Brokers and Medicaid
What Is a Medicaid Managed Care Organization? How Health Plans Handle NEMT Rides
A Medicaid managed care organization (MCO) is a health plan the state pays a fixed monthly amount per member to cover a full set of Medicaid benefits under a comprehensive risk contract, as defined in 42 CFR 438.2. When rides are part of the plan's benefits, the plan or its transportation broker approves them, contracts with ride companies, and pays claims. You must still enroll with state Medicaid first.
- An MCO is a health plan paid a monthly amount per member to cover most Medicaid care, rides included in many states.
- Many plans send rides through a transportation broker, so the broker is who you contract with and bill.
- Some states keep rides out of the plans. New York has done so for mainstream plan members since December 1, 2015.
- Every plan network provider must be screened and enrolled by the state Medicaid agency, even if it never serves fee-for-service riders.
- A plan may turn you down if its network is full, but it must tell you the reason in writing.
Most Medicaid members get their care through a health plan rather than straight from the state. For a ride company, that plan decides a lot: who books the trip, what you are paid, and where the claim goes.
What a Medicaid managed care organization is
A managed care organization, or MCO, is a health plan that contracts with a state to cover its Medicaid members. The state pays it a set amount per member per month, called capitation. Under 42 CFR 438.2, the state makes that payment whether or not the member uses any care during the period it covers. The plan carries the risk: if its members’ care costs more than the payments, the plan takes the loss.
What makes a plan an MCO is a comprehensive risk contract. Under 438.2, that contract covers inpatient hospital care plus at least one of a listed set of other services, or any three or more of them. Plans with narrower contracts have other names.
| Plan type | What it covers | What it means for rides |
|---|---|---|
| Managed care organization (MCO) | A full set of benefits, including hospital care | Often covers rides, and often hires a broker to run them |
| Prepaid ambulatory health plan (PAHP) | A limited set of benefits with no hospital care, such as dental or transportation | A broker the state pays per member to provide only rides is a NEMT PAHP under 42 CFR 438.9 |
| Primary care case management (PCCM) | Care coordination, generally paid a monthly case management fee, with medical services paid fee-for-service | Services, rides included, are paid through the state’s fee-for-service program |
As of July 1, 2024, CMS counted 67.9 million people in comprehensive managed care plans, out of about 87 million Medicaid enrollees. Some states run rides as their own managed program. Georgia’s NEMT manual (July 1, 2026) pays the broker a monthly rate for every eligible member in each of its five regions, and its April 2026 update lists Verida as the broker in all five. CMS’s 2024 report counted 1,908,368 Georgia members in that NEMT program on July 1, 2024.
How health plans cover NEMT
A state can put rides inside its health plans or keep them out. CMS guidance SMD 23-006 (September 28, 2023) confirms states may carve transportation out of managed care. Either way, the state Medicaid agency stays responsible for making sure members get rides.
| How the state set it up | Who you contract with and bill | Examples |
|---|---|---|
| Rides are a plan benefit, run by a broker the plan hires | The plan’s transportation broker | Since January 1, 2026, Anthem, CareSource, and MHS send HIP and Hoosier Healthwise rides through WellTrans (bulletin BT202608). As of September 2026, Indiana’s plan comparison page lists WellTrans for Anthem and MHS and LCP Transportation for UnitedHealthcare in Hoosier Care Connect |
| Rides are a plan benefit, approved by the plan | The plan or its vendor, under the plan’s rules | Texas Medicaid plans approve rides for their members (MTP handbook, September 2026). Illinois says to bill HealthChoice Illinois plans for their members (handbook, March 11, 2024) |
| Rides are carved out of the plans | The state’s broker or the state | New York moved mainstream plan members’ rides to its state transportation program on December 1, 2015. Georgia runs rides for plan members through its own NEMT broker |
| The member is not in a plan yet | The state’s fee-for-service program or broker | Texas enrolls new members as fee-for-service first, and plan enrollment usually is not retroactive |
Plans may also offer rides beyond the Medicaid benefit. Indiana’s comparison page lists CareSource rides to food banks and grocery stores, and five trips a month straight to the pharmacy. Ask the plan’s broker whether those extra trips come to your company and how they are paid.
