# Medicaid NEMT Spending by State in 2027: What Each State Reports to CMS and How Many Rides It Buys

Canonical URL: https://nemtguide.com/guides/nemt-spending-by-state/ · Updated 2026-10-06

States and territories reported $2.83 billion of NEMT spending to CMS for fiscal year 2024: $2.27 billion in regular medical payments, $79 million in supplemental payments, and $486 million as administration. Every state figure is a floor, because rides paid through health plan capitation are not on those lines. Read each state's dollars beside its 2021 ride days per 10,000 members before you compare states.

- States and territories reported $2.83 billion on three NEMT lines of the CMS-64 for fiscal year 2024, and $486 million of it was claimed as administration.
- Rides paid through health plan capitation are not on those lines, so every state figure is a floor and a small number does not mean a small program.
- Minnesota's CMS lines show $32.0 million, while its human services department reported $151.4 million in paid claims for 2024, most of it through health plans.
- CMS counted 55.5 million NEMT ride days in 2021 and 81.3 million in 2019, and it flags Utah's 2021 data as unreliable.
- Do not divide a state's dollars by its ride days: they cover different years and follow different reporting rules.

CMS publishes what each state reports spending on NEMT, and the figures are easy to misread. For fiscal year 2024, states and territories reported $2.83 billion on three NEMT lines of the CMS-64, the form each state files to claim federal Medicaid money. The grid below puts each state's figure beside its ride days and its ride companies' receipts, because no one of the three tells the whole story. For the size of the industry overall, see [NEMT industry trends](https://nemtguide.com/guides/nemt-industry-trends/).

## NEMT spending, ride days, and company receipts in every state

The grid lists all 50 states and DC in alphabetical order. It is not a ranking: a small number in the first column can mean a state's rides are paid somewhere these lines do not reach, not that the state buys few rides.

| State | Reported to CMS, FY 2024 ($ millions) | Ride days per 10,000 members, 2021 | Company receipts, 2022 ($ millions) |
|---|---|---|---|
| Alabama | 13.3 | 321 | 18.5 |
| Alaska | 93.0 | 5,834 | 3.4 |
| Arizona | 73.7 | 14,681 | 244.4 |
| Arkansas | 84.5 | 5,180 | 12.0 |
| California | 4.3 | 2,096 | 1,067.9 |
| Colorado | 280.2 | 11,811 | 85.0 |
| Connecticut | 71.1 | 3,419 | 146.3 |
| Delaware | 32.1 | 3,024 | 24.1 |
| District of Columbia | 20.1 | 1,607 | Withheld |
| Florida | 13.5 | 5,391 | 249.5 |
| Georgia | 131.9 | 4,657 | 142.8 |
| Hawaii | 0.4 | 2,017 | Withheld |
| Idaho | 33.3 | 10,970 | Withheld |
| Illinois | 45.2 | 3,615 | 149.0 |
| Indiana | 35.4 | 3,571 | 43.7 |
| Iowa | 0.3 | 8,822 | 79.6 |
| Kansas | None reported | 2,102 | Withheld |
| Kentucky | 156.4 | 4,113 | 95.4 |
| Louisiana | 0.7 | 1,970 | 50.7 |
| Maine | 58.7 | 16,295 | 15.3 |
| Maryland | None reported | 206 | 123.7 |
| Massachusetts | 326.6 | 20,095 | 276.5 |
| Michigan | 18.9 | 3,189 | 77.1 |
| Minnesota | 32.0 | 17,998 | 144.7 |
| Mississippi | 27.5 | 5,095 | 23.5 |
| Missouri | 58.2 | 8,171 | 30.8 |
| Montana | 5.1 | 6,237 | Withheld |
| Nebraska | None reported | 3,533 | 12.2 |
| Nevada | 33.7 | 4,767 | 74.3 |
| New Hampshire | 0.3 | 12,438 | 14.5 |
| New Jersey | 185.7 | 11,325 | 123.6 |
| New Mexico | 70.3 | 4,710 | 45.1 |
| New York | 0.2 | 11,987 | 745.9 |
| North Carolina | 146.2 | 4,296 | 76.4 |
| North Dakota | 1.7 | 2,407 | 7.7 |
| Ohio | 25.9 | 2,512 | 202.4 |
| Oklahoma | 35.1 | 8,590 | 46.4 |
| Oregon | 8.6 | 10,333 | 129.3 |
| Pennsylvania | 152.8 | 1,502 | 202.5 |
| Rhode Island | 0.6 | 14,864 | 28.7 |
| South Carolina | 112.8 | 5,968 | 46.1 |
| South Dakota | 4.0 | 2,153 | 5.3 |
| Tennessee | None reported | 3,878 | 33.4 |
| Texas | 1.0 | 6,069 | 194.6 |
| Utah | 14.7 | Flagged by CMS | 70.1 |
| Vermont | 16.3 | 6,361 | No figure |
| Virginia | 72.0 | 13,231 | 207.2 |
| Washington | 123.3 | 3,478 | 230.4 |
| West Virginia | 38.3 | 10,766 | 1.8 |
| Wisconsin | 159.3 | 30,665 | 143.3 |
| Wyoming | 0.4 | 1,194 | Withheld |

