# NEMT Driver Drug Testing in 2027: DOT Rules, Broker Rules, and Paperwork

Canonical URL: https://nemtguide.com/guides/nemt-driver-drug-testing/ · Updated 2026-09-29

DOT drug testing rules cover NEMT drivers who need a CDL and staff working under contract for transit agencies funded by federal urban or rural transit grants. Sedan, minivan, and wheelchair van drivers outside those two groups follow broker and state rules instead. Those usually mean a urine test before hire, random tests, tests after accidents and on suspicion, and removal after a positive result.

- DOT testing covers drivers who need a CDL, and anyone doing safety-sensitive work under contract for a transit agency funded under 49 U.S.C. 5307, 5309, or 5311.
- Everyone else follows broker and state rules, such as MTM Health's pre-hire, random, post-accident, and suspicion tests.
- Keep DOT and non-DOT testing fully separate, with their own pools, forms, and records.
- Take a driver off the road at once after a positive result, a refusal, or signs of impairment.
- As of September 2026, DOT drug tests are urine tests, and adding fentanyl to the panel is still only a proposal.

Federal Medicaid law requires every state to make sure each NEMT provider it pays has a process to address violations of state drug laws. That rule, section 1902(a)(87) of the Social Security Act, does not say how. The testing rules themselves come from three places: DOT rules for some drivers, your broker contracts, and your state's Medicaid and employment laws. Which ones apply to each driver decides the forms, the lab, and the records you need.

## Which drug testing rules apply to your drivers

| Your drivers | Rules that apply | What it means |
|---|---|---|
| Drive a vehicle that needs a CDL: designed for 16 or more people including the driver, or rated at 26,001 pounds or more | FMCSA testing rules (49 CFR part 382) and DOT test procedures (49 CFR part 40) | A full DOT program, including the Clearinghouse |
| Drive, dispatch, or maintain vehicles under contract for a transit agency funded under 49 U.S.C. 5307, 5309, or 5311 | FTA testing rules (49 CFR part 655) and part 40 | A full DOT program for those jobs, in any size of vehicle |
| Drive sedans, minivans, or wheelchair vans that need no CDL, for brokers, health plans, facilities, or private pay riders | Broker contracts, state Medicaid rules, and state testing laws | A non-DOT program |
| Some of each | Both sets of rules | Two separate programs, each with its own random pool and forms |

**FMCSA rules follow the CDL.** Part 382 covers every driver who operates a commercial motor vehicle and needs a CDL (49 CFR 382.103). For this part, that includes a vehicle designed to carry 16 or more people including the driver, or rated at 26,001 pounds or more (49 CFR 382.107). The general motor carrier rules set aside the transportation of sick and injured people (49 CFR 390.3T), but that exception does not apply to drug testing (49 CFR 382.103). FMCSA's Clearinghouse FAQs say it covers all CDL drivers on public roads, at intrastate and interstate carriers alike, passenger carriers included. See [do NEMT drivers need a CDL](https://nemtguide.com/guides/do-nemt-drivers-need-a-cdl/).

**FTA rules follow the contract.** Part 655 covers recipients of federal transit grants under sections 5307, 5309, and 5311, and their contractors (49 CFR 655.3). Safety-sensitive work includes operating a revenue service vehicle, controlling dispatch, and maintaining vehicles, and "vehicle" includes a van or an automobile (49 CFR 655.4). So a sedan driver can be covered when the trips are part of a transit agency's service. Section 5310 grants, the formula grants for seniors and people with disabilities, are not on the list in 655.3. If you drive a van bought with a 5310 grant, ask the agency which testing its agreement requires. For transit work, see ADA paratransit contractor.

**Everyone else follows the broker.** For a company with no CDL vehicles and no transit contract, the broker agreements set the testing rules.

