# 1915(b) Waiver: How States Limit Medicaid Rides to One Broker

Canonical URL: https://nemtguide.com/glossary/1915b-waiver/ · Updated 2026-10-02

A 1915(b) waiver is CMS approval, under section 1915(b) of the Social Security Act, for a state to limit which providers its Medicaid members may use. For NEMT, it lets a state send every ride in a region through one broker or a chosen group of ride companies. As of October 2026, Medicaid.gov lists current NEMT waivers for Arkansas, Florida, Kentucky, and Maine.

- Section 1915(b) has four parts. Part (b)(4), selective contracting, limits members to chosen providers, and part (b)(1) can require them to use a managed care network such as a broker.
- A 1915(b) waiver lasts 2 years, or up to 5 years when it covers people with both Medicare and Medicaid, and must then be renewed.
- Arkansas, Florida, Kentucky, and Maine run NEMT under 1915(b) waivers approved through 2027 or 2028.
- Under a waiver, Medicaid enrollment alone brings you no trips. You need a contract with the broker or the state.
- Federal rules do not require a waiver broker to be picked by competitive bid, and the federal self-referral ban for state plan brokers does not apply to it.

Medicaid's default rule is freedom of choice: under section 1902(a)(23) of the Social Security Act, a member may get care from any qualified provider willing to serve them. A 1915(b) waiver is how a state sets that rule aside. For a ride company, it settles one question above all: whether a Medicaid enrollment brings you trips, or only a contract does.

## What a 1915(b) waiver is

Section 1915(b) lets the Secretary of Health and Human Services waive most requirements of section 1902 when doing so is cost-effective, efficient, and consistent with Medicaid's purposes. Medicaid.gov lists four kinds:

- **(b)(1), freedom of choice.** Members must get services through a managed care network, such as a health plan or a primary care case management system.
- **(b)(2), enrollment broker.** A locality acts as a central broker that helps members choose among competing health plans. This broker picks plans, not rides.
- **(b)(3), non-Medicaid services.** The state shares the waiver's savings with members by paying for added services.
- **(b)(4), selective contracting.** Members may get a service only from providers that agree to the state's payment, quality, and utilization standards.

The limits are written into 42 CFR 431.55. A restriction never applies in emergencies or to family planning, and the state must document the waiver's effect on access and quality. A selective contracting waiver also may not treat classes of providers differently for reasons unrelated to how effective and efficient they are.

### How long a waiver lasts

A 1915(b) waiver runs at most 2 years unless the state asks to continue it (section 1915(h)(1) and 42 CFR 431.55(b)(3)). CMS then has 90 days to deny the request or ask for more information, or the request is deemed granted. A waiver that covers people with both Medicare and Medicaid may run 5 years and renew for 5 years at a time (section 1915(h)(2)). Both lengths are in use for NEMT: Florida's and Kentucky's current waivers run 2 years, and Arkansas's and Maine's run 5.

Each renewal must show the waiver is cost-effective. Medicaid.gov offers a shorter (b)(4) application for states that selectively contract inside fee-for-service Medicaid, the form Texas used in 2021. It eases the cost paperwork but still requires the state to show members keep access. CMS's technical guide for that application says the program must cost no more than the same services would in an "any willing provider" system, and CMS renews it only if actual spending came in under that projection.

## 1915(b) waiver vs the state plan broker option

Since the Deficit Reduction Act of 2005, a state can also hire a NEMT broker through its state plan under section 1902(a)(70), with no waiver at all. The federal rule is 42 CFR 440.170(a)(4). CMS's final rule of December 19, 2008 (73 FR 77519) explains why it matters: before the act, a state that covered rides as a medical service needed a 1915(b) waiver to selectively contract with a broker, and a state plan broker program spares the state the two-year waiver renewals.

The two paths put different rules on the broker:

| | State plan broker | 1915(b) waiver broker |
|---|---|---|
| How long it lasts | Part of the state plan, no renewal | 2 years, or 5 with dual eligible members, then renewal |
| How the broker is picked | Competitive bidding under 2 CFR 200.317 to 200.327 | No federal competitive bid rule |
| Trips to companies tied to the broker | Barred, with limited exceptions such as rural areas with no other provider | Not barred by the federal self-referral rule |

The last two rows come from the 2008 rule, which says the 1915(b) process neither bars the broker from self-referring nor requires that it be chosen by competitive bid. For what a state plan broker must do, see [federal rules for NEMT brokers](https://nemtguide.com/guides/federal-rules-for-nemt-brokers/).

States can switch between the two. Kentucky's application says CMS granted it a 1915(b)(4) waiver in December 1998, the state moved its Human Service Transportation Delivery program to the state plan in 2006, and it returned to a waiver after reviewing how the program ran.

