How to start a NEMT business in Kentucky: HSTD regional brokers, operating authority, and enrollment
In Kentucky, the Transportation Cabinet runs Medicaid NEMT for the Department for Medicaid Services, outside the health plans. The Human Service Transportation Delivery (HSTD) program splits the state into 15 regions, each with one broker, and every Medicaid member, in a health plan or not, books rides through the broker for their county. To join, you get for-hire operating authority from the Division of Motor Carriers, subcontract with your region's broker, and enroll with Kentucky Medicaid as Provider Type 56. New providers need at least three approved drivers and three working vehicles.
Kentucky NEMT at a glance
- Runs the program
- Kentucky Transportation Cabinet, Office of Transportation Delivery (OTD), for the Department for Medicaid Services (DMS)
- Program
- Human Service Transportation Delivery (HSTD) program, non-emergency medical transportation
- How rides are arranged
- Regional brokers, one per area. The Transportation Cabinet contracts one broker for each of 15 regions. DMS pays the Cabinet a monthly capitated rate per member under a 1915(b) waiver.
- Brokers you will contract with
- GRITS (Audubon Area Community Services), PACS, LKLP, FTSB, BGCAP, RTEC, SVTS, LVCAP
- State operating license
- Kentucky for-hire passenger operating authority from the Division of Motor Carriers: a Taxi certificate or a Disabled Persons Vehicle (DPV) certificate, with a qualified plate for each vehicle.
- EVV for NEMT trips
- Not required
- Medicaid enrollment
- 1,272,217 (May 2026, Medicaid and CHIP)
On this page
How Medicaid NEMT works in Kentucky
Under 907 KAR 3:066, the Department for Medicaid Services hands NEMT to the Transportation Cabinet through an interagency agreement approved under a federal 1915(b) waiver. DMS pays the Cabinet one capitated amount per member each month, set separately for each HSTD region. The Cabinet's Office of Transportation Delivery runs the program under 603 KAR 7:080 and contracts a broker for each region.
Every Medicaid member except qualified Medicare beneficiaries and Phase 3 KCHIP children rides through the broker for the county where they are coded, whether or not they are in a managed care plan. Members call at least 72 hours ahead, weekends and holidays included. Brokers schedule Monday through Friday 8 a.m. to 4:30 p.m. and Saturday 8 a.m. to 1 p.m., transport Monday through Friday 6 a.m. to 8 p.m. and Saturday 8 a.m. to 1 p.m., and run urgent care rides around the clock.
Your contract is with the broker, not the state. The broker takes every reservation and dispatches trips to approved subcontractors, you invoice the broker, and the broker pays you. The Cabinet sets one subcontractor rate per certificate type in each region, the same for every provider including the broker, and gives brokers 45 days' notice before changing it. Stretcher trips are not part of HSTD; they are non-emergency ambulance service.
Governing rule:603 KAR 7:080: Human service transportation delivery
Who brokers Medicaid rides in Kentucky
One broker per region, eight organizations in all. Several brokers hold more than one region. Contract with the broker for the counties you want to serve.
| Broker | Serves | Provider sign-up |
|---|---|---|
| Audubon Area Community Services (GRITS) | Region 1: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Marshall, McCracken. Region 3: Daviess, Hancock, Henderson, McLean, Ohio, Union, Webster. Region 4: Breckinridge, Grayson, Hardin, Larue, Marion, Meade, Nelson. | Provider page270-686-1651 |
| Pennyrile Allied Community Services (PACS) | Region 2: Caldwell, Christian, Crittenden, Hopkins, Livingston, Lyon, Muhlenberg, Todd, Trigg. | Provider page270-886-6641 |
| LKLP Community Action Council (LKLP) | Region 5: Adair, Allen, Barren, Butler, Edmonson, Green, Hart, Logan, Metcalfe, Simpson, Taylor, Warren. Region 13: Breathitt, Clay, Harlan, Jackson, Knott, Lee, Leslie, Letcher, Owsley, Perry, Wolfe. Region 15: Bath, Boyd, Carter, Elliott, Greenup, Lawrence, Menifee, Morgan, Rowan. | Provider page606-487-1872 |
| Federated Transportation Services of the Bluegrass (FTSB) | Region 6: Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer, Trimble. Region 9: Boone, Campbell, Carroll, Gallatin, Grant, Kenton, Owen, Pendleton. Region 10: Fayette. Region 11: Bourbon, Clark, Estill, Harrison, Madison, Montgomery, Nicholas, Powell. | Provider page859-233-0066 |
| Bluegrass Community Action Partnership (BGCAP) | Region 8: Anderson, Boyle, Casey, Franklin, Garrard, Jessamine, Lincoln, Mercer, Scott, Washington, Woodford. | Provider page502-695-4290 |
| Rural Transit Enterprises Coordinated (RTEC) | Region 12: Bell, Clinton, Cumberland, Knox, Laurel, McCreary, Monroe, Pulaski, Rockcastle, Russell, Wayne, Whitley. | Provider page606-256-9835 |
| Sandy Valley Transportation Services (SVTS) | Region 14: Floyd, Johnson, Magoffin, Martin, Pike. | Provider page606-886-7039 |
| Licking Valley Community Action Program (LVCAP) | Region 16: Bracken, Fleming, Lewis, Mason, Robertson. | Provider page606-845-0081 |
The regions are numbered 1 to 16 with no Region 7, which gives 15 regions covering all 120 counties.
