# How to Add NEMT to a Taxi or Limo Business in 2027: Enrollment, Drivers, and Wheelchair Vans

Canonical URL: https://nemtguide.com/guides/add-nemt-to-taxi-business/ · Updated 2026-09-30

To add NEMT to a taxi or limo business, enroll the company in your state Medicaid program's taxi or livery category, get an organization NPI with taxonomy code 344600000X, and credential every driver and car with the broker that assigns trips. Train drivers in passenger assistance. Some states, such as New York, pay only for cars you own or lease, and wheelchair trips need ramp or lift vans.

- Several states enroll taxis in their own Medicaid category, such as New York taxi and livery, Illinois taxi, and Indiana specialty 263.
- Your taxi license is a condition of enrollment, not a substitute for it. Medicaid enrollment, an NPI, and broker credentialing come on top.
- Cabs owned by your drivers may not qualify. New York taxi providers and Illinois providers are paid only for vehicles they own or lease.
- Medicaid riders never pay a fare. You bill Medicaid or the broker, and a trip log with times and the rider's signature backs every claim.
- Wheelchair trips pay more, but they need ramp or lift vans, securement training, and in New York a separate ambulette enrollment.

A taxi or limo company already has what most new NEMT companies lack: licensed drivers, insured cars, a dispatcher, and people who know the streets. What changes is who books the ride, who pays for it, and the records behind every trip. The rules below are current as of September 2026, with examples from New York, Illinois, Indiana, and Virginia where states differ.

## How Medicaid trips differ from street hails

A street hail is paid at the curb. A Medicaid trip is assigned days ahead, paid weeks later, and paid only when the records show it ran as authorized. MTM Health's handbook for Virginia's fee-for-service program (approved August 10, 2026) shows how a broker runs the work.

| | Street hail or phone order | Medicaid or broker trip |
|---|---|---|
| Who books it | The rider | The state, its broker, or a health plan, usually days ahead. MTM's Virginia program offers trips to providers 7 days before the appointment. |
| Who pays | The rider, at the end of the ride | Medicaid or the broker. The rider pays no fare, and MTM bars its Virginia drivers from accepting money from members. |
| Price | Meter, zone, or flat fare | A state fee schedule or the broker's rate sheet |
| When you arrive | As soon as you can | Inside a [pickup window](https://nemtguide.com/glossary/pickup-window/): 15 minutes before to 15 minutes after the scheduled time in Virginia |
| Return rides | A new call | [Will-call](https://nemtguide.com/glossary/will-call-trip/) returns, due within 45 minutes of the call in Virginia |
| Help at the door | None required | [Curb-to-curb](https://nemtguide.com/glossary/curb-to-curb/) unless the trip manifest calls for [door-to-door](https://nemtguide.com/glossary/door-to-door/) or hand-to-hand help |
| Proof | A receipt | A trip log with scheduled and actual times and the rider's signature, plus location tracking for the whole ride |
| Getting paid | Cash or card, right away | A clean claim, filed within 6 months of the ride with MTM in Virginia |

Three rules catch taxi owners off guard:

- **The mode is fixed.** The broker assigns the vehicle type and the level of help for each trip. MTM's Virginia handbook says an unapproved mode, a substituted vehicle, or a different level of help than authorized can mean no payment.
- **Empty miles are yours.** Illinois pays nothing for unloaded miles, waiting time, or a no-show (HFS handbook, March 11, 2024). Indiana pays enrolled taxis by the trip, with no separate mileage.
- **Scores decide your volume.** MTM's Virginia standards call for on-time performance above 95 percent, and vendor no-shows, meaning assigned trips you fail or refuse to run, under 0.25 percent. Falling short can bring a performance improvement plan, liquidated damages, or removal from the network.

The [trip documentation guide](https://nemtguide.com/guides/nemt-trip-documentation/) covers what each log needs.

