Which NEMT drivers fall under DOT drug testing rules?

Only two groups. The FMCSA program in 49 CFR Part 382 reaches CDL holders, and a CDL applies to passenger vehicles only when the design seats 16 or more, driver included, or its GVWR reaches 26,001 pounds. The FTA program in Part 655 reaches transit agencies funded under Sections 5307, 5309, or 5311 and the contractors who drive for them. A sedan or minivan driver on Medicaid trips usually sits outside both, which leaves the broker contract and state law in charge.

Is an alcohol test allowed before a job offer?

No. The EEOC treats a test that measures whether or how much someone has been drinking as a medical examination under the ADA, and medical examinations are not allowed before a conditional job offer. Screening for current illegal drug use is not a medical examination, so a drug screen can come earlier. Many companies run both after the offer to keep it simple.

Does a medical cannabis card excuse a positive DOT test?

No. Part 40 bars the reviewing doctor from reporting a marijuana result as negative on the strength of a state-law recommendation, and explanations about hemp or CBD products are rejected too. For company tests, state law decides. California, for example, protects off-duty cannabis use and bars acting on tests that only find nonpsychoactive metabolites, while Louisiana's Medicaid manual forbids NEMT drivers to use any marijuana behind the wheel, medical marijuana included.

What random testing rate do brokers require?

Each contract sets its own rate. MTM's Rhode Island handbook requires pre-employment and post-accident screens, plus random screens that reach over one in four drivers a year. MTM's Pennsylvania agreement sets random testing at whatever FTA currently requires, and FTA held its 2026 minimums at half of covered employees for drugs and one in ten for alcohol. Louisiana Medicaid calls for a yearly five-panel drug screen plus a screen whenever drug use is suspected.

What should happen after a driver tests positive?

Pull the driver from all trips that day. After that, your policy and the payer decide. MTM's Pennsylvania agreement bars a driver with a positive result from carrying its members again, and it counts a refusal as a positive. In Louisiana, a driver can come back once a substance abuse professional has signed off with a final evaluation and a clearance to work, and the broker then confirms three follow-up screens in the next six months.

How long should drug and alcohol test records be kept?

For CDL drivers, FMCSA sets three tiers: five years for refusals, verified positives, breath results at 0.02 and above, and program records; two years for collection paperwork; one year for negatives. All of it stays in a secure, access-controlled place. For drivers outside DOT rules, keep records for as many years as the strictest broker contract or state law demands, and store them apart from the regular personnel file.

NEMT Drug and Alcohol Testing Policy (Free Template)

How to use this template

Start by sorting your drivers into the right testing program, because that decides how much of this policy you are free to write yourself.

CDL drivers. Anyone required to hold a CDL is covered by Part 382, the FMCSA testing regulation. For passenger work, a CDL is required once a vehicle seats 16 or more, driver included, or has a GVWR of 26,001 pounds or more. These drivers follow the federal procedures word for word, including a Clearinghouse query before hire and another every 12 months.
Transit contractors. When a transit agency paid with Section 5307, 5309, or 5311 grants contracts with you for rides, FTA rules in Part 655 reach you as its contractor. The agency will hand you its requirements.
Everyone else. A typical sedan, minivan, or wheelchair van driver is outside both programs. Their testing comes from your broker contracts, your state’s employment laws, and this policy.

Federal Medicaid law still asks something of every provider. Section 1902(a)(87) of the Social Security Act has each state make sure that every NEMT provider “has in place a process to address any violation of a State drug law.” A written policy that drivers sign is the plainest proof you have one.

Fill in every bracket, delete the options you do not use, and have an employment lawyer in your state read it before rollout. Give each driver and attendant a copy before any testing starts, collect the signed acknowledgment, and file it in the driver’s file. If some of your drivers are DOT-covered and others are not, keep two versions. Under Part 382, anything a company adds on its own authority has to be described plainly as company policy, and Part 40 bars running a company test on a DOT sample.

The template

[Company name] drug and alcohol policy

Effective date: [date] | Policy contact: [name, title, phone]

1. Who this covers

This policy covers every driver, attendant, and escort employed or contracted by [Company name], plus owners, dispatchers, mechanics, and office staff whenever they drive or ride with a passenger. [Name any drivers covered by DOT rules and state that the DOT sections apply to them.]

2. What is not allowed

While on duty, on company property, or in a company vehicle, you may not:

Use, have, sell, or be under the influence of illegal drugs.
Be under the influence of marijuana in any form, including medical marijuana, whatever state law allows off duty.
Use alcohol, or report for duty within [4] hours of drinking.
Report for duty with a breath alcohol level of [0.02] or higher.
Misuse a prescription drug or use someone else’s.
Drive while taking any medication that your doctor or the label says makes driving unsafe. Tell your supervisor you cannot drive. You do not have to name the medication.

3. When you will be tested

Test	When it happens
Pre-employment	After a conditional job offer and before your first trip. Alcohol testing happens only after the offer.
Random	Unannounced, selected by [a third-party administrator / a computer program], at a rate of at least [] percent of drivers per year for drugs and [] percent for alcohol. Every driver has the same chance each time.
Post-accident	As soon as possible after any accident that [injures anyone / leads to a tow / results in a citation to you / involves a passenger]. Alcohol within [2] hours, drugs within [32] hours.
Reasonable suspicion	When a supervisor trained to recognize impairment notes specific signs in your appearance, behavior, speech, or smell and writes them down.
Broker or payer request	Whenever a broker or payer requires a test under its contract.
Annual	[Every 12 months, if a broker or state requires it.]
Return to duty and follow-up	Before you return after a violation, then unannounced for [__] months.

