Brokers and Medicaid
What Is a Medicaid Provider Agreement? The Clauses NEMT Owners Should Read First
A Medicaid provider agreement is the contract you sign with your state Medicaid agency to become an enrolled provider and bill it for rides. Federal law requires it to make you keep trip records, hand them over on request, disclose your owners, and put your NPI on every claim. States add their own terms on record years, reporting deadlines, billing, and ending the agreement.
- Federal rules require one with every provider a state Medicaid program pays (42 CFR 431.107).
- The records clause sets your clock: Ohio requires six years from payment, and Florida five years.
- Report changes quickly: 35 days for new owners under federal rules, and 30 days in Ohio and Florida.
- Medicaid's payment is payment in full, so you may not bill the rider or family for the rest.
- The agreement lasts only as long as your enrollment, which the state must revalidate at least every five years.
What a Medicaid provider agreement is
Every state Medicaid program must have an agreement with each provider that furnishes services under its plan (42 CFR 431.107). For a transportation company, signing it is part of enrollment, and it is what lets you bill. Florida law says the state may pay only a provider with an agreement in effect, and Texas says you must enter a written agreement with its Health and Human Services Commission (Provider Procedures Manual, September 2026).
Federal law sets the floor. In the agreement you promise to:
- Keep records that show the extent of the services you provide.
- Hand them over on request to the state Medicaid agency, the federal Secretary of Health and Human Services, or the state’s Medicaid Fraud Control Unit, along with information about the payments you claimed.
- Disclose your ownership and control, under 42 CFR part 455, subpart B.
- Give the state your NPI and put it on every claim.
A separate rule makes Medicaid’s payment, plus any cost sharing the state plan sets, your payment in full (42 CFR 447.15). States add more. Ohio’s rule calls it a contract in which you agree to follow its terms, state law, the state’s rules, and federal law (Ohio Administrative Code 5160-1-17.2, effective September 19, 2019).
It is not your only agreement. A broker or health plan contract is separate, and so is the trading partner agreement you sign to send claim files. Brokers and health plans often ask for your state enrollment first, because the state must screen and enroll the network providers of its Medicaid health plans. A plan may contract with you for up to 120 days while that enrollment is pending (42 CFR 438.602(b)).
When you sign it and what comes with it
You sign the agreement as part of the application, and several federal deadlines are tied to it:
- Ownership disclosures are due when you apply, when you sign the agreement, at revalidation if the state asks, and within 35 days after any change in ownership (42 CFR 455.104).
- Criminal convictions of any owner, agent, or managing employee related to Medicare, Medicaid, or Title XX must be disclosed before the state enters or renews the agreement (42 CFR 455.106).
- The application fee, if your state counts your company as an institutional provider, must be paid before the state signs, unless you already paid it to Medicare or another state (42 CFR 455.460). It is $750 for applications filed in 2026. See the 2026 fee.
How you sign varies. Texas has a principal of the company with authority to bind it e-sign the agreement, and that signature certifies that the whole application is complete and correct. South Carolina has you accept its participation agreement, direct deposit agreement, W-9, and trading partner agreement by electronic signature on the online application (manual dated July 1, 2026). In California, a transportation company new to Medi-Cal files the Medi-Cal Provider Agreement, form DHCS 6208, with its transportation application package.
The clauses to read first
Federal rules set the minimum. Two states show how much further an agreement can go:
| Clause | Federal floor | Ohio (OAC 5160-1-17.2) | Florida (section 409.907, 2026 Statutes) |
|---|---|---|---|
| How long you keep records | Keep records that show the extent of your services | Six years from the date you receive payment, or until an audit started in that time is finished | Five years |
| Handing records over | On request, to the state, HHS, or the fraud control unit | Within 30 days, or payments are withheld and you may be terminated. Audits may use statistical sampling. | Access for the agency, the Attorney General, and the federal government, including patient records you cannot separate |
| Reporting changes | New owners disclosed within 35 days | Within 30 days for any change in licensure, ownership, address, or service locations | Any change in a principal, such as an officer, managing employee, or 5 percent owner, in writing within 30 days |
| Billing | Medicaid’s payment is payment in full | Bill only for services performed, charge no more than your usual fee, and collect nothing more from the patient or family | Bill other insurers first, then accept Medicaid as payment in full |
| Sanctions | Owners with certain Medicaid crimes disclosed | Certify that no owner, officer, employee, or independent contractor is sanctioned under Medicare, Medicaid, or Title XX | Comply with all Medicaid laws and keep required licenses in good standing |
| Money and liability | Report and return overpayments within 60 days | Tell the agency about any bankruptcy filing | Refund overpayments promptly, cover claims caused by your negligence, and carry liability insurance if the agency asks |
| Ending it | The state must terminate for certain reasons | Not in this rule | Either side may end it after reasonable notice |
What those clauses mean for a van company
Say Ohio Medicaid asks for the trip logs behind 40 rides you were paid for in 2022. Under Ohio’s rule, those records had to be kept for six years from payment, and you have 30 days to produce them before payments stop. Keep each trip’s log, driver, vehicle, and signature together so you can pull them fast. See NEMT record retention for what to keep and for how long.
