and stamped signatures are refused. You also attach NPI and taxonomy code verification from NPPES and, if the company has an FEIN, the IRS letter confirming it. If you run Medicaid trips before your effective date, you carry that financial risk yourself.

For-profit companies can hold up to three numbers (02, 07, and 08), and nonprofits up to three as well (04, 07, and 08). The Cabinet also sets a floor for newcomers: three active, approved drivers matched by three working passenger vehicles.

Sharing trips with FTSB’s own fleet

State law guarantees rider choice for two certificate types. Under KRS 281.874, a rider certified as Type 07 or Type 08 may pick FTSB or any eligible subcontractor working in the region, and books through FTSB either way. FTSB can extend that choice to Type 02 riders, though it is not required to.

If the rider leaves the decision to FTSB, 603 KAR 7:080 ranks the tiebreakers:

1. Coordination with other trips.
2. Cost efficiency.
3. If neither settles it, Type 07 and Type 08 trips rotate among all providers, FTSB included.

The statute adds that the broker must share Type 07 and 08 requests fairly between itself and every certified subcontractor, and the Cabinet decides any dispute over provider choice. In exchange, subcontractors accept three limits: no soliciting Medicaid trips, no handing an assigned trip to another provider, and no role in deciding who is eligible or what mode they ride. Because choice and rotation apply only to Type 07 and Type 08 riders, holding both certificate types puts you in line for more of those shared trips.

Driver standards

Drivers and escorts all meet one standard in 603 KAR 7:080, and the broker or subcontractor certifies compliance to the Cabinet.

Screening details are in driver background checks and whether someone with a record can drive.

Vehicle standards

603 KAR 7:080 spells out vehicle equipment in detail. A broker must pull any vehicle out of service at once if its licensing, authority, or safety falls short, and Cabinet staff inspect vehicles as part of their oversight.

• Climate and belts. Heat and air conditioning must work, or the van stays parked until fixed. Every passenger seat needs a working, clean belt kept off the floor when unused. Carry two or more belt extensions, and mount a belt cutter over the driver’s door.
• Emergency gear. A fire extinguisher with an up-to-date inspection tag, three reflective triangles on stands, a spill kit with a scrub brush, latex gloves, liquid absorbent, disinfectant, and hazardous waste bags, and a fully stocked first aid kit.
• Boarding. If the floor is more than a foot off the ground, add a retractable step or a sturdy metal four-legged stool measuring 8 1/4 by 15 by 14 inches (height, width, depth). A milk crate is not allowed.
• Markings. Your legal company name on both front doors, in block letters 2 inches tall. Inside, display the vehicle number, your company name, and the program coordinator’s customer service number.
• Paperwork on board. A packet in the driver’s compartment or visor holding accident procedures and forms, the insurance card, the registration, and the vehicle card.
• Navigation and radio. Maps or GPS good enough to find every rider and destination, plus a two-way dispatch link used in line with HIPAA.
• Inspection. If a vehicle falls outside 601 KAR 1:005, an automotive technician inspects it once a year, and you need written proof it passed before its first trip.

Lift-equipped wheelchair vans must meet ADA specifications, and FTSB refuses service to a rider who will not let the chair be secured. The NEMT vehicle requirements guide compares Kentucky’s list with other states.

Day-of-trip rules

Because riders share vehicles, FTSB tells them to allow 45 minutes plus the direct driving time between leaving home and the appointment. A rider who needs no special equipment may be sent by taxi, public bus, or private car, grouped with other riders where practical. Children ride in federally approved car seats, and any child 12 or younger travels with an adult. Escorts ride at no charge. A relative can be the escort, and one escort can accompany several riders going to the same destination. A driver or any other employee of the transportation provider may not act as a guardian’s designee for a child 12 or under.

In bad weather FTSB cancels or cuts back service, and it tries to keep dialysis, chemotherapy, and radiation riders moving. Tell FTSB right away about any accident or moving violation on a trip, because the broker has 24 hours to report it to the Cabinet. Keep trip records for five years, encounter data on each trip included.

House Bill 2 and the program’s future

The General Assembly enacted House Bill 2 on April 14, 2026 by overriding the Governor’s partial veto, and the law appears as Acts Chapter 179. Its emergency clause made it effective at once. Any section the state decides needs federal approval can wait until that approval is granted. For the broker program, the law:

• Requires a GPS device in each vehicle serving Medicaid riders, precise enough for the broker to locate it at any moment on the job. The devices are the broker’s expense, not the state’s.
• Withholds 2 percent of every broker’s capitation. A broker wins it back by meeting region-specific targets for utilization, completed trips, cancellations and reschedules, delays, average trip minutes and miles, how long scheduling takes, and how satisfied riders are.
• Sets a floor for the medical loss ratio: 85 percent for fiscal 2027, which opened July 1, 2026, then 87 and 89 percent, and 90 percent for every year beginning July 1, 2029. Brokers that fall short send the excess capitation back.
• Calculates capitation from each region’s NEMT-eligible members only, rather than total enrollment.
• Allows hospitals and skilled nursing facilities to transport their own patients or residents, with the regional broker paying them at the mileage rate a contracted driver would earn for that ride.

The Medicaid Oversight and Advisory Board has until December 31, 2026 to report on NEMT, including the regional broker setup and delivery models used in other states. DMS begins a yearly program review in 2027. Since delays and cancellations now decide how much capitation FTSB recovers, a subcontractor’s on-time record matters more to the broker than it did before.

Contacts

Records FTSB can check

Each FTSB invoice faces a six-month deadline, so the proof behind it has to be easy to pull. HealthRide keeps a record of every completed trip with its GPS miles, pickup time, drop-off time, and rider signature. During the day, the live map tracks each van and each trip’s status. A CSV or PDF trip log lets you check the month’s FTSB invoice against what drivers actually ran.