How to Become a Medicaid Transportation Provider in 2027: Enrollment Step by Step

Medicaid has no national sign-up for ride companies. Each state runs its own program, and where you apply depends on how your state buys rides. The screening behind every application comes from the same federal rules, so the paperwork looks much alike from state to state.

Who you apply to: how your state pays for Medicaid rides

Federal rule 42 CFR 431.53 requires every state plan to ensure necessary transportation and to describe how. States pay ride companies directly, leave rides to health plans, use counties, or hire a broker. CMS says ride companies are Medicaid providers either way, whether they enroll with the state or work under another enrolled provider such as a vendor or a county (SMD 23-006, September 28, 2023).

How your state runs rides	Where you apply	Do you also enroll with the state?	Example, as of September 2026
The state pays you directly (fee for service)	The state Medicaid agency	That is your enrollment	Arizona fee-for-service: AHCCCS provider type 28
Health plans arrange rides, often through a broker	Each plan or its broker	Yes. The state must screen and enroll every plan network provider.	North Carolina requires every health plan NEMT provider to enroll in NCTracks
A county arranges rides for the state	The county	Depends on the state	North Carolina Medicaid Direct: a signed county contract plus NCTracks enrollment
One broker runs rides for the state	The broker	Depends on the state	Georgia: a service agreement with the broker for each region you serve

Many states mix these models. North Carolina uses health plan brokers for plan members and county social services departments for NC Medicaid Direct members. Arizona pays for fee-for-service rides itself, including rides for American Indian Health Program members, while its health plans set their own prior authorization rules for their members’ rides. See how states run NEMT, NEMT brokers by state, and our state guides to find your state’s model.

When a health plan pays for the ride

Under 42 CFR 438.602(b), the state must screen, enroll, and periodically revalidate every network provider of its Medicaid health plans. You do not have to serve fee-for-service members to enroll. A plan may sign you while the state works on your enrollment, for up to 120 days. If the state says it cannot enroll you, or the 120 days run out, the plan must end your contract at once.

North Carolina applies this to rides. Its managed care NEMT policy (amended January 1, 2025) requires each plan’s NEMT providers, and its broker, to enroll through NCTracks. NEMT companies there need no license, certification, or accreditation to enroll, but they must finish online training and pass a site visit.

When a broker runs rides for the state

A state may hire a broker under 42 CFR 440.170(a)(4). The broker must be picked through competitive bidding, and it must make sure transport staff are licensed, qualified, competent, and courteous. The same rule bars you from paying or giving the broker anything to win referrals.

A broker state can leave enrollment to the broker. Georgia’s NEMT manual (version of July 1, 2026) tells transportation providers to contact the broker and arrange a service agreement for each region they want to serve. Verida has held every Georgia region since April 1, 2026. See the Georgia guide and the Verida profile.

The federal screening every state runs

Every state screens Medicaid providers under 42 CFR part 455, subpart E. Screening follows a risk level: limited, moderate, or high. NEMT is a Medicaid-only provider type, so each state picks its level, and CMS says states may raise NEMT from the limited minimum to moderate or high.

Screening level	What the state does	NEMT examples, as of September 2026
Limited	Confirms you meet federal and state rules for your provider type, verifies licenses in any state, and runs database checks before and after enrollment	The federal minimum
Moderate	Everything in limited, plus site visits before and after enrollment	North Carolina NEMT vans, in its enrollment matrix of August 16, 2026
High	Everything in moderate, plus a criminal background check and fingerprints	Arizona NEMT companies, in the provider profile revised September 2026, and Ohio wheelchair van companies at first enrollment (moderate at revalidation)

A state must move you to high risk if it suspended your payments over a credible allegation of fraud, waste, or abuse, if you have an existing Medicaid overpayment, or if the OIG or another state’s Medicaid program excluded you in the past 10 years. The same applies if a moratorium kept you from enrolling and you apply within 6 months after it was lifted (42 CFR 455.450). See Medicaid provider risk levels.

Database checks

The state confirms the identity and exclusion status of your company and of every owner, agent, and managing employee. It checks the Social Security Death Master File, NPPES, the OIG’s List of Excluded Individuals and Entities, and the federal excluded parties list, and it rechecks the exclusion lists at least monthly (42 CFR 455.436). Search yourself, your co-owners, and your managers on the OIG exclusion list and SAM.gov before you apply.

