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How to start a NEMT business in Maryland: local grantees, PSC authority, and vendor contracts

Updated

Maryland has no NEMT broker. The Maryland Department of Health pays grants to the local health departments, plus the Montgomery County Department of Transportation, and each grantee arranges rides for Medicaid recipients in its own jurisdiction. HealthChoice plans do not run rides. For a transportation company, the work comes from a vendor contract with the county program, and most for-hire carriers also need Public Service Commission authority.

Maryland NEMT at a glance

Runs the program
Maryland Department of Health (MDH), Office of Long Term Services and Supports
Program
Non-Emergency Medical Assistance Transportation (NEMT) grant program
How rides are arranged
County-run programs. MDH funds local health departments and the Montgomery County Department of Transportation as grantees. Each screens riders and hires or subcontracts transportation vendors.
Brokers you will contract with
None. Local health departments and the Montgomery County Department of Transportation
State operating license
No NEMT license. The PSC regulates most intrastate for-hire passenger carriers, and drivers of vehicles carrying 15 or fewer passengers need a PSC passenger-for-hire license.
EVV for NEMT trips
Not required
Medicaid enrollment
1,178,359 (May 2026, Medicaid only)
On this page

How Medicaid NEMT works in Maryland

MDH runs NEMT as a grant program under COMAR 10.09.19. Grants go to local agencies that act as agents of the state: the local health departments and, for Montgomery County, the county Department of Transportation. Grantees screen each request, arrange the ride, develop new transportation resources, and provide transportation only when the recipient has no other way to get there.

The program is a safety net. Screening asks whether the household owns a car, whether friends, relatives, or volunteers can drive, whether a bus runs between home and the appointment, and whether the appointment can move. Riders who say they cannot use public transit need a physician's documentation. Grantees may refuse to pay for a ride requested less than 24 hours ahead (COMAR 10.09.19.04), and some counties, such as Anne Arundel and Harford, ask for two business days.

HealthChoice managed care plans are not responsible for grant-funded transportation. COMAR 10.67.06.27 limits their role to helping enrollees reach their local grantee. Grantees that subcontract must name the subcontractors, the scope, the payment level, and their monitoring plan in the grant proposal to MDH.

Governing rule:COMAR 10.09.19: Transportation Grants

Who brokers Medicaid rides in Maryland

There is no statewide or plan-level broker. Each of Maryland's 24 jurisdictions runs its own program, and each program chooses its own vendors. The examples below show the pattern.

BrokerServesProvider sign-up
Local health departments (statewide)Medicaid recipients in their county or Baltimore City, fee-for-service and HealthChoice alike. Each program books its own rides and chooses its own vendors.Provider page
Montgomery County Department of TransportationMontgomery County, as MDH's grantee there instead of the health department.
Baltimore County Department of HealthBaltimore County. Transdev runs shared rides to medical appointments. Hart to Heart is the contracted vendor for wheelchair and ambulance rides, discharges, and transfers, and it may use subcontractors.Provider page410-887-2828
Anne Arundel County Department of HealthAnne Arundel County. AAA Transport runs the rides and takes same-day changes.Provider page410-222-7152
Harford County Health DepartmentHarford County. All American Ambulance and Transport is the transportation provider.Provider page410-638-1671

Where a county uses one primary vendor, a subcontract with that vendor is another way in. Baltimore County's vendor, Hart to Heart, may use subcontractors for wheelchair and ambulance rides.

MDH reconciles each grant every year (COMAR 10.09.19.08) and monitors grant funding quarterly. A grantee may not refuse a ride because its grant money has run out. It must work the problem out with MDH instead (COMAR 10.09.19.09).

How to become a NEMT provider in Maryland

Maryland splits the job in two: state authority from the Public Service Commission, and work from the county programs.

  1. Form the business

    Register with the Maryland Department of Assessments and Taxation (SDAT) and get a federal EIN. The PSC application asks for your SDAT department ID, your articles of organization or incorporation, a current certificate of good standing, and any trade name filing.

