# NEMT Insurance Requirements in 2027: Coverage Types and Minimum Limits

Canonical URL: https://nemtguide.com/guides/nemt-insurance-requirements/ · Updated 2026-09-28

NEMT insurance requirements come from your state, each broker or health plan you work with, and federal rules if you carry riders for pay across state lines. Most programs ask for commercial auto liability, general liability, and workers' compensation. As of September 2026, Louisiana's managed care rules accept a $300,000 combined single limit for auto liability, while MTM Health asks for $2 million in Missouri.

- Your required limits are the highest of your state's rules and every broker and health plan contract you sign.
- Brokers often ask for more than the state: MTM Health wants $1 million to $2 million each in several states.
- Carrying riders for pay across a state line brings a federal floor of $1.5 million in liability for vans seating 15 or fewer.
- Brokers check that your certificate names them as additional insured or certificate holder, and many want every vehicle listed.
- A lapse can end a broker contract at once, and Louisiana can take back pay for every trip run while underinsured.

Every broker checks your insurance before it sends a trip, and a gap in coverage cannot be fixed after a crash. There is no single NEMT insurance rule. Your required limits are the highest of what your state, your operating license, and every broker and health plan contract ask for, so you buy once to the strictest list.

## Who sets NEMT insurance requirements

Four layers can apply to the same van:

| Who sets it | What it covers | Example |
|---|---|---|
| Federal Medicaid rules | No insurance limits of their own | CMS says states may require vehicle liability insurance for NEMT drivers |
| Federal motor carrier rules | Riders carried for pay across state lines | $1.5 million for a vehicle seating 15 or fewer |
| Your state | Vehicle licensing, NEMT licenses, and Medicaid program rules | New Jersey mobility assistance vehicle licenses, Louisiana managed care rules |
| Brokers and health plans | Everything in your contract | MTM Health, SafeRide Health, Verida |

CMS's Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) says federal Medicaid law sets only a short list of driver standards and leaves the rest to states. A state Medicaid agency may add its own, including carrying vehicle liability insurance.

Contracts usually go further than the law. MTM Health's standard provider agreement, in the January 1, 2023 version Pennsylvania posts, says its limits must meet its client contracts and every federal, state, and local rule. It also reserves the right to require more than the law does. It adds that its minimums may not be enough to protect you, and that you may buy more.

## The coverage a NEMT company needs

| Coverage | What it pays for | Who asks for it (as of September 2026) |
|---|---|---|
| Commercial auto liability | Injuries and damage your vehicles cause, including to your riders | Every state rule and broker on this page |
| General liability | Claims from your business operations and premises, apart from driving | MTM Health, SafeRide Health, Verida, Modivcare, MediTrans, MediDrive, New Jersey, and Arizona and Texas health plan rules |
| Workers' compensation and employer's liability | Employees hurt on the job | State law, MTM Health, and Arizona and Texas health plan rules |
| Sexual abuse and molestation | Abuse claims against a driver or staff member | Verida, Modivcare, and Arizona health plans for providers serving children or vulnerable adults |
| Hired and non-owned auto | Vehicles you rent or borrow, and employees' own cars used for work | Verida, and Arizona and Texas health plan rules |
| Umbrella or excess liability | Extra limits above your auto and general liability | Texas health plan rules |
| Professional liability | Claims of errors in the services you provide | Arizona health plan contracts |

Auto limits come in two forms. A split limit, such as $25,000 per person, $50,000 per accident, and $25,000 property damage, caps each part of a claim. A combined single limit, such as $500,000, is one amount for the whole accident. Read which form each program asks for.

## Minimum insurance limits by state

States set limits through different laws: NEMT licenses, Medicaid managed care rules, and plan contracts. Here are the published minimums in six states, as of September 2026, plus the federal floor for interstate trips.

