# How States Run NEMT in 2027: Brokers, Health Plans, and Direct Billing

Canonical URL: https://nemtguide.com/guides/how-states-run-nemt/ · Updated 2026-09-29

States run NEMT in four main ways: a broker the state hires, statewide or by region; Medicaid health plans that arrange rides for their own members; the state or its counties running rides in house; or a mix, the most common setup. The model decides where you apply, who approves each trip, who pays you, and who sets your rate.

- Federal rules let each state choose its own setup, and many states run more than one model at the same time.
- Where a broker runs rides, you sign with the broker and it usually pays you. New York is the big exception: you bill Medicaid.
- Where health plans run rides, each plan or its broker is a separate contract, and fee-for-service riders go through someone else.
- Where the state or a county runs rides, you enroll with Medicaid or sign with the county, and the trip is usually approved before you drive.
- Montana (October 1, 2026) and Colorado (January 1, 2027) are moving to one statewide broker, and Wisconsin has picked a new vendor with no switch date yet.

Every state has to get its Medicaid members to covered care, but states do it in very different ways. Before you apply anywhere, find out which model your state uses. It tells you who to call, what to sign, and who sends the money.

## What federal rules require of every state

The duty is simple. Under [42 CFR 431.53](https://www.ecfr.gov/current/title-42/section-431.53), each state plan must say the Medicaid agency will ensure necessary transportation to and from providers, and describe how. How it does that is largely up to the state.

CMS explains the options in its Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023):

- **As a medical service.** The state pays transportation companies directly, at its regular federal match. The usual Medicaid rules apply: the benefit covers the whole state, and members may choose any qualified provider willing to serve them.
- **As an administrative activity.** The state claims the cost at the 50 percent administrative match and has more freedom in how it designs the program. It can even pay members directly for their own travel.
- **Through a broker.** Section 1902(a)(70) of the Social Security Act lets a state hire a broker without a waiver, even if that limits member choice or covers only part of the state.
- **Through managed care.** Rides can be part of what Medicaid health plans cover under a 1932(a) state plan amendment, a 1915(b) waiver, or a 1115 demonstration. States may also carve rides out of the plans.

Whatever the setup, CMS says the state stays responsible for making sure members can get the rides they need and that Medicaid rules are met. The state must also attest that every NEMT provider and driver it pays meets the minimum standards in section 1902(a)(87): no one on a federal exclusion list, a valid license for every driver, a process for drug law violations, and a way to report each driver's driving history.

### The rules for brokers

Federal rule [42 CFR 440.170(a)(4)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-440/subpart-A/section-440.170) sets the terms when a state hires a [NEMT broker](https://nemtguide.com/glossary/nemt-broker/):

1. The broker is picked through competitive bidding, judged on experience, performance, references, resources, qualifications, and cost.
2. It must monitor member access and complaints, and make sure drivers are licensed, qualified, competent, and courteous.
3. The state audits it regularly.
4. It may not send trips to companies it has a financial tie to, or run trips itself, except in narrow cases the state documents.
5. Transportation companies may not pay the broker anything to win trips.

A broker paid a fixed amount per member, instead of state plan rates, can also count as a NEMT prepaid ambulatory health plan under [42 CFR 438.9](https://www.ecfr.gov/current/title-42/section-438.9). Then some of the Medicaid managed care rules apply to it too.

## The four ways states run NEMT

Most states fit one of four models, and many use two at once for different groups of members.

| Model | Who arranges the ride | Who you sign with | Who pays you | Who sets your rate |
|---|---|---|---|---|
| State-hired broker, statewide or by region | The broker's call center | The broker for each region you serve | Usually the broker. In New York, the state. | The broker contract |
| Medicaid health plans (carve-in) | The rider's health plan, or a broker the plan hires | Each plan or plan broker | The plan or its broker | Each contract |
| State or county runs rides in house | A state, county, or tribal office | The state Medicaid program, or the county program | The state or county | The state fee schedule or county contract |
| A mix | Depends on the rider's coverage | Often a plan broker plus a fee-for-service broker or the state | Depends on the rider | Depends on the rider |

"Fee-for-service" means members who are not in a Medicaid health plan. See [fee-for-service Medicaid](https://nemtguide.com/glossary/fee-for-service-medicaid/) and [Medicaid managed care organization](https://nemtguide.com/glossary/managed-care-organization/) for the terms.