Broker contracts with the Commonwealth run one fiscal year at a time, July 1 to June 30, with four one-year renewal options, and are awarded through competitive proposals under KRS Chapter 45A.
Members choose their provider. If they do not, the broker assigns trips by coordination first, then cost, and then rotates specialty (Type 07 and 08) trips among providers.
How to become a NEMT provider in Kentucky
Kentucky's order matters: operating authority first, then the broker, then Medicaid enrollment with the broker's signature.
Form the business
Set up the company and file with the Kentucky Secretary of State as your business type requires. You will need the Secretary of State number to open a Motor Carrier Portal account.
Get for-hire operating authority
Apply through the Division of Motor Carriers for a Taxi certificate or a Disabled Persons Vehicle (DPV) certificate. DPV vehicles must be ADA-compliant with a lift or ramp and may carry ambulatory riders too. Before applying, have your insurer file a Form E, complete a vehicle inspection by an automotive service technician and nationwide criminal background checks, and have at least one vehicle ready. Processing takes up to 14 business days. Motor Carriers then qualifies each vehicle and issues a plate and fee receipt card.
Subcontract with your regional broker
Tell the broker for your counties that you hold a certificate and want to subcontract. The broker reviews the contract, inspects vehicles, and collects insurance, registrations, workers compensation proof, your operating certificates, and fee receipt cards. The Transportation Cabinet must approve every subcontractor before the agreement takes effect.
Screen and train your drivers
Every safety-sensitive employee goes into a statewide random drug and alcohol pool and passes a background check and a pre-employment drug and alcohol test. Drivers complete first aid, bloodborne pathogens, and passenger assistance training. The broker walks you through the process.
Enroll with Kentucky Medicaid as Provider Type 56
File a separate MAP 811 application for each service type: 02 ambulatory for-profit (specialty 263) or 04 ambulatory non-profit (262), 07 ambulatory escort (264), and 08 wheelchair (265). The broker signs each application, and you submit it in the Kentucky Medicaid Provider Enrollment Portal with the broker's signature page and your operating certificate. Give the broker a copy of each Welcome Letter with your Medicaid provider number.
Start with the minimum fleet
New providers must keep at least three active, approved drivers and three operational passenger vehicles in the program. The broker sends your information to the Office of Transportation Delivery, which enters you in the system before trips start. Providers may not solicit Medicaid trips.
Vehicle and driver requirements in Kentucky
The Transportation Cabinet's rule, 603 KAR 7:080, sets the standards for everyone in HSTD. Brokers enforce them and add their own contract terms, rates, and pickup standards.