Here is what each column holds.

- **Reported to CMS, FY 2024.** The total of three NEMT lines on each state's CMS-64 for the federal fiscal year from October 1, 2023 to September 30, 2024: regular payments, supplemental payments, and administration. Each is the federal and state share together, in millions of dollars. "None reported" means all three lines read zero. The file also has a separate Medical Transport line for Medicaid expansions funded by CHIP allotments, $50.1 million nationwide and $14.0 million of it in Illinois, which the grid leaves out.
- **Ride days per 10,000 members, 2021.** From the tables in CMS's expanded report to Congress, dated June 20, 2023. A ride day is a day on which a Medicaid member used NEMT, however many rides that day held. Members are those with full or comprehensive benefits. CMS lists 10 for Utah but leaves the state out of its national totals, because 96.0 to 99.9 percent of Utah's transportation claims and encounter records, depending on the year, carry one invalid procedure code. That is why the cell says flagged.
- **Company receipts, 2022.** The receipts of companies with paid employees in NAICS 485991, special needs transportation, from the 2022 Economic Census, in millions of dollars. Withheld means the Census Bureau did not release that state's figure. Its file has no figure for Vermont.

Nationally, CMS counted 6,504 ride days per 10,000 members in 2021, with Utah, Puerto Rico, and the Virgin Islands left out. That is 55.5 million ride days in all, down from 81.3 million in 2019. The Census Bureau counted 3,662 establishments and $5.8 billion in receipts for 2022.

## Why every figure in the grid is a floor

Each column leaves something out. Read these limits before you compare two states.

- **Rides paid through health plans are not on the lines.** CMS's report to Congress says the NEMT lines on the CMS-64 undercount spending, because rides under capitated arrangements, such as comprehensive health plans and transportation prepaid ambulatory health plans, are reported with the managed care payments. For a comprehensive plan, the monthly payment cannot be split to show the ride share. See [capitation](https://nemtguide.com/glossary/capitation/). Iowa shows $0.3 million in the grid, and its health plans receive a monthly payment per member. [How states run NEMT](https://nemtguide.com/guides/how-states-run-nemt/) shows which states, among them Texas, California, and Florida, have health plans arrange rides for their members.
- **States split rides across three lines.** CMS says a state may claim NEMT as a medical expense, an administrative expense, or both. Mileage paid back to members who drive or ride transit is one kind of ride that can be claimed as administration. The grid adds all three lines, so Colorado, Minnesota, and Wyoming, which report all of it as administration, do not read as zero. CMS's report lists the same three states as reporting all NEMT as administration in 2020 and 2021.
- **A small figure is not a small program.** New York shows $0.2 million, although CMS counted 11,987 ride days per 10,000 members there in 2021 and its special needs transportation companies reported $745.9 million in receipts in 2022. The CMS file does not say why the lines are so small, so look to New York's own budget documents, and see the [New York guide](https://nemtguide.com/states/new-york/) for how its rides are paid. Kansas, Maryland, Nebraska, and Tennessee show nothing on any line, and CMS counted 2,102, 206, 3,533, and 3,878 ride days per 10,000 members in them.
- **Dollars and rides cover different years.** The dollars are fiscal year 2024, the ride days are calendar 2021, and the receipts are 2022. CMS says 2021 ride days were still about 30 percent below pre-pandemic levels.
- **Ride days undercount too.** CMS finds rides in claims and [encounter data](https://nemtguide.com/glossary/encounter-data/). A ride a state claims as an administrative expense, such as mileage paid to a member, is not in that data, and CMS left Utah, Puerto Rico, and the Virgin Islands out of the 2021 national count.
- **Receipts cover more than Medicaid.** NAICS 485991 is companies "primarily engaged in providing special needs transportation (except to and from school or work) for the disabled or elderly," so the figure includes private pay and contract rides along with Medicaid. A one-van owner with no employees is not in it.

