# ADA Requirements for NEMT in 2027: Vehicles, Wheelchairs, Service Animals, and Refusals

Canonical URL: https://nemtguide.com/guides/ada-requirements-for-nemt/ · Updated 2026-09-29

The ADA applies to NEMT companies through the Department of Transportation's rules in 49 CFR part 37. You must carry any wheelchair your lift and van can hold, allow service animals and oxygen, never charge riders extra because of a disability or require an attendant, train staff, name an ADA contact with a complaint process, and buy accessible new vans unless your service is already equivalent.

- The ADA rules in 49 CFR part 37 cover a NEMT company as a private company in the business of carrying people on rides booked on request, the same rules taxi services follow.
- A new van must be wheelchair accessible unless your service already gives wheelchair riders equal service. Cars and used vehicles are outside the purchase rule.
- Carry any wheelchair your lift and securement area can hold, and never refuse a chair because it is hard to secure.
- You may refuse a rider only for violent, seriously disruptive, or illegal conduct, or a direct threat to others.
- Name one ADA contact, publish how to file a complaint, and train every driver and dispatcher to proficiency.

Most ADA questions a NEMT owner faces come down to four things: which vans you buy, how drivers handle wheelchairs, which animals and devices ride along, and when a ride can be refused. The answers come from the U.S. Department of Transportation's ADA rules, not from Medicaid. They apply to every ride you give, whoever pays for it.

## Does the ADA apply to NEMT companies?

Yes. The Department of Transportation (DOT) writes the ADA rules for private transportation companies in 49 CFR part 37. A NEMT company is a private company primarily engaged in the business of transporting people, and it runs demand responsive service, meaning rides booked on request rather than on a fixed route. Part 37 has purchase and service rules for exactly that kind of company, and it puts taxi services under the same rules ([49 CFR 37.29](https://www.ecfr.gov/current/title-49/section-37.29)). DOT's interpretation adds that any service where a rider calls for a car and a driver to take them places counts as taxi service (Appendix D to part 37).

Several layers stack on top of each other, and you meet all of them at once.

| Layer | Who writes it | What it covers |
|---|---|---|
| DOT service rules, 49 CFR part 37 | U.S. Department of Transportation | Nondiscrimination, vehicle purchases, lifts and securement, service animals, training, complaints |
| DOT vehicle specs, 49 CFR part 38 | U.S. Department of Transportation | Lifts, ramps, securement stations, belts, door height |
| Justice Department rules, 28 CFR 36.301 to 36.306 | U.S. Department of Justice | Eligibility criteria, reasonable changes to policies, communication aids (brought in by 49 CFR 37.5(f)) |
| Public agency contracts | The agency, under 49 CFR 37.23 | The agency's own ADA duties for the service you run for it |
| Broker and state rules | Your broker agreement and state NEMT manual | Accessible vans, ADA training, and inspections written into your contract |

When the DOT and Justice Department rules seem to conflict, DOT's part 37 wins ([49 CFR 37.21](https://www.ecfr.gov/current/title-49/section-37.21)).

### Rides you run for a public agency

Work under a contract or other arrangement with a public agency, such as overflow rides for a transit authority's paratransit service, brings in the agency's rules. The agency must make sure you meet the part 37 rules that would apply if it ran the service itself. Vehicles you buy or lease for that work, new or used, must be accessible wherever the agency would have to buy accessible ones ([49 CFR 37.23](https://www.ecfr.gov/current/title-49/section-37.23)). DOT's interpretation says this reaches only the contracted service, not the rest of your business.

### What Medicaid and brokers add

CMS's Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) says that if a rider uses a wheelchair, the state must make sure the provider carries them in a wheelchair accessible vehicle. Brokers put the ADA into your contract. MTM Health's standard agreement, in the January 1, 2023 version Pennsylvania posts, requires compliance with the ADA and Section 504 of the Rehabilitation Act (section 2.U). It requires every vehicle that carries riders using mobility devices to meet DOT's ADA vehicle rules (section 4.A), and it requires drivers to allow service animals (section 3.H).