Vehicles
| Requirement | State rule | Broker contract |
|---|---|---|
| Operating authority and plates | Taxi certificate (no more than 8 regular seats) or DPV certificate (ADA-compliant with lift or ramp, no more than 15 regular seats), with a plate issued for each qualified vehicle. | The broker collects copies of certificates and fee receipt cards and removes any vehicle out of compliance with licensing or authority. |
| Inspection | Written proof of a safety inspection by an automotive technician before first use and an annual inspection after that (603 KAR 7:080, Section 25). | The broker inspects vehicles at subcontracting. |
| Safety equipment | Working heat and air, a clean seat belt at every seat, two seat belt extensions, a belt cutter mounted above the driver's door, a charged fire extinguisher with a current tag, three reflective triangles, a first aid kit and spill kit, and maps or GPS. | Same. |
| Interior and boarding | Interior mirror for the passenger area, anti-skid flooring, "No Smoking, Eating or Drinking" and seat belt signs, and a step stool of set dimensions (not a milk crate) when the floor is over 12 inches high. | Same. |
| Markings | Company legal name on the driver and passenger doors in 2-inch block letters. Inside, the provider name, vehicle number, and the program coordinator's customer service phone number. | Same. |
| Communication | A two-way system linking the vehicle and the dispatcher, used in a HIPAA-compliant way. | The subcontract sets hours of operation, scheduling rules, rates, and pickup and delivery standards. |
Drivers
| Requirement | State rule | Broker contract |
|---|---|---|
| Age and license | At least 18, licensed in Kentucky for the vehicle driven (603 KAR 7:080, Section 12). | Same. |
| Driving record | No more than two moving violation convictions in the past three years. Moving violations or accidents on a trip are reported to the broker immediately. | Same. |
| Criminal history | No convictions for any sexual crime or crime of violence. A driver or escort with any misdemeanor or felony conviction in the past five years needs approval from the broker, the subcontractor, and the Cabinet. Motor Carriers requires nationwide criminal background checks for operating authority. | The broker reviews background checks during subcontracting. |
| Drug and alcohol testing | Pre-employment drug test (603 KAR 7:080). The Office of Transportation Delivery also requires pre-employment drug and alcohol tests and a statewide random pool for every safety-sensitive employee. | The broker walks new subcontractors through testing and pool enrollment. |
| Training | Orientation and safety training covering first aid, bloodborne pathogens, passenger assistance, and intellectual and developmental disability awareness when the Cabinet offers it. | Minimum trainings set by the broker during subcontracting. |
Insurance minimums in Kentucky
Kentucky sets per-vehicle liability minimums for every for-hire passenger carrier in KRS 281.655, filed with Motor Carriers by your insurer on a Form E. Brokers also require Kentucky workers compensation.
| Coverage | Minimum | Set by |
|---|---|---|
| Vehicles with up to 7 regular seats | $100,000 per person, $300,000 per accident, $50,000 property damage | KRS 281.655 |
| Vehicles with 8 or more regular seats | $100,000 per person, $600,000 per accident, $50,000 property damage | KRS 281.655 |
| Proof and cancellation | Form E filed by the insurer before the certificate is issued. Coverage stays in force until 30 days after the insurer notifies the Cabinet of cancellation. | KRS 281.655 |
| Workers compensation | Proof of Kentucky workers compensation coverage given to the broker | 603 KAR 7:080, Section 12; broker contract |
Does Kentucky require EVV for NEMT?
No. Kentucky requires EVV for personal care, home health, private duty nursing, and certain 1915(c) waiver services, through the state's Therap system or an approved third-party system. NEMT is not on the list.
HSTD uses its own records instead. Brokers and subcontractors collect encounter data on every trip, keep trip invoices, monthly reports, and vehicle inventories for five years, and submit invoices to the broker within six months of the date of service. Specialty trips (Types 07 and 08) require a written recommendation from the member's clinician after the first 30 days.
What changed in Kentucky in 2025 and 2026
Kentucky had 1,272,217 people on Medicaid and CHIP in May 2026 (CMS preliminary data). In state fiscal year 2023, the latest year in the program's published summary, HSTD brokers delivered 2,870,995 trips to 244,229 unduplicated riders over 36.8 million miles, at an average cost of $53.99 per trip and $4.21 per mile. Capitated payments to the program totaled $155.0 million.
Taxi-type ambulatory trips (Type 02) made up 39 percent of FY 2023 trips and non-profit ambulatory trips (Type 04) 35 percent. Wheelchair trips (Type 08) were 15 percent and escorted ambulatory trips (Type 07) 8 percent.
The program's rules are stable. The Cabinet recertified 603 KAR 7:080 without changes effective April 25, 2025, and DMS last amended 907 KAR 3:066 effective June 18, 2024. The current DMS rule denies rides to members with a working vehicle unless a clinician, employer, school, mechanic, or transportation authority says it cannot be used, and lets DMS exclude providers that solicit members who have their own transportation. Broker contracts run on a July 1 fiscal year.
