# Bariatric Transportation in 2027: Weight Ratings, Crews, and Who Pays More

Canonical URL: https://nemtguide.com/guides/bariatric-transportation/ · Updated 2026-09-29

Bariatric transportation is NEMT for riders whose weight or wheelchair size needs higher-rated equipment and often a second crew member. No federal rule defines it, so states and brokers draw the line: one Washington broker uses chairs over 32 inches wide or 600 pounds. Few payers add money for it, but from July 1, 2026 Colorado pays $63.70 for an XL wheelchair trip with two attendants, against $34.14 standard.

- No federal rule defines bariatric. Each state or broker sets its own weight or size line, so ask for it in writing.
- ADA lifts are built for at least 600 pounds, and you must carry any rider and chair your lift and van can safely hold.
- Check the lift label, ramp and stretcher ratings, and the van's weight rating before you accept a heavy rider.
- Plan two crew members for bariatric stretcher trips and heavy chairs on steps. New Jersey and DC require them, and Colorado's XL wheelchair rate needs two attendants.
- Few fee schedules pay a bariatric rate. Colorado does, and some brokers, such as MTM Health in Rhode Island, pay more.

Heavier riders need the same rides to dialysis, therapy, and the doctor as anyone else. The difference is equipment. Your lift, ramp, tie-downs, stretcher, and van each have a weight rating, and some trips need two people to do safely. This guide covers the numbers to check, the crew rules, and the payers that pay more for the extra work.

## What counts as bariatric transportation

No federal rule defines bariatric transportation. The federal ADA vehicle rules set a 600-pound design load for lifts, and each state or broker draws its own bariatric line. It can be the rider's weight, the chair's size, or the crew needed.

| Program | Where the bariatric line falls, as of September 2026 |
|---|---|
| District of Columbia, broker contract with Verida from October 1, 2026 | Riders with a body mass index over 40, or at least 100 pounds over ideal weight |
| Community in Motion, a Washington broker (pricing form revised January 28, 2026) | Wheelchairs over 32 inches wide or over 600 pounds |
| Mississippi broker bid terms (issued January 13, 2023, won by Modivcare) | The broker must have providers who can carry riders over 400 pounds |
| Health First Colorado, the state's Medicaid program (since November 1, 2025) | An XL wheelchair trip that uses two attendants to load and unload |
| Virginia (DMAS, May 26, 2026) | Providers must meet the Virginia Office of Emergency Medical Services requirements and guidelines for bariatric transport |

Some brokers treat bariatric as its own [level of service](https://nemtguide.com/glossary/level-of-service/). Modivcare's June 2026 guide for facilities that book rides for HMSA members in Hawaii lists bariatric wheelchair as a level that needs a medical necessity form, like wheelchair and stretcher. Other programs leave it out. Oklahoma's SoonerRide 2023 program overview lists bariatric wheelchair and bariatric stretcher as levels of service it does not cover.

## Weight ratings for lifts, ramps, securement, stretchers, and vans

Every piece of equipment between the curb and the securement station has a limit. Check each one against the rider and the chair together.

| Equipment | The rule | Source |
|---|---|---|
| Lift on an ADA vehicle | Design load of at least 600 pounds. Working parts carry a safety factor of 6, and the platform and frame a factor of 3. | 49 CFR 38.23(b)(1) |
| Public use lift | Tested with a 600-pound load and labeled "DOT-Public Use Lift" | FMVSS No. 403 |
| Private use lift | Tested with the maker's rated load or 400 pounds, whichever is greater. The rated load is on a label near the controls. | FMVSS No. 403 |
| Lift in Wisconsin | At least 700 pounds | Wisconsin Trans 301.62 |
| Ramp or lift in New Jersey | At least 500 pounds | N.J.A.C. 8:40-5.7 |
| Ramp 30 inches or longer | 600 pounds, or 300 pounds for shorter ramps | 49 CFR 38.23(c)(1) |
| Securement on vans rated up to 30,000 pounds | 2,500 pounds of forward force per tie-down, and at least 5,000 pounds per chair | 49 CFR 38.23(d)(1) |
| Stretcher, Modivcare in Mississippi | Gurney rated for 400 pounds | Modivcare manual, February 2024 |
| Stretcher mount, Virginia | Tested to a 2,200-pound pull, with a cot at least 22 inches wide | Virginia DMAS, May 26, 2026 |
| Boarding step, Modivcare in Mississippi | Holds 300 pounds, no more than 12 inches off the ground | Modivcare manual, February 2024 |