## Step 1: Check what your taxi license and insurance already cover

Medicaid does not replace your taxi license. It requires it.

- **Illinois** enrolls taxis licensed by the Secretary of State and, where applicable, by local regulators. Passenger cars licensed as livery or public transportation enroll as service cars.
- **New York** enrolls taxi companies outside New York City in category of service 0603. In Westchester and Nassau counties you also need a base license from that area's Taxi and Limousine Commission. You must keep records showing every driver holds a Class E license and every vehicle has livery plates.
- **Virginia** requires vehicles with taxi plates to follow state and local taxi ordinances and to hold a current license from the local taxi authority where one exists (DMAS requirements, updated May 26, 2026).

**Insurance.** Taxi rules and broker contracts set their own limits. Virginia requires taxis to carry the greater of the state DMV amount or the city or county taxi ordinance amount. MTM Health's standard provider agreement, in the January 1, 2023 version Pennsylvania posts, asks for $500,000 combined single limit auto liability and $500,000 general liability, with MTM named as an additional insured. Send each broker's insurance section to your agent and ask in writing whether your policy covers Medicaid rides. See [NEMT insurance requirements](https://nemtguide.com/guides/nemt-insurance-requirements/).

### Who owns the cars

This step can change how a cab company runs. If your drivers own or lease the cars they drive, some states will not pay for trips in them.

- **New York** requires ambulance, ambulette, and taxi providers (categories 0601, 0602, and 0603) to own each vehicle outright or lease it in the company's name, with the registration, insurance, and maintenance in the company's name too. A provider that uses vehicles registered to, insured by, or maintained by someone else can be disenrolled. Livery and black car providers in New York City (0605) and ride-hail companies (0609) are exempt and may use drivers who own and operate their own cars.
- **Illinois** does not pay for trips in vehicles the provider does not own or lease and operate.
- **MTM's standard agreement** defines a driver as a person directly retained or employed by the provider, and bars subcontracting any service without MTM's written consent.

If your drivers are independent contractors with their own cabs, decide early whether NEMT runs in company-owned cars with employed drivers. The [1099 or W-2 guide](https://nemtguide.com/guides/nemt-drivers-1099-or-w2/) covers the tax side of that choice.

## Step 2: Enroll with Medicaid in the taxi category

Several states enroll taxis as their own provider type, separate from wheelchair van companies. The category decides what you may bill and how each trip is paid.

| State | Taxi category | What enrollment asks for | How taxi trips are paid |
|---|---|---|---|
| New York | 0603 Taxi, outside New York City. 0605 Livery or black car, New York City only. | A $750 application fee and a letter of support from Medical Answering Services (MAS), the state's fee-for-service broker. In New York City, a TLC base license: livery, for-hire, paratransit, or black car. | Fees by county on the state schedule, or the rate MAS negotiates with you |
| Illinois | Taxi, or service car for passenger cars licensed as livery | A fingerprint-based background check, possible on-site visits by the Office of Inspector General, and state-approved safety training for every driver | The local community rate set by local government, or the state maximum where taxi rates are not regulated |
| Indiana | Specialty 263, Taxi | A separate transportation Provider ID, plus a contract with Verida, the fee-for-service broker. Taxis may operate under a city taxi or livery license. | The metered or zoned fare up to the state maximum. Unregulated taxis get the lower of their charge or the maximum for the trip's length. No separate mileage. |

Dates: New York's enrollment page was updated in May 2026, Illinois's handbook is dated March 11, 2024, and Indiana's Transportation Services module is version 6.1 of August 19, 2025.

New York's order matters. First you apply to MAS, which decides whether to give a letter of support. New enrollment applications without that letter have been rejected since April 15, 2024. Then you apply to the Department of Health, which MAS says can take 90 days or longer. After approval, you join the MAS network under its contract. Enrollment does not guarantee trips: MAS assigns them by the rider's choice of provider, then the medical practitioner's choice, then by rotation.