The sanctions clause reaches your drivers. Ohio’s version covers employees and independent contractors, so check every driver against the OIG exclusion list before the first ride and on a set schedule after. The change clause reaches your office. A new partner, a new business address, or a new manager who runs day-to-day operations can each trigger a report. For ownership changes, see how to sell a NEMT business.
How the agreement lasts and how it ends
Your agreement lives only as long as your enrollment. States must revalidate every provider at least every five years (42 CFR 455.414). Texas gives most providers a five-year enrollment period, opens revalidation up to 180 days before the due date, and gives a request filed before the due date a 45-day grace period to finish. Miss it, and Texas disenrolls you from every state health care program, including its Medicaid health plans. See Medicaid revalidation.
States must also end or deny enrollment in certain cases (42 CFR 455.416, as amended December 2, 2025):
- A 5 percent owner did not give timely, accurate information or cooperate with screening.
- A 5 percent owner was convicted of a Medicare, Medicaid, or CHIP crime in the last 10 years, unless the state documents why ending it is not in the program’s interest.
- Medicare or another state’s Medicaid or CHIP program terminated you, and you are in the federal termination database.
- A 5 percent owner did not submit fingerprints within 30 days of a request, or you refused a site visit, unless the state documents an exception.
Before you sign, find the agreement’s termination clause and the state’s appeal rules, and ask whether a termination affects your broker and health plan contracts. If a payment problem comes first, see payment suspension. For the full enrollment path, see how to become a Medicaid transportation provider and Medicaid provider number.
Frequently asked questions
Who signs the Medicaid provider agreement for a company?
Someone who can legally bind the company. Texas requires a principal of the entity with authority to bind it to sign, and by e-signing that person certifies that everything in the application, including every owner entry, is complete and correct. False or incomplete information is a Medicaid program violation. Sign it yourself or have an officer sign it, never a billing vendor or office helper.
Is the provider agreement the same as a broker contract?
No. The provider agreement is with the state Medicaid agency and makes you an enrolled Medicaid provider. A broker or health plan contract is a separate agreement with its own rates, trip rules, and termination terms. Many brokers and health plans require you to be enrolled with the state first, because states must screen and enroll the network providers of Medicaid health plans (42 CFR 438.602(b)).
How long does a Medicaid provider agreement last?
As long as your enrollment stays active. States must revalidate every provider at least every five years (42 CFR 455.414). In Texas most providers have a five-year enrollment period, revalidation opens up to 180 days before the due date, and a provider that misses it is disenrolled from all Texas state health care programs, including Medicaid health plans. Florida law also lets either side end the agreement after reasonable notice.
Can I charge a Medicaid rider the difference between my price and what Medicaid pays?
No. Federal rules limit Medicaid to providers who accept the agency's payment, plus any cost sharing the state plan sets, as payment in full (42 CFR 447.15). Ohio's agreement bars seeking the rest from the patient, the family, or anyone else, and Florida's bars billing the recipient or the recipient's responsible party.
What happens if I find I was overpaid?
Report and return it. Federal law requires a provider to report and return a Medicaid overpayment, with a written reason, within 60 days after it is identified, and money kept past that deadline counts as an obligation under the False Claims Act (42 U.S.C. 1320a-7k(d)). Florida's provider agreement also requires you to report money received in error promptly and refund it.