Never divide a state's dollars by its ride days to get a price per ride. The two cover different years, and the dollars leave out the plan payments.

## What Kentucky and Minnesota report themselves

A few states publish their own totals. Kentucky's CMS lines come close to its own figure, and Minnesota's do not.

**Kentucky** briefed its legislature's Budget Review Subcommittee on Health and Family Services on November 5, 2025. Kentucky pays a monthly capitation rate per member, set for each region and paid out to that region's broker. For state fiscal year 2025, July 1, 2024 to June 30, 2025, total capitated payments were $174,953,006 for 3,363,272 trips, up from 3,155,584 trips in state fiscal year 2024. Kentucky's CMS lines for fiscal year 2024 add up to $156.4 million, in the same range as the state's own figure for a different year. Dividing the payments by the trips gives about $52 a trip, but the rates also include an allowance for the brokers' administration and a risk margin, according to the briefing, so it is not what a ride company is paid. See the [Kentucky guide](https://nemtguide.com/states/kentucky/).

**Minnesota's** Department of Human Services briefed the House Fraud Prevention Committee on March 2, 2026. For 2024 it reported paid claims, federal and state, of $32.2 million for fee-for-service rides and $119.2 million through health plans, for 1.4 million and 5.5 million trips. It said health plans oversee 80 percent of NEMT spending. Minnesota's CMS lines show $32.0 million, all of it as administration, which is close to the fee-for-service share. The plan share is not in that number, so the CMS figure is about a fifth of the state's own total. See the [Minnesota guide](https://nemtguide.com/states/minnesota/).

## How to use these figures for your own state

1. **Read your state's three columns together.** Small dollars beside high ride days, as in Iowa, can mean the rides are paid through health plans, so your route in would be the plans and the broker they hire. Read [how states run NEMT](https://nemtguide.com/guides/how-states-run-nemt/) to see whether to apply to a state broker, to plans, or to a county program.
2. **Size your county, not your state.** A state total says little about the trips within reach of your vans. [NEMT market research](https://nemtguide.com/guides/nemt-market-research/) shows how to estimate demand where you drive.
3. **Count the companies you would compete with.** The receipts column shows what special needs transportation companies with employees in your state took in. See [how many NEMT companies there are](https://nemtguide.com/guides/how-many-nemt-companies/).
4. **Get the state's own total when you need one.** Look in the Medicaid agency's budget request, a legislative briefing, or the managed care rate documents. The Kentucky and Minnesota numbers above came from briefings to legislators.
5. **Check the rate before the dollars.** What you earn depends on the rate your broker or plan pays, not on the state total. See [NEMT reimbursement rates](https://nemtguide.com/guides/nemt-reimbursement-rates/).