## The ADA rules that apply to every ride

These service rules apply to public and private transportation companies alike. Citations are to 49 CFR.

| Rule | What it means on a NEMT ride | Citation |
|---|---|---|
| No discrimination | You cannot deny or reduce service because of a disability | 37.5(a) |
| No special charges | No extra fee for the lift, the wheelchair, or a service animal | 37.5(d) |
| No required attendant | A rider may travel alone. You do not have to provide personal care. | 37.5(e) |
| Insurance is no excuse | You cannot refuse riders or devices because your insurer asks you to | 37.5(g) |
| Carry wheelchairs | Any wheelchair the lift and vehicle can hold, including three-wheeled scooters | 37.3, 37.165(b) |
| Help with equipment | Drivers help with lifts, ramps, and securement, and leave the seat to do it | 37.165(f) |
| No forced transfer | You may suggest a move to a vehicle seat, but never require it | 37.165(e) |
| Standees may use the lift | Riders with canes or walkers may board by the lift or ramp | 37.165(g) |
| Service animals | Always allowed in the vehicle | 37.167(d) |
| Oxygen and respirators | Allowed, under DOT hazardous materials rules | 37.167(h) |
| Enough time | Riders get the time they need to board and get off | 37.167(i) |
| Accessible information | Riders can get information and book rides in accessible formats | 37.167(f) |
| Working equipment | Lifts, ramps, and securement kept working and repaired promptly | 37.161 |
| Trained staff | Everyone trained to proficiency for their own duties | 37.173 |
| ADA contact and complaints | One named person and a published complaint process | 37.17 |

## Which NEMT vehicles must be wheelchair accessible

The purchase rule for private companies in the business of carrying people turns on three questions. Is the vehicle new, is it a car, and does your service already give wheelchair users equal service?

| Vehicle you buy or lease | What the ADA requires |
|---|---|
| New car or sedan | Never has to be accessible |
| New van with fewer than 8 seats, including the driver | Accessible, unless your service is already equivalent |
| New larger van or cutaway bus with 8 or more seats | Accessible, unless your service is already equivalent |
| Used vehicle | Outside the purchase rule |
| Any vehicle for work under contract with a public agency | Accessible wherever the agency would need one |

The rules are in [49 CFR 37.103](https://www.ecfr.gov/current/title-49/section-37.103) and 37.23. DOT's interpretation in Appendix D confirms that no private company has to buy an accessible car, and that private companies in the business of carrying people do not have to buy accessible used vehicles. Brokers and states may still require a wheelchair van for each rider who needs one.

### The equivalent service test

Before each new vehicle, look at your service as it runs today, without the new vehicle. Compare what a wheelchair user gets with what every other rider gets on these points ([49 CFR 37.105](https://www.ecfr.gov/current/title-49/section-37.105)):

- Response time, meaning how soon after a call you can send a vehicle
- Fares
- Service area
- Hours and days of service
- Information about the service
- How riders book
- Limits on capacity or availability
- Any limits based on trip purpose

The service must also be given in the most integrated setting that fits the rider. If a wheelchair rider would wait longer, pay more, or be turned away where a rider who walks would not, your service is not equivalent and the new van must be accessible. DOT says to answer the question every time you buy or lease. Measure it against the next rider who needs an accessible vehicle, even if no one has asked yet. Write down your answer and the date for each purchase.

As an example, a company with two wheelchair vans that books wheelchair and walking riders with the same notice, fares, area, and hours can add a new ambulatory minivan. A company whose only wheelchair van is booked three days out, while walking riders get next-day rides, would have to buy the new van accessible.

