Brokers and Medicaid
What Is Human Service Transportation (HST)? How HST Brokers Run Medicaid Rides
Human service transportation (HST) is transportation that public health and social service programs pay for, so older adults, people with disabilities, and people with low incomes can reach care, work, and services. Massachusetts and Kentucky run Medicaid rides this way: a regional broker books trips for several state programs and subcontracts them to local transportation companies, which contract with the broker, not the state.
- Human service transportation is the umbrella for rides paid by programs such as Medicaid, disability services, vocational rehabilitation, and aging services.
- Massachusetts's HST Office manages rides for MassHealth and five other agencies through two brokers, MART and GATRA.
- Kentucky's HSTD program sends Medicaid, Kentucky Works, and other program trips through one broker in each of 15 regions.
- In both states your contract is with the broker, which assigns the trips and pays you.
- Kentucky sets uniform subcontractor rates and requires brokers to pay within three business days of being paid.
Medicaid is not the only public program that pays for rides. Disability agencies, job programs, and aging services all move people too, and some states pool those trips under one system they call human service transportation. When your state runs Medicaid rides that way, you work for a regional broker that may send you a dialysis trip in the morning and a day program route in the afternoon.
What human service transportation means
The Federal Transit Administration describes human services transportation as rides that connect people to their homes, jobs, education, medical appointments, and communities. Federal coordination efforts focus on three groups: people with disabilities, older adults, and people with low incomes. The Coordinating Council on Access and Mobility, set up in 2004 by Executive Order 13330, links the federal agencies that pay for these rides. Nine of its 11 members, including Health and Human Services, Labor, Transportation, and Veterans Affairs, run grant programs that can fund them.
Medicaid rides are one piece. CMS says states may use public transit agencies to coordinate NEMT, but they must be chosen by competitive bid. Medicaid pays only for necessary rides to covered services, it is the payer of last resort, and it may pay for a ride but not buy the vehicle (SMD 23-006, September 28, 2023).
Local planning is open to you. Each recipient of a federal Section 5310 grant for senior and disability transportation must certify that its projects come from a locally developed, coordinated public transit-human services transportation plan. That plan must be developed with seniors, people with disabilities, and representatives of public, private, and nonprofit transportation and human services providers (49 U.S.C. 5310). See Section 5310 grants and paratransit.
How Massachusetts runs HST
The Executive Office of Health and Human Services (EOHHS) runs a Human Service Transportation (HST) Office. It manages rides for the eligible consumers of six agencies:
- MassHealth (Medicaid)
- Department of Developmental Services
- Department of Public Health Early Intervention
- Massachusetts Rehabilitation Commission
- Massachusetts Commission for the Blind
- Department of Mental Health
Each agency keeps full control over who qualifies for its trips. Two regional transit authorities serve as brokers, down from six before the contract that began July 1, 2021:
| Broker | Area | Office line |
|---|---|---|
| MART (Montachusett Regional Transit Authority) | Western, Central, Metro Boston, and Northeastern Massachusetts | 978-353-0333 (brokerage division, Fitchburg) |
| GATRA (Greater Attleboro Taunton Regional Transit Authority) | Southeastern Massachusetts, Cape Cod, and the Islands | 508-823-8828 (administration, Taunton) |
As of August 2026, the state says the brokers manage over eight million consumer trips, arranged by subcontracting with local transportation companies. The work falls into two kinds, which the HHS Inspector General’s January 2021 audit describes:
- Demand-response trips. A MassHealth provider files a PT-1 request for a member, MassHealth approves it, and the broker schedules each ride to a covered service, such as a medical, dental, mental health, or substance use disorder visit. GATRA says PT-1 approval can take up to three business days.
- Program-based trips. Regular, often daily, routes that carry a group of consumers to a common program site, such as a day habilitation program.
GATRA’s rider FAQ says the brokers assign each trip to a transportation company on a low-cost, most appropriate basis and by vehicle availability, and that HST policy does not let riders choose their own company. MART’s standards, effective July 1, 2025, pay providers by electronic funds transfer within 45 days of an approved, finalized invoice, based on each provider’s own rate structure.
Every company follows the Commonwealth’s Transportation Provider Performance Standards, and agencies may add their own. The same 2021 audit found that 86 of 100 sampled Massachusetts NEMT claim lines from 2016 and 2017 did not meet federal or state rules. For all 100, driver qualifications and vehicle inspection, registration, and maintenance policies or schedules were not adequately documented. Keep every trip log, driver file, and inspection record ready to show. See NEMT trip documentation.
How Kentucky runs HSTD
Kentucky calls its system the Human Service Transportation Delivery (HSTD) program. The Department for Medicaid Services contracts with the Transportation Cabinet’s Office of Transportation Delivery to run Medicaid rides, and the Cabinet contracts one broker for each region. The program runs under a 1915(b) waiver for April 1, 2025 through March 31, 2027 that classifies it as a prepaid ambulatory health plan paid on a risk basis.
