Northwest Regional Council Transportation in 2027: Medicaid Rides and How Providers Join

Northwest Regional Council (NWRC) is an association of county governments. The elected officials of Island, San Juan, Skagit, and Whatcom counties created it in 1971, and two elected officials from each county still make up its governing board. It serves as the area agency on aging for those four counties. The Washington State Health Care Authority (HCA) also uses it as the Apple Health broker for nonemergency medical transportation (NEMT) there.

HCA’s December 2024 report to the Legislature says five of Washington’s six NEMT brokers are nonprofit community organizations and one is an area agency on aging. NWRC is that one. Its NEMT work sits beside in-home care, meals, caregiver support, and care coordination, and the whole agency reported $33.13 million in revenue and 141 full-time-equivalent staff in 2025.

Which counties Northwest Regional Council covers

HCA’s county directory, current in September 2026, lists “Northwest Regional Council/Area Agency on Aging” as the broker for all four counties. NWRC has offices in Bellingham, Mount Vernon, and on Camano Island, and its Medicaid trip line runs out of Bellingham.

County	What shapes the trips there
Whatcom	Free bus passes for riders on a route, and WTA specialized paratransit
Skagit	Free bus passes for riders on a route, and Skagit DAR paratransit
Island	Island paratransit, and a council office on Camano Island
San Juan	Washington State Ferries is the only major access for vehicles (WAC 468-300-700)

Riders book with the broker for the county they live in. Two neighboring areas belong to other brokers:

Neighboring counties	Their Apple Health broker
Snohomish	Hopelink
Okanogan, Chelan	People for People

A company based in Snohomish County that also wants Skagit or Whatcom trips needs a subcontract with each broker. See working with multiple NEMT brokers.

How NWRC matches riders to a ride

NWRC’s Higher Mode form tells doctors the state requires it to use the lowest-cost mode that is accessible and fits the rider’s condition, and that it cannot pay for a costlier ride for convenience or preference. That is the rule in WAC 182-546-5200. Its 2025 annual report counts the cheaper options next to the trips:

Transportation Services, 2025	Count
Trips provided	153,035
Bus rides	66,381
Ferry rides	4,139
Train rides	384
Plane flights	22
Nights of lodging	5,746

NWRC’s 2026 new client letter and NEMT page list what riders are offered before a vehicle:

• Bus pass. A rider on a bus route gets a free pass. Depending on where they live, they need at least one medical appointment a month to qualify.
• Gas voucher. A rider with a car, or a friend who drives, gets vouchers for contracted gas stations after sending a copy of the driver’s license, registration, and insurance.
• Mileage. Where no contracted station is on the route, NWRC pays 35 cents a mile in 2026.
• Ferry, parking, and lodging. NWRC repays these with approval in advance.
• Vans or taxis. A rider who cannot drive or ride the bus gets a vehicle.

Statewide, HCA’s December 2024 report says more than a third of NEMT trips ran on public transit between 2013 and 2019. After COVID-19 and driver shortages cut transit service, many trips moved back to taxis and commercial vehicles, and transit is only now expanding again. See least costly mode.

The Higher Mode form

A rider who lives on a bus line but cannot use it needs a medical professional to sign NWRC’s Documentation of Medical Need for Taxi or Cabulance (Form 2420, May 2, 2023). The form lists four levels:

1. Fixed-route bus. The rider can walk up to three-quarters of a mile or call a flex-route bus.
2. Paratransit. The rider can use WTA specialized, Skagit DAR, or Island paratransit door to door.
3. Taxi. A medical condition rules out the bus.
4. Cabulance. The rider must ride in a wheelchair and cannot move into a sedan or van.

The form reminds doctors that every bus is fully ADA accessible and that a rider in a poorly served area may ask for a taxi one way. A persistent condition is reviewed a year after signing, and a temporary one lasts the months the doctor enters. Levels 3 and 4 are the trips a private company carries, so a sedan fleet and a wheelchair van both have a place here.

Ferries, islands, and the Canadian border

Two kinds of trips here need extra planning: ferry trips and trips across the Canadian border.

