How to start a NEMT business in Virginia: DMV authority, brokers, and DMAS rules
Virginia Medicaid rides are arranged by brokers, not by DMAS. Each of the five Cardinal Care health plans contracts its own broker, and DMAS contracts one for fee-for-service members. You never enroll with DMAS for NEMT. You do need a DMV Non-Emergency Medical Transportation Carrier certificate, backed by a $25,000 surety bond, before you carry a single Medicaid member.
Virginia NEMT at a glance
- Runs the program
- Virginia Department of Medical Assistance Services (DMAS)
- Program
- Cardinal Care Non-Emergency Medical Transportation (NEMT)
- How rides are arranged
- Health plans each contract a broker. Each Cardinal Care health plan contracts a broker, and DMAS contracts a separate broker for fee-for-service members. Brokers enroll, assign, and pay providers.
- Brokers you will contract with
- Modivcare, MTM Health (including Access2Care), MediDrive, SafeRide Health
- State operating license
- DMV Non-Emergency Medical Transportation Carrier certificate, a $25,000 surety bond or letter of credit, and NEMT-designated registrations and plates.
- EVV for NEMT trips
- Not required
- Medicaid enrollment
- 1,456,891 (May 2026, Medicaid only)
On this page
How Medicaid NEMT works in Virginia
DMAS runs Virginia Medicaid and FAMIS under the Cardinal Care name. Since July 1, 2025, Cardinal Care Managed Care members choose among five health plans: Aetna Better Health of Virginia, Anthem HealthKeepers Plus, Humana Healthy Horizons of Virginia, Sentara Health Plans, and UnitedHealthcare of the Mid-Atlantic. Molina is no longer a Cardinal Care plan, and its members who did not choose another plan moved to Humana on July 1, 2025.
Each plan contracts a transportation broker, and DMAS contracts a broker for fee-for-service members, mostly people not yet assigned to a plan. Each broker enrolls providers and volunteer drivers, trains drivers, inspects vehicles, negotiates contracts and rates, assigns trips, and pays providers. Brokers preauthorize every trip, and while members can ask for a provider, the broker does not have to honor it.
The DMV licenses the operators. A company that carries only Medicaid members on trips arranged by DMAS or a DMAS-contracted broker holds a Non-Emergency Medical Transportation Carrier certificate, may carry only those members, and may be paid only through Medicaid. DMAS publishes one set of driver, attendant, and vehicle requirements for fee-for-service NEMT, and plan brokers use requirements that are similar or the same.
Governing rule:DMAS: NEMT driver, attendant, and vehicle requirements (May 26, 2026)
Who brokers Medicaid rides in Virginia
Which broker pays you depends on the member's health plan. DMAS lists each plan's reservation line in its transportation contacts sheet, and brokers will not assign you trips until you complete their enrollment.
| Broker | Serves | Provider sign-up |
|---|---|---|
| Modivcare | Humana Healthy Horizons of Virginia (since July 1, 2025) and Sentara Health Plans. Modivcare also holds the DMAS fee-for-service contract, awarded in January 2018 to LogistiCare, its former name.DMAS is moving fee-for-service NEMT from Modivcare to MTM Health. | Provider page |
| MTM Health | Anthem HealthKeepers Plus members through Access2Care, which MTM Health has owned since October 2024. MTM Health is also taking over DMAS fee-for-service rides and is training fee-for-service providers and drivers now, on the same reservation line, 1-866-386-8331.Confirm the fee-for-service start date with DMAS at transportation@dmas.virginia.gov before you plan around it. | Provider page |
| MediDrive | Aetna Better Health of Virginia members statewide. Members book three business days ahead at 1-800-734-0430. | Provider page |
| SafeRide Health | UnitedHealthcare of the Mid-Atlantic members. Members book at 1-888-462-6049, and Ride Assist stays at 1-833-215-3885.Since March 1, 2026. | Provider page |
Enroll with every broker whose members you want to carry. There is no single Virginia network.
Volunteer drivers who carry members in their own cars need an NPI and taxonomy code, at least two years of driving experience, and full auto coverage that does not exclude passengers.
How to become a NEMT provider in Virginia
Two approvals matter in Virginia: DMV operating authority and broker enrollment. DMAS itself does not enroll NEMT providers.