## Which states use each model

Pennsylvania's Department of Human Services sorted all 50 states and DC in a broker study dated June 25, 2026, using a federally funded profile of each state's program. Here is its grouping, with changes since then from the states' and plans' own notices.

| Model (Pennsylvania DHS study, June 25, 2026) | States | Changes to know about |
|---|---|---|
| State-hired broker only, statewide (11) | Connecticut, Delaware, Idaho, Missouri, Nevada, New Jersey, New York, Oklahoma, Rhode Island, Utah, Wisconsin | Nevada uses two brokers: MTM for everyone in urban counties, and SafeRide for health plan members in rural counties (page updated March 25, 2026). Wisconsin announced its intent to pick a new vendor on May 21, 2026, with no switch date set as of August 25, 2026. |
| State-hired broker only, by region (9) | Arkansas, Georgia, Kentucky, Maine, Massachusetts, South Carolina, Vermont, Washington, West Virginia | Georgia has used one broker in all five regions since April 1, 2026. South Carolina's three regions all use Modivcare, and West Virginia contracts with Modivcare (as of September 2026). |
| Health plans for plan members, plus a broker or state program for everyone else (20 and DC) | Arizona, California, District of Columbia, Florida, Hawaii, Illinois, Indiana, Iowa, Kansas, Louisiana, Minnesota, Mississippi, Nebraska, New Hampshire, New Mexico, North Carolina, Ohio, Oregon, Tennessee, Texas, Virginia | In Iowa, all three health plans and fee-for-service use the same broker, MTM (as of September 2026). Virginia's fee-for-service trips move to MTM Health on October 1, 2026. |
| State or county runs rides only (7) | Alabama, Alaska, Maryland, Montana, North Dakota, South Dakota, Wyoming | Montana moves to a statewide broker for rides on or after October 1, 2026. |
| State or county programs plus state-hired brokers (3) | Colorado, Michigan, Pennsylvania | Colorado is set to move every trip to one statewide broker on January 1, 2027. |

A "regional" state can still have one company in every region, and a "statewide" state can still split by county. Always confirm on the state's own page. Our [NEMT brokers by state](https://nemtguide.com/guides/nemt-brokers-by-state/) guide names the broker in each state and links the official page, and each [state guide](https://nemtguide.com/states/) covers the local rules.

## What each model means for where you apply and bill

### Where a state-hired broker runs rides

You apply to the broker, not the state. Georgia's Medicaid agency lists the broker's jobs (page updated April 7, 2026): recruiting and contracting with transportation providers, paying providers, checking each member's need for a ride, and booking and assigning trips. Georgia pays its broker a monthly rate per eligible member in each region. The broker then pays you at the rates in its contract. See [how to bill NEMT brokers](https://nemtguide.com/guides/how-to-bill-nemt-brokers/).

In a regional state you need a contract in each region you serve. As of September 2026, Kentucky's Transportation Cabinet splits Medicaid rides into 15 regions served by 8 brokers, and Washington's Health Care Authority lists 6 brokers by county. A van that crosses a county line can cross into a different broker's network.

A single statewide broker means one contract for the whole state. Wisconsin's Department of Health Services says one vendor gives members and providers one contact for eligibility, scheduling, credentialing, billing, and complaints (page last revised August 25, 2026).

**New York works differently.** Medical Answering Services is the state's only broker. It authorizes each trip, but you bill New York Medicaid through eMedNY, using the prior authorization number it gives you. The state's policy manual (effective August 25, 2023) says the broker negotiates rates with each provider, and those rates replace the state fee schedule. To get in, you apply to the broker first. It decides whether to give you a letter of support, and eMedNY rejects new applications filed after April 15, 2024 without one.

### Where health plans run rides

When rides are carved in, each Medicaid health plan is responsible for its own members. Pennsylvania's study notes that plans may run rides themselves and contract directly with transportation companies, or hand the work to a broker. Either way, the member books through the plan.

That means more contracts. As of September 2026, Texas lists 14 Medicaid health plans using three ride vendors. That drops to two on October 1, 2026, when Blue Cross and Blue Shield of Texas moves its members from Modivcare to MTM Health. In Tennessee, BlueCare and TennCare Select members ride with Verida, while UnitedHealthcare and Wellpoint members ride with Tennessee Carriers. To carry every Medicaid rider in one county, you may need two or three contracts.

Fee-for-service members still ride, just through someone else:

| State | Health plan members | Fee-for-service members |
|---|---|---|
| Texas | Each plan approves and arranges rides | The state's Medical Transportation Program approves every trip. Demand response companies enroll directly with TMHP (manual dated September 2026). |
| Illinois | Bill the member's health plan | Enroll with HFS in IMPACT, get prior approval from Transdev, and bill the state (handbook dated March 11, 2024) |
| Indiana | Each plan's contracted vendor | Mostly brokered through Verida. You must be enrolled with IHCP and hold a Verida contract. |
| Florida | Each plan's vendor | Modivcare or MTM Health, under a 1915(b) waiver running July 1, 2025 to June 30, 2027 |
| Nebraska | Plans cover and arrange rides | You enroll with Nebraska Medicaid and the state pays you directly (state plan effective December 27, 2021) |
| North Carolina | Book through the plan | NC Medicaid Direct and Tribal Option members go through the local Department of Social Services |
| Mississippi | MTM Health for Magnolia, Molina, and TrueCare | Modivcare |

See [contracting with Medicaid health plans for transportation](https://nemtguide.com/guides/contract-with-medicaid-health-plans/) and [working with more than one broker](https://nemtguide.com/guides/multiple-nemt-brokers/).

