NEMT Payer Mix in 2027: How Much of Your Revenue Should Come from One Broker

Starting with one broker makes sense: one contract brings steady trips fast. The risk comes later, when that broker carries most of your revenue. A decision you do not control, such as a state rebid, a health plan switching brokers, or a broker reassigning your standing orders, can then take most of your trips in a month. Your payer mix is how you measure that risk and shrink it.

What payer mix means for a NEMT company

Your payer mix is the share of your revenue that comes from each payer. Count it two ways, because each shows a different risk:

• By who pays you. The broker, plan, facility, agency, or rider whose agreement you signed and whose deposits you receive. This shows how much one agreement ending would cost.
• By the program behind the trips. One broker often carries trips for several health plans. This shows how much one plan switching brokers would cost, even while your broker agreement stays in place.

The payers open to a small company fall into a few groups. Who pays for NEMT covers each one in depth, and how states run NEMT shows which Medicaid setup your state uses.

Payer	Who you sign with	What you need first	Who sets your rate
State Medicaid, fee-for-service	The state Medicaid agency, in states that pay rides directly	Medicaid enrollment	The state fee schedule
Medicaid broker	The broker	Broker credentialing, and in some states Medicaid enrollment too, as WellTrans requires in Indiana	The broker’s rate sheet
Medicaid health plan with its own ride network	The plan	Plan credentialing	Your plan contract
Medicare Advantage plan with a ride benefit	Often the plan’s broker, as HealthSpring uses MTM Health	Broker credentialing	The broker
PACE program	The PACE organization	A written contract that meets PACE transportation rules	Your contract
VA special mode rides	The VA	The VA’s terms for special mode rides	The VA
Hospitals, dialysis centers, nursing facilities	The facility	A facility agreement	You and the facility
Aging agencies and transit programs	The area agency on aging or transit agency	Grant or contract terms	The agency
Private pay	The rider or family	Local permits where required	You

Why depending on one broker is the biggest risk

Broker agreements guarantee no trips

Read the termination and trip-volume sections of a broker agreement and you will often find the same pattern. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, shows it clearly:

• No minimum volume. The agreement does not guarantee any minimum number of trips, and volume may vary (section 14.C).
• Trips can move. MTM may assign or reassign any trip, including recurring trips, at its sole discretion. You have no right to transport any particular rider or serve any particular facility (section 2.Q).
• Short notice. Either side may end the agreement for convenience on 30 days’ written notice (section 14.A).
• Client loss. MTM may end it immediately if its contract with the state or plan ends, loses funding, or the client asks MTM to drop you (section 14.D).

WellTrans’s Indiana agreement (revised October 16, 2025) reads the same way. WellTrans has no obligation to send a specific number of trip requests and may withdraw trips already assigned. Either side may end it without cause on 60 days’ written notice, and WellTrans may end it immediately if its client directs. Rhode Island’s broker contract (effective July 1, 2025) even bars its broker from offering providers guaranteed ridership (section 7.3.3).

Health plans and states change brokers

When a state runs NEMT as a brokerage program under its Medicaid plan, federal rules require it to choose the broker through competitive bidding (42 CFR 440.170(a)(4)), so every contract period can bring a new broker. Health plans switch too.

Effective	Who	What changed
June 8, 2024	Mississippi Medicaid	MTM Health to Modivcare. MTM’s bid protest had delayed the start from October 1, 2023.
March 1, 2026	HealthSpring Medicare Advantage	Modivcare to MTM Health, as the sole NEMT provider for its members
April 1, 2026	Georgia Medicaid	Modivcare left the Central, Southwest, and East regions. Verida now serves all five.
October 1, 2026	BCBS of Texas Medicaid	Modivcare to MTM Health
November 1, 2026	BCBS of New Mexico Medicaid	Modivcare to MTM Health

Standing orders follow the broker, not you. Blue Cross and Blue Shield of Texas told providers on June 29, 2026, and again on August 26, 2026, that recurring trips and trips already scheduled after October 1, 2026 will be fulfilled by MTM Health. A company in only one of those networks gains or loses those riders on that date. The NEMT broker transition guide covers how to get through a switch.