Form the business
Register the company with the Virginia State Corporation Commission and get a federal EIN. DMV asks for FEIN verification from the IRS with the operating authority application.
Get a DMV NEMT Carrier certificate
File Form OA 151 with a $25,000 surety bond (Form OA 435) or letter of credit (Form OA 447), which stays on file for three years from the date the certificate is issued, and Form OA 210 for each business official. Fees are $50 to file and $3 for the operating authority registration. Vehicles need registrations and plates designated for NEMT carriers. DMV has taken applications online since January 1, 2026 and requires online filing from February 1, 2027.
Enroll with each broker
Contact Modivcare for Humana and Sentara, SafeRide Health for UnitedHealthcare, MediDrive for Aetna, and MTM Health for Anthem (through Access2Care) and for fee-for-service trips as they move over. MTM Health's process runs through application, credentialing, and contracting with a designated representative, and MediDrive credentials drivers and vehicles on an ongoing basis.
Train every driver on the broker program
Every driver, attendant, taxi driver, and volunteer driver completes the broker's driver training before the first trip, unless the broker approves your own course in writing. For MTM Health fee-for-service trips, that means the online PASS Basic course plus a six-hour in-person driver training, and stretcher training for stretcher drivers. A current PASS Basic and Securement certification is honored until it expires.
Pass vehicle inspections
Brokers inspect every vehicle in person before it carries members and every six months after, and they apply pass, provisional, or fail stickers. Wheelchair and stretcher vans are inspected twice a year.
DMAS: NEMT driver, attendant, and vehicle requirements (May 26, 2026)
Keep credentialing current
Brokers review every driver and attendant before the first trip and at least once a year, and they enroll drivers in the DMV Driver Alert monitoring program. Plan for the review by keeping licenses, background checks, and training records current.
Vehicle and driver requirements in Virginia
DMAS sets the minimum for fee-for-service NEMT, plan brokers follow similar rules, and every broker may add requirements.
Vehicles
| Requirement | State rule | Broker contract |
|---|---|---|
| Operating authority | DMV NEMT Carrier certificate, NEMT plates, and vehicles titled and licensed in Virginia. Taxis also need any local taxi license. | Required before any Medicaid trip. |
| Inspections | In-person inspection before first use and every six months, with pass, provisional, or fail stickers; the words Medicaid and FAMIS may not appear on stickers or vehicles. | MTM Health: inspection twice a year, sticker in the lower right corner of the passenger-side rear window. |
| Climate control | Air conditioning to 68 degrees and heat to 74 degrees, measured at the rear of the vehicle. | Same. |
| Equipment | Seat belt cutter, one or two belt extensions, stocked first aid kit, ABC fire extinguisher, spill kit, and a GPS device or current maps. | Same. |
| Markings | Business name and phone number on both sides in permanent letters at least 3 inches tall; broker toll-free number and complaint steps posted inside. | Same. |
| Wheelchair vans | Four working securements per station, a working interlock, and a vehicle-mounted lap and shoulder belt at each station; vans taking hospital discharges carry a spare wheelchair at least 20 inches wide. | MTM Health: every wheelchair secured facing forward with four straps plus a lap and shoulder belt. |
Drivers
| Requirement | State rule | Broker contract |
|---|---|---|
| Age and license | At least 18, with a valid license held for at least two years; DMV record no worse than minus 2 points. | MTM Health: valid Virginia license and a Virginia DMV driving record check. |
| Driving history | No more than two chargeable accidents or moving violations in three years, and no suspension or revocation for moving violations in five years. | MediDrive: motor vehicle report at credentialing and ongoing. |
| Criminal history | No barrier crime under Va. Code 37.2-314(B); Virginia State Police or national criminal checks and the sex offender registry before the first trip. | MediDrive adds OIG and GSA SAM exclusion checks and a national sex offender check. |
| Drugs and alcohol | No use of alcohol, narcotics, illegal drugs, or impairing medications on duty; known abusers may not drive. | MediDrive: current drug screen for every driver. |
| Training | The broker's driver training before the first trip, or a written-approved internal course. | MTM Health: defensive driving, basic first aid, and wheelchair securement. MediDrive: PASS, wheelchair, defensive driving, and First Aid, CPR, and AED. |
| On the job | Uniform shirt or NEMT program ID badge; no phone or headphone use while moving; confirm each member is safely inside the destination. | MTM Health: arrive within 15 minutes of the scheduled pickup and keep each trip within the direct travel time plus 45 minutes. |
Insurance minimums in Virginia
DMV sets the liability floor for NEMT carriers by seating capacity, and DMAS points to the DMV amounts for wheelchair and stretcher vans. Brokers may require more.