Every state also runs federal screening. Where the state charges the federal application fee, it is $750 for applications submitted in 2026 (Federal Register notice of December 3, 2025). Federal law also requires each state to confirm that every NEMT provider and driver is not excluded from federal health programs, that each driver has a valid license, and that the company has a process for state drug law violations and a process for reporting each driver's driving history to the state (Social Security Act section 1902(a)(87), explained in CMS's Medicaid Transportation Coverage Guide of September 28, 2023). The [Medicaid provider guide](https://nemtguide.com/guides/how-to-become-a-medicaid-transportation-provider/) walks through the application itself.

### Your NPI and taxonomy code

Apply for an organization NPI (Type 2) in NPPES under the company's legal name. The national code set, version 26.1 of July 1, 2026, has a code for you: **344600000X, Taxi**, a commercial vehicle for non-emergency rides that meets the local, county, or state rules where it operates. If you add wheelchair vans, add **343900000X, Non-emergency Medical Transport (VAN)** to the same record and mark one code as primary. Match your codes to the state's category before you apply. See [NEMT taxonomy codes](https://nemtguide.com/glossary/taxonomy-code/) and [how to get an NPI for NEMT](https://nemtguide.com/guides/how-to-get-an-npi-number-for-nemt/).

## Step 3: Get credentialed with each broker

Brokers keep their own file on your company, separate from your Medicaid enrollment. MTM Health's Virginia handbook lists what it tracks:

- **The company:** business license and its expiration, state operating authority, FMCSA authority where required, NPI, service area, and hours.
- **Each driver:** training dates, license expiration, last background check, last drug screen where required, and last driving record review.
- **Each vehicle:** inspection, registration, and insurance expiration dates, and passenger capacity.

Every vehicle is inspected before it carries a member and again twice a year. Every trip must run with location tracking on from pickup to drop-off. Lapsed documents cost money: MTM can cut your trip volume and refuse payment for trips run by drivers whose documents expired. See [NEMT broker credentialing](https://nemtguide.com/guides/nemt-broker-credentialing/), and find the brokers in your state in [NEMT brokers by state](https://nemtguide.com/guides/nemt-brokers-by-state/).

## Step 4: Train drivers for riders who need help

Your drivers already know the roads. NEMT riders need skills a street fare never does.

- **Virginia (MTM Health):** before a first trip, each driver completes passenger assistance training (PASS), HIPAA, and defensive driving, plus first aid and wheelchair securement where they apply. Taxi drivers who give door-to-door or hand-to-hand help must also have PASS. Drivers must be at least 21 with two years of driving experience. They may have no more than two chargeable accidents or moving violations in three years, no suspension for moving violations in five years, and must pass criminal background and sex offender registry checks.
- **Illinois:** every taxi, medicar, and service car driver completes a state-approved safety program before carrying a Medicaid rider, and again every three years. If you cannot show the certificate, the state recovers every payment for rides by that driver.

Conduct rules change too. In MTM's Virginia program, drivers wear a company shirt or a program ID badge, get out to help with doors, never use a handheld phone while moving, see each rider safely inside before leaving, and never accept money or goods from members. See [NEMT driver training](https://nemtguide.com/guides/nemt-driver-training/) and [PASS certification](https://nemtguide.com/glossary/pass-certification/).

## Step 5: Decide whether to add wheelchair vans

Federal disability rules already apply to your taxis, NEMT or not. Under [49 CFR 37.29](https://www.ecfr.gov/current/title-49/section-37.29), a taxi company does not have to buy accessible cars. When it buys or leases a vehicle other than a car, such as a van, that vehicle must be accessible unless the company already gives equivalent service to riders with disabilities. A taxi company may not refuse a rider who can use its cars, refuse to help stow a wheelchair, or charge riders with disabilities more. The rule's appendix counts limousine and car services as taxi service.

