Running a Mixed NEMT Fleet: How to Size and Schedule Sedans, Wheelchair Vans, and Stretcher Vans

A mixed fleet lets you take more of the trips brokers offer, but every vehicle type adds its own drivers, training, credentials, and pay rates. The goal is to own just enough of each type for your busiest hours.

What a mixed NEMT fleet is

A mixed fleet carries riders at more than one level of service. The broker or state sets the level on each trip from the rider’s needs, and your vehicle has to match it.

Level of service	Who rides	Vehicle	Common base code	Crew
Ambulatory	Walks to the vehicle and rides in a regular seat	Sedan, minivan, or passenger van	A0120, or A0100 for taxis	One driver
Wheelchair	Rides seated in their own wheelchair	Ramp minivan or lift van with securements	A0130	One driver trained on the lift or ramp and securements
Stretcher	Must ride lying down, with no medical care on the way	Stretcher van with a locked stretcher mount	T2005	Two people in Georgia

Federal policy sets the direction. CMS says states must use the least costly mode that fits the rider’s physical and emotional condition, and that a rider who uses a wheelchair must travel in a wheelchair-accessible vehicle (SMD 23-006, September 28, 2023). The level of service glossary entry explains how the level gets assigned.

That gives a mixed fleet one simple rule: a vehicle can serve its own level or a lower one, never a higher one. Mississippi’s NEMT permit law says nothing stops a provider from using a permitted vehicle for ambulatory riders (House Bill 610, effective July 1, 2025). A sedan, though, can never take a wheelchair or stretcher trip.

How many of your trips need each vehicle type

Statewide numbers give a starting point. Mississippi’s legislative review committee, PEER, counted the state’s Medicaid NEMT trips by mode in its October 15, 2024 review of the program.

Mississippi Medicaid, fiscal year 2023	Trips	Share of rides in a provider’s vehicle
Ambulatory	430,457	79.8%
Wheelchair lift	95,186	17.7%
Stretcher van	10,348	1.9%
Non-emergency ambulance	3,135	0.6%
Total in a provider’s vehicle	539,126	100%

Another 64,931 trips that year were gas mileage reimbursements, and 198 were on public transportation. The mix also moves. In fiscal year 2019 the same program ran 188,751 wheelchair trips and 2,978 stretcher trips, so wheelchair trips were 25.7% of rides in a provider’s vehicle and stretcher trips 0.4%.

Networks lean on vehicles that can do both. In the May 2026 county-by-county vehicle counts from Indiana’s fee-for-service broker, vehicles that carry both ambulatory and wheelchair riders appear 751 times and ambulatory-only vehicles 632 times. A vehicle that serves several counties is counted in each.

Your own mix depends on the riders and facilities you serve. Dialysis is a large share in many programs: in Mississippi, 28.4% of trip legs in April 2024 went to dialysis appointments. Georgia’s manual lists an ambulatory member whose dialysis, chemotherapy, or radiation leaves them unable to travel without physical help as a reason for a higher level of service (section 815.1.3).

Count your own trips before you buy. Pull four normal weeks of broker offers and trip logs, and count each level by hour. Include the offers you turned down because you had no vehicle of that type. CareOregon lists “Provider does not supply vehicle type required for trip” as an acceptable reason to hand a trip back (manual version 1.3, February 2024), and every one of those is demand you could not serve. See dialysis transportation for how standing orders shape the week.

How to size each vehicle type, step by step

Size from the top level down, because the higher levels are the ones only certain vehicles can cover.

1. Decide on stretcher first. A stretcher van can need its own permit, depending on the state, and in Georgia it takes two people on every trip. If you see only a trip or two a day, turning those offers back can cost less than a crew that sits. See stretcher van requirements.
2. Size wheelchair vans to your busiest window. Count the wheelchair pickups in the busiest two hours of your busiest day. Divide by how many wheelchair riders one van can pick up in that window. Federal standards require at least one securement location on vehicles 22 feet long or less and at least two on longer ones (49 CFR 38.23), and many carry more.
3. Count what those vans can absorb. Between wheelchair runs, a wheelchair van can carry ambulatory riders going the same way. Federal standards allow fold-down seats in the securement area when no wheelchair is there.
4. Size ambulatory vehicles to what is left. Subtract the ambulatory trips your wheelchair vans can take, then divide by the trips one sedan or minivan runs in a day.
5. Add spares of the most capable type. A spare wheelchair van can cover a sedan trip. A spare sedan cannot cover a wheelchair trip.
6. Check it against the calculator. The NEMT fleet size calculator turns the same inputs into vehicles and driver shifts.

