# How to Negotiate NEMT Broker Rates in 2027: When Brokers Pay More and How to Ask

Canonical URL: https://nemtguide.com/guides/negotiate-nemt-broker-rates/ · Updated 2026-09-29

You can negotiate NEMT broker rates when you offer what the broker is short of: wheelchair or stretcher vans, rural coverage, or reliable same-day and discharge rides. Verida in Indiana and MTM Health in Wisconsin, for example, can agree on rates with each provider. Know your cost per trip, bring your on-time and hand-back numbers, ask in writing at signing or renewal, and never agree on prices with other providers.

- Brokers have the most room to pay more on trips they struggle to cover: stretcher, wheelchair, rural, and short-notice rides.
- In some states the broker cannot move the rate alone. Kentucky's Transportation Cabinet sets it, and Louisiana sets a floor.
- Your case is your own numbers: cost per trip by level of service, empty miles, on-time rate, and how rarely you hand trips back.
- Ask in writing before you sign, at renewal, or inside the window to reject a rate change, and get any new rate in a signed amendment.
- Never agree on rates, or on refusing trips, with other providers. Federal antitrust law treats that as price fixing or a boycott.

A broker rate is not always fixed. Brokers are judged on getting riders to care, and some trips are hard to cover. When you can take those trips reliably, you have something to bargain with. When you run the same short ambulatory trips as everyone else, you mostly do not.

## Can you negotiate a NEMT broker rate?

Sometimes. Who sets your rate decides how much room there is. A broker is paid by the state or a health plan and pays you from that money. In Kentucky, for example, each regional broker gets a fixed amount per member each month, a [capitation](https://nemtguide.com/glossary/capitation/) rate. Some states let the broker set provider rates. Others set them, or set a floor.

| Where | Who sets what you are paid | What it means for you |
|---|---|---|
| Indiana, Verida (fee-for-service) | Verida's rate schedule is based on the state fee schedule, and each provider signs a Verida rate agreement. Verida can negotiate higher or special rates with each provider individually (module published August 19, 2025). | Room to ask, starting from the state rate |
| Wisconsin, MTM Health | All rate details are discussed and determined with each provider individually (provider page, September 2026). The state announced on May 21, 2026 that it intends to move to Verida, with no date set. | Room to ask |
| Virginia, MTM Health | Pay is figured from the Schedule A rate sheet for Virginia, by miles driven, mode of transportation, and shared rides (handbook approved August 10, 2026) | Ask about how your trips are classed, not only the rate |
| WellTrans (Indiana agreement) | You are paid the lower of your billed charge or the rate table, which is titled "Negotiated Rates" and set by level of service for trips of 0 to 3, 4 to 6, and 7 to 10 miles, plus a rate per mile after 10 (revised October 16, 2025) | Each mileage band is its own number to negotiate |
| Louisiana | The published Medicaid fee-for-service rate is the minimum a broker pays, unless you and the broker agree otherwise in the provider agreement (Medicaid Services Manual, issued July 14, 2025) | Never sign a rate below the fee schedule by accident |
| Kentucky | The Kentucky Transportation Cabinet sets the rates regional brokers pay their subcontracted providers (state presentation, November 5, 2025) | Push the Cabinet and the legislature, not only the broker |

The federal rules leave the state in charge. CMS says states may direct brokers to use specific payment methods for providers, and are expected to make sure a broker does not offer payment so low that local providers will not take part (SMD 23-006, September 28, 2023). That matters if your broker's rates are so low that few providers will run trips in your area.

## Which trips brokers pay more for

A broker's weak spots are the trips it cannot fill. Those are the trips to price higher. The table shows public examples of how programs pay more, and how short brokers can run.

| Trip type | Why the broker needs you | A published example |
|---|---|---|
| Stretcher | Fewer vans, each with a stretcher and restraints | Arizona pays a $49.09 base for a stretcher van in Phoenix and Tucson, against $11.15 for a wheelchair van (rates effective October 1, 2026) |
| Rural and long trips | Long empty drives and few providers | Arizona pays more for trips that start outside Phoenix and Tucson, billed with the TN modifier: $86.70 for a stretcher base and $12.21 for a wheelchair base. It says the rural rate reflects dirt roads, long distances to reach the member, and a lack of providers. |
| Trips far outside your area | No provider is closer | Louisiana's state plan allows an extra per-mile rate when the state finds a provider needs more pay to travel far outside its service area, paid only when no willing and available provider is in the rider's region (approved March 24, 2025) |
| Hands-on help | Staff with extra training and insurance | Louisiana pays $21.50 plus $1.30 a mile for a wheelchair van and $13.50 plus $1.10 for a standard trip (T2003). Its door-through-door wheelchair level of care pays $31.50 plus $1.30 a mile and needs prior approval (fee schedule effective October 1, 2025). |
| Hospital discharges and will-call returns | Tight deadlines with penalties | MTM Health's Virginia handbook: a discharge pickup within 3 hours or liquidated damages, and a [will-call](https://nemtguide.com/glossary/will-call-trip/) pickup within 45 minutes of the call |
| Trips no one takes | Missed trips show up in state reports | In May 2026, 340 trip legs in Indiana's fee-for-service program, 1.0% of scheduled rides, were missed because no provider was assigned. Providers sent back 11.5% of the trips assigned to them. |