| Where | Rule | Auto liability | Other minimums |
|---|---|---|---|
| Arizona health plans | AHCCCS Minimum Subcontract Provisions, for contracts of $50,000 or more (effective October 1, 2024, revised January 9, 2025) | $1 million combined single limit for owned, hired, and non-owned vehicles | General liability $1 million each occurrence and $2 million aggregate. Professional liability $1 million and $2 million. Workers' comp at statutory limits with $1 million employer's liability. |
| Colorado | Health First Colorado NEMT rule, 10 CCR 2505-10 8.014.3.B.6.e (current version effective July 10, 2026) | $300,000 per person and $600,000 per accident for bodily injury, $50,000 property damage | Drivers who use their own cars for a provider must also carry $25,000 per person and $50,000 per accident for bodily injury, and $15,000 property damage |
| Louisiana | Medicaid Managed Care Organization Manual (updated May 28, 2026) | $25,000 per person, $50,000 per accident, and $25,000 property damage, or a $300,000 combined single limit | General liability where a local ordinance requires it and for all door-through-door wheelchair service. Workers' comp as state law requires. |
| New Jersey | N.J.A.C. 8:40-3.3, mobility assistance vehicle licenses (readopted effective September 25, 2023) | $500,000 per occurrence for each vehicle, bodily injury and property damage combined | $300,000 premises and operations general liability |
| Ohio | Ohio Revised Code 4766.06, for licensed nonemergency services such as ambulettes | $100,000 per person and $300,000 per accident for bodily injury, $50,000 property damage, for each vehicle | Liability of $500,000 per occurrence and $500,000 aggregate |
| Texas health plans | Uniform Managed Care Manual 16.4, section 5300 (version 2.0.1, effective August 1, 2021) | $750,000 combined single limit for owned, hired, and non-owned vehicles | Workers' comp at statutory limits with $1 million employer's liability. The section also lists $1 million and $2 million general liability and $1 million umbrella. |
| Interstate trips for pay | 49 CFR 387.33T | $1.5 million for a vehicle seating 15 or fewer, driver included. $5 million for 16 or more. | Proof on the federal MCS-90B endorsement or an MCS-82B surety bond |

A few details matter:

- **Arizona's** smaller subcontracts, worth under $50,000 over their term, carry lower general liability limits: $500,000 each occurrence and $1 million aggregate. Plans decide when to require sexual abuse and molestation coverage for providers serving children or vulnerable adults, with a sublimit of at least $500,000 on larger contracts and $250,000 on smaller ones. See the [Arizona guide](https://nemtguide.com/states/arizona/).
- **Louisiana** requires the certificate to say the coverage is for a non-emergency medical transportation vehicle. The health department must be an additional insured on auto and general liability, and a vehicle cannot carry riders until the plan has an updated policy showing it.
- **New Jersey** requires the Department of Health to be a certificate holder and each vehicle's VIN on the certificate if vehicles are insured as scheduled autos. See the [New Jersey guide](https://nemtguide.com/states/new-jersey/).
- **Ohio's** policies must give the licensing board 30 days' notice before cancellation.
- **Texas** requires health plans to make sure every ride provider other than a rideshare company carries the section 5300 coverage. Insurers must be rated A or better, with a financial size of VII or better, by A.M. Best. See the [Texas guide](https://nemtguide.com/states/texas/).

Your state may also require insurance for a vehicle permit or a city license. Check with your state Medicaid agency and your insurance department, and see [NEMT license requirements](https://nemtguide.com/guides/nemt-license-requirements/).

### Crossing a state line

If you carry riders for pay across a state line, federal rules for for-hire passenger carriers apply. No such carrier may operate until it has at least $1.5 million in public liability for a vehicle seating 15 or fewer, driver included, and $5 million for 16 or more ([49 CFR 387.33T](https://www.ecfr.gov/current/title-49/section-387.33T)). Proof is the MCS-90B endorsement from your insurer (or an MCS-82B surety bond), kept at your main office, and a policy can be canceled only on 35 days' written notice. The rules exempt a few services, such as a taxicab seating fewer than 7 passengers that does not run a regular route ([49 CFR 387.27](https://www.ecfr.gov/current/title-49/section-387.27)).

## What NEMT brokers require

Brokers publish their own minimums, and they are often higher than the state's. As of September 2026:

| Broker and program | Auto liability | General liability | Also required |
|---|---|---|---|
| MTM Health, standard agreement (January 1, 2023 copy) | $500,000 combined single limit | $500,000 each occurrence and $500,000 aggregate | Workers' comp at statutory limits. MTM named as additional insured. Loading and unloading covered. |
| MTM Health, Missouri | At least $2 million | At least $2 million | MTM as certificate holder and additional insured, plus workers' comp |
| MTM Health, Nevada and Rhode Island | At least $1.5 million | At least $1.5 million | Same as Missouri |
| MTM Health, Minnesota | At least $1 million | At least $1 million | Same as Missouri |
| MTM Health, Wisconsin | $1 million combined single limit | $1 million combined single limit | Coverage at the level your vehicle's registration class requires |
| SafeRide Health | At least $500,000 | At least $1 million each occurrence and $2 million aggregate | SafeRide as additional insured |
| Verida, Georgia page | All owned, hired, and non-owned vehicles, each vehicle listed | Sexual abuse and molestation coverage of $1 million with a $2 million aggregate | Insurers rated A- or better. Your provider relations manager gives your state's full limits. |
| Modivcare | At least your state's minimum | Limits vary by state | Sexual abuse and molestation coverage, and workers' comp in most states if you have employees |
| MediTrans, Louisiana | At least $1 million per occurrence | Required | Workers' comp or an approved waiver, with MediTrans as certificate holder |
| MediDrive, Colorado | $300,000 per person, $600,000 per accident, $50,000 property damage | Required | Insurer rated A or better |

MTM Health's Iowa page requires general and auto liability without listing a limit, and its Texas page says insurance is discussed during credentialing. Verida tells providers to get their state's full list from their provider relations manager. So before you buy or renew, ask every broker you work with for its current limits in writing.