### Where the state or a county runs rides

Here you deal with the public program itself. In North Dakota (manual updated January 2026), you enroll with ND Medicaid. A human service zone or tribal office approves each ride on form SFN 1507, except rides from a hospital, and gives you a copy before the trip. You bill the state on a CMS-1500 or an 837P claim.

States add their own twists:

- **South Dakota** (manual updated August 2026) enrolls community transportation providers only if they are a government entity, a nonprofit registered with the Secretary of State, or an enrolled secure medical transportation provider. Claims are due within 6 months after the month of the ride.
- **Alabama's** NET program, in procedures dated July 10, 2025, takes each ride request through its Recipient Call Center, at least 5 days before a scheduled appointment. A ride is paid once Medicaid has the medical provider's claim for the visit, and transporter pay files are built on the 1st and 16th of each month.
- **Maryland** gives grants to its local health departments and to Montgomery County's Department of Transportation, which arrange rides locally (notice released February 25, 2026).
- **Michigan** runs fee-for-service rides through its Department of Health and Human Services. Members request rides at the county MDHHS office, and the department registers providers, approves trips, and pays for them. Wayne, Oakland, and Macomb counties use a broker instead (state plan amendment effective October 1, 2024).
- **Ohio** sends members outside health plans to the Medicaid transportation coordinator at their county job and family services office. They can also call an enrolled wheelchair van company directly.
- **Pennsylvania** runs its Medical Assistance Transportation Program county by county. As of the June 25, 2026 study, 8 counties provide rides themselves, 38 hire a vendor (usually a transit agency), 7 split the work, 13 let the state contract directly with transit agencies, and Philadelphia has used a broker since 2005.

In most of these states, [Medicaid enrollment](https://nemtguide.com/guides/how-to-become-a-medicaid-transportation-provider/) is your contract, and the claim form is your invoice. See [how to bill Medicaid for NEMT](https://nemtguide.com/guides/how-to-bill-medicaid-for-nemt/) and [the CMS-1500 for NEMT](https://nemtguide.com/guides/cms-1500-for-nemt/).

## Do you need Medicaid enrollment in every model?

Often, yes, even when a broker or plan gives you the trips. Federal rule [42 CFR 438.602(b)](https://www.ecfr.gov/current/title-42/section-438.602) requires states to screen and enroll every network provider of a Medicaid health plan. A plan may sign you while enrollment is pending, but for no more than 120 days.

CMS lets each state decide whether to enroll the company, the individual drivers, or both. It also lets states raise the screening level for transportation, which can add site visits and fingerprint background checks. Some examples:

- **New York:** broker letter of support, then Medicaid enrollment, then the broker's network contract.
- **Indiana:** IHCP enrollment plus a contract with the fee-for-service broker.
- **Texas:** demand response companies and rideshare companies enroll directly with TMHP for fee-for-service trips.
- **Montana:** under the July 9, 2026 notice, the new broker takes over provider enrollment and billing from the state's claims contractor.

Broker credentialing comes on top of enrollment. See [NEMT broker credentialing](https://nemtguide.com/guides/nemt-broker-credentialing/).

## How to find out how your state runs NEMT

1. **Open the state Medicaid agency's transportation page.** It names the broker, the regions, or the health plans. Start from your state's row in [NEMT brokers by state](https://nemtguide.com/guides/nemt-brokers-by-state/).
2. **Read the state plan's Attachment 3.1-D.** CMS asks each state to describe its transportation delivery model there, including who provides rides and how the state claims the cost. Approved amendments are posted on Medicaid.gov.
3. **List the health plans in your county.** If rides are carved in, check each plan's transportation page for its vendor.
4. **Ask how fee-for-service members ride.** They often go through a separate broker, a county office, or the state.
5. **Call each broker's provider line** and ask whether it is adding providers where you drive. If it is not, see [what to do when a broker network is full](https://nemtguide.com/guides/broker-network-full/).