Short notice costs brokers money. WellTrans's agreement says that when a provider hands back a trip with less than 12 hours' notice and WellTrans has to buy "premium price" backup transportation, the provider pays the extra. If your company can take same-day trips and hospital discharges without handing them back, say so, with your numbers. See [hospital discharge transportation](https://nemtguide.com/guides/hospital-discharge-transportation/) for how those trips work.

Ask about nights, weekends, and holidays too. If your vans run early or late, ask whether the rate sheet has an after-hours line, and what the broker pays when it has no provider for those hours. See after-hours NEMT.

## Where you have little room to negotiate

Some rates move only when the state moves them.

- **Short ambulatory trips in cities.** Many providers can run them, and some programs have cheaper backups. Colorado's 2026 NEMT law (HB26-1328, in effect July 1, 2026) lets a rideshare company take a trip when no enrolled provider can run it in time or none serves the rider's area. Arizona's rate file for October 1, 2026 lists $0.67 a mile for S0215 mileage by a rideshare company on health plan trips, against the $1.28 fee-for-service rate.
- **States that set the rate.** In Kentucky, the Transportation Cabinet sets subcontractor rates. Kentucky's HB 2 (Acts Chapter 179, 2026) also requires each regional broker to reach a medical loss ratio, the share of its capitation spent on services, of at least 85% in the state fiscal year that began July 1, 2026, rising to 90% from July 1, 2029. A broker that falls short pays the excess back to the state. Raise that with the Cabinet and your legislators.
- **Rates tied to the state fee schedule.** When a broker's schedule follows the state's, as Verida's does in Indiana, the lasting fix is a state rate increase. See [how NEMT rate increases happen](https://nemtguide.com/guides/nemt-rate-increase/).
- **Standing orders priced on least cost.** In Louisiana, the broker assigns standing orders to the least costly provider and reviews each one at least monthly. A higher rate can move a standing order to someone cheaper.

State rate changes still help you at the table. Louisiana's Act 969 of 2026 (HB 1028) directs the Louisiana Department of Health to set a minimum rate of $14.50 per trip and $2.10 per mile, wheelchair trips included. It takes effect only once the legislature funds it, and as of September 2026 the posted schedule is still the one effective October 1, 2025. Because Louisiana's fee schedule is the floor for broker pay unless your agreement says otherwise, a funded increase would raise that floor. The [reimbursement rates guide](https://nemtguide.com/guides/nemt-reimbursement-rates/) tracks rate changes by state.

## Build your case with your own trip data

A broker answers numbers, not complaints. Pull three to six months of your own records and put them on one page.

### Your cost for each kind of trip

Start with your [cost per trip](https://nemtguide.com/guides/nemt-cost-per-trip/) by level of service: ambulatory, wheelchair, stretcher. Include the [deadhead miles](https://nemtguide.com/glossary/deadhead-miles/) to each pickup. CMS says miles with no rider aboard generally cannot be paid on their own, but it recognizes they are a significant cost for providers and lets states build that cost into the rate (SMD 23-006). Your empty miles belong in your case. Two calculators help: the [cost per mile calculator](https://nemtguide.com/tools/nemt-cost-per-mile-calculator/) and the [deadhead cost calculator](https://nemtguide.com/tools/nemt-deadhead-cost-calculator/).

Here is a worked example with made-up costs. Use your own.

| Line | Example |
|---|---|
| Trip | A round trip in a wheelchair van, 15 loaded miles each way |
| Pay at Louisiana's floor | 2 legs x ($21.50 + 15 x $1.30) = $82.00 |
| Miles you drive | 30 loaded + 24 empty (12 to the first pickup, 12 back after the return) = 54 |
| Vehicle cost at $0.76 a mile | 54 x $0.76 = $41.04 |
| Driver cost at $22 an hour, 2.5 hours | $55.00 |
| Your cost | $96.04 |
| Gap before any profit | $14.04 short, about $7 a leg |

The 76 cents is the IRS business standard mileage rate from July 1, 2026, which the IRS raised from 72.5 cents because of higher fuel prices. It is set for cars. Figure your van's own number, then show the broker the gap and the rate that closes it. A specific ask, such as a rural add-on or a higher wheelchair base, gets a clearer answer than a request for "more."