Medicaid wheelchair trips go further. Brokers send them only to vans with a ramp or lift and drivers trained in securement. MTM's Virginia standards require four working securements, a working interlock, and a vehicle-mounted lap and shoulder belt at every wheelchair station, plus a record of each lift's maker, model, age, and rated capacity. Providers that accept hospital discharges carry a spare wheelchair with a seat at least 20 inches wide.

The pay difference is large. New York's schedule dated April 5, 2026 pays New York City ambulette trips, its name for wheelchair van service, $52.90 plus $3.60 per loaded mile. Taxi and livery trips there get $22.97 plus $2.93. A 10-mile ride pays $88.90 in an ambulette and $52.27 in a livery car. But ambulette is its own category, 0602, and it needs a common carrier certificate or contract carrier permit from the state Department of Transportation and a DMV letter of compliance with Article 19-A dated on or after the most recent July 1. Once enrolled, an ambulette company may also run curb-to-curb taxi trips without a separate taxi license, billed with taxi codes, though local Taxi and Limousine Commission licensing can still apply.

Before you buy, read [wheelchair vans for NEMT](https://nemtguide.com/guides/wheelchair-van-for-nemt/), [what a wheelchair van costs](https://nemtguide.com/guides/wheelchair-van-cost/), and [wheelchair securement](https://nemtguide.com/guides/wheelchair-securement/).

## What Medicaid pays a taxi company

Taxi trips pay less than wheelchair van trips, and rates vary widely by area. Here is what New York's fee-for-service schedule, dated April 5, 2026, pays for taxi and livery trips: an A0100 base per trip plus S0215 per loaded mile.

| Area | Base per trip | Per loaded mile | 5-mile trip | 10-mile trip | Rate effective |
|---|---|---|---|---|---|
| New York City | $22.97 | $2.93 | $37.62 | $52.27 | April 1, 2022 |
| Westchester County | $7.41 | $2.34 | $19.11 | $30.81 | April 1, 2022 |
| Erie County | $7.36 | $2.66 | $20.66 | $33.96 | December 31, 2022 |
| Monroe County | $3.23 | $3.47 | $20.58 | $37.93 | December 31, 2022 |
| Albany County | $7.52 | $1.34 | $14.22 | $20.92 | December 31, 2022 |

The schedule says these fees apply to the fee-for-service broker and may reflect network negotiations. The policy manual says rates MAS negotiates with a provider replace the schedule. Two more New York rules shape the math:

- **Miles to the tenth.** For dates of service since August 1, 2019, you bill loaded miles to the tenth of a mile, and rounding up is not allowed.
- **Shared rides.** When you carry several Medicaid riders together, you bill a base for each rider but mileage only from the first pickup to the last drop-off.

For other states' taxi rates and units, see the [A0100 billing code](https://nemtguide.com/glossary/a0100/). Then compare each rate with what a trip costs you to run, using [NEMT cost per trip](https://nemtguide.com/guides/nemt-cost-per-trip/).

## Mistakes that cost taxi companies their Medicaid pay

- **A driver who is not on file.** A trip run by a driver without current credentials or training can go unpaid, or be recovered later.
- **Cars the company does not own or lease.** In New York, a taxi provider using vehicles registered to others can be disenrolled.
- **Passing trips to another company.** New York no longer allows even short-term subcontracting or borrowed vehicles when your fleet is short. Call the broker right away so it can reassign the trip.
- **Missing trip log fields.** MTM denies a Virginia claim if the trip ID, scheduled or actual pickup time, departure time, arrival time, or the member's signature is missing.
- **Rewarding riders.** New York's manual says it is illegal to give or offer a Medicaid member anything of value for using your service, including free or discounted personal rides. Keep any loyalty discount for regular fares away from Medicaid riders. See [anti-kickback rules for NEMT](https://nemtguide.com/guides/anti-kickback-rules-for-nemt/).
- **Collecting from the rider.** Federal rules require you to accept Medicaid's payment in full (42 CFR 447.15). Bill every trip to Medicaid or the broker, never to the member.