### Read the lift label, not the brochure

The number that counts is the one on your lift. A private use lift must show "DOT-Private Use Lift" and the maker's rated load on a label near the controls, and the owner's manual insert repeats it. A public use lift carries the words "DOT-Public Use Lift." Write the rated capacity in your vehicle file. Virginia requires brokers to record the maker, model, age, and rated capacity of every lift in the network so heavy riders go to vans that can lift them, and Mississippi's broker bid terms require the same record of each vehicle's lifting capacity. The [wheelchair van guide](https://nemtguide.com/guides/wheelchair-van-for-nemt/) covers choosing a higher-rated lift.

### Check the platform and the securement area

Weight is only half the fit. An ADA lift platform must be at least 28 1/2 inches wide at its surface, 30 inches wide just above it, and 48 inches long, and each securement station needs a clear floor area of 30 by 48 inches (49 CFR 38.23). Measure a wide chair before the trip, not at the curb. Ramps deployed to the ground can be as steep as 1 in 4 under the same rule, so pushing a heavy manual chair up one is a two-person job. See [wheelchair securement](https://nemtguide.com/guides/wheelchair-securement/) for strapping a heavy chair at four points on its frame.

### Check the van's weight rating

The van has a limit too. Its certification label, on the driver's door edge or pillar, shows the gross vehicle weight rating (GVWR). Federal rules set the GVWR at no less than the empty weight, plus the rated cargo load, plus 150 pounds for each designated seat (49 CFR 567.4). A converted van carries a second label from the converter, with a revised GVWR if the conversion changed it (49 CFR 567.7). On vans rated 10,000 pounds or less, the tire and loading placard states the most the occupants and cargo together may weigh (FMVSS No. 110).

Here is an example with made-up numbers. A 450-pound rider in a 300-pound power chair adds 750 pounds to the van, the weight the rating allows for five seats. Count the driver, the second crew member, and any other riders too. The GVWR glossary entry explains the labels.

### Stretchers

Bariatric stretcher work needs a cot rated above the rider's weight and a mount rated for the cot. Modivcare's Mississippi inspection form checks for a gurney rated for 400 pounds with at least three belts. Virginia requires cots built to the federal KKK-A-1822E ambulance specification, with chest, hip, knee, and shoulder restraints and a mount tested to a 2,200-pound pull. A standard cot there is at least 22 inches wide, which may not fit every rider. See [stretcher van requirements](https://nemtguide.com/guides/stretcher-van-requirements/) and the bariatric stretcher entry.

## What the ADA says about heavier riders and chairs

Federal ADA rules in 49 CFR 37.165 apply to public and private transportation companies, and they shape every bariatric request:

- **Carry the rider if the lift can.** You must carry a wheelchair and rider that are larger or heavier than the part 38 design standard if your lift and vehicle can accommodate them. You may decline only when the combined weight is over the lift's rating, or carrying them is shown to be inconsistent with legitimate safety requirements.
- **The lift rating is your limit.** DOT's guidance gives the example of a lift rated for 800 pounds: you may limit it to 800 pounds, but you must carry anyone within that limit.
- **Size works the same way.** A chair larger than the 30 by 48 inch footprint must be carried if it fits the lift and the securement area. One that would block the aisle and slow an emergency exit may be refused.
- **No refusal over securement.** You may not deny a ride because the chair cannot be secured well by your system.
- **Suggest, never require, a transfer.** You may recommend that a rider move to a vehicle seat, but you may not require it.
- **Help is your job.** Your staff must help with securement, ramps, and lifts when needed or asked. You may not require the rider to bring an attendant (49 CFR 37.5).