## What brokers and states require

As of September 2026:

| Program | What it requires |
|---|---|
| MTM Health, standard contract (January 1, 2023 version) | A written substance free workplace policy, sent to MTM on request. Tests before hire, after accidents, on suspicion, and at random at current FTA rates, for drivers and attendants. A refusal counts as a positive result. A driver who tests positive may no longer carry members. No positive test and no treatment for drug or alcohol abuse in the past 5 years. A driver suspected of being under the influence comes off service at once and is tested at the provider's expense. |
| MTM Health in Rhode Island (July 1, 2026) | A verifiable five-panel program with tests before hire, after accidents, and at random for more than 25 percent of drivers each year |
| Louisiana Medicaid (July 14, 2025) | A five-panel screen every year and on reasonable suspicion, with results sent straight to the broker by the testing agency. A driver who fails returns only after a substance abuse professional's final evaluation and clearance, then three follow-up screens over 6 months. |
| Texas Medicaid health plans (handbook version 2.0.1, August 1, 2021) | A drug and alcohol testing program that follows 49 CFR parts 40 and 655 and bars any substance that may impair driving |
| CareOregon (manual version 1.3, February 2024) | A drug-free workplace with an anti-drug policy and awareness program, and proof sent to the brokerage on request. Drivers may have to sign an attestation. Suspected drivers are tested at the provider's expense, and a refusal or positive result disqualifies them. |
| Virginia (DMAS, May 26, 2026) | No use or abuse of alcohol, narcotics, illegal drugs, or prescription drugs that affect the ability to work, on duty or at any time, and no drivers known to abuse them |
| Georgia (July 1, 2026) | Remove a driver at once when you suspect driving under the influence. No driver with a drunk or drugged driving conviction in the 5 years before hire. |
| SafeRide Health | Pre-hire drug screens, with documents, during onboarding |
| Modivcare | A passed drug screening test for each driver |
| Verida | Current drug screens for all owners and drivers |

The Texas rule names the DOT procedures, yet part 40 bars giving a DOT test to anyone DOT rules do not cover (49 CFR 40.13). Ask the plan in writing how it wants a program for non-CDL drivers set up. For each broker's full driver list, see [NEMT driver requirements](https://nemtguide.com/guides/nemt-driver-requirements/).

## DOT testing rules when they apply

### When tests happen

The FMCSA rules for CDL drivers, as of September 2026:

| Test | When | Key rule |
|---|---|---|
| Pre-employment | Before the first safety-sensitive work | A verified negative drug result first. An alcohol test is optional, but if you use one, every new hire gets it after a conditional offer (49 CFR 382.301). |
| Random | Unannounced, spread through the year | For 2026, at least 50 percent of the average number of drivers for drugs and 10 percent for alcohol. Each driver has an equal chance at every selection and goes to the site at once when told (49 CFR 382.305). |
| Post-accident | As soon as practical | Always after a death. After an injury treated away from the scene or a tow-away, only if the driver gets a moving violation citation, within 8 hours for alcohol and 32 hours for drugs (49 CFR 382.303). |
| Reasonable suspicion | When a trained supervisor sees signs | Based on specific, current observations of appearance, behavior, speech, or body odor (49 CFR 382.307) |
| Return-to-duty | After any violation | A negative test under direct observation, after a substance abuse professional's evaluation (49 CFR 40.67) |
| Follow-up | After returning | At least 6 unannounced tests in the first 12 months, and more for up to 4 more years if the substance abuse professional sets them (49 CFR 40.307) |

FMCSA raised the random drug rate from 25 to 50 percent starting January 1, 2020, and changes it only by notice in the Federal Register. FTA set the same 50 and 10 percent rates for 2026 in its notice of January 15, 2026. FTA's post-accident rule is different: after a nonfatal accident, you test the operator unless their performance can be completely ruled out as a cause (49 CFR 655.44).

Alcohol rules for CDL drivers are strict. A result of 0.04 or more is a violation. A result of 0.02 to 0.039 keeps the driver off duty until the next regular shift, and for at least 24 hours (49 CFR 382.505). Drivers may not drink on duty or in the 4 hours before duty.

A company whose only CDL driver is the owner must still test that owner from a random pool of two or more drivers (49 CFR 382.103). A consortium or third-party administrator can put the owner in its larger pool.

### The Clearinghouse for CDL drivers

The FMCSA Drug and Alcohol Clearinghouse holds CDL drivers' violations. For each CDL driver you must:

1. **Run a full query before the first covered work,** with the driver's electronic consent in the Clearinghouse (49 CFR 382.701).
2. **Run a query at least once a year** on every covered driver. A limited query meets the yearly rule, but if it finds a record, you must run a full query within 24 hours or take the driver off covered work.
3. **Report within 3 business days** alcohol results of 0.04 or more, refusals, negative return-to-duty results, and other violations you learn of. The medical review officer reports verified positive drug results (49 CFR 382.705).

