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How to start a NEMT business in Washington: regional brokers, licensing, and standards

Updated

Washington runs Medicaid rides through six regional brokers that the Health Care Authority contracts directly, each covering its own group of counties. Apple Health managed care plans do not arrange rides. There is no NEMT license. For-profit operators get Department of Licensing for-hire vehicle certificates, and every provider needs a subcontract with the broker for the counties it serves.

Washington NEMT at a glance

Runs the program
Washington State Health Care Authority (HCA)
Program
Apple Health nonemergency transportation (brokered NEMT)
How rides are arranged
Regional brokers, one per area. HCA contracts six regional brokers, each assigned to a set of counties. The broker for the client's county authorizes every ride and pays the providers it subcontracts.
Brokers you will contract with
Hopelink, Paratransit Services, People for People, Special Mobility Services, Northwest Regional Council, Community in Motion
State operating license
No NEMT license. DOL for-hire vehicle certificates ($55 per vehicle) plus a $110 for-hire permit where the city or county does not license for-hire businesses. Nonprofit special-needs carriers hold a UTC permit instead.
EVV for NEMT trips
Not required
Medicaid enrollment
1,724,000 (May 2026, Medicaid only)
On this page

How Medicaid NEMT works in Washington

HCA covers nonemergency transportation under WAC 182-546-5000 through 182-546-6200 and has used a brokerage model since 1989. Six regional brokers cover all 39 counties. The broker checks that the client is eligible and that the appointment is a covered service, picks the lowest-cost mode that fits the client's condition, sets the level of assistance (curb-to-curb through hand-to-hand), and authorizes the trip before it happens.

The benefit sits outside managed care. HCA's Apple Health integrated managed care contract, revised July 1, 2026, lists nonambulance transportation (taxi, cabulance, volunteer drivers, public transit) as a service the state provides, not the plans. Plans coordinate with the brokers instead of paying for rides. Clients call the broker for their county at least two business days ahead, and HCA suggests 7 to 14 days.

For a provider there is one door per region: a written subcontract with the broker. WAC 182-546-6200 lets brokers pay only subcontracted providers. Under HCA's sample broker contract, HCA pays each broker a capped monthly administrative fee plus the direct cost of trips, and brokers must pay providers within 10 calendar days of receiving HCA's monthly payment. At Hopelink the most common options are transit passes and gas card reimbursement, so door-to-door trips go to clients who cannot use either.

Governing rule:Chapter 182-546 WAC, sections 5000 through 6200: Nonemergency transportation

Who brokers Medicaid rides in Washington

Six brokers, each with fixed counties. Contract with the broker that covers the counties you drive in. A fleet that works across a regional line needs a subcontract with each broker. HCA's contracted broker list is the official county map.

BrokerServesProvider sign-up
HopelinkKing and Snohomish counties.Since 1990.Provider pageKing 800-923-7433, Snohomish 855-766-7433
Paratransit ServicesPierce, Kitsap, Thurston, Lewis, Mason, Grays Harbor, Pacific, Clallam, and Jefferson counties.Provider page360-377-7007
People for PeopleYakima, Benton, Franklin, Walla Walla, Columbia, Kittitas, Chelan, Douglas, and Okanogan counties.Provider page509-248-6793
Special Mobility ServicesSpokane, Adams, Asotin, Ferry, Garfield, Grant, Lincoln, Pend Oreille, Stevens, and Whitman counties.Provider page509-534-9760
Northwest Regional CouncilWhatcom, Skagit, Island, and San Juan counties.Provider page360-738-4554
Community in Motion (formerly Human Services Council)Clark, Cowlitz, Klickitat, Skamania, and Wahkiakum counties.Provider page360-694-9997

A client's health plan does not change who pays you. Every Apple Health client with a transportation benefit rides through the broker for the client's county.

Some trips never go through a broker. PACE programs, adult day health centers, and hospice providers arrange their own transportation, and involuntary treatment transports go to ambulances or designated carriers (WAC 182-546-5550).