Pricing is covered too. An entity may not impose special charges on riders with disabilities for services needed to accommodate them (49 CFR 37.5(d)). DOT's guidance says charging more because a rider needs a lift-equipped van, including higher mileage charges, is inconsistent with the rule. If you sell rides to [private pay](https://nemtguide.com/guides/private-pay-nemt/) riders, have a transportation attorney review any bariatric fee before you publish it. The [ADA requirements guide](https://nemtguide.com/guides/ada-requirements-for-nemt/) covers the rest of the rules.

## When a bariatric trip needs two crew members

Many bariatric trips need a second person. Several programs require one, and some pay for one.

| Program | When a second person is required or paid |
|---|---|
| New Jersey mobility assistance vehicles | A second crew member at loading and unloading when a wheelchair rider is moved up or down five or more steps, or weighs 200 pounds or more and is moved up or down two or more steps (N.J.A.C. 8:40-5.3, readopted effective September 25, 2023) |
| Health First Colorado | The XL wheelchair rate applies only when two attendants help the rider load and unload |
| District of Columbia broker contract | Bariatric and stretcher vans require two stretcher staff |
| Virginia (DMAS) | At least two crew members in every stretcher van, with the second seated in the back |
| Modivcare in Mississippi | A driver and a transportation attendant on every stretcher vehicle |
| Illinois fee-for-service | An employee attendant on a wheelchair van trip is covered when medically needed and approved in advance |

The reason is injury risk. NIOSH calls patient handling the single greatest risk factor for work-related musculoskeletal disorders among health care workers (May 9, 2024). It tells employers to provide assistive devices and train workers to use them. Its home health guidance lists slip sheets, slide boards, rollers, slings, gait belts, and mechanical lifts (Publication 2012-120).

Build that into your trips:

1. **Never lift a rider by hand** when a lift, ramp, transfer board, or stair chair can do the work.
2. **Carry the right carrier.** MTM Health's Virginia handbook (updated July 30, 2026) requires providers to supply scoop, Reeves, or stair chair stretchers when a rider needs one. See stair chair.
3. **Plan the hardest point of the trip,** such as the stairs at home, not the easy curb at the clinic.
4. **Train both crew members together** on the lift, the cot, and the transfer steps. The passenger transfer techniques guide covers the methods, and [NEMT driver training](https://nemtguide.com/guides/nemt-driver-training/) covers the rest of a driver's training.

## Which payers pay a bariatric rate

Many fee schedules pay the same rate whatever the rider weighs. Arizona's fee-for-service rates effective October 1, 2026, Nebraska's schedule revised July 1, 2026, North Dakota's July 2026 schedule, and Indiana's schedule effective January 1, 2027 list no bariatric code. Where extra money exists, it comes in three forms: a higher base rate, a paid attendant, or a broker fee.

| Payer | What it pays | Effective |
|---|---|---|
| Health First Colorado (fee-for-service) | [A0130](https://nemtguide.com/glossary/a0130/) with modifier U9, the XL or bariatric wheelchair van base rate: $63.70 a trip, against $34.14 for a standard wheelchair trip. Wheelchair van mileage ([S0209](https://nemtguide.com/glossary/s0209/)) is $2.74 a mile. | July 1, 2026 (the U9 rate was $65.00 from November 1, 2025) |
| Illinois (fee-for-service) | No bariatric code. A $30.00 wheelchair van base rate, plus $20.00 for an attendant ([T2001](https://nemtguide.com/glossary/t2001/)) and $20.00 for an additional attendant (T2001 with TK), with prior approval | January 1, 2026 |
| MTM Health, Rhode Island | Bariatric stretcher: $300.00 base for the first 5 miles and $4.50 for each mile after, or $315.00 base after hours. Standard stretcher: $175.00 base. These are the rates for pickups within 40 miles of where your vehicles are kept. | Schedule effective July 1, 2023 |
| Community in Motion, Washington | An optional flat bariatric wheelchair fee that you propose, added to your pickup fee and mileage, for chairs over 32 inches wide or over 600 pounds | Pricing form revised January 28, 2026 |