Ferry trips

San Juan County riders reach mainland care by ferry, and NWRC counted 4,139 ferry rides in 2025. Two ferry rules matter for your drivers:

• Vehicle priority. WAC 468-300-700 puts some vehicles ahead of the first-come line. Marked nonprofit special needs vehicles qualify with a ferry system permit and advance notice to each terminal. Some marked for-profit passenger carriers, including for-hire vehicles, qualify on routes where the ferry is the only major land access, with a preapproved schedule or advance notice. Call Washington State Ferries at 206-464-6400 to confirm your vehicles qualify before you promise an island pickup time.
• Medical preferential loading. When a long wait on the dock would put a rider’s health at risk, the rider’s licensed health care provider can enroll the rider online for one day, 30 days, or a year. On a full sailing the rider takes the next available boat, not the first spot on, in one vehicle under 22 feet. The rider needs the printed confirmation email and a matching ID, and fares still apply. On the Anacortes and San Juan Islands route, arrive 30 minutes before sailing. Other routes need at least 20 minutes.

Plan the ferry wait into your driver’s hours and your price. The rural NEMT guide covers pricing long, low-density trips.

Point Roberts and British Columbia

Washington pays for some care in British Columbia for residents of Point Roberts and other communities along the border (WAC 182-501-0184). Nonemergency care there is covered when crossing the border for care is the general practice, or when no U.S. provider is within 25 miles and the Canadian provider is closer. NEMT to any other foreign location is not paid (WAC 182-546-5800). Confirm each cross-border trip with NWRC before you accept it.

Trips that come with their own paperwork

Several NWRC forms tell you what a trip will involve before you arrive.

• Hospital discharges. Hospitals fax form F-2421 on weekdays from 8 a.m. to 5 p.m. It records whether the rider can travel without a medical attendant, whether a prescription must be filled on the way home, who supplies the wheelchair (NWRC has standard-size chairs only), the rider’s weight, and whether a bariatric chair is needed. For stretcher trips it lists the steps into the home and the medical reason. The form also asks whether the rider can manage their own oxygen, because drivers cannot give it.
• Behavioral health facilities. For trips to or from an institution for mental diseases (IMD), the facility certifies on Form 1266 (April 28, 2023) that the rider is medically and behaviorally stable, safe to transport, and does not need secured transportation.
• Out-of-area care. A referring doctor faxes the Verification of Medical Necessity with a copy of the referral. NWRC asks riders for five full business days’ notice when a specialist is in another city. When the care is not available locally, it may arrange a trip to the closest provider in another county, such as in Seattle (WAC 182-546-5700).
• Lodging. When a rider must stay near distant care, NWRC can pay for lodging for up to one calendar month, and any extension must be approved in advance (WAC 182-546-5900).

After hours, NWRC’s NEMT page tells emergency room staff to call (360) 733-8294 for a ride home, and its discharge form sends hospitals to Yellow Cab on evenings, weekends, and holidays. NWRC does not take riders to the emergency room. If you can cover wheelchair or stretcher discharges at night, say so when you apply. HCA’s December 2024 report calls after-hours discharge resources very limited. See after-hours NEMT.

What NWRC and the state require of providers

State rules require every subcontracted company to be licensed, equipped, and run under federal, state, and local law and its contract (WAC 182-546-5200). Most for-profit companies need a Department of Licensing for-hire license and vehicle certificates, and the Washington state guide walks through them. NWRC must also check you and your staff against the federal exclusion lists before contracting and on an ongoing basis.

HCA’s sample broker contract, the model it still posts in September 2026, shows the standards HCA writes into its broker contracts:

Area	Requirement in HCA’s sample contract
Driver records	A valid license, a driving record abstract, and insurance before the first ride
Background checks	A Washington State Patrol fingerprint check for new drivers, every three years, with a WATCH name check in between
Vehicles	Inspected before first use, with 10 percent of each fleet checked on site every other year and 10 percent by desk audit in the other years
Insurance	The minimum your regulator sets, or, if no agency regulates you, the same types and limits the broker carries
Payment	Paid within 10 calendar days after the broker receives HCA’s monthly payment
Rates	Adjustable at least quarterly, with an appeals process in the subcontract

Ask for NWRC’s own subcontract, since its terms and insurance limits govern your work. The NEMT credentialing checklist and driver file checklist keep your records ready for its audits.