### The federal specs for an accessible van

A van counts as accessible only if it meets 49 CFR part 38 ([49 CFR 37.7](https://www.ecfr.gov/current/title-49/section-37.7)). Part 38 applies to new, used, and remanufactured vans alike. It does not require you to add a lift to a van that never had one (49 CFR 38.21).

| Feature | What part 38 requires |
|---|---|
| Lift | Design load of at least 600 pounds, a platform at least 30 by 48 inches, and an interlock so the van cannot move unless the lift is stowed |
| Ramp | 600-pound load for ramps 30 inches or longer (300 pounds if shorter), 30 inches wide, and no steeper than 1 in 4 when deployed to the ground |
| Securement stations | At least one on vehicles 22 feet long or less, and at least two on longer vehicles |
| Securement strength | On vehicles rated up to 30,000 pounds, 2,500 pounds per tie-down leg and 5,000 pounds per wheelchair |
| Movement | An occupied chair moves no more than 2 inches in any direction when secured |
| Rider belts | A lap belt and shoulder harness at each station, never used in place of securing the chair |
| Door | At least 56 inches of headroom above the raised lift or ramp on vehicles 22 feet long or less |

The U.S. Access Board updated its guidelines for buses and vans on December 14, 2016. As of September 2026, the Board says DOT has not adopted that update, so part 38 is still the enforceable standard. For the full list of federal, state, and broker rules, see [NEMT vehicle requirements](https://nemtguide.com/guides/nemt-vehicle-requirements/) and what a [wheelchair accessible vehicle](https://nemtguide.com/glossary/wheelchair-accessible-vehicle/) is.

## Wheelchairs, lifts, and securement on the ride

The lift and securement rules in [49 CFR 37.165](https://www.ecfr.gov/current/title-49/section-37.165) shape every wheelchair trip.

**Carry the chair if the van can hold it.** You must carry a wheelchair and rider that are larger or heavier than part 38's design standard if the lift and vehicle can accommodate them. You may decline only when the combined weight is over the lift's rating or carrying the chair is shown to be unsafe. DOT's example: a lift rated for 800 pounds may be limited to 800 pounds. A chair that extends past the 30 by 48 inch footprint but still fits the lift and the securement area must be carried. One that would block the aisle and slow an emergency exit may be refused. Ask about the chair and its weight when the trip is booked, and send a van that fits. See [bariatric transportation](https://nemtguide.com/guides/bariatric-transportation/) for heavy chairs.

**Know what counts as a wheelchair.** The rule covers manual and power chairs and three-wheeled scooters that can be used indoors (49 CFR 37.3). Canes, crutches, and walkers must be accommodated too. You do not have to let a rider sit on a walker for the ride instead of a seat.

**Use the securement stations.** You do not have to let a wheelchair ride outside a securement location. When every station on the van is taken, you do not have to board another wheelchair user, so plan shared rides around the number of stations.

**Secure every chair, and never refuse one as too hard to secure.** On a part 38 van you must use the securement system, and you may require the rider to let you secure the chair. You may not deny the ride because the chair cannot be secured to your satisfaction. The [wheelchair securement guide](https://nemtguide.com/guides/wheelchair-securement/) covers the four-point steps.

**Offer, never force, a transfer.** You may explain the risks and recommend a move to a vehicle seat. The rider decides.

**Help, even if it means leaving the seat.** Drivers must deploy the lift, help with the tie-downs when the rider cannot, and push a manual chair up a steep ramp if needed. DOT says this overrides any company rule that drivers stay seated. It also says you should respect the direction the rider prefers to board, unless the chair only fits one way or there is a direct threat to safety.

**Keep the equipment working.** Lifts, ramps, and securement must be kept in working order and repaired promptly. While one is out of order, you must take reasonable steps to serve the riders who need it ([49 CFR 37.161](https://www.ecfr.gov/current/title-49/section-37.161)). DOT treats an isolated breakdown as no violation, but failures from poor maintenance are one. Check the lift before every shift with the [vehicle inspection checklist](https://nemtguide.com/templates/nemt-vehicle-inspection-checklist/), and send another accessible van when one fails.

## Service animals and portable oxygen

DOT's rules require you to let service animals ride with their users ([49 CFR 37.167(d)](https://www.ecfr.gov/current/title-49/section-37.167)). DOT defines a service animal as any guide dog, signal dog, or other animal individually trained to do work or perform tasks for a person with a disability. That is broader than the Justice Department's dogs-only definition in 28 CFR 36.104, and for transportation the DOT definition controls. DOT's interpretation says service animals must always be permitted in any private or public transportation vehicle, and charging extra to carry one is inconsistent with the rule.