4. How testing works

Samples go to a laboratory certified by the U.S. Department of Health and Human Services.
Drug tests cover at least [cocaine, marijuana, opioids, amphetamines, and phencyclidine (PCP)] [and any others a broker requires].
A medical review officer reviews every non-negative drug result and gives you a chance to explain it, such as a valid prescription, before reporting it to us.
Alcohol is tested by breath [or saliva screening, confirmed by breath].
You may ask for a retest of the original sample at your own cost within [__] days of being told the result. [Check your state’s rule.]

5. Refusing a test

These count as a refusal: not reporting for a test within [__] minutes of being told, leaving before it is finished, not giving a sample without a medical reason, tampering with or substituting a sample, or refusing to sign the required forms. A refusal is treated the same as a positive result.

6. What happens after a violation

You are removed from all driving and passenger contact right away.
[Choose one: Your employment ends. / You are suspended without pay and may come back only after a substance abuse evaluation, a negative test before your first shift back, and unannounced follow-up tests.]
We tell any broker whose contract requires notice.
While a reasonable suspicion or post-accident result is pending, you will not drive.

7. Getting help

If you think you have a problem with alcohol or drugs, tell [name] before you are selected for a test. [Describe any leave or employee assistance program.] The SAMHSA National Helpline, 1-800-662-4357, is free, confidential, and open around the clock.

8. Privacy of results

Test results are kept apart from your personnel file, in a locked or access-controlled place, and shared only with the people who need them and with brokers or agencies whose contracts or laws require them.

9. State law

[State-specific terms, such as marijuana protections, retest rights, or posting requirements.]

10. Acknowledgment

I have read the [Company name] drug and alcohol policy, my questions about it were answered, and I will comply with it. I understand that testing is a condition of driving for [Company name].

Name	Signature	Date	Witness

Which rules apply to your drivers

	FMCSA (Part 382)	FTA (Part 655)	Company policy
Who is covered	Drivers required to have a CDL	Transit agencies with Section 5307, 5309, or 5311 funds, and their contractors	Everyone else, under broker contracts and state law
Random rate	FMCSA minimums; the rule’s base rates are half of driver positions for drugs and one in ten for alcohol	Same base rates, kept for 2026	Your choice, unless a contract sets it
Post-accident	After a fatality, or after an injury or tow when the driver gets a citation	After a fatality, and after other qualifying accidents unless the operator is ruled out as a cause	Your definition
Reasonable suspicion	Supervisor with 60 minutes of alcohol and 60 minutes of drug training	Trained supervisor	Your procedure
Written policy	Required materials explaining the rules, with a signed receipt from each driver	Adopted by the agency’s governing board and given to each covered employee	Required by some brokers, and in Minnesota before any testing

Broker contracts often add rules the law does not.

MTM, Pennsylvania. MTM’s agreement calls for a Substance Free Workplace Policy that covers at least pre-employment and random screens, and MTM can ask to see it. When a driver seems impaired, the provider pulls them from service and pays for the test. The screen must at least cover cocaine, marijuana, opioids, amphetamines, and PCP.
Louisiana Medicaid. Drivers pass a five-panel screen yearly and whenever drug use is suspected, and the testing agency sends each result straight to the broker.
CareOregon. Providers run a drug-free workplace program and may have drivers sign an attestation that they understand it. Failing a test, or refusing one, disqualifies the driver from NEMT work.
Virginia Medicaid. Volunteer drivers need a drug screen as part of credentialing.
Georgia Medicaid. Anyone convicted of driving under the influence during the five years before hire cannot drive in the program.

Marijuana and state law

Company testing for marijuana is where state law matters most. Four examples show how far apart the rules are.

State	What the law says
California	Off-duty cannabis use is protected, a result showing only nonpsychoactive metabolites cannot be held against someone, and applicants cannot be asked about past use. Testing that federal or state law requires still goes ahead.
Nevada	Employers may not refuse to hire because a pre-employment test finds marijuana, except for jobs that require driving when federal or state law requires the test, or jobs that could affect others’ safety.
Minnesota	Any testing needs a written policy that lists six required items. Cannabis testing of applicants is generally barred, but for positions that meet the state’s safety-sensitive definition, or that involve face-to-face care or assistance for vulnerable adults or patients, cannabis is tested like any other drug.
New York	Cannabis tests are generally barred unless Labor Law 201-D or another law permits them. Employers may ban cannabis during work hours and in company vehicles, and act on specific, observable signs of impairment.

Louisiana’s Medicaid manual pulls in the opposite direction for NEMT drivers: no marijuana behind the wheel, and that includes medical marijuana the state otherwise allows.

Common mistakes

Testing for alcohol before the offer. The EEOC treats alcohol tests as medical examinations. Wait until you have made a conditional offer.
Random selection that is not random. Picking the driver you have doubts about is a reasonable suspicion test, and it needs a supervisor’s written observations.
Letting the driver finish the shift. Take a driver off trips as soon as a supervisor has reasonable suspicion, not after the result comes back.
One policy for DOT and company testing. DOT samples cannot be used for other tests, and company rules must be labeled as the company’s own.
No proof of receipt. Without a signed acknowledgment, you cannot show a driver knew the rules.
Copying another state’s policy. Marijuana, retest, and posting rules change at the state line.

Keep the signed acknowledgment and each test date in the driver file, and check the rest of the screening rules in our guide to NEMT driver requirements.

Keeping screens on schedule

HealthRide keeps each driver’s credentials in one place with their expiration dates, so an annual drug screen can sit next to the license and CPR card. Reminders go out before a date passes, and a lapsed screen shows up as a warning when dispatch goes to assign that driver. See fleet and credentials.

Driver drug and alcohol testing policy: fill-in template for NEMT companies