## Frequently asked questions

### Can my drivers use cabs they own for Medicaid trips?

It depends on the state and the category. New York requires taxi providers in category 0603 to own each vehicle or lease it in the company's name, with the registration, insurance, and maintenance in its name too. New York City livery and black car providers, category 0605, may use drivers who own and operate their own cars. Illinois does not pay for trips in vehicles the provider does not own or lease and operate.

### Can a Medicaid rider pay the fare or tip the driver?

Not the fare. Federal rules require Medicaid providers to accept the program's payment as payment in full (42 CFR 447.15), and New York's transportation policy manual says members never pay a copay and providers never ask a member for payment. Tips depend on the broker. MTM Health's Virginia handbook bars drivers from soliciting or accepting money or goods from members, so a no-tips rule for Medicaid riders is the safe policy.

### What taxonomy code does a taxi company use for NEMT?

344600000X, Taxi, in the national code set (version 26.1, July 1, 2026). It describes a commercial vehicle for non-emergency rides that meets the local, county, or state rules where it operates. If you add wheelchair vans, add 343900000X, Non-emergency Medical Transport (VAN), to the same NPI record and mark one code as primary. Check which code your state pairs with its taxi category before you apply.

### Does a taxi company have to buy wheelchair accessible vehicles?

Not under the federal taxi rule, 49 CFR 37.29. A taxi company does not have to buy accessible cars. When it buys or leases a vehicle other than a car, such as a van, that vehicle must be accessible unless the company already gives equivalent service. It may never charge riders with disabilities more or refuse to help stow a wheelchair. Medicaid wheelchair trips are a separate choice that needs ramp or lift vans.

### Can a limo or black car company do NEMT?

Yes, where the state has a category that fits. New York City enrolls livery and black car companies in category 0605, which needs a Taxi and Limousine Commission base license: livery, for-hire, paratransit, or black car. Illinois enrolls passenger cars licensed as livery as service cars. The federal disability rule treats limousine and car services as taxi service, so the same nondiscrimination duties apply.

### Do taxi trips across a state line need FMCSA operating authority?

Usually not. Federal law exempts taxicab service from FMCSA's operating authority rules: a vehicle for 8 or fewer people, driver included, not run on a regular route, that is licensed as a taxi or charges local fares mainly by distance (49 U.S.C. 13506 and 13102). The exemption ends at 8 seats, driver included. Brokers still check, so keep proof of your taxi license on file.

## Official resources

- [eMedNY: Non-medical transportation provider enrollment](https://www.emedny.org/info/providerenrollment/transportation/Option2.aspx)
- [Medical Answering Services: Become a transportation provider](https://wp2.medanswering.com/transportation-providers/become-a-provider/)
- [Illinois HFS: Handbook for Providers of Transportation Services](https://hfs.illinois.gov/content/dam/soi/en/web/hfs/sitecollectiondocuments/transportationhandbook.pdf)
- [Indiana Health Coverage Programs: Transportation Services module](https://www.in.gov/medicaid/providers/files/modules/transportation-services.pdf)
- [MTM Health: Virginia NEMT Transportation Provider Handbook](https://www.mtm-inc.net/wp-content/uploads/2018/12/VA-Provider-Handbook-2026.pdf)
- [CMS: NPPES, apply for or update an NPI](https://nppes.cms.hhs.gov/)
- [NUCC: Health Care Provider Taxonomy Code Set](https://www.nucc.org/index.php/code-sets-mainmenu-41/provider-taxonomy-mainmenu-40)
- [HHS OIG: List of Excluded Individuals and Entities](https://oig.hhs.gov/exclusions/)
- [eCFR: 49 CFR 37.29, Private entities providing taxi service](https://www.ecfr.gov/current/title-49/section-37.29)