How to become a Northwest Regional Council provider

1. Pick your service. Choose your counties and modes: sedans for taxi-level riders, wheelchair vans for cabulance riders, stretcher trips, island runs, or nights and weekends.
2. Get licensed and insured. Line up your state business license, any city license, your for-hire license and vehicle certificates, and your insurance.
3. Email the contracts unit. Write to NWRCContracts@dshs.wa.gov and say you want to subcontract for non-emergency medical transportation. The council’s contract page names that address for NEMT contracting as of September 2026.
4. Ask for the documents. Request the subcontract, insurance limits, driver and vehicle checklist, and rate form.
5. Propose your rates. HCA sets no NEMT rates, so you negotiate yours. Price ferry waits, long mainland trips, wheelchair trips, and after-hours work on their own lines. See how to get NEMT broker contracts.
6. Pass the first checks. Every driver is verified and every vehicle inspected before its first trip.

A second contract: WA Cares Fund transportation

As the area agency on aging, NWRC also signs providers for the WA Cares Fund, Washington’s long-term care insurance benefit. Benefits became available to qualified Washingtonians on July 1, 2026, and NWRC’s contract page lists transportation among the services it is actively contracting for. These trips go to groceries, medical appointments, social services, and recreation, so they are not limited to Medicaid appointments.

WA Cares’ transportation application details, updated February 3, 2026, set the entry rules:

• One credential: a for-hire endorsement from the Department of Revenue, an auto transportation company certificate under chapter 480-30 WAC, or a nonprofit transportation certificate under chapter 480-31 WAC.
• A Department of Social and Health Services background check for each owner with 5 percent or more and the contract signer, at application and renewal.
• A Washington State Patrol check for every employee, volunteer, or subcontractor with unsupervised access to riders, before access and every two years.
• Insurance that meets the department’s requirements, a W-9, your business license, and your current rates for information.
• A contract of no more than two years.

Apply through the WA Cares provider application and send questions to the same contracts address. The area agency on aging transportation guide explains how these senior ride contracts usually work.

How trips run and how you get paid

Every NEMT trip other than an ambulance trip needs NWRC’s approval before it runs (WAC 182-546-6000). Riders must make every change through NWRC’s office, so send riders who ask you for a new time back to the call center. Two state rules shape the ride itself:

• Side stops. A stop is paid only when it is tied to the approved trip, such as the next medical appointment or a pharmacy close to the usual route (WAC 182-546-5600). NWRC asks clinics to call it when a rider leaves with a prescription to fill.
• After hours. When NWRC is closed, you may give an urgent care or hospital discharge ride under its after-hours instructions and ask for retroactive authorization within two business days, or you may decline it (WAC 182-546-5200).

NWRC pays only companies it subcontracts with (WAC 182-546-6200), and HCA’s sample contract (Exhibit I) bars you from seeking payment from HCA or the rider. HCA passes the full trip cost through to providers and pays brokers a separate administrative rate that only the Legislature can change, per its December 2024 report.

The call center is closed on the remaining 2026 holidays in its client letter: October 12, November 11, November 26 and 27, and December 25. On those days the after-hours rules apply, so plan your coverage.

Who to call

For	Contact (September 2026)
Transportation contracts	NWRCContracts@dshs.wa.gov
Medicaid trip line	(360) 738-4554 or 800-860-6812. Fax (360) 734-5446. NWRCRides@dshs.wa.gov
After-hours ER returns	(360) 733-8294
Main office	(360) 676-6749, fax (360) 738-2451. Weekdays 8:30 a.m. to 4:30 p.m.
Offices	600 Lakeway Drive, Bellingham. 301 Valley Mall Way, Mount Vernon. 606 Arrowhead Rd., Camano Island
Ferry vehicle priority	Washington State Ferries customer service, 206-464-6400 or 888-808-7977
HCA NEMT program	hcanemttrans@hca.wa.gov

HCA’s May 2025 broker list and its county directory show a different fax, (360) 734-5476, so confirm the number before you send forms. When you write to NWRC, name the counties, vehicle types, and hours you can cover. Island trips, wheelchair discharges, and night work are the rides the bus pass and the gas voucher cannot replace.