A broker’s money trouble becomes yours

WellTrans’s agreement lets it delay your payments when its client, the state or health plan, is unable or unwilling to pay WellTrans. Brokers themselves can struggle too. The broker Modivcare filed for Chapter 11 on August 20, 2025, and its reorganization plan took effect on December 29, 2025. With one broker, every deduction, delay, or dispute hits all of your income at once. See NEMT broker penalties for how brokers take charges out of payments.

Lenders and buyers discount concentration

The SBA’s lending rules, SOP 50 10 8.1 effective October 1, 2026, put a number on it. For a Working Capital CAPLine, a line of credit backed by your receivables, receivables from any one customer that make up more than 20 percent of the total generally stay out of the borrowing base. The exceptions include a customer with a long-standing positive credit history with you. Without an exception, the lender needs SBA’s written consent to count them. Ask your lender how it applies these rules.

Selling carries the same test. When a new owner or another company buys a business for $3 million or more with SBA financing, the lender’s quality of earnings report must assess customer concentration, contract continuity, and whether revenue will hold after the sale. See NEMT business loans and how to sell a NEMT business.

How to measure your payer mix

Use money you actually collected, after denials and deductions, over the last 3 and 12 months. Three formulas do the work:

Payer share = money collected from one payer ÷ total money collected × 100

Revenue at risk = monthly money collected from your largest payer

Months covered = cash on hand ÷ monthly fixed costs

Fixed costs are the bills that stay when trips stop: insurance, vehicle payments, rent, and the staff you keep. Put each payer’s notice period next to its share. That tells you how fast each share could disappear.

A worked example

Here is a hypothetical company with four vans. Every number is an example.

Payer	Collected per month	Share	Notice to end
Broker A	$31,200	60%	30 days
Broker B	$7,800	15%	60 days
Dialysis center agreement	$5,200	10%	As the contract says
PACE program	$3,900	7.5%	As the contract says
Private pay riders	$3,900	7.5%	None
Total	$52,000	100%

Broker A looks like one payer, but its trips come from four programs:

Program behind Broker A’s trips	Collected per month	Share of all revenue
Medicaid health plan 1	$15,600	30%
Medicaid health plan 2	$7,800	15%
Medicaid health plan 3	$4,680	9%
Medicare Advantage plan	$3,120	6%

Now test it. Revenue at risk is $31,200 a month. With $18,000 in monthly fixed costs and $30,000 in the bank, months covered is 1.7. If Broker A gave 30 days’ notice, the company would have those 30 days, plus about seven weeks of fixed costs in the bank, to replace most of that work. And if health plan 1 moved to a broker the company does not work with, 30 percent of revenue would go on the plan’s switch date while Broker A stays.

How much revenue should come from one broker

No federal or state rule caps the share of revenue one broker may carry. Set your own limit with three tests:

1. The notice test. Could you pay your fixed costs for the largest payer’s notice period, plus the time it takes to get credentialed with another payer, with that payer’s revenue gone? If not, that payer is too large.
2. The plan test. Could you lose the trips of your largest single health plan on its switch date? Notice can be short: HealthSpring’s provider notice of its March 1, 2026 switch is dated February 26, 2026.
3. The lender test. Is any one customer above 20 percent of your receivables? That is the SBA line for credit backed by receivables.

A new company fails all three at first, and that is normal. The first goal is a second payer, so that losing one agreement would not close the business. Then keep adding until the largest payer passes the notice test. Grow toward the 20 percent line as the company gets bigger and starts to borrow.

Share is not the only goal. A payer that adds volume at a rate below your cost per trip makes the mix look better and the business worse. Work out your cost per trip before you chase new work.