The Justice Department's rules, which apply to private transportation companies through 49 CFR 37.5(f), set out how staff handle an animal whose role is not obvious. Staff may ask only two questions: is the animal required because of a disability, and what work or task has it been trained to perform. They may not ask for certification or proof of training, and your company is not responsible for the animal's care (28 CFR 36.302(c)). The [service animals in NEMT guide](https://nemtguide.com/guides/service-animals-in-nemt/) goes into the details.

You also may not bar a rider with a disability from traveling with a respirator or portable oxygen, consistent with federal hazardous materials rules (49 CFR 37.167(h)). See transporting riders with oxygen.

## When you can refuse a ride, and when you cannot

The ADA lets you refuse a rider who engages in violent, seriously disruptive, or illegal conduct, or who is a direct threat to the health or safety of others ([49 CFR 37.5(h)](https://www.ecfr.gov/current/title-49/section-37.5)). A direct threat is a significant risk that cannot be removed by changing a policy or providing an aid (49 CFR 37.3). Deciding it takes an individual assessment of this rider, based on current medical knowledge or the best objective evidence: how severe the risk is, how likely harm is, and whether a change would reduce it (28 CFR 36.208).

| You may refuse or stop a ride when | You may not refuse a ride because |
|---|---|
| The rider is violent, seriously disruptive, or breaking the law | The rider's disability causes an appearance or involuntary behavior that annoys or offends others |
| The rider is a direct threat after an individual assessment | Staff or other riders fear the condition, such as HIV |
| A safety rule that applies to every rider and rests on actual risk is broken, such as refusing a seat belt | Your insurance company asks you to avoid riders with disabilities or certain devices |
| The chair is over the lift's weight rating or cannot fit the vehicle | The wheelchair is hard to secure |

DOT's own example is a rider with Tourette syndrome who makes involuntary profane outbursts. That may annoy others, but it is not a reason to refuse the ride. Safety rules are allowed only if they rest on actual risks, not speculation or stereotypes (28 CFR 36.301(b)). MTM Health's standard agreement requires drivers to make riders wear seat belts and to refuse to start or continue a trip when they will not (section 3.I).

When you could lawfully refuse a rider, you may instead offer the ride on a condition that solves the problem, such as an attendant riding along. Write down every refusal: what happened, who decided, and when you told the broker. The [incident report form](https://nemtguide.com/templates/nemt-incident-report-form/) works for this, and difficult or unsafe riders covers de-escalation.

## Charges, attendants, and escorts

You may not impose special charges on riders with disabilities, including wheelchair users, for services the rules require or that are needed to accommodate them (49 CFR 37.5(d)). DOT's interpretation gives examples:

- A shuttle that charges most riders $20 for a trip cannot charge $40 because the rider needs its lift-equipped van.
- Higher mileage charges for using an accessible vehicle are inconsistent with the rule.
- Charging extra to carry a service animal is inconsistent with the rule.
- A fee charged to everyone, such as $1 to stow luggage, may also be charged to stow a folding wheelchair.

Medicaid and broker trips work differently. The payer sets the rate for each level of service, and you accept the Medicaid payment, plus any cost sharing the state sets, as payment in full (42 CFR 447.15). Private pay is where the rule bites. Before you publish a wheelchair price above your ambulatory price, have a transportation attorney review it. See [private pay NEMT](https://nemtguide.com/guides/private-pay-nemt/) for pricing and collection.

You may not require a rider with a disability to bring an attendant (49 CFR 37.5(e)). You also do not have to provide attendant services such as help with eating, dressing, or toileting. Riders may still bring one. MTM Health's agreement says you must carry the rider and one escort or attendant as requested, with more needing MTM's approval (section 2.FF). Some states pay for an escort under code [T2001](https://nemtguide.com/glossary/t2001/).