| Coverage | Minimum | Set by |
|---|---|---|
| Vehicles seating 1 to 6, driver included | $350,000 bodily injury and property damage | Virginia DMV, NEMT Carrier requirements |
| Vehicles seating 7 to 15, driver included | $1,500,000 bodily injury and property damage | Virginia DMV, NEMT Carrier requirements |
| Vehicles seating 16 or more, driver included | $5,000,000 bodily injury and property damage | Virginia DMV, NEMT Carrier requirements |
| Surety bond | $25,000 bond or irrevocable letter of credit, on file for three years from certificate issue | Virginia DMV, NEMT Carrier requirements |
| Taxis and multi-passenger vans | The greater of the DMV amount or the city or county taxi ordinance | DMAS NEMT requirements (May 26, 2026) |
| MediDrive network | General liability, auto liability, and workers compensation, at amounts set in the contract | Broker contract |
Does Virginia require EVV for NEMT?
No. Virginia applies EVV to personal care, respite, and companion services, including consumer-directed care, and to home health services, which DMAS added in July 2023. NEMT is not included.
Brokers check NEMT their own way: they preauthorize every trip, inspect every vehicle twice a year, issue ID badges after driver training, and monitor driving records through DMV Driver Alert. Fee-for-service members book five business days ahead unless the trip is urgent, and standing orders for dialysis, therapy, and similar care can run up to six months.
What changed in Virginia in 2025 and 2026
Virginia had 1,456,891 people on Medicaid and 187,417 on CHIP in May 2026.
The broker map has changed four times since mid 2025. Humana joined Cardinal Care on July 1, 2025 with Modivcare as its broker, MediDrive took over Aetna Better Health of Virginia, UnitedHealthcare moved to SafeRide Health on March 1, 2026, and DMAS is moving fee-for-service rides from Modivcare to MTM Health. Providers who carried fee-for-service, Aetna, or UnitedHealthcare trips need the new broker's credentialing to keep them.
Modivcare, still the broker for Humana and Sentara, filed for Chapter 11 on August 20, 2025 and emerged on December 29, 2025 with its funded debt cut by more than 85 percent.
Rates are negotiated with each broker. DMV operating authority went online on January 1, 2026, and paper applications end on February 1, 2027.
DMAS awards its fee-for-service NEMT brokerage contract (RFP 2018-01) to LogistiCare, now Modivcare.
MTM Health announces it has closed its acquisition of Access2Care, the NEMT broker DMAS lists for Anthem HealthKeepers Plus.
Cardinal Care Managed Care moves to five plans. Humana joins with Modivcare as its broker, and Molina members move to Humana.
Modivcare files for Chapter 11.
Modivcare emerges from Chapter 11 with its funded debt cut by more than 85 percent.
DMV opens online applications and renewals for operating authority, including NEMT Carrier certificates.
UnitedHealthcare of the Mid-Atlantic moves Cardinal Care rides to SafeRide Health.
DMAS updates its NEMT driver, attendant, and vehicle requirements.
MTM Health's Virginia fee-for-service member handbook is approved as DMAS moves fee-for-service NEMT to MTM Health.
DMV requires all operating authority applications and renewals to be filed online, except TNC renewals.
Frequently asked questions
- Who is the NEMT broker in Virginia?
- It depends on the member. Modivcare serves Humana and Sentara members. SafeRide Health has served UnitedHealthcare members since March 1, 2026. MTM Health serves Anthem HealthKeepers Plus through Access2Care and is taking over fee-for-service trips from Modivcare. MediDrive serves Aetna Better Health of Virginia. DMAS lists each plan's reservation line on its NEMT page.
- Do I need a DMV license to do NEMT in Virginia?