### Your performance numbers

Brokers pay for reliability. Show how you do against the broker's own standards. MTM Health's Virginia handbook (approved August 10, 2026) is one public set:

| Your number | MTM Virginia standard |
|---|---|
| On-time pickups | Above 95%, within 15 minutes before or after the pickup time |
| Trips you hand back | Under 0.5% of assigned trips |
| Provider no-shows | Under 0.25% |
| Substantiated complaints | Under 0.1% of completed trips |
| Trips tracked by GPS | Above 90.01% |
| Denied claims | Under 0.29% |

Add the trips you took that others would not: same-day requests, discharges, long rural runs. See [NEMT broker scorecards](https://nemtguide.com/guides/nemt-broker-scorecards/) and [how to get more broker trips](https://nemtguide.com/guides/get-more-broker-trips/) for how brokers grade and reward providers.

## How to ask for a higher rate, step by step

1. **Get your current terms in writing.** Ask for your rate exhibit (MTM calls it Schedule A, WellTrans calls it Attachment 1 to Exhibit B) and the performance and penalty terms (MTM's Schedule B, WellTrans's Exhibit A).
2. **Pick the trips you want repriced.** Choose two or three trip types where you are strong and the broker is short, not every rate at once.
3. **Choose the structure.** A higher base, a higher loaded-mile rate, a rural or out-of-area add-on, paid wait time on long trips, or a rate for a second crew member. WellTrans, for example, generally pre-authorizes wait time only on trips over 50 miles.
4. **Write one page.** List what you offer (vans by type, counties, hours, response times), your cost for each trip type, your performance numbers, and the rate you need.
5. **Send it to provider relations in writing.** Email the network or provider relations contact on the broker's page for your state, and ask for a written answer by a date. Our [broker directory](https://nemtguide.com/brokers/) lists contacts for [MTM Health](https://nemtguide.com/brokers/mtm-health/), [Verida](https://nemtguide.com/brokers/verida/), [WellTrans](https://nemtguide.com/brokers/welltrans/), and others.
6. **Time it.** Ask before you sign, at renewal, and whenever the broker's need peaks. MTM's standard agreement (January 1, 2023 version) runs three years and renews only by written agreement of both sides. WellTrans's renews each year unless one side gives notice 45 days before the year ends. A new broker taking over a state or health plan, as Verida plans to in Wisconsin, has to build a network by its start date. See [NEMT broker transitions](https://nemtguide.com/guides/nemt-broker-transition/).
7. **Get it signed.** MTM's agreement can be amended by mutual written agreement. WellTrans's says amendments must be in a written document signed by both sides. A promise on the phone is not a rate.
8. **Check your first payments.** Match the next remittances to the new rate, trip by trip.

## If the broker says no or cuts your rate

- **Answer a rate cut inside the window.** MTM's standard agreement lets it amend the agreement, rates included, by written notice. The change is binding unless you reject it in writing within 30 days. Put every notice on your calendar the day it arrives.
- **Change what you offer.** In Virginia, MTM assigns trips by the capacity, hours, trip distance, and credentialing status in your profile. Offer only the hours and counties where the rate covers your cost. Be careful about taking only long trips. Louisiana's manual says a provider with a pattern of rejecting local trips in favor of long ones can face trip reductions or other sanctions.
- **Spread your work.** Facility contracts, private pay riders, and a second broker make any one rate matter less. See [working with more than one broker](https://nemtguide.com/guides/multiple-nemt-brokers/).
- **Leave with proper notice.** MTM's agreement allows either side to end it on 30 days' written notice, and you must run trips already assigned. WellTrans's requires 60 days' written notice without cause. See [how to leave a NEMT broker](https://nemtguide.com/guides/leave-a-nemt-broker/).
- **Take it to the state.** If rates in your area are so low that providers will not take trips, tell your state Medicaid agency in writing, with your numbers. See how to escalate a broker problem.