With HCA approval, a tribe can provide transportation for its members, with coordination and payment through the broker. Brokers must negotiate in good faith when a tribe asks for a contract (WAC 182-546-5200).

How to become a NEMT provider in Washington

HCA does not sign transportation companies directly. Get your state licensing in place, then apply to the broker for your counties.

  1. Form the business

    Register the company, get a federal EIN, and open a Washington business license through the Department of Revenue's Business Licensing Service. Use one legal name and one DBA everywhere. The Department of Licensing delays for-hire applications when the business license, vehicle registrations, and insurance certificate do not show the same names.

  2. Get for-hire authority

    Companies carrying passengers for pay need a DOL for-hire vehicle certificate for each vehicle ($55) and, if the city or county does not license for-hire businesses, a for-hire permit ($110). The application needs a for-hire addendum signed by your local jurisdiction, vehicle registrations, and a liability insurance certificate naming DOL as certificate holder. DOL mails the license within 14 business days of a complete application. Private nonprofits serving people with special transportation needs apply to the Utilities and Transportation Commission instead.

    DOL: Get your license, taxis and for-hire vehicles

  3. Run driver background checks

    HCA's sample broker contract requires a Washington State Patrol fingerprint background check for every new driver, repeated every three years, with a WATCH name check in the years between. Results are reviewed against RCW 43.43.830 and the DSHS Secretary's List of disqualifying crimes. Brokers also screen providers and staff against federal exclusion lists before contracting and on an ongoing basis.

    HCA: Sample NEMT broker contract

  4. Apply to the regional broker

    Each broker recruits its own providers. Hopelink, for example, requires at least one year of NEMT experience, a fleet of five or more vehicles, and a physical office in Washington, and reviews applications within 30 days. Call the other brokers on their main lines to ask about openings in your counties.

    Hopelink: Medicaid transportation (partner requirements)

  5. Pass the broker's inspections

    Under HCA's sample broker contract, the broker inspects every vehicle and checks every driver file before first use. After that it inspects 10 percent of your fleet and drivers every other year, on-site in odd years and by desk audit in even years, with half the on-site checks unannounced. If more than 5 percent fail, the broker checks the whole fleet.

  6. Drive only authorized trips

    Every nonambulance trip needs prior authorization from the broker. The one exception: when the broker is closed and a client needs urgent care or a hospital discharge, you can follow the broker's after-hours instructions and request retroactive authorization within two business days (WAC 182-546-5200).

    WAC 182-546-5200: Broker and provider requirements

Vehicle and driver requirements in Washington

Washington's NEMT rule sets few operating standards of its own. The detail lives in HCA's contract with each broker, which the broker passes down in your subcontract. The broker column follows the sample broker contract HCA publishes for the program. Terms can change when contracts renew, so check them against your own subcontract.

Vehicles

RequirementState ruleBroker contract
Operating authorityDOL for-hire vehicle certificate for each vehicle, plus a for-hire permit where the city or county does not license for-hire businesses (RCW 46.72). Nonprofit special-needs carriers hold a UTC permit (RCW 81.66).Proof of licensing at credentialing. Hopelink asks for the for-hire license number on its application.
Safety and accessibilityProviders must be licensed, equipped, and operated under federal, state, and local law (WAC 182-546-5200). The state seat belt law (RCW 46.61.688) applies to every vehicle.Wheelchair securement devices, working seat belts for every seat, child seat capability, working heat and ventilation, interior lights, two side mirrors and an interior mirror, and an accurate speedometer and odometer.
Dispatch contactDrivers may not hold a phone or other personal electronic device while driving (RCW 46.61.672).A two-way radio or phone linking every vehicle to dispatch. A vehicle with a dead link comes out of service until it is fixed.
Markings and conditionNone in WAC 182-546.Provider name and vehicle number prominently displayed. Clean interior and exterior with no torn seats, broken windows, or major body damage.
InspectionsNone in WAC 182-546.Inspection before first use, then 10 percent of each fleet every other year, alternating on-site and desk audits. Failed vehicles leave service until reinspected.