Queries cost a flat $1.25 each, bought in plans on the Clearinghouse site. An owner-operator must name a consortium or third-party administrator in its Clearinghouse registration. Since November 18, 2024, a driver in "prohibited" status loses the CDL's commercial privileges until finishing the return-to-duty process. Drivers who do only FTA-covered work are outside the Clearinghouse. See FMCSA Clearinghouse.

### What the lab tests for, and how

DOT labs test for five drug classes: marijuana, cocaine, amphetamines, opioids, and PCP (49 CFR 40.82). DOT has allowed oral fluid tests since 2023, but HHS's list of certified labs dated September 1, 2026 includes none certified for oral fluid. A DOT rule effective June 10, 2026 requires a directly observed urine collection wherever part 40 calls for an oral fluid test that cannot yet be done. In practice, DOT drug tests are urine tests for now.

### Keep DOT and non-DOT tests apart

A DOT test must be completely separate from any non-DOT test. It comes first, and a non-DOT test needs its own specimen. You may never use the federal custody and control form for a non-DOT test, even with the DOT wording crossed out. And you may not give a DOT test to someone DOT rules do not cover (49 CFR 40.13).

## How to set up a NEMT drug testing program

1. **Sort every role.** Mark each driver, attendant, dispatcher, and mechanic as FMCSA, FTA, or non-DOT, using the table at the top.
2. **Write the policy.** For FMCSA drivers, your written materials must cover the topics in 49 CFR 382.601, and each driver signs a receipt. FTA employers need a policy statement adopted by their governing board (49 CFR 655.15). For everyone else, copy each broker's rules into the policy. The [NEMT drug and alcohol policy template](https://nemtguide.com/templates/nemt-drug-and-alcohol-policy/) has both versions.
3. **Line up your service agents.** You need a collection site, a lab, and a medical review officer who reviews every lab result before it reaches you. DOT programs also need a list of substance abuse professionals. A consortium or third-party administrator can bundle these and run random pools for a small company.
4. **Register in the Clearinghouse** if any driver needs a CDL, and buy a query plan.
5. **Set up random selection.** Use a scientifically valid method, such as a computer random number generator matched to employee numbers, and keep DOT and non-DOT pools separate. Keep a record of every selection.
6. **Train supervisors.** Anyone who decides on a reasonable suspicion test needs at least 60 minutes on alcohol and 60 minutes on drugs under DOT rules (49 CFR 382.603 and 655.14). FTA also requires 60 minutes of training for every covered employee.
7. **Hand out the policy and collect signatures** before testing starts, and from each new hire.
8. **Test before the first ride** and wait for the result. For DOT-covered hires, also get 2 years of testing history from past DOT-regulated employers, with the driver's written consent. FMCSA employers get the FMCSA part of that history through the Clearinghouse (49 CFR 40.25).
9. **Send results where contracts require.** Louisiana wants them from the testing agency straight to the broker. MTM Health wants your policy on request.
10. **File everything** in a locked, limited-access file kept apart from the general personnel file. The records table below shows how long.

## After a positive test or a refusal

**Remove the driver from all rides at once.** MTM Health and CareOregon require it, and under FMCSA rules a driver in prohibited status may not drive a commercial vehicle until the return-to-duty process is done. Also remove a driver who shows signs of impairment while you arrange a test. Never let that driver drive to the collection site.

**Treat a refusal like a positive.** Under DOT rules, refusals include not showing up when sent, leaving before the test is done, not allowing a required observed collection, and a specimen the medical review officer reports as adulterated or substituted (49 CFR 40.191). MTM Health's standard contract counts a refusal within the set time as a positive result, and CareOregon disqualifies the driver.

**Follow the return path your rules set.**

- **DOT drivers** return only after a substance abuse professional's evaluation, any education or treatment, and a negative return-to-duty test, then follow-up tests. DOT reminded employers and substance abuse professionals of these steps in a notice on March 4, 2026.
- **MTM Health trips.** A driver who tests positive may no longer carry MTM members, and a positive test or treatment in the past 5 years bars a new driver.
- **Louisiana.** A substance abuse professional's clearance, then three follow-up screens over 6 months, confirmed by the broker.