For each broker's full signup steps, see [MTM Health](https://nemtguide.com/brokers/mtm-health/), [SafeRide Health](https://nemtguide.com/brokers/saferide-health/), [Verida](https://nemtguide.com/brokers/verida/), [Modivcare](https://nemtguide.com/brokers/modivcare/), [MediTrans](https://nemtguide.com/brokers/meditrans/), and [MediDrive](https://nemtguide.com/brokers/medidrive/).

## What brokers check on your certificate of insurance

Having the right limits is only half of it. The certificate of insurance and the endorsements behind it also have to match the contract, or credentialing stalls.

| What they check | Who requires it |
|---|---|
| Your legal or trade name as the named insured | New Jersey requires the provider's trade name |
| The broker, plan, or state as additional insured | MTM Health, SafeRide Health, Arizona health plans (the State of Arizona), Louisiana (its health department), Texas health plans (the State of Texas) |
| The broker or agency as certificate holder | MTM Health, MediTrans, New Jersey (its health department) |
| Every vehicle listed | MTM Health for scheduled auto policies, Verida, New Jersey (VINs), Louisiana (updated policy before a new vehicle rides) |
| Notice before cancellation | Arizona health plans and Louisiana (30 days), Ohio (30 days to the board), MTM Health (a notice of cancellation endorsement) |
| Primary and non-contributory coverage | MTM Health, Arizona and Texas health plans |
| Waiver of subrogation | MTM Health, Arizona and Texas health plans |
| A strong insurer | A- VII or better by A.M. Best for Arizona health plans, A and VII for Texas health plans, A- for Verida, A for MediDrive |

MTM Health's agreement also asks that your policies cover loading and unloading, the moments a rider gets into or out of the vehicle. It names MTM as additional insured up to your full liability and umbrella limits, not only the minimums. When you add or remove a van on a scheduled policy, tell MTM immediately.

## Workers' compensation for NEMT drivers

State law decides when you must carry workers' compensation, and the lines differ:

| State | When coverage is required |
|---|---|
| Georgia | Three or more regular employees, part-time included. Officers of a corporation and members of an LLC count toward the three. |
| Florida | Four or more employees outside construction, counting corporate officers and LLC members |
| Texas | Most private employers may choose whether to carry it |

Brokers and plans can require it even where your state does not. MTM Health's standard agreement requires statutory coverage. If you do not cover your drivers, you must show the government document that exempts you, contract each driver through the driver's own company, and send MTM the contract pages. MTM also reserves the right to require coverage from providers who are exempt. MediTrans offers a waiver form for owner-operators without employees. Arizona health plan contracts waive it only for providers exempt under Arizona law who sign the sole proprietor or independent contractor waiver form.

Whether your drivers are employees or contractors changes this answer, so read [NEMT drivers: 1099 or W-2](https://nemtguide.com/guides/nemt-drivers-1099-or-w2/) and workers' comp for NEMT before you hire.

## Why a personal auto policy is not enough

A personal policy is priced for a family car, not a business that carries riders. The Texas Department of Insurance's auto insurance guide (updated December 11, 2025) lists accidents while driving for a ride-hailing service, and accidents while driving for business, among the things most personal policies do not cover. MTM Health and MediTrans ask for commercial auto liability by name, and every broker on this page sets auto limits for the vehicles you use.

A few programs let drivers use their own cars. Colorado's Medicaid rule, for example, requires drivers who use a personal vehicle for a provider to carry their own coverage on top of the provider's: $25,000 per person and $50,000 per accident for bodily injury, and $15,000 property damage. Ask the broker how its program handles them before any driver uses a personal car.

## What happens if your coverage lapses

A lapse stops your trips and can cost you money already paid:

- **MTM Health.** Its standard agreement ends immediately if you fail to keep insurance in force.
- **New Jersey.** A licensed provider must stop all mobility assistance vehicle service as soon as any required coverage is canceled or expires.
- **Louisiana.** Running trips without the minimum coverage breaks the program's rules, and the state or the health plan may recoup payment for every trip in that period.

Set renewal reminders at least 30 days before each policy ends, and send renewal certificates to every broker before the old ones expire.