Fingerprints

At high risk, the company and each person with a 5 percent or greater ownership interest submit fingerprints. The state must deny or end enrollment if fingerprints do not arrive within 30 days of a request, unless it documents that doing so is not in the program’s best interest (42 CFR 455.416 and 455.434). Arizona also fingerprints every director, executive director, chief executive officer, and president listed on the company’s Arizona Corporation Commission record (PEP-902, revised December 17, 2024).

Site visits

At moderate and high risk, the state visits before and after enrollment to confirm your application is accurate and you meet the rules. Every enrolled provider must also allow unannounced inspections of any location, and refusing a site visit is grounds for denial or termination (42 CFR 455.432 and 455.416). Arizona checks that your company logo is on every vehicle during its visit. See the Medicaid site visit for NEMT.

The application fee

CMS set the fee at $750 for applications submitted from January 1 through December 31, 2026. It applies to institutional providers, and each state decides whether NEMT companies count. Arizona and Ohio charge NEMT companies $750, and North Carolina charges $850 because state law adds $100. You skip the federal fee if you are enrolled in Medicare or another state’s Medicaid, or paid the fee there (42 CFR 455.460). Arizona collects the fee again at revalidation and reactivation. For the other costs of opening, see what it costs to start a NEMT business.

Who can be turned away

Under 42 CFR 455.416, a state must deny or end enrollment when:

• A 5 percent owner was convicted of a crime related to Medicare, Medicaid, or CHIP in the last 10 years, unless the state documents that denial is not in the program’s best interest.
• Medicare or another state’s Medicaid or CHIP program terminated the provider on or after January 1, 2011, and it is still in the federal termination database.
• An owner does not give timely, accurate information or cooperate with screening.

A state may also deny you for false information on the application or an identity it cannot verify. States add their own rules. Ohio’s screening rule lists offenses that permanently bar a person from its Medicaid program, including patient abuse or neglect and kidnapping. Florida runs a Level 2 background screening on every principal, including officers, directors, managing employees, and 5 percent owners (Florida Statutes 409.907, 2026). If you are denied, the state must give you the appeal rights in its own law.

Rules for your drivers

Section 1902(a)(87) of the Social Security Act, added by the Consolidated Appropriations Act, 2021, sets a federal floor for every NEMT company and driver paid by Medicaid:

1. Neither the company nor any driver is excluded from federal health care programs.
2. Each driver has a valid driver’s license.
3. The company has a process to address any violation of a state drug law.
4. The company has a process to disclose each driver’s driving history, including traffic violations, to the state Medicaid program.

States usually collect this as a signed attestation. Arizona’s NEMT provider profile has the owner attest to a drug-law process, and North Carolina requires an NEMT driver attestation form signed by the office administrator. States and brokers add the rest, covered in NEMT driver requirements.

What the enrollment application asks for

Every state asks for the same core facts. Here is what to gather, with examples from state rules as of September 2026.

What you provide	What it covers	State examples
Legal name, address, and tax ID	Your EIN and a W-9	Arizona requires a completed W-9
Ownership and control	Name, address, date of birth, and Social Security number of each 5 percent owner, officer, director, partner, and managing employee, plus family ties among owners	Ohio collects this for every direct or indirect 5 percent owner and managing employee
NPI and taxonomy code	A Type 2 NPI with a transportation code such as 343900000X, non-emergency medical transport van	Arizona and North Carolina let NEMT companies enroll without an NPI. Ohio requires one.
Licenses and permits	The state confirms each is current and unrestricted	Arizona asks for the ADOT Vehicle for Hire permit. North Carolina’s NEMT enrollment requires none.
Vehicles	Registration and insurance for each company vehicle	Arizona asks for both
Drivers	A list of each driver	Arizona wants each driver’s full legal name, date of birth, Social Security number, and start and end dates
Training	Courses the state requires	Arizona’s owner takes the AHCCCS NEMT certification course. North Carolina requires online training.
Bank account	Direct deposit for payments	Arizona requires an EFT form with a blank check or a bank letter, or it denies the application
Application fee	The 2026 federal fee, where your state charges it	$750 in Arizona and Ohio, $850 in North Carolina

Ownership disclosures come from 42 CFR 455.104. They also include the name of any other Medicaid provider your owners hold an ownership or control interest in. See how to get an NPI number for NEMT, taxonomy codes, and EFT enrollment.

Last, you sign a provider agreement. Under 42 CFR 431.107, you agree to keep records of the services you provide and to hand them over on request to the state, HHS, or the state’s Medicaid Fraud Control Unit. You also agree to meet the disclosure rules and, if you are eligible for an NPI, to give it to the state and put it on every claim. That is why complete trip records matter from the first ride.