## When a state changes its model

States rebid broker contracts, and health plans switch vendors. Each change moves trips and reopens contracting. These are dated in official notices:

| Date | State | Change |
|---|---|---|
| October 1, 2026 | Montana | Modivcare starts statewide for rides on or after this date and takes over provider enrollment and NEMT billing |
| October 1, 2026 | Virginia | Fee-for-service trips move to MTM Health |
| October 1, 2026 | Texas | Blue Cross and Blue Shield of Texas moves to MTM Health |
| November 1, 2026 | New Mexico | Blue Cross and Blue Shield of New Mexico moves to MTM Health (notice updated September 9, 2026) |
| January 1, 2027 | Colorado | MediDrive, in the nine-county Denver metro since July 1, 2026, takes every trip statewide (HCPF's date as of August 2026) |
| No date set | Wisconsin | Verida is set to replace MTM Health under a May 21, 2026 notice of intent |

Not every state is moving toward brokers. Pennsylvania's June 25, 2026 study concluded that its county-based program remains the most effective way to deliver its rides, and that a statewide broker's risks outweigh its benefits.

When your state or a plan changes, get credentialed with the new company before the start date, and bill your last trips under the old contract on time. The [NEMT broker transition](https://nemtguide.com/guides/nemt-broker-transition/) guide walks through it, and our news covers [Montana's new broker](https://nemtguide.com/news/montana-modivcare-nemt-broker/) and [Wisconsin's vendor award](https://nemtguide.com/news/wisconsin-verida-nemt-award/).

## Frequently asked questions

### What is the most common way states run NEMT?

A mix. In a study dated June 25, 2026, Pennsylvania's Department of Human Services sorted every state and DC. It counted 20 states that use only brokers the state hires, 7 that run rides only through the state or its counties, and 23 states plus DC that combine models, most often health plans for plan members plus a broker or state program for everyone else.

### What is the difference between a NEMT carve-in and a carve-out?

In a carve-in, rides are part of the Medicaid health plan's benefits and payment, so the plan arranges them, often through a broker it hires. In a carve-out, the state keeps rides out of the health plan contracts and arranges them itself, often through a broker it hires. CMS guidance of September 28, 2023 confirms states may do either. Massachusetts, for example, runs a regional broker program carved out of managed care.

### Do I bill the broker or Medicaid?

It depends on the model. Most brokers pay you under their own contract; Georgia lists making payments to providers among its broker's duties. New York is different: its broker authorizes the trip and you bill the state's eMedNY system. In fee-for-service programs such as North Dakota and South Dakota, you bill the state on a CMS-1500 or 837P claim. For health plan members, you bill the plan or its broker.

### Can a NEMT broker run its own vans?

Generally not. Federal rule 42 CFR 440.170(a)(4)(ii) bars a broker the state hires from giving trips to itself or to companies it has a financial tie to. The exceptions are rural areas with no other qualified provider, rides so specialized no one else can do them, too few other providers, and government brokers that meet cost rules. The state must document the need, and CMS says the broker should use its own vehicles only when no contracted provider is available.

### Do I need Medicaid enrollment if my state uses a broker?

Often, yes. Federal rule 42 CFR 438.602(b) requires states to screen and enroll every network provider of a Medicaid health plan. New York requires a letter of support from its broker and then Medicaid enrollment. Indiana requires IHCP enrollment plus a Verida contract for brokered trips. In Montana, the broker takes over provider enrollment from the state's contractor under the new program.

### Who sets my rate in each model?

With a broker or health plan, your contract sets it. In New York the broker negotiates rates that replace the state fee schedule. In fee-for-service programs, the state fee schedule sets it. CMS guidance of September 28, 2023 says states may tell brokers how to pay providers, and should make sure broker pay is not so low that local companies refuse to join.

### How do I find out how my state runs NEMT?

Start with the state Medicaid agency's transportation page, which names the broker, the regions, or the health plans. Then read the state plan's Attachment 3.1-D, where CMS asks each state to describe its transportation model. Approved amendments are on Medicaid.gov. Our NEMT brokers by state guide links the official page for every state.

## Official resources

- [CMS: Medicaid Transportation Coverage Guide (SMD 23-006)](https://www.medicaid.gov/federal-policy-guidance/downloads/smd23006.pdf)
- [eCFR: 42 CFR 440.170, Transportation and the NEMT brokerage program](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-440/subpart-A/section-440.170)
- [Medicaid.gov: Medicaid state plan amendments (search your state's transportation pages)](https://www.medicaid.gov/medicaid/medicaid-state-plan-amendments)
- [Medicaid.gov: State overviews](https://www.medicaid.gov/state-overviews)
- [Pennsylvania DHS: MATP broker study (June 25, 2026)](https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/docs/publications/documents/highlighted-reports/matp-broker-study-act-46-of-2025-june-25-2026.pdf)