For a list of who manages rides in each state, see NEMT brokers by state.
How to join a health plan’s ride network
- Enroll with your state Medicaid agency. Under 42 CFR 438.602(b), the state must screen and enroll every network provider of its plans, and you do not have to serve fee-for-service riders to be enrolled. Illinois requires both plan and fee-for-service transportation providers to enroll in its IMPACT system. See how to become a Medicaid transportation provider.
- Find out who runs rides for each plan in your area. Look for the plan’s transportation vendor on the state’s plan comparison page or in the plan’s member handbook. In Indiana, a ride company contracts with Verida for Traditional Medicaid members or with the plan’s NEMT broker for plan members.
- Apply to that broker and pass credentialing. Under 42 CFR 438.214, each plan must follow a written process to credential and recredential its network, set by a uniform state policy. Plans may not contract with anyone excluded from federal health programs, so check the OIG exclusion list for every owner and driver. See NEMT broker credentialing.
- Read the agreement before you sign. Check the rate schedule, the claim deadline, and who checks eligibility. WellTrans’s Indiana agreement (revised October 16, 2025) says WellTrans verifies each rider’s eligibility and schedules the trips. The MTM Health agreement posted by Pennsylvania (January 1, 2023 version) pays uncontested invoices within 30 days. It treats claims sent more than 90 days after the ride as not payable, unless its client sets another limit.
- Ask for the reason in writing if you are turned down. A plan does not have to contract with more providers than its members need. Under 42 CFR 438.12, it must give you written notice of why it declined you, and it may not turn you away solely because of the license or certification you hold.
A plan may sign a provisional agreement while your state enrollment is pending, but only for up to 120 days. If the state will not enroll you, the plan must end the agreement right away and tell affected members.
What changes when a rider is in a health plan
- You bill the plan’s side, not the state. New York’s transportation manual says claims sent to Medicaid for members whose plan covers transportation are denied, and the provider must bill the plan.
- Plan dates matter. A rider can join a plan, change plans, or leave between trips. Check eligibility for each ride date. See Medicaid eligibility verification.
- Plans and brokers change. On January 1, 2026, MDwise stopped serving Indiana’s HIP and Hoosier Healthwise members, and the remaining plans in those programs send rides through WellTrans (bulletin BT202608, January 15, 2026). See Indiana HIP rides move to WellTrans.
- Rates are negotiated. Federal rules let a plan pay different amounts to different kinds of providers. Your rate is the one in your agreement. See contracting with Medicaid health plans.
Frequently asked questions
Is a Medicaid MCO the same as a NEMT broker?
No. An MCO covers a full set of benefits, such as hospital and doctor care, under a comprehensive risk contract. A broker only arranges rides. Many plans hire a broker to run their rides. When a state pays a broker a monthly amount per member to provide only rides, federal rules call that broker a NEMT prepaid ambulatory health plan (42 CFR 438.9).
Do I need to be enrolled in Medicaid to join a health plan's ride network?
Yes. Under 42 CFR 438.602(b), the state must screen and enroll every network provider of a Medicaid plan. A plan may sign a provisional agreement while your enrollment is pending, but for no more than 120 days, and it must end the agreement if the state will not enroll you.
Can a Medicaid health plan refuse to contract with my NEMT company?
Yes. Under 42 CFR 438.12, a plan does not have to contract with more providers than its members need. It may not turn you away solely because of the license or certification you hold, and if it declines you, it must give you written notice of the reason.
Who pays if a rider changes health plans?
The plan covering the rider on the date of the ride. Plan enrollment has its own start and end dates, and in Texas it is usually not retroactive. When a plan leaves the market, rides move too. In Indiana, MDwise stopped serving HIP and Hoosier Healthwise members on January 1, 2026, and the remaining plans in those programs send rides through WellTrans.
How fast does a Medicaid health plan have to pay my claim?
Under 42 CFR 447.46, each MCO contract must require the plan to pay 90 percent of clean claims from practitioners within 30 days of receipt and 99 percent within 90 days, unless the plan and a provider agree on another schedule in their contract. When a plan's broker pays you, the broker agreement sets the timing, such as 30 days for uncontested invoices in the MTM Health agreement posted by Pennsylvania (January 1, 2023).