## Which NEMT programs run under a 1915(b) waiver

These are the NEMT waivers on Medicaid.gov's State Waivers List with current approvals as of October 2026:

| State | Waiver and authority | Approved period | Who manages rides |
|---|---|---|---|
| Arkansas | AR.0003.R11.00, (b)(4) | April 1, 2023 to March 31, 2028 | One broker per region |
| Florida | FL-0018.R05.00, (b)(1) and (b)(4) | July 1, 2025 to June 30, 2027 | MTM in Regions B to F, Modivcare in A, G, H, and I |
| Kentucky | KY-0006.R05.00, (b)(1) and (b)(4) | April 1, 2025 to March 31, 2027 | Transportation Cabinet, with a broker in each of 15 regions |
| Maine | ME-0001.R03.00, (b)(1) and (b)(4) | April 1, 2023 to March 31, 2028 | Regional brokers based on MaineDOT transit districts |

All four run their brokers as [prepaid ambulatory health plans](https://nemtguide.com/glossary/prepaid-ambulatory-health-plan/), so a set of federal managed care rules applies to them, including credentialing. Florida's waiver covers only members outside its Medicaid health plans. Members in a plan get rides through the plan.

A waiver can also skip the broker. Texas's (b)(4) waiver, approved for June 1, 2021 through May 31, 2026, let HHSC end its contracts with managed transportation organizations and contract directly with [demand response](https://nemtguide.com/glossary/demand-response/) companies for fee-for-service members. The application limited each member to a single provider in their service area. HHSC still signs those companies through open enrollment HHS0016482, which takes applications until September 15, 2027. The [Texas guide](https://nemtguide.com/states/texas/) covers the rates.

## What a 1915(b) waiver means for your company

Arkansas's application shows the change plainly. Under its old state plan program, a member could book a ride with any Medicaid-enrolled NEMT provider, such as a taxi or wheelchair van company. Under the waiver, members must arrange rides through the single broker for their region.

1. **Medicaid enrollment is not enough.** You need a contract with your region's broker, or with the state under a selective contract. Members cannot pick you.
2. **The broker decides your volume.** A waiver broker chooses which companies join its network and may run its own vans. Kentucky's waiver makes each regional broker responsible for coordinating and providing the rides in its region, and the state rule it quotes, 603 KAR 7:080, has the Transportation Cabinet approve each subcontractor. Ask how trips are assigned before you sign. See [NEMT broker](https://nemtguide.com/glossary/nemt-broker/).
3. **Payment timing depends on who pays you.** When the state pays you directly under a selective contract, 42 CFR 431.55(f)(4) holds it to the federal standard in 42 CFR 447.45: 90 percent of clean claims paid within 30 days of receipt and 99 percent within 90 days. A broker paid per member pays you under your contract with it.
4. **Mark the expiration date.** Changes tend to arrive with a renewal or a new waiver. Maine's 2023 renewal came with a new broker RFP and one state-set rate per region, and Texas posted notice of its 2021 change on November 27, 2020, about six months before it took effect.

### A dispatch example in Florida

A fee-for-service member in Florida's Region G needs a ride to dialysis and calls Modivcare, the region's vendor. The waiver says no prior authorization is needed. Instead, the vendor screens the caller for ambulatory, wheelchair, or stretcher needs, oxygen, and an attendant, picks the mode, and assigns the trip to a provider on its own list. A wheelchair van company in Region G gets that ride only if it is in Modivcare's network. If the member later joins a Medicaid health plan, the next ride is booked through the plan. See the [Florida guide](https://nemtguide.com/states/florida/), and [how states run NEMT](https://nemtguide.com/guides/how-states-run-nemt/) for the other models.

## Frequently asked questions

### What is the difference between a 1915(b) waiver and a 1915(c) waiver?

A 1915(b) waiver changes how services are delivered: it limits which plans or providers members may use. A 1915(c) waiver adds home and community services, sometimes including non-medical rides, for people who would otherwise need an institution. A state can run both at once, for example a 1915(c) waiver for home services next to a 1915(b) waiver that limits which providers deliver them.

### Can a state use a 1915(b) waiver to stop covering NEMT?

A 1915(b) waiver changes who gives the rides, not whether members get them. Under 42 CFR 431.55, the state must document the waiver's effect on access and quality, and the limits never apply in emergencies. Iowa and Georgia, which dropped NEMT for some adults, did it through section 1115 demonstrations instead.

### Can a broker under a 1915(b) waiver give trips to its own vans?

Federal rules allow it. CMS's final rule of December 19, 2008 says the 1915(b) process neither bars the broker from self-referring nor requires that it be chosen by competitive bid. Florida's waiver says its two vendors may provide rides directly or subcontract them, and Kentucky's makes each regional broker responsible for coordinating and providing the rides in its region. A state plan broker under 42 CFR 440.170(a)(4) is barred from most such referrals. The state's contract with the broker may set its own limits.

### How do I find out whether my state's NEMT runs under a 1915(b) waiver?

Open the State Waivers List on Medicaid.gov, filter by your state and the 1915(b) authorities, and look for a transportation or NEMT program. Open the newest waiver number: its page gives the approval, effective, and expiration dates. The approved application's selective contracting section says whether members are limited to a single provider in their service area.

## Official resources

- [Medicaid.gov: State Waivers List (filter by state and 1915(b) authority)](https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list)
- [Medicaid.gov: Managed Care Authorities](https://www.medicaid.gov/medicaid/managed-care/managed-care-authorities)
- [CMS: 1915(b)(4) Fee-for-Service Selective Contracting Waiver Application](https://www.medicaid.gov/Medicaid/downloads/1915b4-ffs-application.pdf)
- [eCFR: 42 CFR 431.55, Waiver of other Medicaid requirements](https://www.ecfr.gov/current/title-42/section-431.55)