- Yes. A company that carries only Medicaid members on trips arranged by DMAS or a DMAS broker needs a DMV Non-Emergency Medical Transportation Carrier certificate. File Form OA 151 with a $25,000 surety bond or letter of credit, pay the $50 filing fee, and register vehicles with NEMT plates.
- Do I enroll with DMAS to become a Medicaid transportation provider?
- No. DMAS does not enroll NEMT providers directly for fee-for-service or managed care trips. You enroll with each broker whose members you want to carry, and the broker handles credentialing, inspections, rates, trip assignment, and payment.
- How much insurance does a Virginia NEMT carrier need?
- DMV requires $350,000 of bodily injury and property damage coverage for vehicles seating 1 to 6 including the driver, $1,500,000 for 7 to 15, and $5,000,000 for 16 or more, plus the $25,000 bond. Taxis and multi-passenger vans must also meet any higher local taxi ordinance, and brokers can ask for more.
- What are the driver requirements for NEMT in Virginia?
- Drivers must be at least 18, hold a valid license for at least two years, keep a DMV record no worse than minus 2 points, have no more than two chargeable accidents or moving violations in three years, pass criminal and sex offender registry checks with no barrier crimes, and finish the broker's driver training before the first trip.
- How often are NEMT vehicles inspected in Virginia?
- Before the first trip and every six months after, in person, by the broker. Wheelchair and stretcher vans are inspected twice a year, and each vehicle gets a pass, provisional, or fail sticker.
- Does Virginia require EVV for NEMT?
- No. Virginia EVV covers personal care, respite, companion, and home health services. NEMT trips are preauthorized and checked by the brokers instead.
- What is changing for Virginia fee-for-service NEMT in 2026?
- DMAS is moving fee-for-service NEMT from Modivcare to MTM Health. MTM Health is training fee-for-service providers and drivers, requires the online PASS Basic course and in-person driver training before any fee-for-service trip, and keeps the reservation line at 1-866-386-8331. Confirm the start date with DMAS.
Running NEMT in Virginia with HealthRide
A Virginia fleet that serves several Cardinal Care plans works with several brokers. HealthRide runs every trip on one dispatch board and records every payment, whichever payer it came from, in one ledger.
With six-month inspections and yearly credentialing, dates pile up fast. Vehicle inspections and credential expiry reminders in HealthRide keep those dates from sneaking up on you.
Official resources
- DMAS: Non-emergency transport (providers)
- DMAS: NEMT driver, attendant, and vehicle requirements (May 26, 2026)
- DMAS: NEMT FFS and MCO provider enrollment (July 1, 2025)
- DMAS: Transportation contacts for reservations and ride assist (October 2025)
- DMAS: FFS NEMT RFP 2018-01 notice of award
- DMAS: Cardinal Care members
- DMAS: Electronic Visit Verification
- DMAS: Fee-for-service NEMT website
- Virginia DMV: Non-Emergency Medical Transportation Carrier
- Virginia DMV: Apply for for-hire intrastate operating authority
- Virginia SCC: Businesses
- MTM Health: Virginia Medicaid fee-for-service NEMT
- MTM Health: Virginia transportation providers
- MTM Health: Virginia DMAS provider training
- MTM Health: Virginia FFS NEMT member handbook (June 2026)
- MTM Health: Acquisition of Access2Care finalized
- MediDrive: About the Aetna Better Health of Virginia program
- MediDrive: Virginia transportation providers
- MediDrive: Virginia medical facilities (scheduling rules)
- UnitedHealthcare Community Plan of Virginia: Cardinal Care
- UnitedHealthcare Community Plan of Virginia: Member handbook transportation addendum (SafeRide)
- SafeRide Health: What to expect as a NEMT provider
- Anthem HealthKeepers Plus: Transportation (Access2Care)
- Humana Healthy Horizons in Virginia: Transportation
- Modivcare: Virginia facility resources
- Modivcare: Transportation providers
- CMS: State Medicaid and CHIP enrollment data
- SEC: Modivcare Form 8-K, August 2025
- SEC: Modivcare Form 8-K, December 2025
- SEC: Modivcare press release on completing its restructuring (8-K exhibit 99.1)
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