NEMT vs Rideshare in 2027: Where App-Based Rides Fit in Medicaid

Rideshare apps now carry some Medicaid riders to their appointments, including riders a small NEMT company could have driven. That does not make rideshare a replacement for NEMT. It is one more mode in the Medicaid system, with its own rules, rates, and limits, and those limits mark out the work that still belongs to you.

What rideshare means in Medicaid

Medicaid calls rideshare companies transportation network companies, or TNCs. The national provider taxonomy has carried a code for them, 342000000X, since January 1, 2021, defined as a ride-sharing company that provides prearranged or contracted non-emergency medical transportation through mobile or online technology (NUCC code set, version 26.1). A NEMT van company uses a different code, 343900000X. Georgia’s NEMT manual (July 1, 2026) describes a TNC as a company that uses software applications to connect customers with drivers in privately owned vehicles, and that holds a Georgia TNC license where one applies.

CMS calls TNCs “a type of transportation provider” and leaves it to each state whether and how to use them (SMD 23-006, September 28, 2023). The usual Medicaid rules still apply. Each ride must be the least costly appropriate mode that meets the member’s medical needs, and payment must be consistent with efficiency, economy, and quality of care.

	NEMT company	Rideshare company
Drivers	Your employees or contractors, credentialed to your broker’s standards	Drivers using their own cars
Vehicles	Sedans, wheelchair vans, stretcher vans	Personal cars
Riders it can take	Ambulatory, wheelchair, stretcher, and riders who need hands-on help	Ambulatory riders who need no physical help, where allowed
Help given	Curb-to-curb, door-to-door, or hand-to-hand, as the trip requires	Rides only, for members who need no physical help (Georgia)
How it joins	Medicaid enrollment and broker credentialing	A contract with the state, a health plan, or a broker, and enrollment where the state requires it
Same driver on repeat trips	Possible	Unlikely

How states and brokers use rideshare

MACPAC’s June 2021 report to Congress found that, as of February 2021, at least 14 states and the District of Columbia used rideshare companies as first-choice NEMT providers. That means a rider could be assigned a rideshare on the first request, not only as a backup. Other states allowed it only in limited cases. Current state rules show that range:

Program	When rideshare may take a Medicaid trip
Louisiana	For ambulatory members only, under contract with a health plan, the state, or their broker (state plan amendment LA-25-0017, effective November 20, 2025)
Virginia fee-for-service (MTM Health)	For members who get in and out alone and use no mobility device, only when driver and vehicle meet all Medicaid and MTM Health credentialing, screening, insurance, and training requirements
Georgia	Only as a backup when the assigned provider no-shows or no provider is available, or on the member’s request with broker approval, and only for ambulatory members who need no physical help. The broker needs the member’s prior knowledge or consent and keeps a record of it.
Colorado	Only when the assigned provider cannot do the trip and no other enrolled provider can in time, or when no provider is available in the member’s county or service area when the trip is requested. The broker documents each use and the reason (HB26-1328, in effect July 1, 2026).
Indiana	Rideshare companies enroll as provider specialty 267, then contract with the fee-for-service broker or a health plan’s broker
Arizona	Rideshare companies have their own provider type (NT) in the state’s rate file. They serve health plan members only through the plan’s NEMT broker, which books every ride, and they may not take calls from members (medical policy 310-BB, effective October 1, 2026).
Texas fee-for-service	Rideshare companies enroll directly with TMHP, as demand response companies do, and bill trips under T2003 (Medical Transportation Program handbook, September 2026)

Georgia also bars rideshare for trips to and from nursing homes and adult day health centers, and it says some broker rules may not apply to rideshare trips, such as vehicle signage, inspections, training, and complaint procedures. For Louisiana’s change, see Louisiana approves rideshare for Medicaid NEMT. Colorado’s law came with other new rules for providers. See Colorado’s NEMT video camera law.

Which riders rideshare cannot take

The limits come from the rider’s needs. CMS’s Coverage Guide says states must consider a member’s support needs when choosing the mode, and that a member who uses a wheelchair must ride in a wheelchair accessible vehicle. MACPAC’s June 2021 report adds that rideshare drivers and vehicles are not trained or equipped for members with high physical or behavioral health needs, and that even members who walk on their own may need more help than a rideshare driver usually gives.

Rider	Rideshare?	Why
Walks, gets in and out alone, needs no help	Often, where allowed	Louisiana, Georgia, and Virginia limit rideshare to these riders
Uses a wheelchair	Generally no	Needs a wheelchair accessible vehicle. Arizona’s rate file is an exception that lists rideshare wheelchair van rates.
Must lie down	No	Needs a stretcher van or an ambulance. See NEMT vs ambulance.
Needs help from the door to the vehicle	Generally no	Georgia allows rideshare only for members who need no physical help. See door-to-door service.
Must be handed from one responsible person to another	Generally no	Virginia’s hand-to-hand level exists for riders such as some with dementia or developmental disabilities
Cannot find a driver, walk to a pickup spot, or correct a wrong address	Poor fit	MACPAC’s June 2021 report lists these as reasons some riders should not be assigned to rideshare
Rides to dialysis or treatment several times a week	Poor fit	MACPAC found that a different driver on each ride gives little continuity, a concern for riders whose condition could change or worsen fast
Lives in a rural area	Often unavailable	CMS’s expanded report to Congress (June 20, 2023) says rideshare is generally not available in rural areas
Going to or from a nursing home or adult day health center	No, in Georgia	Georgia’s manual bars it

Rideshare driver rules vs NEMT driver rules

Federal law sets one floor for everyone except public transit authorities. Section 1902(a)(87) of the Social Security Act, added by the Consolidated Appropriations Act, 2021, requires states to ensure that every NEMT provider and driver, rideshare companies included, meets four minimums. It generally applies to services on or after December 27, 2021, with a later date allowed for states that needed new state laws (CMS informational bulletin, July 12, 2021):

1. The provider and each driver are not excluded from federal health care programs or listed on the HHS Inspector General’s exclusion list.
2. Each driver has a valid driver’s license.
3. The provider has a process to address any violation of a state drug law.
4. The provider has a process to disclose each driver’s driving history, including traffic violations, to the state Medicaid program.