A worked example

The trip volumes and trips per vehicle below are example numbers. Only the mix comes from Mississippi’s fiscal year 2023 data.

Step	Example numbers	Result
Busiest day at the Mississippi mix	60 trips × 79.8%, 17.7%, and 1.9%	48 ambulatory, 11 wheelchair, 1 stretcher
Wheelchair vans for the peak	6 wheelchair pickups in the busiest two hours ÷ 2 per van	3 wheelchair vans
Ambulatory trips those vans absorb	3 vans × 4 ambulatory trips in their gaps	12 trips, leaving 36
Ambulatory vehicles for the rest	36 trips ÷ 10 trips per sedan a day	4 sedans (3.6 rounded up)
Stretcher	1 trip a day will not keep a two-person crew busy	Hand it back so the broker can place it
Spare	One of the most capable type	1 more wheelchair van
Fleet		4 wheelchair vans and 4 sedans

Change the example numbers to your own and the answer changes with them. The point is the order: wheelchair capacity first, sedans to fill in.

What each level pays

Rates show why the mix matters. Arizona’s fee-for-service schedule, effective October 1, 2026, pays these amounts. Metro trips start in the Phoenix or Tucson metro areas, and every other trip is rural and billed with the TN modifier.

Level	Base code	Base, metro	Base, rural	Mileage code	Per mile, metro	Per mile, rural
Ambulatory	A0120	$6.64	$7.27	S0215	$1.28	$1.63
Wheelchair	A0130	$11.15	$12.21	S0209	$1.54	$1.66
Stretcher	T2005	$49.09	$86.70	T2049	$1.54	$1.66

The stretcher base rate is about 4.4 times the wheelchair base in the metro areas and about 7.1 times in rural areas. That gap has to pay for the second crew member and the stretcher equipment.

Pay follows the rider, not the vehicle. Indiana tells providers to bill by the level of service given, not by vehicle type, and to bill an ambulatory member carried in a wheelchair vehicle at the ambulatory level and rate (module version 6.1, August 19, 2025). So a wheelchair van that spends its day on sedan trips earns sedan pay. Broker contracts set their own rates, but the state schedule is a fair benchmark. The fleet size calculator page works through a 10-mile trip at both rates.

Scheduling across levels of service

A mixed fleet is scheduled in layers. The general method is in NEMT scheduling. These steps are specific to running more than one vehicle type.

Place the scarce vehicles first

Build the stretcher runs first, then the wheelchair runs, then the ambulatory runs. The higher-level vehicles have the fewest substitutes, so their trips set the shape of the day.

Fill wheelchair vans with riders going the same way

When a wheelchair van has an empty securement area and a fold-down seat, an ambulatory rider on the same route can ride along where your broker allows shared rides. Keep every rider inside the broker’s ride-time limit. The multiloading guide covers how shared rides are billed.

Plan each leg at its own level

A rider’s two legs can need different vehicles. Georgia’s manual recognizes that a rider who walks in for dialysis, chemotherapy, or radiation may need physical help going home. Indiana bills a same-day trip with two levels on two separate claims, each with the mileage for its own base.

Check the rider’s weight against the lift

Federal standards require a lift design load of at least 600 pounds (49 CFR 38.23). MTM Health’s Virginia handbook puts the member’s weight, including the mobility device, on each manifest, and tells providers to document each lift’s maker, model, age, and rated capacity and to be able to carry bariatric riders where that applies. Match heavy riders to your highest-rated lift.

