Northwest Regional Council provider guide: Apple Health rides in northwest Washington

Who runs Apple Health rides in the northwest corner

Northwest Regional Council (NWRC) arranges nonemergency rides for Apple Health clients in Whatcom, Skagit, Island, and San Juan counties under contract with the Washington Health Care Authority (HCA). Its structure is unusual for a broker. Elected officials from those four counties created NWRC in 1971 as an association of county governments, and its board is made up of two elected officials from each county. It is also the region’s Area Agency on Aging, so ride brokering shares a roof with in-home care, caregiver support, dementia programs, and tribal elder outreach.

That sets NWRC apart. HCA’s report to the Legislature of December 1, 2024 counts the other five Washington brokers as nonprofit community groups, which leaves NWRC as the lone Area Agency on Aging. Our guide to Area Agency on Aging transportation explains what else these agencies fund.

NWRC’s 2025 annual report shows the scale of its transportation work.

Bus rides alone equal more than 40 percent of the trip count. The transportation office sits at 600 Lakeway Drive in Bellingham, and NWRC also keeps offices in Mount Vernon and on Camano Island. The other five brokers, county by county, are in our Washington state guide.

How NWRC matches a rider to a mode

State rules make the broker pick the cheapest mode the rider can get into that also suits their condition and abilities (WAC 182-546-5200). NWRC’s 2026 letter to new clients shows how that plays out:

• Riders who can drive, or who have a friend who can, get gas vouchers for contracted stations or, when none is on the route, mileage reimbursement at 35 cents a mile. NWRC first needs copies of the driver’s license, registration, and insurance.
• Riders on a bus route get a free bus pass, which in some areas requires at least one medical appointment a month.
• Riders who cannot drive or use the bus ride in vans or taxis.
• Short distances. NWRC helps only when the appointment is farther than three-quarters of a mile, except for riders with a physical limitation.
• Own resources come first, whether that is a car, a friend who drives, or free bus service.

For a rider who lives on a bus line, a doctor has to justify anything above the bus. NWRC’s Higher Mode form asks the medical professional to choose between fixed-route bus (which can mean walking up to three-quarters of a mile, or calling a flex-route bus), paratransit such as WTA specialized service, Skagit Dial-A-Ride, or Island paratransit, a taxi, and a cabulance. The form defines a cabulance trip as door-to-door service for a patient who has to stay in their wheelchair and cannot transfer into a sedan or van. A lasting condition is reviewed one year after the form is signed, and a temporary one carries an expected number of months.

The same form tells doctors that all buses are fully ADA accessible, with lifts and ramps, and that riders in poorly served areas can ask for a taxi one way. For a van or cabulance company, NWRC work tends to mean certified wheelchair riders, discharges, and pickups where transit does not reach. Our pages on the least costly mode rule and paratransit explain how those choices get made.

Ferries and water taxis

San Juan County riders depend on the Anacortes and San Juan Islands ferry route, so boats are part of the job here. Washington’s rules list ferries and water taxis among the modes a broker may use (WAC 182-546-5100), and HCA’s sample broker contract tells brokers to make them available. NWRC reimburses ferry tickets, parking, and lodging when they are approved in advance, and it counted 4,139 ferry rides in 2025.

If your vehicle carries a rider onto a Washington State Ferries boat, plan for the dock. WAC 468-300-700 sets the order of preferential loading, and the top spot goes to ambulances and emergency medical vehicles dispatched on a call. An ordinary NEMT van does not share that priority. The rule does list other vehicle classes that can load ahead of the line, including visibly marked nonprofit special-needs carriers, some for-profit passenger carriers on routes where the ferry is the only major land access, and ride-share vehicles carrying at least three elderly or disabled riders (or two plus an attendant). Each class carries conditions such as a WSF permit or registration and advance notice to every terminal involved. Call WSF at 206-464-6400 before you build a schedule around it.

Riders have their own route to priority. The WSF Medical Preferential Load Program covers people whose health would be put at risk by a long wait on the dock, certified online by a licensed health care provider.

Fares still apply. Build the sailing and the terminal wait into every island pickup time, and remind enrolled riders to bring their printed confirmation and ID. Our guide to rural routes covers planning across long, broken service areas.

Getting a subcontract with NWRC

HCA sends prospective transportation providers to the regional broker for the counties they want to work in. Payment follows the same logic: WAC 182-546-6200 allows a broker to pay a non-ambulance provider only under a subcontract. For these four counties, that means NWRC.

