# How to Start a Non-Medical Transportation Business in 2027: Programs, Permits, and Pay

Canonical URL: https://nemtguide.com/guides/non-medical-transportation-business/ · Updated 2026-10-02

A non-medical transportation business drives riders who can walk, in sedans and minivans, on trips that need no medical vehicle: jobs, day programs, errands, and in California, ordinary rides to Medi-Cal visits. Medicaid waivers, area agencies on aging, Medi-Cal, some Medicare Advantage plans, and private riders pay. You form the company, get your state's for-hire permit, insure for paid rides, and enroll with each payer.

- Waiver rides go only to the places in a rider's service plan, never to medical care the state plan covers.
- Paid rides usually need a for-hire permit: ADOT's Vehicle for Hire permit in Arizona, a DPS registration or limousine certificate in Georgia, a CPUC permit in California.
- Most personal auto policies exclude driving for hire, so put every car on a commercial policy before the first paid ride.
- In Florida, staff who go along on a rider's trips and outings can make you a companion service that registers with AHCA for $50.75 every two years.
- Shared rides pay very differently: Ohio's waiver pays every rider the full per-trip rate, while Medi-Cal pays a lower base rate per rider when riders share the car.

A non-medical transportation company is the simplest kind of ride business to equip. It needs no lift, ramp, or stretcher, only sedans or minivans and drivers who are good with people. The work is in the paperwork: a for-hire permit for the cars, insurance that covers paid rides, and a separate sign-up with every program that pays.

## What a non-medical transportation business does

The company drives riders who can walk to the car and sit in a regular seat. Many trips go somewhere other than a doctor: a job, a day program, a senior center, the grocery store, church, or a family visit. The driver opens doors, steadies a rider, and stows a walker, but the rider needs no special vehicle.

"Non-medical" means two different things depending on who pays. In Medicaid waivers it describes where the ride goes: anywhere in the rider's service plan except medical care. In California's Medi-Cal it describes the vehicle: an ordinary car, taxi, or transit ride to a covered appointment, for a rider who needs no wheelchair van. [NEMT vs NMT](https://nemtguide.com/glossary/nemt-vs-nmt/) compares the two. If you want Medicaid trips to medical visits in a sedan instead, see [how to start an ambulatory transportation business](https://nemtguide.com/guides/start-an-ambulatory-transportation-business/).

## Who pays for non-medical rides

There is rarely one big contract. Each payer below has its own sign-up, so plan on several small enrollments.

- **Medicaid waivers.** CMS's core definition of waiver non-medical transportation is a ride to waiver and other community services, activities, and resources in the rider's service plan. It comes on top of the state's medical transportation and never replaces it, and family, neighbors, friends, or community agencies that can drive for free come first (1915(c) technical guide, version 3.6, January 2019). You enroll with the agency that runs each waiver. See [how to become a waiver transportation provider](https://nemtguide.com/guides/waiver-transportation-provider/).
- **Area agencies on aging.** Older Americans Act supportive services include transportation to reach supportive and nutrition services, and rides an area agency arranges with local transportation providers ([42 U.S.C. 3030d(a)(2)](https://www.law.cornell.edu/uscode/text/42/3030d)). Each agency serves a city, a county, or a multi-county district, and the Eldercare Locator at 1-800-677-1116 finds yours. See [area agency on aging transportation](https://nemtguide.com/guides/area-agency-on-aging-transportation/).
- **Medi-Cal in California.** Medi-Cal's non-medical transportation (NMT) is a ride by private or public vehicle to a covered appointment for a member with no other way to get there. DHCS says licensed medical transportation companies can provide NMT for fee-for-service and plan members, and Medi-Cal health plans also contract with other transportation providers.
- **Medicare Advantage plans.** A CMS memo of April 24, 2019 lists transportation for non-medical needs, such as grocery shopping and banking, as a benefit plans may offer chronically ill members. The plan may reimburse it, arrange it, or provide it. See [Medicare Advantage transportation](https://nemtguide.com/guides/medicare-advantage-transportation/).
- **Riders and families.** Private pay covers any trip a rider books. The [senior transportation guide](https://nemtguide.com/guides/senior-transportation-business/) shows how to price errands and wait time.

A company new to Medi-Cal that wants only NMT files the full transportation package: the application (DHCS 6206), disclosure statement (DHCS 6207), provider agreement (DHCS 6208), and the application fee. For each car it attaches DMV registration and proof of insurance, and for each driver a California license, a DMV driving record, and the MCSA-5875 and MCSA-5876 medical forms (provider manual pages updated August 2020).

## The permit you need to carry riders for pay

Driving riders for pay usually takes a for-hire permit, and the rules change from state to state. Three states show how different the permits are, as of October 2026.

