What Is Curb-to-Curb Service? What the NEMT Driver Does and Does Not Do

What curb-to-curb service means

Curb-to-curb service is the level of help where the driver’s job starts and ends at the vehicle. The rider gets from their door to the curb on their own, or with a family member or caregiver, and the driver takes over at the car or van.

MTM Health’s Virginia handbook (approved August 10, 2026) calls it the default level of assistance, for riders who need little if any help between the vehicle and the door. As of September 2026, Pennsylvania’s Medical Assistance Transportation Program (MATP) tells riders that they are picked up at the curb. Other programs describe the same level:

Program	How it describes curb-to-curb
Virginia Medicaid, MTM Health handbook (approved August 10, 2026)	The default level. The driver opens and closes doors, helps the rider in and out, and folds and stores a wheelchair or other mobility device.
Pennsylvania MATP (DHS page, September 2026)	Riders are picked up at the curb. Door-to-door service is given when the need is medically verified.
MTM Health provider agreement (January 1, 2023), posted by Pennsylvania DHS	Curb-to-curb is the standard service. Door-to-door and door-through-door need MTM’s prior approval, based on medical necessity.
Georgia NEMT manual (July 1, 2026), dialysis trips	Ambulatory riders ride curb to curb and walk to and from the vehicle without help. An escort or facility staff gives any extra help.
Texas health plan NEMT handbook (version 2.0.1, 2021)	Demand response rides in a standard car, van, or bus are curb-to-curb transportation.
New York Medicaid (manual effective August 25, 2023)	Taxi and livery rides are curb-to-curb.

The assistance level is separate from the vehicle. Virginia assigns the mode (car, wheelchair van, or stretcher van) and the level of assistance as two choices, so a wheelchair rider who reaches the curb on their own can ride curb-to-curb. See NEMT level of service for how the two fit together.

What the driver does and does not do

Task	On a curb-to-curb trip
Park at the curb closest to the pickup point	Yes. CareOregon’s manual (February 2024) asks for this.
Get out to open and close the vehicle doors	Yes, in Virginia and Texas. Texas does not apply this to rideshare drivers.
Help the rider get in, sit down, and get out	Yes
Help with the seat belt and wheelchair securement	Yes. Texas has the driver confirm every wheelchair is secured and every rider belted before driving.
Help the rider use the lift or ramp	Yes, in Texas
Fold and store a wheelchair, walker, or other mobility device	Yes
Install a child safety seat	No. Texas bars drivers from installing or securing one.
Carry bags or personal items	Not required in Texas
Walk the rider between the building door and the vehicle	No. That is door-to-door service.
Go inside the building	No. Virginia drivers stay at or near the vehicle.
Lift or carry the rider	No. Virginia excludes lifting on curb-to-curb and door-to-door trips.

Help at the vehicle is part of the ride, not an extra. MTM Health’s provider agreement (January 1, 2023) bars drivers from charging riders for general help, such as opening doors, offering an arm to lean on, or holding a bag.

Check your state’s baseline, because some expect help past the curb. Georgia’s NEMT manual (July 1, 2026) has drivers get out to open and close doors and give help as needed to or from the main door of the destination. Louisiana has its broker make sure providers give door-to-door help to and from the main entrance when a rider who needs it asks (section 10.3, issued July 14, 2025).

Curb-to-curb compared with other assistance levels

Level	Where the driver’s help starts and ends	Example rule
Curb-to-curb	At the vehicle	The default in Virginia Medicaid
Door-to-door	From the door of the pickup location to the door of the destination	Virginia: help between the vehicle and the door, with no lifting
Door-through-door	Past the building door, inside	MTM Health provider agreement: needs prior approval
Hand-to-hand	From one responsible person to another	Virginia: for some riders with dementia or developmental disabilities

Who decides that a trip is curb-to-curb

The broker or state sets the level when it books the trip, and it appears on your manifest. In Virginia, MTM Health assigns the least restrictive and most appropriate mode and level of assistance from the rider’s medical needs, functional ability, and safety. Each manifest lists the required level. Drivers may give only the authorized level, and a trip that does not match it may go unpaid or lead to corrective action.

CMS tells states to look past the default. Its Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) says riders with disabilities in many cases need more than curb-to-curb service, and states must consider each rider’s support needs when they choose the mode. If a curb-to-curb rider cannot reach the curb safely, call the broker to change the level. Do not leave the rider stranded, and do not mark a no-show without following your broker’s steps.

A dispatch example

A rider books a round trip to dialysis. The morning trip leg is curb-to-curb: she waits at the curb with her walker, and the driver helps her in and stores the walker. After treatment she is weak and cannot walk from the clinic door to the van.

DOT’s examples for public paratransit, in Appendix E to 49 CFR Part 37, describe this exact case. A dialysis rider who waits at the curb on the way in may need help to the door on the way home. When the need is predictable, DOT says to handle it in advance. For a NEMT trip, that means asking the broker to set the return leg to door-to-door before the day of the ride.

If the need comes up without warning, call dispatch, help her safely, and write down what happened and the times on your trip log. The dialysis transportation guide covers standing orders and return pickups.

Curb-to-curb and the ADA

The federal ADA rule for public paratransit uses neither term. 49 CFR 37.129 requires origin-to-destination service, and DOT’s guidance in Appendix D to Part 37 leaves it to local planning whether that service is door-to-door or curb-to-curb.

Private companies have duties too. Under 49 CFR 37.5, a private company primarily in the business of transporting people must make reasonable modifications for riders with disabilities, following the Department of Justice’s rules. DOT’s examples in Appendix E, written for transit agencies, show where the line usually sits:

• Opening an outside building door for a rider should generally be done.
• Helping a rider up a driveway or sidewalk incline, or around snow, construction, or a broken sidewalk between the vehicle and the door, should generally be done.
• Helping a rider from their door to the vehicle in extreme weather should generally be done.
• Door-through-door help, past the building door, generally does not have to be given.

Each example has the same limit: no direct threat to safety, and no leaving the vehicle unattended or out of sight for a long time. See ADA requirements for NEMT and paratransit vs NEMT.