How to become a Medicaid transportation provider, step by step

1. Find out who arranges rides in your counties. Check your state guide, then call the Medicaid agency, the plans, the county, or the broker and ask which service levels they need.
2. Check that enrollment is open. A state can freeze new enrollments for a provider type for 6 months at a time, renewed in 6-month steps (42 CFR 455.470). Minnesota froze new NEMT enrollment for companies located in its seven-county Twin Cities metro from January 27, 2026 to January 27, 2027. See enrollment moratoriums.
3. Form your company and get your numbers. File with your secretary of state, get a free EIN from the IRS, and get a free NPI if your state or brokers use one.
4. Get licenses, insurance, vehicles, and drivers ready before you apply. License checks and the site visit look at the real company, not a plan for one.
5. Screen everyone yourself. Search each owner, manager, and driver on the OIG exclusion list and SAM.gov.
6. Apply in your state’s system and pay the fee. Ohio takes applications online only. Upload every document the checklist asks for.
7. Answer every request fast. Send fingerprints within 30 days of a request, and be ready for the site visit.
8. Sign the provider agreement and set up direct deposit.
9. Credential with each broker and health plan. This runs alongside the state steps or after them.
10. Keep your file current. Report changes on time and watch for your revalidation date.

How long enrollment takes

No federal rule sets a deadline. States set their own, and some publish them.

Where	What the state rule or agency says, as of September 2026
Arizona	Applications are generally processed within 60 days. Enrollment usually starts on the approval date.
California	The agency has 180 days to act. If it calls your application incomplete, you have 60 days to fix it, and it then has 60 days to respond. From July 1, 2026 to June 30, 2027, a missed deadline no longer makes you a provisional provider by default.
Florida	Level 2 background screenings typically take 5 to 7 business days. Enrollment takes effect on the date the agency receives your application.
Ohio	No set time. Errors or missing documents send the application back to the end of the queue.
Any state, health plan networks	A plan may sign you for up to 120 days while the state finishes your enrollment.
Minnesota, seven-county metro	No new NEMT providers are enrolled until January 27, 2027.

Broker and plan credentialing adds its own time. The guide to how long it takes to start a NEMT business lays out the whole timeline.

Joining brokers and health plans

State approval is not a trip offer. Brokers and plans run their own credentialing. MTM Health, for example, takes each new provider through an application, an interview, contracting, credentialing, and training before the first trip. Its system will not assign trips to a provider whose credentials are out of date.

Broker agreements build on your Medicaid standing. MTM’s standard agreement, in the January 1, 2023 version Pennsylvania posts, makes you responsible for every license and registration needed to operate as a Medicaid provider in your service area. It pays nothing for trips run by drivers or attendants it has not credentialed. Modivcare’s provider page lists driver checks, such as PASS wheelchair training, first aid and CPR, a drug screen, a motor vehicle report, and a background check, plus vehicle registration, inspection, and insurance.

See NEMT broker credentialing, how to get NEMT broker contracts, and the NEMT credentialing checklist.

Staying enrolled

• Revalidate on time. States must revalidate every provider at least every 5 years (42 CFR 455.414). Arizona revalidates every 4 years, and North Carolina charges its application fees again at each 5-year re-credentialing.
• Report ownership changes within 35 days. Federal rules require updated ownership disclosures within 35 days after any change in ownership (42 CFR 455.104). Florida wants changes in any principal reported in writing within 30 days.
• Report driver changes. Arizona requires driver changes to be reported in its portal within 30 days.
• Keep running exclusion checks. CMS says NEMT companies must screen their own employees for exclusions, and the state rechecks the federal lists monthly, so check your staff at least as often.
• Do not let enrollment lapse. After a deactivation, the state must screen you again and charge the application fee before reactivating you (42 CFR 455.420).

The guide to Medicaid revalidation for NEMT covers the renewal cycle in detail.

Why applications stall or get denied

• Missing or wrong documents. Ohio says errors and missing documents send an application to the back of the queue. Use your state’s checklist and upload everything at once.
• Details that do not match. Enter your legal name, address, and tax ID exactly as they appear on your IRS records, NPI record, and licenses.
• A missed fingerprint deadline. At high risk, fingerprints are due within 30 days of the request.
• A failed or refused site visit. Have your office, vehicles, and records ready before you apply.
• An unpaid fee. California’s statute lists failure to pay the application fee, and failure to submit required fingerprints, as grounds for denial.
• An excluded or terminated owner. Check every owner before you apply.
• An enrollment freeze. Check for a moratorium before you buy vehicles or sign a lease.

See Medicaid provider application denied for the fix for each one.