Frequently asked questions
- Who is the NEMT broker in Kentucky?
- It depends on the region. The Transportation Cabinet contracts one broker for each of 15 HSTD regions: Audubon Area Community Services (GRITS), PACS, LKLP, FTSB, BGCAP, RTEC, SVTS, and LVCAP. FTSB covers Louisville (Region 6), Northern Kentucky (Region 9), and Lexington (Region 10). The HSTD hotline is 888-941-7433.
- Do Kentucky managed care members use a different NEMT broker?
- No. Under 603 KAR 7:080, the regional broker transports every Medicaid member coded to its counties, except qualified Medicare beneficiaries and Phase 3 KCHIP children, whether or not the member is in a managed care plan.
- Do I need a license to run a NEMT business in Kentucky?
- Yes. You need for-hire passenger operating authority from the Division of Motor Carriers, either a Taxi certificate or a Disabled Persons Vehicle certificate, before a broker will subcontract with you. DPV vehicles must be ADA-compliant with a lift or ramp.
- How do I enroll with Kentucky Medicaid as a transportation provider?
- After you subcontract with your regional broker, file a MAP 811 for each service type as Provider Type 56 (specialties 262 to 265), get the broker's signature, and submit in the Kentucky Medicaid Provider Enrollment Portal with your operating certificate. Share each Welcome Letter with the broker.
- What insurance does a Kentucky NEMT provider need?
- KRS 281.655 requires $100,000 per person, $300,000 per accident, and $50,000 property damage for vehicles with up to 7 regular seats, and $600,000 per accident for vehicles with 8 or more. Your insurer files a Form E with Motor Carriers. Brokers also need proof of Kentucky workers compensation.
- What are the driver requirements for NEMT in Kentucky?
- Drivers must be at least 18, licensed in Kentucky, have no more than two moving violations in three years and no convictions for sexual or violent crimes, pass a pre-employment drug test, and complete first aid, bloodborne pathogens, and passenger assistance training. A driver with any conviction in the last five years needs approval from the broker, the provider, and the Cabinet.
- How many vehicles do I need to start a Kentucky NEMT company?
- New providers in the program must keep at least three active, approved drivers and three operational passenger vehicles. Motor Carriers requires at least one vehicle ready before it grants a certificate.
- Does Kentucky require EVV for NEMT?
- No. Kentucky EVV covers personal care, home health, private duty nursing, and certain waiver services. HSTD trips are documented through broker encounter data and trip invoices kept for five years.
- How much notice do Kentucky Medicaid members give for rides?
- At least 72 hours, counting weekends and holidays. Urgent care rides, needed within 12 hours, are available 24 hours a day, and hospital discharges during operating hours do not need 72 hours' notice.
Running NEMT in Kentucky with HealthRide
Kentucky providers work inside one region's rules, rates, and trip types, with 02, 07, and 08 trips on the same day. HealthRide matches wheelchair and ambulatory needs to the right vehicle on one dispatch board, and Ryder Go plans the full day in one click.
Credential expiry reminders track annual vehicle inspections and driver training, and the trip log exports as CSV or PDF when a broker or the Cabinet asks for records.
Official resources
- KYTC: Office of Transportation Delivery
- KYTC: Find a HSTD broker in your area
- KYTC: Become a subcontract transportation provider
- KYTC: How to schedule non-emergency medical transportation
- 603 KAR 7:080: Human service transportation delivery
- 907 KAR 3:066: Nonemergency medical transportation waiver services and payments
- Kentucky DMS: Medical transportation
- Kentucky DMS: Non-emergency transportation services, Provider Type 56
- Kentucky DMS: MAP 811 provider enrollment application
- DriveKY: Passenger vehicle authority
- KRS 281.655: Bonds or insurance policies
- KRS 281.873: Specialty carrier transport and escorts
- Kentucky DMS: Electronic Visit Verification
- KYTC/OTD: NEMT summary report, fiscal year 2023
- CMS: State Medicaid and CHIP applications, eligibility determinations, and enrollment data
HealthRide plans the whole day in one click and bills every ride.
$59 per vehicle per month. No contracts.