Write down every step and date. For a crash, Louisiana's 72-hour accident report to the broker must include a drug screen done within 12 hours of the crash, so book the test before the paperwork. The [incident report form](https://nemtguide.com/templates/nemt-incident-report-form/) keeps the details together.

## Marijuana, prescriptions, and state testing laws

**Marijuana on DOT tests.** A medical marijuana card changes nothing, and as of September 2026 marijuana is still a Schedule I drug. The medical review officer may not verify a test as negative because a doctor recommended marijuana under a state law, and hemp products are not a valid explanation (49 CFR 40.151). CareOregon's manual bars driving under the influence of marijuana by name.

**Prescriptions.** MTM Health's contract requires drivers to report any medicine that could affect driving and not carry members while it does. A driver may work on a prescription only with written word from their medical provider that it will not affect driving.

**State testing laws for non-DOT drivers.** State law can limit your non-DOT program. Two examples, as of September 2026:

- **California.** Employers may not penalize off-duty cannabis use away from work, or a test that finds only nonpsychoactive cannabis metabolites. Pre-hire tests that do not screen for those metabolites are allowed, and laws that require testing still apply (Government Code 12954, operative January 1, 2024).
- **Minnesota.** Applicants may be tested only after a job offer, with the same test for everyone offered that job. Random tests are allowed only for safety-sensitive jobs (Minnesota Statutes 181.951).

**Disability law.** Once you have 15 or more employees, federal disability law applies. A test for illegal drugs is not a medical exam under it (42 U.S.C. 12114), so it can come before a job offer. The EEOC treats an alcohol test as a medical exam, so applicants take one only after a conditional offer. See marijuana and NEMT drivers for the full picture.

## How long to keep drug testing records

| Record | How long | Rule |
|---|---|---|
| Positive drug results, alcohol results of 0.02 or more, refusals, and substance abuse professional referrals | 5 years | 49 CFR 382.401 |
| Collection records, including random selections and accident and suspicion decisions | 2 years | 49 CFR 382.401 |
| Negative and canceled drug results, and alcohol results under 0.02 | 1 year | 49 CFR 382.401 |
| Supervisor and driver training records | While the person does the work, plus 2 years | 49 CFR 382.401 |
| Clearinghouse queries and responses | 3 years. Since January 6, 2023, a valid Clearinghouse registration meets this rule. | 49 CFR 382.701 |
| Records of your operations under the contract | 10 years | MTM Health's standard contract |

Keep non-DOT records at least as long as your longest broker contract requires. Store every test record in a secure place with controlled access, as DOT rules require for DOT records.

## What is changing in drug testing

- **Fentanyl.** DOT proposed adding fentanyl and norfentanyl to its drug panel on September 2, 2025. As of September 29, 2026, no final rule had been published, so it is still a proposal.
- **Saliva tests.** DOT tests stay urine tests until HHS certifies labs for oral fluid. Since June 10, 2026, a directly observed urine collection replaces any required oral fluid test that cannot be done.
- **Marijuana rescheduling.** The DEA scheduled a hearing starting June 29, 2026 on moving marijuana to Schedule III. As of September 29, 2026, no final rule had been published, and DOT tests still screen for marijuana.
- **Random rates.** FMCSA and FTA announce rate changes in the Federal Register, and a new rate applies from January 1 of the next year. Check the 2027 rates before January 1, 2027.

Pair this page with [NEMT driver background checks](https://nemtguide.com/guides/nemt-driver-background-check/) for the rest of the driver file, and keep each driver's test dates in the [driver qualification file](https://nemtguide.com/templates/nemt-driver-file-checklist/).

## Frequently asked questions

### Do NEMT drivers need DOT drug testing?

Only some. FMCSA testing covers drivers who need a CDL, such as drivers of vehicles designed for 16 or more people including the driver, and the exception for carrying sick and injured people does not excuse them (49 CFR 382.103). FTA testing covers companies that drive, dispatch, or maintain vehicles under contract for a transit agency funded under 49 U.S.C. 5307, 5309, or 5311. Other drivers follow their broker and state rules instead.