## Booking, information, and communication

Riders with disabilities must be able to get information about your service and book rides. That includes accessible formats and technology for people with vision, hearing, or speech disabilities (49 CFR 37.167(f)). The Justice Department's communication rules add specifics (28 CFR 36.303):

- Answer calls through a telecommunications relay service the same way you answer any other call.
- If you use voicemail or an automated phone menu, it must work for callers using relay services and text telephones.
- Do not require a rider to bring someone to interpret.
- Do not rely on an adult companion to interpret, except in an emergency or when the rider asks, the adult agrees, and it is appropriate. Never rely on a child, except in an emergency.

At booking, ask what the rider needs: the type of mobility device and its weight if it is heavy, a service animal, oxygen, or help at the door. That tells dispatch which van and driver to send.

## Training, your ADA contact, and complaints

**Train to proficiency.** Every public or private company running demand responsive rides must train its staff to proficiency, as fits their duties. That means operating vehicles and equipment safely and treating riders with disabilities respectfully and courteously ([49 CFR 37.173](https://www.ecfr.gov/current/title-49/section-37.173)). DOT's interpretation says there is no required course or refresher schedule, but staff must be proficient at all times. A dispatcher must know enough to send the right vehicle, a driver must run the lift and securement correctly, and a mechanic must know how to maintain lifts.

Brokers set their own schedule. Modivcare's 2025 compliance attestation requires owners and drivers to complete its compliance training, which includes the ADA, each calendar year. New employees finish it within 30 days of hire, and training records are kept for at least 10 years. See [NEMT driver training](https://nemtguide.com/guides/nemt-driver-training/).

**Name an ADA contact.** Every public or private company covered by part 37 must name at least one person to coordinate its ADA compliance ([49 CFR 37.17](https://www.ecfr.gov/current/title-49/section-37.17)). In a small company it can be the owner or the office manager.

**Publish a complaint process.** You must have complaint procedures that resolve complaints promptly and fairly. Riders must be able to find and use them:

1. Advertise how to file a complaint, with your ADA contact's name, address, phone number, and email, for example on your website.
2. Make the process usable by people with disabilities.
3. Respond promptly with your decision and the reasons.
4. Keep a record of each complaint and your response.

The [complaint log](https://nemtguide.com/templates/nemt-complaint-log/) keeps that record, and [rider complaints filed with a broker](https://nemtguide.com/guides/broker-rider-complaints/) explains the broker side.

## Who enforces the ADA and what violations cost

The U.S. Department of Justice enforces the ADA for private transportation companies, whether or not they receive federal money ([49 CFR 37.11](https://www.ecfr.gov/current/title-49/section-37.11)). Riders file complaints through ADA.gov.

| Who acts | What they can get | Source |
|---|---|---|
| A rider | A court order to change the policy, vehicle, or practice | 42 U.S.C. 12188(a) |
| The Justice Department, for a pattern or practice or an issue of public importance | Court orders, damages for riders when it asks, and civil penalties of up to $118,225 for a first violation and $236,451 for a later one | 42 U.S.C. 12188(b); 28 CFR 85.5, penalties assessed after July 3, 2025 |
| Your broker | Nonpayment for a trip and liquidated damages when a vehicle does not meet requirements | MTM Health agreement, section 4.D (January 1, 2023 version) |
| Your state | Oversight of transportation entities so riders with disabilities get vehicles that meet their needs | CMS SMD 23-006 |

## An ADA checklist for a small NEMT company

1. **Name your ADA contact in writing,** and post your complaint process with that person's name, address, phone, and email on your website and rider materials.
2. **Write your service rules down:** no extra charges tied to a disability, no required attendants, service animals and oxygen allowed, and the only reasons a ride may be refused. Put them in your [policies and procedures](https://nemtguide.com/guides/nemt-policies-and-procedures/).
3. **Run the equivalent service test before every new vehicle** you buy or lease, and file your answer with the purchase papers.
4. **Check lifts, ramps, and securement before every shift.** Take a van with a broken lift off wheelchair trips and get it repaired promptly.
5. **Train every driver and dispatcher** before their first ride, retrain anyone whose skills slip, and keep signed records.
6. **Make booking work for everyone:** relay calls, accessible voicemail, and rider information in large print or electronic formats on request.
7. **Record rider needs at booking** so dispatch sends a van and driver that fit.
8. **Log every refusal and complaint** with the reason and your response.
9. **Read the ADA sections of every broker agreement and handbook,** and meet the stricter rule when they differ.