Here is how Colorado's rate works on a 10-mile leg. An XL wheelchair trip pays $63.70 plus 10 miles at $2.74, or $91.10. The same leg as a standard wheelchair trip pays $34.14 plus $27.40, or $61.54. The $29.56 difference is what pays the second attendant, so check it against your wage and the extra time the trip takes.

Colorado pays the U9 rate directly to providers in the 55 counties outside its broker area. In the nine counties of its broker area, including Denver, MediDrive has been the state's broker since July 1, 2026 and pays its network providers itself, so ask it how it pays XL trips. In broker states, ask each broker in writing whether it pays a bariatric fee, an attendant fee, or both, and put the number in your contract. See [how to negotiate NEMT broker rates](https://nemtguide.com/guides/negotiate-nemt-broker-rates/) and the [rate sheet template](https://nemtguide.com/templates/nemt-rate-sheet/).

## How to book a bariatric trip safely

The worst bariatric trip is the one where the wrong van shows up. Mississippi's broker bid terms treat that as the broker's failure: liquidated damages of $1 to $5,000 per instance when the broker knew or should have known a rider needed a special accommodation, including a bariatric transport, did not tell the provider, and the rider could not be carried because the wrong vehicle or too few trained staff arrived. Modivcare has been the state's broker since June 8, 2024. Get the details before you accept.

1. **Weight of the rider and the chair.** Ask plainly and privately, as an equipment question. Add the two and compare with your lift label.
2. **Width and length of the chair.** Compare with your lift platform and the 30 by 48 inch securement area.
3. **How the rider moves.** Can the rider stand, pivot, or bear weight? That decides between a lift ride, a transfer, and a stretcher.
4. **Steps, doors, and elevators at both ends.** Count steps. In New Jersey, two steps with a 200-pound wheelchair rider means a second crew member.
5. **Stretcher and equipment needs.** Check the cot's rating, and ask about oxygen or anything else that rides along.
6. **Timing for discharges.** Heavy trips take longer to staff. Modivcare's Hawaii guide lets facilities request gurney or bariatric discharges a day before discharge, while ambulatory and wheelchair discharges are requested the same day.

Record the answers on your [trip request form](https://nemtguide.com/templates/nemt-trip-request-form/) so dispatch sends the right van and crew every time.

## Equipping your fleet for bariatric trips

Bariatric work pays only if you can take the trips other providers turn down. Work through the fleet in this order:

1. **Lift capacity.** Know every lift's rated load. If you plan on bariatric trips, buy a lift rated well above 600 pounds. The [wheelchair van cost](https://nemtguide.com/guides/wheelchair-van-cost/) guide covers what heavier lifts add to a conversion.
2. **Securement.** Use tie-downs and belts rated for heavier chairs, and keep all four points on the chair's frame.
3. **Seat belt extensions.** Georgia and MTM Health in Virginia require at least two in every vehicle, and Modivcare's Mississippi inspection form checks for them.
4. **Stretcher and mount.** Match a bariatric cot with a mount rated for it.
5. **Transfer aids.** Carry slide boards, slip sheets, and a stair chair where your riders need them.
6. **Van weight rating.** Keep every trip under the GVWR on the label.
7. **Crew.** Staff two-person crews for bariatric stretcher trips, and train them together.
8. **Paperwork.** List the equipment and its ratings on your broker credentialing forms, so heavy trips come to you.