  2. Apply to the PSC for carrier authority

    The PSC regulates most intrastate for-hire passenger carriers, including sedan and van services. File the Form 28 carrier application with a certificate of auto liability insurance, proof of workers compensation (or the exclusion form if you employ no drivers), your rates, and your service area. Each vehicle needs a valid Maryland state inspection certificate, and vehicles over 10 model years old or over 10,000 pounds GVWR need semiannual inspections. Vehicles designed for more than 8 passengers, driver included, also need a USDOT number. Allow 6 to 8 weeks for processing.

    PSC: Carrier application packet (Form 28)

  3. License your drivers with the PSC

    Anyone driving a for-hire vehicle that carries 15 or fewer passengers needs a PSC passenger-for-hire driver's license before driving. Since April 1, 2026, the PSC accepts these applications online only. COMAR 20.95.01.26 lets the PSC deny a license indefinitely for a crime of violence and for other felonies within the past seven years.

    COMAR 20.95.01.26: Driver screening standards

  4. Check for WMATC authority near DC

    Carriers running point-to-point service inside the Washington Metropolitan District, which includes Montgomery and Prince George's counties, must also hold a Washington Metropolitan Area Transit Commission certificate and show it to the PSC.

    PSC: Transportation applications and forms

  5. Contact the county programs

    Call the local transportation office in each county you want to serve. Counties hire vendors under their own procurement rules, so ask when the next solicitation opens and what the current vendor contract requires. Where a county uses a primary vendor, ask that vendor about subcontracting.

    MDH: Community Support Services (NEMT)

Vehicle and driver requirements in Maryland

Maryland's NEMT grant rules say little about vehicles and drivers. The standards come from the PSC and from each county's vendor contract, which the county sets under its own procurement.

Vehicles

RequirementState ruleBroker contract
Operating authorityPSC authority for intrastate for-hire passenger carriers. WMATC authority for point-to-point service inside the Washington Metropolitan District.Each county vendor contract sets its own credentialing terms.
InspectionsA valid Maryland state inspection certificate when PSC authority is granted. Semiannual inspections for vehicles over 10 model years old or over 10,000 pounds GVWR (PSC).Set in the county vendor contract.
Vehicle ageNo more than 12 model years old, unless the vehicle is over 10,000 pounds GVWR or a historic vehicle (PSC carrier application).Set in the county vendor contract.
Wheelchair vansA wheelchair van has a lift tailgate or side lift (COMAR 10.09.19.02). Grant funds cannot pay for wheelchair van service for ambulatory riders, or ambulance service for riders who do not need to lie flat.The county's grant manager decides the mode for each rider.
Child seatsNone in COMAR 10.09.19.Harford County requires riders to bring an age- and weight-appropriate car seat or booster for children.

Drivers

RequirementState ruleBroker contract
Driver licenseA PSC passenger-for-hire driver's license for anyone driving a for-hire vehicle that carries 15 or fewer passengers. Applications are online only from April 1, 2026.Set in the county vendor contract.
Criminal historyThe PSC may deny a license indefinitely for a crime of violence and for any other felony within seven years of applying (COMAR 20.95.01.26).Set in the county vendor contract.
Wait and no-show rulesNone in COMAR 10.09.19.Baltimore County drivers wait no more than 15 minutes before leaving and reporting a no-show to the county.

Insurance minimums in Maryland

The PSC sets per-vehicle minimums by seating capacity. The Motor Vehicle Administration floor applies to every vehicle registered in Maryland.

CoverageMinimumSet by
Auto liability, any Maryland vehicle$30,000 per person, $60,000 per accident, $15,000 property damageMaryland MVA
For-hire vehicle seating 7 or fewer passengers$50,000 per person, $100,000 per accident, $20,000 property damage, or $120,000 combined single limitPSC carrier application (Form 28)
For-hire vehicle seating 8 to 15 passengers$75,000 per person, $200,000 per accident, $50,000 property damage, or $250,000 combined single limitPSC carrier application (Form 28)
For-hire vehicle seating 16 or more passengers$75,000 per person, $400,000 per accident, $100,000 property damage, or $500,000 combined single limitPSC carrier application (Form 28)
Workers compensationPolicy or binder number if you employ drivers, or the PSC exclusion form if you do not and are eligiblePSC carrier application (Form 28)
County vendor contractSet by each county in its vendor contractCounty contract

Does Maryland require EVV for NEMT?