### Arizona: an ADOT Vehicle for Hire permit

No vehicle for hire company may operate in Arizona until the ADOT Motor Vehicle Division issues it a permit ([A.R.S. 28-9503](https://www.azleg.gov/ars/28/09503.htm)). A sedan or minivan company usually fits the livery class: a vehicle with up to 15 seats, driver included, charging a flat rate or flat hourly rate between zones or within an area, and allowed to run prearranged trips.

1. **Register your business name** with the Arizona Corporation Commission or the Secretary of State.
2. **Submit one application** through the DocuSign link on ADOT's livery application page. ADOT emails you once it is processed.
3. **Print the permit** from your ServiceArizona account and keep a copy in every vehicle.

The permit lasts three years. The statute sets an application fee only for taxis, $24 per taxi up to $1,000, and none for livery vehicles. Report contact changes within 10 business days and ownership changes within 30 days. ADOT revokes the permit if your insurance lapses. For the AHCCCS side, see the [Arizona guide](https://nemtguide.com/states/arizona/).

### Georgia: GIMC registration or a limousine certificate

Georgia's Department of Public Safety splits carriers by who rides. A company that carries only elderly or disabled riders, 10 or fewer at a time, for hire in non-emergency vehicles within Georgia registers under GIMC with the DPS UCR-GIMC Section (844-238-8097). The [Georgia guide](https://nemtguide.com/states/georgia/) walks through that registration.

A company that carries any riders, not only elderly or disabled ones, in sedans, SUVs, or other vehicles for up to 10 people and charges by the vehicle, a flat rate, or by the hour needs a Class B Limousine Carrier Certificate instead, and DPS notes that this authority does not include non-emergency carriers. DPS's application, form TR0050 (the December 2014 form DPS still posts in October 2026), sets out the rest:

- **Fee:** $90 for fewer than 6 vehicles, $165 for 6 to 15, and $215 for more than 15.
- **Timeline:** about 8 to 12 weeks, and you cannot operate until the certificate arrives.
- **Owners:** a state background check (GCIC for Georgia residents) and a certified 3-year driving history for every owner, partner, and officer, plus a DPS training class.
- **Assets:** at least $50,000, and personal assets can count.
- **Vehicles:** a DPS safety inspection every year, and GIMC registration for in-state carriers.
- **Drivers:** a chauffeur endorsement from the Department of Driver Services.
- **Fares:** flat rate, charter, or hourly only. Per-person fares are not allowed.
- **Insurance:** filed by your insurer on Form E, at least $100,000 per person, $300,000 per accident, and $50,000 for property damage for vehicles seating 12 or fewer.

### California: a CPUC permit for non-medical trips

California's Passenger Charter-Party Carriers' Act exempts vehicles used exclusively for medical transportation (Public Utilities Code 5353(i)). The Public Utilities Commission applies that exemption vehicle by vehicle. Rides to doctors, clinics, and hospitals and rides for people with developmental disabilities to and from regional centers qualify. General paid rides for non-medical purposes do not.

That matters if one car does both kinds of work. The commission says a vehicle used for medical rides and other paid passenger trips may lose the exemption entirely, including for its medical trips. A car that takes paying riders shopping or to social outings needs charter-party authority. The P permit covers vehicles seating fewer than 16, driver included, and its charges must be based on mileage, time, or both. A carrier that does not offer rides to the public, and drives only under contracts with businesses or government agencies, fits the Z permit instead. See [California TCP permit](https://nemtguide.com/guides/california-tcp-permit/) and the [California guide](https://nemtguide.com/states/california/).

## Florida: county permits and the companion rule

In Florida, counties and cities issue vehicle-for-hire licenses, and the [Florida NEMT license guide](https://nemtguide.com/guides/florida-nemt-license/) lists the county offices. A 2024 law helps a sedan company that crosses county lines: a valid vehicle-for-hire license from the county or city where you are based lets you operate in any other county or city without another license or fee, if no license of yours was suspended or revoked in the past 5 years (2026 Florida Statutes, 320.0603). It does not cover airports or seaports, wheelchair or stretcher rides, or riders whose condition makes a regular bus, taxi, or other vehicle for hire impractical.

### When riding along makes you a companion service

Florida defines a companion as someone who spends time with or cares for an elderly, handicapped, or convalescent person and goes with them on trips and outings. A companion may not give hands-on personal care (400.462(8)). Anyone who provides companion services must register with the Agency for Health Care Administration, though contractors of the Agency for Persons with Disabilities who serve only people with developmental disabilities are exempt (400.509). If your drivers will stay with riders during outings, ask AHCA in writing whether you need to register.