## How to find your state's line in the CMS file

The files are public, so you can check any figure in the grid:

1. Open CMS's page for expenditure reports from MBES/CBES and download the zip named Financial Management Report for FY 2024.
2. Open the workbook "FY 2024 FMR NET EXPENDITURES." Its footer reads "Created On: Monday, April 14, 2025."
3. Open the tab named "MAP" followed by your state. Find the rows "Non-Emergency Medical Transportation, Reg. Payments" and "Sup. Payments" near the top (rows 86 and 87 in this workbook), and read the Total Computable column. The same row names appear again lower down, in the CHIP-allotment block, and read zero.
4. Open the tab named "ADM" followed by your state and read the row "Non-Emergency Medical Transportation."
5. Add the three numbers.

Colorado shows $0 on its MAP tab and $280,246,726 on its ADM tab, which is why the grid adds all three lines. As of October 2026, fiscal year 2024 is the newest on CMS's page. CMS posts a new workbook for each fiscal year, so recheck the lines for your state when the next one appears.

## Frequently asked questions

### How much does Medicaid spend on NEMT?

For fiscal year 2024, which ran October 1, 2023 to September 30, 2024, states and territories reported $2,267,828,409 in regular NEMT payments, $78,999,035 in supplemental payments, and $486,349,524 in administration to CMS, about $2.83 billion in all. That counts the federal and state share and leaves out rides paid through health plan capitation, so actual spending is higher.

### Which state spends the most on Medicaid NEMT?

On the CMS lines, Massachusetts reports the most at $326.6 million, followed by Colorado at $280.2 million and New Jersey at $185.7 million. That is not a fair ranking, because the lines leave out rides paid through health plan capitation and states split rides across three lines. Minnesota shows $32.0 million on them while its own department reported $151.4 million in paid claims for 2024. Look for your state's own total in its budget documents or a legislative briefing.

### Why does my state show almost nothing on the CMS lines?

Often because the rides are paid somewhere those lines do not reach. CMS says rides under capitated arrangements, such as comprehensive health plans, are reported with the managed care payments, and a plan's monthly payment cannot be split to show its ride share. A small figure is not a small program: Iowa shows $0.3 million, and CMS counted 8,822 ride days per 10,000 Iowa members in 2021.

### How many NEMT rides does Medicaid cover each year?

CMS counted 81.3 million ride days in 2019, 53.1 million in 2020, and 55.5 million in 2021, when 3.3 million members used rides. A ride day is a day a member used NEMT, however many rides it held, so rides are higher. CMS calls these counts lower bounds because rides a state claims as administration are not in its claims data.

### How do I look up my state's NEMT spending in the CMS file?

Download the FY 2024 Financial Management Report from CMS and open the net expenditures workbook. On the tab named MAP plus your state, read the Total Computable column for the NEMT regular payments and supplemental payments rows near the top. On the ADM tab for your state, read the NEMT row. Add the three lines, because a state may use any mix of them.

### Is there newer NEMT ride data than 2021?

Not in the reports CMS lists as of October 2026. Its Assurance of Transportation page links an initial report to Congress from June 2022 and an expanded report dated June 20, 2023, which covers 2018 through 2021. The 2021 ride days in the grid come from that expanded report, the newest state-by-state count on the page.

### Do the company receipts in the grid show Medicaid revenue?

No. They come from the 2022 Economic Census for NAICS 485991, special needs transportation, which covers companies with paid employees serving the disabled or elderly, except trips to and from school or work. The receipts include private pay and contract rides along with Medicaid, and a one-van owner with no employees is not counted.

## Official resources

- [CMS: Expenditure reports from MBES/CBES (download the Financial Management Report)](https://www.medicaid.gov/medicaid/financial-management/state-expenditure-reporting-for-medicaid-chip/expenditure-reports-mbescbes)
- [CMS: Assurance of transportation](https://www.medicaid.gov/medicaid/benefits/assurance-of-transportation)
- [CMS: Expanded Report to Congress on NEMT in Medicaid, 2018 to 2021](https://www.medicaid.gov/medicaid/benefits/downloads/nemt-rtc-2018-2021.pdf)
- [U.S. Census Bureau: 2022 Economic Census data](https://www.census.gov/programs-surveys/economic-census/data/tables.html)