## Frequently asked questions

### Does every NEMT vehicle have to be wheelchair accessible?

No. No private company has to buy an accessible car, and the purchase rule covers only new vehicles. When a company in the business of carrying people buys or leases a new van or other vehicle that is not a car, it must be accessible unless its service already gives wheelchair users equal service (49 CFR 37.103 and 37.105). Brokers and states can require more, and CMS says states must make sure a Medicaid rider who uses a wheelchair rides in a wheelchair accessible vehicle.

### Can I charge more for a wheelchair ride?

Be careful. Federal rules bar special charges on riders with disabilities, including wheelchair users, for services the rules require or that are needed to accommodate them (49 CFR 37.5(d)). The Department of Transportation's interpretation says charging more because a rider needs the lift-equipped van, or higher mileage charges for an accessible vehicle, is inconsistent with the rule. Medicaid and broker rates are set by the payer. For private pay, have an attorney review your price list.

### Can a driver refuse a wheelchair that is too big or too heavy?

Only if the lift or vehicle truly cannot hold it. You must carry the wheelchair and rider whenever the lift and vehicle can accommodate them, even when they are larger or heavier than the 600-pound design standard. You may decline if the combined weight is over the lift's rating or carrying the chair is shown to be unsafe. You may never refuse a chair because it is hard to secure (49 CFR 37.165).

### Can I require a rider to bring an attendant?

No. Federal rules bar requiring a rider with a disability to travel with an attendant (49 CFR 37.5(e)), and you do not have to provide personal care such as help with eating or toileting. The exception is a ride you could lawfully refuse, for example after violent conduct, which you may offer on the condition that an attendant comes. Brokers such as MTM Health require you to carry one escort when one is requested.

### Do I have to allow emotional support animals?

The transportation rule covers any guide dog, signal dog, or other animal individually trained to do work or perform tasks for a person with a disability (49 CFR 37.3). An animal that offers comfort but is not trained for a task does not meet that definition, and the Justice Department's rules say emotional support alone is not a task. A trained service animal must always be allowed, with no extra fee.

### Can a rider bring portable oxygen on a NEMT ride?

Yes. You may not bar a rider with a disability from traveling with a respirator or portable oxygen supply, consistent with federal hazardous materials rules (49 CFR 37.167(h)). The Department of Transportation's interpretation notes that those rules let a passenger bring a portable medical oxygen supply on board, so a company cannot forbid it. Follow your broker's handbook for how tanks are carried in the vehicle.

### Who enforces the ADA against a NEMT company?

The U.S. Department of Justice enforces the ADA for private transportation companies (49 CFR 37.11). A rider can sue for a court order. In a Justice Department case, a court can award damages and civil penalties of up to $118,225 for a first violation and $236,451 for a later one (penalties assessed after July 3, 2025). Brokers enforce it through contracts: MTM Health's standard agreement requires ADA compliance.

## Official resources

- [eCFR: 49 CFR part 37, the ADA rules for transportation providers](https://www.ecfr.gov/current/title-49/subtitle-A/part-37)
- [eCFR: 49 CFR part 38, accessibility specifications for vans and buses](https://www.ecfr.gov/current/title-49/subtitle-A/part-38)
- [eCFR: Appendix D to part 37, the Department of Transportation's interpretation](https://www.ecfr.gov/current/title-49/subtitle-A/part-37/appendix-Appendix%20D%20to%20Part%2037)
- [U.S. Access Board: Accessibility guidelines for vehicles](https://www.access-board.gov/ada/vehicles/)
- [ADA.gov: Businesses that are open to the public (Title III)](https://www.ada.gov/topics/title-iii/)
- [ADA.gov: File a complaint with the Justice Department](https://www.ada.gov/file-a-complaint/)
- [CMS: Medicaid Transportation Coverage Guide (SMD 23-006)](https://www.medicaid.gov/federal-policy-guidance/downloads/smd23006.pdf)