Under 603 KAR 7:080, HSTD carries trips for more than Medicaid:
- Medicaid NEMT
- Kentucky Works, the state’s TANF work program
- Vocational rehabilitation, including rehabilitation for the blind
- Mental health, developmental disability, and substance use services
- The Office of Aging Services
As of September 2026, the Cabinet lists eight brokers across 15 regions. Region 7 was merged into Region 6.
| Broker | Regions | Office line |
|---|---|---|
| GRITS (Audubon Area Community Services) | 1, 3, 4 | 270-686-1651 |
| PACS | 2 | 270-886-6641 |
| LKLP | 5, 13, 15 | 606-487-1872 |
| FTSB | 6, 9, 10, 11 | 859-233-0066 |
| BGCAP | 8 | 502-695-4290 |
| RTEC | 12 | 606-256-9835 |
| SVTS (Sandy Valley) | 14 | 606-886-7039 |
| LVCAP (Licking Valley) | 16 | 606-845-0081 |
Kentucky writes many provider terms into its rules:
- Rates. The Cabinet sets subcontractor rates for each certificate type in each area, the same for every provider including the broker, and gives brokers 45 days’ notice before changing them (603 KAR 7:080, Section 24).
- Pay. Brokers must pay subcontractors within three business days of being paid by the Cabinet (KRS 281.875). Invoices are due to the broker within six months of the date of service.
- Rider choice. Riders certified for Type 07 (disoriented, may need an escort) or Type 08 (wheelchair) service may choose an eligible subcontractor in their area, or the broker if it also provides rides. When riders do not choose, the broker must spread those trips fairly among itself and every certified subcontractor (KRS 281.874).
- New laws. House Bill 2 (2026 Acts Chapter 179) writes the capitated regional model into statute, requires a GPS device in every vehicle on Medicaid trips at the broker’s cost, and sets spending floors for brokers. See what HB 2 changed.
How to subcontract with an HST broker
The broker holds the state contract, so your agreement, your trips, and your pay all run through it.
In Massachusetts:
- Find your broker by town. The state’s Find your HST broker list shows which towns each broker serves.
- Read the Transportation Provider Performance Standards. They set vehicle, driver, training, and trip rules for every HST company.
- Meet the broker’s minimums. GATRA asks for at least a year of medical transportation, registration with the Secretary of the Commonwealth and its certificate of good standing, and an office in or near its area. Email Inquiries@gatra.org with “application” in the subject line. MART’s requirements and application are in our MART guide.
In Kentucky:
- Get operating authority. Call the Division of Motor Carriers at 502-564-1257 for Taxi or Disabled Persons Vehicle authority, and qualify each vehicle.
- Call the broker for your county. It reviews the contract, inspects your vehicles, and collects your insurance, registrations, and workers’ compensation proof.
- Set up drivers. Put every employee in the statewide drug and alcohol random pool, and finish background checks, pre-employment tests, and training for safety-sensitive staff.
- Enroll with Kentucky Medicaid. File a MAP 811 for each service type (02, 07, and 08 for a for-profit company, or 04, 07, and 08 for a nonprofit), with provider type 56. The broker signs it, and you submit it through the Kentucky Medicaid Provider Enrollment Portal.
- Wait for Cabinet approval. You cannot sign with the broker until the Cabinet approves you. New providers must keep at least three active drivers and three operating vehicles.
In Kentucky you may not solicit Medicaid trips or pass an assigned trip to another company (603 KAR 7:080). See how to get NEMT broker contracts and the Massachusetts and Kentucky guides.
Frequently asked questions
Is human service transportation the same as NEMT?
No. NEMT is one kind of human service transportation: Medicaid rides to covered care. Human service transportation also covers rides that other programs pay for, such as day program routes for people with developmental disabilities, rides to job training, and senior trips funded through aging services. HST brokers in Massachusetts and Kentucky handle several of these programs at once.
Can a rider pick my company for their HST trips?
In Kentucky, riders certified for Type 07 or Type 08 service have the right to choose an eligible subcontractor in their area, or the broker if it also provides rides, and brokers may offer Type 02 riders the same choice (KRS 281.874). In Massachusetts, GATRA says HST policies do not let riders choose their own transportation company; the broker assigns each trip.
Do I need Medicaid enrollment to drive for an HST broker?
In Kentucky, yes. You apply for a Medicaid provider number for each service type on the MAP 811, with provider type 56, after the regional broker signs your application. In Massachusetts, your contract is with MART or GATRA, and you meet the state's HST provider performance standards. Ask the broker what it needs for each program you want to serve.
Who is my HST broker?
In Massachusetts, MART covers Western, Central, Metro Boston, and Northeastern Massachusetts, and GATRA covers Southeastern Massachusetts, Cape Cod, and the Islands. In Kentucky, the Transportation Cabinet lists one broker for each region, such as FTSB for Louisville, Lexington, and Northern Kentucky, and LKLP for several eastern and south central regions.