### What drug test do NEMT drivers take?

Usually a five-panel urine test for marijuana, cocaine, amphetamines, opioids, and PCP. Those are the five classes DOT labs test for (49 CFR 40.82). MTM Health's standard contract defines a drug screen as a urine test that meets HHS or DOT requirements and covers at least those five. Louisiana Medicaid and MTM Health in Rhode Island require at least a five-panel screen too.

### How often are NEMT drivers drug tested?

At least before hire, and then on the schedule your rules set. MTM Health's standard contract adds tests after accidents, on reasonable suspicion, and at random at current FTA rates. For DOT-covered drivers in 2026, random tests must reach 50 percent of drivers for drugs and 10 percent for alcohol each year. MTM Health in Rhode Island requires random tests covering more than 25 percent of drivers a year, and Louisiana requires a test every year.

### Can I use instant or saliva drug tests for NEMT drivers?

Not for DOT tests. Those go to an HHS-certified lab, and HHS listed no lab certified for oral fluid as of September 1, 2026, so DOT drug tests are urine tests for now. For other drivers, follow each broker. MTM Health's standard contract calls for a urine test that meets HHS or DOT requirements, and Louisiana wants results sent to the broker straight from the testing agency.

### What happens if a NEMT driver fails a drug test?

The driver comes off all rides at once. Under MTM Health's standard contract, a driver who tests positive may no longer carry its members, and a positive test in the past 5 years bars a new driver. Louisiana lets a driver return only after a substance abuse professional clears them, followed by three screens over 6 months. Under DOT rules, the driver returns only through a substance abuse professional, a negative return-to-duty test, and follow-up tests.

### Do owners who drive need drug tests?

Yes. MTM Health's standard contract requires the same driver file for owner-drivers as for employees, and Verida asks for current drug screens for all owners and drivers. Under FMCSA rules, an owner who is the company's only CDL driver must be in a random pool of two or more drivers, such as a consortium's pool, and must name a consortium or third-party administrator in the Clearinghouse.

### Can a NEMT driver use medical marijuana?

Not on a DOT test. The medical review officer may not verify a result as negative because a doctor recommended marijuana under a state law, and hemp products are not a valid explanation either (49 CFR 40.151). Broker rules bar driving under the influence of any drug, and CareOregon names marijuana outright. For non-DOT tests, state law can limit what you test for and what you do after a result, so check it first.

### Who pays for NEMT driver drug tests?

The company. MTM Health's standard contract and CareOregon's manual both say a test on reasonable suspicion is at the provider's expense. Collection sites, labs, and medical review officers set their own prices, so get quotes. For CDL drivers, the FMCSA Clearinghouse charges a flat $1.25 per query. In Florida, insurers with an approved plan must tell employers at the first quote and at each renewal about the workers' compensation discount for a drug-free workplace program.

## Official resources

- [eCFR: 49 CFR part 40 (how DOT tests are collected, tested, and reviewed)](https://www.ecfr.gov/current/title-49/subtitle-A/part-40)
- [eCFR: 49 CFR part 382 (FMCSA testing for CDL drivers)](https://www.ecfr.gov/current/title-49/subtitle-B/chapter-III/subchapter-B/part-382)
- [eCFR: 49 CFR part 655 (FTA testing for transit agencies and their contractors)](https://www.ecfr.gov/current/title-49/subtitle-B/chapter-VI/part-655)
- [FMCSA Drug and Alcohol Clearinghouse: register and buy a query plan](https://clearinghouse.fmcsa.dot.gov/)
- [Federal Register: FTA random testing rates for 2026](https://www.federalregister.gov/documents/2026/01/15/2026-00644/prevention-of-alcohol-misuse-and-prohibited-drug-use-in-transit-operations)
- [MTM Health: Standard provider agreement, as Pennsylvania posts it (substance free workplace policy, section 5)](https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/healthchoices/documents/transportation-provider-services-agreement-01-01-2023.pdf)
- [Louisiana Medicaid: NEMT driver drug screen and crash reporting rules (Chapter 10)](https://www.lamedicaid.com/provweb1/providermanuals/manuals/med_trans/med_trans.pdf)