Drivers

RequirementState ruleBroker contract
License and recordDrivers must comply with all federal, state, and local laws during transport (WAC 182-546-5200).Valid driver license, abstract of driving record, and insurance on file before the first trip.
Background checksBrokers screen providers and their employees against federal exclusion lists before contracting and on an ongoing basis (WAC 182-546-5200).Washington State Patrol fingerprint check before the first drive and every three years, WATCH checks in between, reviewed against the DSHS Secretary's List.
TrainingNone in WAC 182-546.Child safety seat installation and use for commercial drivers. CPR and First Aid, passenger assistance training, fire suppression, and defensive driving are recommended.
Drugs and alcoholNone in WAC 182-546.No alcohol or drugs on duty. Prescribed medication that could affect driving needs a prescriber's written note that it will not.
Conduct and assistanceNone in WAC 182-546.Visible company ID, no smoking with clients aboard, no headphones, no eating while driving. Drivers open doors, help clients to the main door, and confirm belts and wheelchair securement before moving.

Insurance minimums in Washington

Washington's NEMT rule sets no dollar amount. The for-hire law sets the floor for licensed operators, and HCA's sample broker contract ties everyone else to the broker's own limits.

CoverageMinimumSet by
Auto liability, any vehicle$25,000 per person, $50,000 per accident, $10,000 property damageRCW 46.29.090
For-hire vehicles licensed by DOL$100,000 per person and $300,000 per accident bodily injury plus $25,000 property damage, or $325,000 combined single limitRCW 46.72.040 and 46.72.050, DOL for-hire licensing
Broker subcontract, providers licensed by DOL or UTCAt least the minimum their licensing law setsHCA sample broker contract, Exhibit I
Broker subcontract, providers not publicly regulatedThe same types and limits HCA requires of the broker, including $1,000,000 per occurrence and $2,000,000 aggregate general liability and $1,000,000 combined single limit auto liabilityHCA sample broker contract, Exhibit I and section 3.7
Workers compensationBrokers must make sure subcontractors meet state workers compensation and employer liability requirementsHCA sample broker contract

Does Washington require EVV for NEMT?

No. Washington requires electronic visit verification for Medicaid-funded in-home personal care, respite, and home health services. Nonemergency transportation is not on that list.

Brokers check trips their own way. Under HCA's sample broker contract, each broker keeps a daily computerized trip log, reviews at least 10 randomly selected trips per provider during its desk audits, and visits provider offices every other year to check how client files and manifests are kept. The same contract holds brokers to an average pickup wait of 15 minutes or less and a maximum of 30.

DSHS: Electronic Visit Verification

What changed in Washington in 2025 and 2026

Washington Medicaid covered 1,724,000 people in May 2026, plus 62,049 children in CHIP, according to CMS preliminary monthly data. Every one of them with a transportation benefit rides through the six brokers, whichever managed care plan they belong to.

Rates are set in each broker's subcontract. Under HCA's sample broker contract, HCA reimburses brokers for trips at cost plus a capped administrative fee. Brokers must pick the lowest-cost mode that fits the client. When fixed-route transit runs within three-quarters of a mile, the client rides it unless a documented need, such as a walker, quad cane, or portable ventilator, calls for something more specialized (WAC 182-546-6200).

The rules change slowly. HCA's 2023 NEMT rule update took effect September 18, 2023. It added against-medical-advice discharges to the list of trips brokers do not provide, limited standalone pharmacy trips to one per week per household without medical documentation, and set seven days' notice for out-of-state travel. An April 2026 update added EPSDT references without changing policy.

The bigger change is on the enrollment side. Under the federal H.R. 1 law, Apple Health for Adults clients must meet work requirements or qualify for an exemption starting January 1, 2027, and HCA begins mailing notices in September 2026.