## Rules to follow when you negotiate

- **Do not agree on prices with other providers.** The FTC says a naked agreement among competitors to fix prices is almost always illegal, whether it sets a minimum, a maximum, or a range. Penalties include up to 10 years in prison and fines up to $1 million for individuals and $100 million for companies.
- **Do not refuse trips as a group.** The FTC says competitors agreeing not to work at prevailing prices to get a higher price raises antitrust concerns. It won a case against a group of trial lawyers who stopped representing poor criminal defendants for the District of Columbia until it raised their fees, and the Supreme Court upheld that ruling in 1990. Deciding alone that a rate is too low for you is fine.
- **Do not trade rate sheets.** WellTrans's agreement makes its rates confidential, and MTM's treats its pricing policies as confidential information. Sharing current prices among competitors can also raise antitrust concerns.
- **Lobby the state together, not the broker.** The FTC says a trade association may represent its members before legislatures and government agencies. That is the place for a joint push on rates.
- **Do not pad the numbers.** Brokers check your data. MTM's Virginia handbook flags trips where the miles billed do not fit the time recorded, and claims where one driver shows up in two vehicles at once. See [NEMT fraud](https://nemtguide.com/guides/nemt-fraud/) for what gets caught.

Start with the one trip type you run best that your broker struggles to fill, price it, and send your one-page ask this month.

## Frequently asked questions

### Will a NEMT broker actually negotiate its rates?

Some say so in writing. Indiana's Medicaid transportation module (August 2025) says Verida bases its rates on the state fee schedule but can negotiate higher or special rates with each provider. MTM Health's Wisconsin provider page (September 2026) says rate details are discussed and set with each provider individually. WellTrans titles the rate table in its Indiana agreement "Negotiated Rates." Other brokers may pay one schedule to everyone, so ask yours in writing.

### Can a broker pay me less than the Medicaid fee schedule?

It depends on your state. In Louisiana, the published fee-for-service rate is the minimum a broker pays, unless you agree to less in your provider agreement, so read the rate exhibit before you sign. In Kentucky, the Transportation Cabinet sets the rates regional brokers pay providers. Where your state sets no floor, your rate is whatever you sign. CMS expects states to make sure a broker does not pay so little that local providers refuse to take part.

### Can NEMT providers band together to demand higher broker rates?

Not by agreeing on prices or refusing trips as a group. The Federal Trade Commission says an agreement among competitors to fix prices is almost always illegal, and that competitors agreeing not to work at the going rate to force a higher one can be an illegal boycott. Each company may decide on its own what it will accept. Providers may ask legislators or the Medicaid agency for higher rates together, for example through a trade association.

### What trips can I ask a broker to pay more for?

The ones it has trouble covering: stretcher and wheelchair trips, long rural trips, trips far outside your usual area, hospital discharges and will-call returns with tight pickup deadlines, and riders who need hands-on help. Arizona's fee schedule shows the gap. From October 1, 2026, a stretcher trip that starts outside Phoenix and Tucson pays a base of $86.70, against $49.09 inside those metro areas.

### What should I do if my broker sends a notice lowering my rate?

Read the amendment clause in your agreement the day the notice arrives. MTM Health's standard agreement lets it change rates by written notice, and the change binds you unless you reject it in writing within 30 days. Reply in writing before that deadline with your cost numbers and ask for a call. If the new rate still does not cover your cost, you can end the agreement with the notice it requires.

### When is the best time to ask for a higher rate?

When the broker needs you most: before you sign, at renewal, when a new broker is building a network for a state or health plan, when your state raises its fee schedule, and when your costs jump. The IRS raised its business standard mileage rate to 76 cents a mile from July 1, 2026, citing higher fuel prices. Point to that change when you ask.

## Official resources

- [CMS: Medicaid Transportation Coverage Guide (SMD 23-006)](https://www.medicaid.gov/federal-policy-guidance/downloads/smd23006.pdf)
- [AHCCCS: Ground transportation fee schedules by year](https://www.azahcccs.gov/PlansProviders/RatesAndBilling/FFS/transportationground.html)
- [Louisiana Medicaid: NEMT fee schedules](https://www.lamedicaid.com/provweb1/fee_schedules/NEMT_Fee.htm)
- [Indiana FSSA: Monthly NEMT broker performance reports](https://www.in.gov/fssa/ompp/non-emergency-medical-transportation/sea-480-data-reports/)
- [IRS: Standard mileage rates](https://www.irs.gov/tax-professionals/standard-mileage-rates)
- [FTC: Price fixing](https://www.ftc.gov/advice-guidance/competition-guidance/guide-antitrust-laws/dealings-competitors/price-fixing)
- [FTC: Spotlight on trade associations](https://www.ftc.gov/advice-guidance/competition-guidance/guide-antitrust-laws/dealings-competitors/spotlight-trade-associations)