## Frequently asked questions

### What is bariatric transportation?

It is transportation for riders whose weight or equipment is beyond what standard vehicles are built to carry. There is no federal definition. The District of Columbia's broker contract starting October 1, 2026 uses a body mass index over 40 or 100 pounds over ideal weight. Community in Motion in Washington uses wheelchairs over 32 inches wide or over 600 pounds. Mississippi's broker bid terms require providers who can carry riders over 400 pounds.

### How much weight can a wheelchair lift hold?

It depends on the lift. Lifts on vehicles covered by the ADA vehicle rules must have a design load of at least 600 pounds for the chair and rider together (49 CFR 38.23). Private use lifts show the maker's rated load on a label near the controls and in the owner's manual insert. Wisconsin requires lifts rated for at least 700 pounds. Ratings differ from lift to lift, so read the label on yours.

### Can I refuse a rider who is too heavy for my lift?

Only if the rider and chair together weigh more than the lift is rated for, or carrying them is shown to be unsafe. Federal rule 49 CFR 37.165 says you must carry a heavier rider and chair if your lift and vehicle can hold them. DOT's example: a lift rated for 800 pounds may be limited to 800 pounds. If your van cannot take the rider, tell the broker at once so it can send one that can.

### Does Medicaid pay more for bariatric trips?

Sometimes. Colorado pays $63.70 for an XL or bariatric wheelchair van trip billed A0130 with modifier U9, which needs two attendants, against $34.14 for a standard trip (July 1, 2026). MTM Health in Rhode Island pays a $300.00 base for a bariatric stretcher trip against $175.00 for a standard stretcher (business hours, schedule effective July 1, 2023). Many fee schedules, including Arizona's and Nebraska's, have no bariatric code, so ask your broker how it pays.

### How many crew members does a bariatric trip need?

Plan on two for bariatric stretcher trips and for heavy wheelchairs on steps. New Jersey requires a second crew member when a wheelchair rider who weighs 200 pounds or more is moved up or down two or more steps. Colorado's bariatric wheelchair rate requires two attendants for loading and unloading. The District's broker contract requires two stretcher staff on bariatric and stretcher vans.

### Can I charge a private pay rider more for a bariatric ride?

Be careful. Federal ADA rules bar special charges on riders with disabilities for services needed to accommodate them (49 CFR 37.5). DOT's guidance says charging more because a rider needs a lift-equipped van, including higher mileage charges, breaks that rule. Before you publish any bariatric surcharge for private pay riders, have a transportation attorney review it. Medicaid and broker rates are set by the payer.

### What should I ask when a bariatric trip is booked?

Ask for the rider's weight and the chair's weight, the chair's width and length, whether the rider can stand or pivot, how many steps and how wide the doors are at each end, and whether a stretcher, oxygen, or other equipment is needed. Compare the answers with your lift, securement area, stretcher, and van ratings before you accept. Ask for the weight privately and plainly, as an equipment question.

## Official resources

- [eCFR: 49 CFR 37.165 (when you must carry a heavier rider and chair)](https://www.ecfr.gov/current/title-49/section-37.165)
- [eCFR: 49 CFR 38.23 (lift, ramp, and securement ratings)](https://www.ecfr.gov/current/title-49/section-38.23)
- [Colorado HCPF: NEMT Billing Manual (XL wheelchair, A0130 with U9)](https://hcpf.colorado.gov/nemt-billing-manual)
- [MTM Health: Rhode Island Transportation Provider Rates](https://www.mtm-inc.net/wp-content/uploads/2018/12/RI-Transportation-Provider-Rates-Schedule-A-1.pdf)
- [New Jersey N.J.A.C. 8:40 (crew rules for heavier wheelchair riders)](https://www.nj.gov/health/ems/documents/reg-enforcement/njac840r.pdf)
- [NIOSH: Safe Patient Handling and Mobility](https://www.cdc.gov/niosh/healthcare/sphm/index.html)