  1. HCA's amended NEMT rules take effect: no broker trips for against-medical-advice discharges, standalone pharmacy trips limited, seven days' notice for out-of-state trips.

    Notice

  2. HCA's contracted broker list, dated May 2025, shows six regional brokers covering all 39 counties.

    Notice

  3. HCA adds EPSDT references to the NEMT definitions and covered-trips rules, with no policy change.

    Notice

  4. HCA's revised Apple Health managed care contract keeps nonambulance transportation outside plan coverage.

    Notice

  5. Apple Health for Adults clients receive notices about federal work requirements and renewals.

    Notice

  6. Work requirements begin for Apple Health for Adults.

    Notice

Frequently asked questions

Who is the Medicaid transportation broker in Washington?
It depends on the county. Hopelink covers King and Snohomish. Paratransit Services covers nine western counties including Pierce, Kitsap, and Thurston. People for People covers nine central counties including Yakima and the Tri-Cities. Special Mobility Services covers ten eastern counties including Spokane. Northwest Regional Council covers Whatcom, Skagit, Island, and San Juan. Community in Motion covers Clark, Cowlitz, Klickitat, Skamania, and Wahkiakum.
Do Apple Health managed care plans have their own NEMT brokers?
No. Washington keeps nonambulance transportation outside managed care. HCA's July 2026 managed care contract lists it as a service the state provides, and the regional broker for the client's county arranges every ride, whatever plan the client is in.
Do I need a license to start a NEMT business in Washington?
There is no NEMT license. A for-profit company carrying passengers for pay needs a Department of Licensing for-hire vehicle certificate for each vehicle ($55) and a for-hire permit ($110) unless its city or county licenses for-hire businesses. Private nonprofits serving people with special transportation needs get a Utilities and Transportation Commission permit instead. Then you need a subcontract with the regional broker.
How do I become a Medicaid transportation provider in Washington?
HCA does not contract with transportation companies directly. Contact the regional broker for the counties where you want to work and apply for a subcontract. Expect the broker to inspect your vehicles, review driver files, and ask for licensing and insurance proof. Hopelink, for example, requires one year of NEMT experience, five or more vehicles, and a Washington office.
What insurance does a Washington NEMT provider need?
DOL for-hire operators need at least $100,000 per person, $300,000 per accident, and $25,000 property damage, or a $325,000 combined single limit. HCA's sample broker contract lets publicly regulated providers carry the minimum their licensing law sets. Providers that are not publicly regulated must match the broker's own coverage, which includes $1 million per occurrence and $2 million aggregate general liability and $1 million auto liability.
What background checks do Washington NEMT drivers need?
Under HCA's sample broker contract, drivers need a Washington State Patrol fingerprint background check before the first drive and every three years, with a WATCH name check in the years between. The results must qualify the driver for unsupervised access to children and vulnerable adults under RCW 43.43.830, and brokers check them against the DSHS Secretary's List of disqualifying crimes.
Does Washington require EVV for NEMT?
No. Washington EVV covers Medicaid-funded in-home personal care, respite, and home health services. Brokers verify NEMT trips through their own trip logs, desk audits of at least 10 trips per provider, and office site visits.
Can I take a hospital discharge when the broker is closed?
Yes, if the broker's after-hours instructions allow it. WAC 182-546-5200 lets a subcontracted provider transport a client to urgent care or home from a hospital discharge when the broker is closed, then request retroactive authorization within two business days. If you cannot meet those conditions, you must decline the trip.
How fast do Washington brokers pay providers?
HCA's sample broker contract requires brokers to pay subcontracted providers within 10 calendar days of receiving HCA's monthly payment for allowed trips. Rates themselves are set in each broker's subcontract.

Running NEMT in Washington with HealthRide

A Washington fleet that crosses a regional line answers to two brokers with two sets of trip requests. HealthRide puts every trip on one dispatch board, keeps driver and vehicle expiration dates in front of dispatch before a trip is assigned, and exports the trip log as CSV or PDF when a broker desk audit 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