If you register, AHCA's rules as of October 2026 are:

- **Cost:** $50.75 for a two-year registration, plus background screening for every employee. Administrators, financial officers, and owners count as employees.
- **Who files:** everyone, including a person working alone with no staff.
- **Form:** AHCA Form 3110-1003, filed online or on paper, naming the counties you will serve within your health planning district (Rule 59A-8.025).
- **Timeline:** AHCA flags any errors within 30 days, you have 21 days to answer, and it decides within 60 days of a complete application.
- **Name:** it cannot include words such as medical, health care, or nursing, or suggest services beyond companion and homemaker work.
- **Advertising:** every ad must show your AHCA registration number (400.509(5)).
- **Records:** a confidential file for each client with contacts, any service agreement, the services given, and activity limits.
- **Renewal:** at least 60 days before it expires, or a $25.38 late fee. If it lapses, you stop operating and apply again as new.

The [senior transportation guide](https://nemtguide.com/guides/senior-transportation-business/#florida-staying-with-the-rider-can-be-a-companion-service) covers how companion work fits next to ride service.

## Insurance for paid rides

Your personal policy will most likely not cover a paid ride. The California Department of Insurance says most standard personal auto policies exclude livery, meaning driving for hire. Its sample exclusion denies coverage while a car is used as a public or livery conveyance, except for a share-the-expense car pool.

A business auto policy can cover business, personal, hired, and non-owned autos, depending on the coverage you buy. The department's commercial insurance guide (revised June 14, 2024) says common combined single limits are $500,000 or $1,000,000. Your state permit sets the floor:

- **Arizona livery, 8 or fewer seats:** $250,000 in liability with $250,000 in uninsured motorist coverage. A second option sets $250,000 per incident once a ride is accepted, with uninsured motorist coverage of $25,000 per person and $75,000 per incident.
- **Arizona, 9 to 15 seats:** $750,000 with $300,000 in uninsured motorist coverage.
- **Georgia limousine carriers, 12 or fewer seats:** $100,000 per person, $300,000 per accident, and $50,000 for property damage.

Each program you join can require more. See [NEMT insurance requirements](https://nemtguide.com/guides/nemt-insurance-requirements/) before you call an agent.

## What non-medical rides pay

Every program sets its own rates, and the biggest difference shows up when riders share the car. Ohio's waiver pays each rider the full per-trip rate however many ride together, while Medi-Cal pays a lower base rate per rider as riders are added.

| Ride (rate date) | One rider | Two riders together | Three riders together |
|---|---|---|---|
| Medi-Cal NMT base rate, A0120 (page updated August 2020) | $17.65 | $14.10 each | $11.17 each |
| Ohio waiver, per trip, Franklin County (January 2, 2025) | $28.29 | $28.29 each | $28.29 each |
| Ohio waiver, per mile, regular car (January 2, 2025) | $0.83 a mile | $0.42 a mile each | $0.42 a mile each |

Here is what that means for one van. Three riders from the same home to the same Franklin County day program bill $84.87 one way at Ohio's per-trip rate. Three Medi-Cal fee-for-service riders sharing one NMT trip to the same clinic bill $33.51 in base rates, before mileage.

**Ohio's developmental disabilities waivers** (Individual Options, Level One, and SELF) pay by trip or by mile under rule 5123-9-18. The per-trip rate runs from $26.91 to $28.85 per rider by county group and includes the driver's cost. Unless the service plan says otherwise, it applies between a rider's home and a job, day program, or similar site the rule lists, and the per-mile rate covers other trips. A rider who rides alone to a regular paying job can qualify for a higher special rate, such as $36.21 for an agency's trip of up to 15 miles in a regular car. Every provider needs an Ohio Medicaid provider agreement, and the Ohio Department of Medicaid is not accepting new enrollments from waivered services organizations or individuals from May 14 to November 14, 2026, unless CMS extends the pause, so a new Ohio company waits for it to lift. [Ohio DODD non-medical transportation](https://nemtguide.com/guides/ohio-dodd-non-medical-transportation/) covers certification and the rest of the rates.

**Medi-Cal fee-for-service** pays up to $17.65 for the base of each one-way NMT trip (A0120) and $1.30 a mile (A0390). A0120 is limited to eight units a month unless the claim shows the rides were needed for Medi-Cal care. Each rider gives an attestation that they have no other way to get there, for one trip or up to a month at a time, and you keep it on file. Medi-Cal health plans set their own rates by contract.