No. Federal EVV rules cover in-home personal care and home health visits, and Maryland providers under them clock in and out through the LTSSMaryland EVV app. NEMT runs through the local grant program and is not part of it.

Grantees document trips instead. COMAR 10.09.19.07 requires each grantee to record whether the rider had other transportation, that each paid trip went to or from a medically necessary service, and which riders were denied and why. Counties add their own rider rules, such as annual physician certification and no-show policies.

MDH: LTSSMaryland Electronic Visit Verification

What changed in Maryland in 2025 and 2026

Maryland Medicaid covered 1,178,359 people in May 2026, plus 195,413 in CHIP, according to CMS preliminary monthly data. NEMT is a last-resort benefit, so only riders with no other option reach the county programs.

Rates are local. MDH funds the grants as an administrative expense under an approved cost allocation plan, and grantees that subcontract report each subcontractor's payment level to MDH in their grant proposals. The grant rules require the most efficient and cost-effective option, including volunteers and charitable groups where possible.

Two 2026 changes matter. MDH published a public notice on February 25, 2026 amending the State Plan to cover lodging and meals for NEMT, with a proposed effective date of January 1, 2026. And from April 1, 2026, PSC passenger-for-hire driver license applications are online only.

  1. MDH tells grant managers how to pay transportation vendor invoices that arrive after the fiscal year closes.

    Notice

  2. MDH ends its COVID-19 NEMT directives, and pre-pandemic NEMT policies resume.

    Notice

  3. Proposed effective date for the State Plan amendment covering NEMT lodging and meals.

    Notice

  4. MDH publishes the NEMT public notice describing the grant model with local health departments and the Montgomery County Department of Transportation.

    Notice

  5. PSC passenger-for-hire and taxicab driver license applications move online only.

    Notice

Frequently asked questions

Who is the NEMT broker in Maryland?
Maryland has no broker. MDH pays grants to the local health departments, and to the Montgomery County Department of Transportation, and each grantee arranges Medicaid rides in its own jurisdiction. Many grantees contract one or more transportation vendors to run the trips.
How do I get NEMT work in Maryland?
Contact the local transportation office in each county you want to serve and ask about its vendor contract and next solicitation. Counties hire vendors under their own procurement rules. Where a county uses one primary vendor, such as Hart to Heart in Baltimore County, a subcontract with that vendor is another way in.
Do I need a PSC permit for NEMT in Maryland?
The Public Service Commission regulates most intrastate for-hire passenger carriers, including sedan and van services. Carrier authority requires the Form 28 application, insurance, workers compensation, and state inspections, and drivers of vehicles carrying 15 or fewer passengers need PSC passenger-for-hire licenses. Near DC, point-to-point service may also need WMATC authority.
Do HealthChoice MCOs arrange NEMT rides?
No. Under COMAR 10.67.06.27, HealthChoice plans are not responsible for transportation provided through the local grants. Their role is to help enrollees reach their local transportation grantee. The county program serves fee-for-service and HealthChoice members alike.
What insurance does a Maryland for-hire van need?
The PSC minimum depends on seating. A vehicle seating 8 to 15 passengers needs $75,000 per person, $200,000 per accident, and $50,000 property damage, or a $250,000 combined single limit. Vehicles seating 7 or fewer need $50,000, $100,000, and $20,000, or $120,000 combined. County vendor contracts can require more.
Does Maryland require EVV for NEMT?
No. Maryland EVV confirms in-home personal care and home health services. NEMT grantees document screening, medical necessity, and denials under COMAR 10.09.19.07 instead.
How far ahead must Maryland Medicaid rides be booked?
At least 24 hours. Grantees may refuse to pay for rides requested with less notice (COMAR 10.09.19.04). Counties can set longer windows. Anne Arundel and Harford ask for two business days, and Baltimore County takes bookings up to seven days ahead with 24 hours' notice.

Running NEMT in Maryland with HealthRide

Maryland vendors take their trips from a county program rather than a broker portal. HealthRide puts every trip on one dispatch board, recurring dialysis rides included, and exports the trip log as CSV or PDF when the county asks for records.

See pricing

Official resources

HealthRide plans the whole day in one click and bills every ride.

$59 per vehicle per month. No contracts.

NEMT in other states

Comparing brokers across states?See who arranges Medicaid rides in every state