Never change the level on your own

MTM Health’s Virginia handbook says using an unapproved mode or substituting vehicles may lead to nonpayment or corrective action. CareOregon allows a swap without asking only when the vehicle still meets the member’s needs, such as a wheelchair van with ambulatory seats for a sedan rider. Level mistakes show up in denials. In May 2026, Indiana’s fee-for-service broker denied 1,090 claims, including 117 for an incorrect mobility type, 67 for an unauthorized vehicle, and 51 for an unauthorized driver.

Train every driver for every vehicle they drive

Federal rules require any public or private demand response operator to train its staff to proficiency, so they run vehicles and equipment safely and assist riders with disabilities properly and respectfully (49 CFR 37.173). Mississippi’s NEMT permit law, as amended effective July 1, 2025, requires the state’s driver standards to include training appropriate to the mode of transportation each driver provides.

In a mixed fleet, training has to follow the vehicle:

• Ambulatory drivers. CTAA’s PASS handbook (updated January 30, 2024) treats PASS Basic as full training for drivers who carry only ambulatory riders. See PASS certification.
• Wheelchair drivers. Full PASS adds lift operation and wheelchair and occupant securement. It must be done hands-on in a vehicle the driver will actually use, either a lift on a body-on-chassis van or a ramp on a minivan, within 90 days of PASS Basic. PASS driver recognition lasts two years. A driver trained on a ramp minivan needs hands-on time on your lift van before driving it.
• Stretcher crews. Verida’s required provider training covers wheelchair and stretcher work, including hands-on training and stretcher operation and safety.
• Broker floors. Modivcare’s provider page lists a PASS wheelchair certificate from hands-on training, first aid and CPR, and defensive driving for drivers. Georgia requires driver training, first aid, and spill kit training before a driver starts, or within 90 days for a driver who has not had it (section 916). Georgia also pulls a driver after one confirmed failure to secure a wheelchair, until the provider documents retraining (section 907.16).

Keep the proof in each driver’s file. MTM’s standard agreement (January 1, 2023) requires a driver orientation and training program with records kept in each driver’s file, and MTM Health’s Virginia handbook asks for a roster with PASS, first aid, and wheelchair securement training dates. A simple matrix shows at a glance who can drive what:

Driver	Sedan or minivan	Ramp minivan	Lift van	Stretcher van	PASS expires
Driver A	Yes	Yes, trained on the ramp	Not yet	No	Two years from the certificate date
Driver B	Yes	Yes	Yes, trained on the lift	Yes, second crew member	Two years from the certificate date

Schedule from the matrix, never from memory. The driver training guide and the training log template cover the rest.

Credentials, spares, and when to add a vehicle type

Credential each vehicle for the level it runs. Texas health plans keep a roster of each provider’s vehicles and backup vehicles with the VIN or plate and the type, such as sedan, minivan, or wheelchair van (UMCM 16.4, section 2110). MTM may not pay for trips in vehicles it has not credentialed (standard agreement, section 2.N). Add every new vehicle to every broker’s list before its first trip.

Keep spares of your most capable type. Florida’s transportation disadvantaged plans require contract carriers to keep one backup vehicle for every ten in service in Duval County (approved September 2025), and one for every six in DeSoto, Hardee, Highlands, and Okeechobee counties (amended February 10, 2026). In a mixed fleet the spare should be a wheelchair van. A lift that breaks takes wheelchair capacity with it, and federal rules require it repaired promptly, with reasonable steps to serve riders while it is out (49 CFR 37.161). The NEMT vehicle breakdown guide covers the day it happens.

Add a wheelchair van when you keep handing wheelchair trips back. Brokers notice patterns. CareOregon’s manual says a pattern of reassigning trips can lead to fewer rides offered, or to a smaller service area or fewer hours. If your turned-back offers are mostly wheelchair trips in one part of the day, that is the next vehicle to buy. The minivan vs full-size wheelchair van guide helps pick the type.

Add a stretcher van only when the volume pays for two people. Mississippi’s whole program ran 10,348 stretcher trips in fiscal year 2023, under 2% of rides in a provider’s vehicle. Check your state’s permits and crew rules first, and price the second crew member into every trip.