Other waivers pay per zone, per day, or per 15 minutes; the [waiver guide](https://nemtguide.com/guides/waiver-transportation-provider/) lists several. Area agency contracts often pay a set rate per trip and may ask you to bring part of the cost as match. For private riders, build prices from your own costs with [how much to charge for NEMT](https://nemtguide.com/guides/how-much-to-charge-for-nemt/).

## How to start a non-medical transportation business, step by step

1. **Choose your payers.** Waiver riders, aging contracts, Medi-Cal, health plans, and private riders each need their own sign-up. Start with one or two.
2. **Check that enrollment is open.** Pauses like Ohio's 2026 moratorium can close a program for months.
3. **Form the company and get an EIN.** See [LLC for NEMT](https://nemtguide.com/guides/llc-for-nemt/). Get an NPI if a program asks for one, as the Medi-Cal application does.
4. **Get your for-hire permit.** Arizona's ADOT permit, Georgia's GIMC registration or limousine certificate, California's CPUC authority for paid non-medical trips, or your county's vehicle-for-hire license in Florida.
5. **Register as a companion service in Florida** if your staff will go along on outings.
6. **Insure every car** on a commercial policy at your permit's minimums or more.
7. **Screen and train drivers** to each program's rules, and get Georgia chauffeur endorsements where they apply.
8. **Enroll with each payer.** File with the waiver agency, ask the area agency when it next buys rides, apply to Medi-Cal, and ask health plans who arranges their non-medical rides.
9. **Keep a record for every trip.** Ohio's rule, for example, asks for the mode, date, plate number, rider name and Medicaid number, pickup and drop-off points, start and stop times, the driver's signature, and everyone who rode along. The [trip log template](https://nemtguide.com/templates/nemt-trip-log-template/) has room for these.
10. **Meet the people who book rides.** Case managers, service coordinators, and senior centers choose providers for their clients, so tell them your area, hours, and phone number.

## Frequently asked questions

### Do I need a license to start a non-medical transportation business?

Usually you need a for-hire permit, not a medical license. Arizona requires an ADOT Vehicle for Hire permit before a livery company operates. Georgia sends companies that carry only elderly or disabled riders to its GIMC registration, and companies selling flat-rate or hourly sedan rides to the public need a Class B limousine carrier certificate. California requires CPUC charter-party authority for paid non-medical trips. Each program you bill has its own enrollment too.

### Can I use my personal car and personal insurance?

Usually not on a personal policy. The California Department of Insurance says most standard personal auto policies exclude livery, which means driving for hire, and its sample exclusion removes coverage while a car is used as a public or livery conveyance. Put each car on a commercial auto policy at the limits your state and each program set, such as Arizona's $250,000 liability floor for livery vehicles with 8 or fewer seats.

### Can a waiver ride take someone to the doctor?

No. CMS's instructions for 1915(c) waivers say waiver transportation may not replace the medical transportation a state must provide. A waiver member's ride to medical care covered by the state plan is billed as state plan transportation or an administrative cost, not as waiver non-medical transportation. Book those trips through the state's NEMT program or broker, and bill the waiver only for trips its service plan lists.

### How much does non-medical transportation pay?

It depends on the program. Ohio's developmental disabilities waivers pay $26.91 to $28.85 per rider for a one-way trip, by county, under rates effective January 2, 2025. Medi-Cal's fee-for-service maximum for a non-medical trip is $17.65 plus $1.30 a mile. Area agencies on aging set rates in each contract, and private riders pay the prices you set.

### Do I need to register as a companion service in Florida?

Possibly, if your staff stay with riders. Florida defines a companion as someone who spends time with an elderly, handicapped, or convalescent person and goes with them on trips and outings, and anyone who provides companion services must register with AHCA. Registration costs $50.75 for two years plus background screening. Agency for Persons with Disabilities contractors serving only people with developmental disabilities are exempt. If you only drive, ask AHCA in writing.

## Official resources

- [Eldercare Locator: find your area agency on aging](https://eldercare.acl.gov/)
- [DHCS: Medi-Cal Transportation Services](https://www.dhcs.ca.gov/services/medi-cal-resources/transportation-services/)
- [ADOT MVD: Livery and Limousines (Vehicle for Hire permit)](https://azdot.gov/mvd/services/professional-services/vehicle-hire-licensing/livery-and-limousines)
- [Georgia DPS: Which license or registration you need](https://www.gamccd.net/lpcwhatdoineed.aspx)
- [CPUC: Charter-party carriers](https://www.cpuc.ca.gov/regulatory-services/licensing/transportation-licensing-and-analysis-branch/charter-party-carriers)
- [AHCA: Homemaker and Companion Services registration](https://ahca.myflorida.com/health-quality-assurance/bureau-of-health-facility-regulation/long-term-care-services-unit/homemaker-companion-services-provider/general-information.html)