Two contacts matter. The transportation office answers at 360-738-4554 (toll free 800-860-6812) and at NWRCRides@dshs.wa.gov. For the contract itself, NWRC’s Contract Opportunities page names Non-Emergency Medical Transportation among the programs it contracts for outside the Medicaid waivers, and it routes contracting questions for those programs to its contracts unit at NWRCContracts@dshs.wa.gov. The same page lists “Transportation” under the WA Cares Fund, Washington’s separate long-term care benefit run by the Department of Social and Health Services. A WA Cares contract is not an Apple Health ride subcontract, so say clearly which one you are after.

Have these ready before you reach out:

1. State licensing. The for-hire endorsement from the Department of Licensing on your business license, a vehicle certificate for each van, and registrations in use class F/H or CAB. A private nonprofit serving riders with special transportation needs can work under a permit from the Utilities and Transportation Commission instead.
2. Insurance that fits your license type. HCA’s sample subcontract terms set two tracks. For-hire carriers regulated under RCW 46.72 must meet the insurance minimum set by law. Carriers that no public agency regulates must match the broker’s own coverage, which in the sample contract means auto liability of at least $1 million per occurrence and general liability of $1 million per occurrence with a $2 million aggregate.
3. Clean driver files. Licenses, driving records, and background checks for each driver. Our driver file checklist lays out the usual contents.
4. A clear offer. Your counties, vehicle types, wheelchair and stretcher capacity, and your after-hours availability.

NWRC’s 2025 annual report lists its direct service providers across all of its programs. The roster includes several transportation companies, an ambulance company, and a cab cooperative, which gives a sense of the mix NWRC already uses.

Discharges, urgent care, and after-hours rides

NWRC’s office hours are 8:30 a.m. to 4:30 p.m. on weekdays, and anything outside them runs through a short list of routes.

• Emergency room returns. When the office is closed, hospital staff call 360-733-8294 to get a rider home. NWRC will not carry anyone to the ER, but it can take a rider to urgent care in place of an ER visit.
• Hospital discharges. Staff fax NWRC’s discharge form between 8 a.m. and 5 p.m. on weekdays. On evenings, weekends, and holidays, the form tells them to contact Yellow Cab.
• Urgent care after 4:30 p.m. or on weekends. Riders call the NWRC number and follow the voice message about whom to call.
• Retroactive approval. WAC 182-546-5200 lets a subcontracted provider carry an urgent care or discharge rider while the broker is closed, provided it works from the broker’s after-hours directions and seeks retroactive authorization no later than two business days after the trip. The alternative is to decline.

The discharge form is worth reading because it shows what NWRC checks before assigning a ride. It asks whether the rider can take the bus, has active contact precautions, can travel without a medical attendant, and needs a prescription filled on the way home. For wheelchair trips, it asks who supplies the chair (NWRC offers only a standard size), the rider’s weight, and whether the destination is accessible. It asks whether an oxygen rider can manage their own oxygen, because drivers cannot administer it. Stretcher requests list the rider’s weight, the number of steps into the home, and the medical reason. Our guide to hospital discharge transportation covers pricing and staffing these calls.

NWRC’s call center closes on its holiday list. For the rest of 2026 that means October 12 (Indigenous Peoples’ Day), November 11, November 26 and 27 (Thanksgiving and Native American Heritage Day), and December 25. Plan standing order coverage and after-hours staffing around those dates.

Rider rules that shape your schedule

NWRC’s client letter and forms set the terms riders hear, and your drivers work inside them.

• Notice. Local rides need at least two full business days’ notice, with weekends and holidays not counted, and riders may call up to 30 days ahead.
• Specialists out of town. Riders sent to a specialist in another city should give at least five full business days, because the referring doctor has to sign NWRC’s paperwork. The doctor’s office faxes a verification of medical necessity along with a copy of the referral.
• Changes go through the office. Riders are told that any change to a scheduled ride must go through NWRC, so send rider requests for new times or stops back to the broker.
• Pharmacy stops. A rider leaving an appointment with a prescription should have the clinic call NWRC. Under WAC 182-546-5600, a pharmacy stop is paid when it is reasonably close to the usual route, and stops for the rider’s convenience are not.
• Daily limit. WAC 182-546-5500 covers one round trip a day, except when a rider’s several appointments cannot all be reached in one.
• Lodging. Facilities request lodging on NWRC’s form, and continued payment needs a client status update faxed every month.

Our guides to cancellations and standing orders help keep those rules straight on the dispatch side.

Contacts

Planning island days in HealthRide

Ferry sailings and long off-island runs make an NWRC schedule easy to break. On the HealthRide dispatch board you assign each trip in one motion. The live map shows every vehicle with late warnings, so a van falling behind stands out early enough to call the rider and the clinic.