## How to meet NEMT insurance requirements, step by step

1. **List every program you will work with.** Include your state license, state Medicaid, each broker, and each health plan.
2. **Get each program's requirements in writing.** Use the provider manual, the contract, or an email from provider relations.
3. **Build one table.** For each coverage, write down the highest limit any program asks for. That is what you buy.
4. **Give your agent the full picture.** Share your vehicles and their seats, lifts or ramps, drivers, counties, and states, and whether you carry children, vulnerable adults, or stretcher riders.
5. **Ask for the endorsements by name.** Additional insured, waiver of subrogation, primary and non-contributory, notice of cancellation, loading and unloading, and hired and non-owned auto.
6. **Check the insurer's rating.** Several programs on this page want an insurer rated A- or better.
7. **Send certificates and list every vehicle.** Add each new van to the policy, and send the updated certificate, before it carries a rider.
8. **Keep proof in every vehicle.** New Jersey, for example, requires the insurance card in the vehicle or with the driver.
9. **Recheck at every renewal.** Limits change when you sign a new broker or enter a new state.

Keep the certificates with the rest of your broker file. The [NEMT broker credentialing](https://nemtguide.com/guides/nemt-broker-credentialing/) guide and the [credentialing checklist](https://nemtguide.com/templates/nemt-credentialing-checklist/) list what else to gather, and [NEMT insurance cost](https://nemtguide.com/guides/nemt-insurance-cost/) covers what drives your premium.

## Frequently asked questions

### What insurance do I need to start a NEMT business?

Plan on commercial auto liability for every vehicle, general liability, and workers' compensation where your state requires it. Many brokers and health plans add sexual abuse and molestation coverage and hired and non-owned auto coverage, and some add umbrella or professional liability. Get each program's written requirements before you buy, then buy to the highest limit on the list.

### How much auto liability insurance does a NEMT company need?

As much as the strictest program you work with requires. As of September 2026, MTM Health's standard agreement sets a $500,000 combined single limit floor, Texas managed care rules require $750,000, Arizona health plan contracts and MediTrans in Louisiana ask for $1 million, and MTM asks for $1.5 million in Nevada and Rhode Island and $2 million in Missouri. Interstate trips for pay need at least $1.5 million.

### Can I use my personal car insurance for NEMT trips?

Do not count on it. The Texas Department of Insurance says most personal auto policies do not cover accidents while you drive for a ride-hailing service or drive for business. MTM Health and MediTrans ask for commercial auto liability by name. A few programs let drivers use their own cars: Colorado's Medicaid rule requires those drivers to carry $25,000 per person, $50,000 per accident, and $15,000 property damage.

### Do NEMT companies need workers' comp?

Usually, once you have employees, but state law sets the line. Georgia requires it at three or more regular employees, Florida at four or more outside construction, and Texas lets most private employers choose. Brokers can require it anyway. MTM Health's standard agreement requires statutory coverage and proof of any exemption, and MediTrans offers a waiver only for owner-operators without employees.

### What does additional insured mean on a NEMT certificate?

It extends your liability policy to protect the broker, health plan, or state when a claim from your trips names them too. MTM Health, SafeRide Health, and Arizona health plans ask to be added, and Louisiana requires its health department on your auto and general liability. A certificate holder only receives the certificate and notices. Your insurance agent adds additional insureds by endorsement.

### Do I need an umbrella policy for NEMT?

Only where a contract calls for one. An umbrella adds limits above your auto and general liability. Texas managed care rules list $1 million in umbrella or excess liability. MTM Health's agreement names MTM as additional insured up to your full liability and umbrella limits, so an umbrella you buy protects MTM as well.

### What happens if my NEMT insurance lapses?

You stop driving until it is fixed. MTM Health's standard agreement ends immediately if you fail to keep insurance. New Jersey requires a mobility assistance vehicle provider to stop all service as soon as required coverage is canceled or expires. Louisiana lets the state or a health plan recoup payment for every trip run while coverage was below the minimum.

## Official resources

- [NAIC: Find your state insurance department](https://content.naic.org/state-insurance-departments)
- [eCFR: 49 CFR 387.33T, Minimum insurance for interstate passenger carriers](https://www.ecfr.gov/current/title-49/section-387.33T)
- [Pennsylvania DHS: MTM Transportation Provider Services Agreement (January 1, 2023)](https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/healthchoices/documents/transportation-provider-services-agreement-01-01-2023.pdf)
- [AHCCCS: Minimum Subcontract Provisions](https://www.azahcccs.gov/PlansProviders/HealthPlans/minimumsubcontractprovisions.html)
- [Texas Department of Insurance: Auto insurance guide](https://www.tdi.texas.gov/pubs/consumer/cb020.html)
- [Georgia State Board of Workers' Compensation: Insurance FAQs](https://sbwc.georgia.gov/frequently-asked-questions/workers-compensation-insurance-faqs)
- [Florida Department of Financial Services: Workers' compensation coverage requirements](https://myfloridacfo.com/division/wc/employer/coverage-requirements)