Which payers to add, and what each takes

Payer to add	What it takes	Watch for
A second broker or plan network in your area	Credentialing with each one. In Texas, the state’s list of 14 Medicaid health plans shows each using MTM, SafeRide, or Modivcare as its ride vendor (September 2026, before BCBS of Texas moves to MTM Health on October 1).	Each network has its own rules, rates, and filing limits
State Medicaid, fee-for-service	Medicaid enrollment, in states that enroll ride providers directly	Your state’s claim rules and fee schedule
Medicare Advantage	MA plans do not have to cover non-emergency rides to covered care, but may offer them as a supplemental benefit that the plan arranges or provides	Plans often use the same brokers, so check who you would really sign with
PACE programs	A written contract with the PACE organization. Vehicles are maintained as the maker recommends, can communicate with the PACE center, and staff are trained for participants’ needs and emergencies (42 CFR 460.70 and 460.76).	See PACE transportation contracts
VA special mode rides	VA pays for special mode rides, such as wheelchair van and ambulance trips, for eligible veterans (38 CFR part 70)	See VA transportation contracts
Hospitals, dialysis centers, nursing facilities	A facility agreement with rates, booking, and payment terms	Price by the ride, never by referral. See NEMT facility contracts and anti-kickback rules.
Aging agencies and transit programs	Older Americans Act grants fund transportation that area agencies on aging provide with local transportation providers (42 U.S.C. 3030d)	See area agency on aging transportation
Private pay riders	Clear prices, card payments, and receipts	Never charge a Medicaid member for a covered ride. See private pay NEMT.

In Rhode Island, the broker contract requires MTM to sign an agreement with any provider willing and able to meet program requirements (section 7.3.4, July 1, 2025). Other states and brokers differ. See what to do when a broker network is full. Check each broker’s page in the broker directory and your state guide. For running two networks at once, see working with multiple NEMT brokers.

The private pay limit is federal. States may enroll only providers who accept Medicaid’s payment as payment in full (42 CFR 447.15). MTM’s agreement (section 6.C) and WellTrans’s agreement also bar billing members for the trips they send you, apart from narrow exceptions each agreement lists, such as copays MTM or its client authorizes.

How your mix changes when you get paid

Every payer has its own filing deadline and payment clock, so your mix also shapes your cash.

Payer	Deadline to file	When it pays
State Medicaid, fee-for-service	Set by your state, and never more than 12 months from the date of service (42 CFR 447.45)	On your state’s payment cycle. The federal 30-day clean claim clock covers practitioners’ claims; other claims must be paid within 12 months of receipt.
Medicaid health plans	Set by the plan	As your plan contract sets. A plan and its providers may agree on their own payment schedule (42 CFR 447.46).
WellTrans, Indiana (October 16, 2025)	Within 60 days. Invoices after 90 days are disallowed.	Twice a month, within 30 days after submission. Payments may wait if its client does not pay WellTrans.
MART, Massachusetts (July 1, 2025)	Within 2 business days after each billing cycle closes (twice a month or monthly, by program)	Within 45 days of an approved final invoice, finalized within 6 business days of each billing cycle’s close
MTM Health, Virginia (August 10, 2026)	6 months from the date of service	As your agreement sets
MTM Health, Rhode Island (July 1, 2026)	90 days from the date of service	As your agreement sets
Private pay	At booking or on your invoice	When you collect

A mix heavy in slow payers needs a bigger cash reserve. See NEMT cash flow and how long Medicaid takes to pay.

How to improve your payer mix, step by step

1. List every payer. Pull 12 months of collected revenue by payer and by program, and work out each share.
2. Read every agreement. Write down the notice period, minimum trips, reassignment rights, offsets, and what happens if the broker loses its client.
3. Run the three tests. Mark each payer that fails the notice, plan, or lender test.
4. Apply to a second network now. Credentialing takes time, so start before you need it. See NEMT broker credentialing.
5. Sell to one kind of facility. Pick the facility that needs your van type most, such as dialysis centers or hospital discharge planners.
6. Add private pay. Set prices from your costs and take cards.
7. Watch for broker changes. Check your state Medicaid agency’s notices and each health plan’s provider news page every month.
8. Hold a reserve. Keep enough cash to cover fixed costs for your largest payer’s notice period.
9. Recheck every quarter. Shares move as contracts start, grow, and end.