States can ask more, and many ask more of NEMT companies than of rideshare:

Program	NEMT company drivers	Rideshare drivers
Louisiana	A CDL or chauffeur license, and a yearly criminal history check through the State Police or the FBI, sent to the health plan or broker	A valid driver’s license, with criminal history checks run by the rideshare company
Georgia	The broker’s full provider rules, including signage, inspections, and training	A valid license, no convictions for sexual or violent crimes, and no impaired-driving conviction in the five years before hire, verified by the broker
Virginia fee-for-service	MTM Health’s credentialing, screening, insurance, and training	The same requirements
Colorado	The credentialing the state sets for providers, drivers, and vehicles, plus two-way video dash cameras for fleets of more than five vehicles	The driver, vehicle, safety, and credentialing rules the state sets for rideshare companies. The camera rule covers transportation providers, and the law’s definition of a transportation provider leaves out rideshare companies.

The gap was wider before the federal floor applied. MACPAC reported in June 2021 that Arizona and Texas had exempted rideshare companies and their drivers from requirements such as background checks, training, credentialing, incident reporting, and insurance, to bring them into the market. Arizona’s current policy requires rideshare companies to keep records of each driver’s criminal background and federal exclusion checks for at least six complete calendar years (medical policy 310-BB, effective October 1, 2026). For what your own drivers need, see NEMT driver requirements.

What rideshare is paid compared with a NEMT company

Georgia’s manual leaves the rideshare rate to a negotiation between the broker and each rideshare company. Arizona is one state that publishes rideshare rates. Its rate file effective October 1, 2026 sets them only for the capped fee schedule its health plans use, next to the fee-for-service rates it pays other providers:

Code	Service	Fee-for-service rate	Rideshare rate
A0120	Base rate, mini-bus or other transportation system, urban	$6.64	$4.00
A0120 TN	Base rate, mini-bus or other transportation system, rural	$7.27	$4.38
S0215	Mileage, urban	$1.28 a mile	$0.67 a mile
S0215 TN	Mileage, rural	$1.63 a mile	$0.92 a mile

On an 8-mile urban trip billed under A0120 and S0215, that is $6.64 plus 8 × $1.28, or $16.88, at the fee-for-service rate. At the rideshare rate it is $4.00 plus 8 × $0.67, or $9.36, about 55 percent as much. Arizona counts trips that start outside the Phoenix and Tucson metro areas as rural. The same file also lists rideshare rates for the wheelchair van and stretcher van codes, at about 53 to 60 percent of the fee-for-service rates.

Lower rates do not always mean lower costs for the program. MACPAC’s June 2021 report found little systematic data on costs. One broker said rideshare had a lower cost per mile. In a Virginia pilot, rideshare rides under 10 miles cost less per trip but brought little to no savings overall, and Massachusetts did not expect savings from its pilot.

Where rideshare wins

Rideshare is good at the trips that strain a small fleet. MACPAC’s interviews found that rideshare companies can:

• add drivers on demand during busy periods
• take longer trips than many NEMT providers will
• respond to urgent same-day and next-day requests
• handle requests at odd hours, such as a late-night hospital discharge
• serve as the rescue ride when a NEMT provider is late or does not show

Most items on that list are trips a NEMT company could not take or did not show up for. In Georgia and Colorado, rideshare gets a Medicaid trip mainly when a NEMT provider fails to show or none is available.

How a small NEMT company competes with rideshare

1. Build around riders an app cannot serve. Wheelchair, stretcher, door-to-door, hand-to-hand, and escorted riders need a trained driver and the right vehicle. See how to start a wheelchair transportation business.
2. Never be the no-show that triggers the backup. Where rideshare is the rescue ride, your missed pickups are its trips. Track on-time performance and fix late routes. See how to improve NEMT on-time performance.
3. Take the short-notice work. MTM Health’s Virginia handbook expects providers to keep capacity for urgent trips, reach a will-call return within 45 minutes, and reach a hospital discharge within three hours, with liquidated damages for missing the discharge window. If you can cover those, the broker has less reason to call an app. See hospital discharge transportation.
4. Hold the standing orders. Riders who go to dialysis or treatment several times a week do better with a familiar driver. Offer the same driver and the same time, and ask the clinic to request you. See dialysis transportation.
5. Cover the rural map. CMS says rideshare is generally not available in rural areas, and those trips still need someone. See rural NEMT.
6. Run credentialed sedans where the rules are equal. Where rideshare drivers must meet the same credentialing as yours, as in MTM Health’s Virginia network, a sedan with a trained, familiar driver competes on service. Rides for riders who walk usually pay less. Arizona’s fee-for-service base rate is $6.64 under A0120 and $11.15 under A0130 for a wheelchair van (October 1, 2026). Check that the rate covers your own cost per trip.
7. Sell what rideshare cannot promise to facilities and families. Nursing homes, adult day centers, and families of riders with dementia need a driver who hands the rider to a person, not a curb. See how to get NEMT facility contracts and private pay NEMT.
8. Read your own state’s rule. Whether rideshare takes trips first, second, or never decides how much of your ambulatory work is at risk. Start with your state guide.