NC IVC Transport in 2027: County Agreements and How a Private Company Is Designated

Involuntary commitment, called IVC in North Carolina, starts with a custody order from a magistrate or clerk. Someone then has to take the person, called the respondent, to an examination and often on to a 24-hour psychiatric facility. The law puts that job on cities and counties, and most still hand it to deputies and police. It also leaves a written door open for private companies, and the state is now trying to move more of these rides out of patrol cars.

Secure and crisis rides in general, including how other states license them, are covered in behavioral health transportation. Ordinary North Carolina Medicaid trips run through NCTracks, county social services offices, and the health plans’ brokers, as the North Carolina guide explains. This page covers only IVC custody and transport.

Who must provide IVC transport in North Carolina

G.S. 122C-251 makes IVC transport a local government duty. A city transports a respondent who lives in the city or is taken into custody inside city limits. The county covers everyone else in the county, and cities and counties may contract with each other.

Rides that cross county lines follow a different rule for each leg:

The ride	Who must provide it
Within one county, including admission and discharge	The city or the county, by residence or place of custody
To another county for a first examination or admission to a 24-hour facility	The county where the respondent was taken into custody
Between counties after a respondent asks to move the court hearing	The county where the petition started
Between counties at discharge from a 24-hour facility	The respondent’s county of residence

The statute allows three ways to do the work: city or county vehicles, a private vehicle under contract with the city or county, or the people named in a transportation agreement the local board adopts. A respondent being discharged may also ride home in their own transportation at their own expense.

The law also sets the tone of the ride. To the extent feasible, officers wear plain clothes, drive unmarked vehicles, and tell respondents they are not under arrest and have committed no crime. The city or county provides a driver or attendant of the same sex as the respondent where feasible, unless the officer lets a family member ride along instead.

How a private company gets designated

Since a 2018 law, every city and county governing body must adopt an involuntary commitment transportation agreement. Law enforcement and other affected agencies, including local acute care hospitals and mental health providers, take part in writing it. The first agreements were due by January 1, 2019.

The agreement may designate law enforcement officers, volunteers, or other public or private personnel to provide all or part of the custody and transport. G.S. 122C-251(g) sets the conditions for a company:

1. Written consent. No company is designated without its own written consent, and no person without their written consent and their employer’s.
2. Only what you agreed to. You provide only the services you consented to in writing, such as transfers from one hospital to a 24-hour facility, and nothing more.
3. A way out. You may withdraw from all or part of the work by written notice to the board that designated you.
4. Notice of changes. When the county changes its agreement, it sends the new version to the district’s magistrates, the clerks of court, the local LME/MCO, and the state Division of Mental Health, Developmental Disabilities, and Substance Use Services at least 10 days before it takes effect.
5. The same procedures. You follow the commitment procedures in Article 5 of Chapter 122C, and the statute says its references to a law enforcement officer apply to anyone designated to provide custody or transport.

The agreement may also say that private personnel or agencies may contract to move respondents from one entity to another. Forsyth County’s agreement works this way: one hospital system signed its own contract with a security company to make these rides, and the county agreement designates that company’s staff.

Training, timing, and rules on the ride

Each LME/MCO keeps a community crisis services plan that includes the transportation agreements for its counties. Under G.S. 122C-202.2, the plan identifies training for transporters, and designated staff who are not law enforcement officers must take it. To the extent feasible, the training covers de-escalation, the safe use of force and restraint, the respondent’s rights, the location of local examination sites, and how to complete and return the custody order to the clerk. It may be a Crisis Intervention Team course or another mental health program. Wake County’s 2019 plan, for example, recommended Crisis Intervention Team training for the officers who respond to and transport people in crisis. Find your county’s LME/MCO in the state’s LME/MCO directory.

Two clocks apply to IVC rides:

• 24 hours to take custody. Under G.S. 122C-261(e), the officer or designated person takes the respondent into custody within 24 hours after the order is signed.
• 6 hours to move. Under G.S. 122C-263, once the examiner’s facility asks for transport to a 24-hour facility, a designated person goes without unnecessary delay and within six hours of the request.

The respondent’s health screening record goes with the respondent, or is made available to the receiving facility at the time of transport. The statute allows reasonable force and restraint only when needed for safety, and asks the transporter to make every effort to avoid restraining a child under 10. It also shields anyone designated to provide custody or transport from liability for reasonable measures taken under the law. Ask your insurer to confirm in writing that your auto and general liability policies cover custody transports, and see NEMT insurance requirements for the base policies. For de-escalation on the ride itself, see handling difficult or unsafe riders.

What county agreements look like

County agreements differ a great deal, so read yours before you call anyone.

• Forsyth County. The agreement effective October 1, 2019 names the county, Winston-Salem, Kernersville, two hospital systems, and a crisis provider. It designates the hospitals’ own security staff and one hospital’s contracted security staff as private agency personnel for some transfers to 24-hour facilities. They must hold current basic life support certification, a nonviolent crisis intervention certificate renewed every year, and a North Carolina driver’s license, and follow Joint Commission standards and the Medicare Conditions of Participation. None of them may carry a respondent to a first examination on a layperson’s petition, and the contracted staff may not serve custody orders. Deputies and police keep that work.
• Wake County. As of October 2026, the Sheriff’s Office says its Judicial Transport Unit moves IVC patients to facilities across the state. The Apex agreement adopted January 26, 2021 says that after the town’s police make the first transport, the Sheriff’s Office handles later transports inside the county, through its own staff or a contract with a private agency. See the Wake County page for the county’s Medicaid ride program.
• Caldwell County. On June 9, 2025, the Board of Commissioners approved an agreement with a private medical transport company to carry IVC patients, pending review by the county manager and county attorney.

Most counties still keep the work with law enforcement. In the state’s report for July 2024 to June 2025, dated January 26, 2026, designated facilities reported 36,108 IVC admissions. Their tables show law enforcement bringing in more than 25,800 of those respondents and contract transportation 2,678, about one in 13. At a February 11, 2026 state advisory committee meeting, the head of the state’s mental health division said every county’s crisis transportation plan lists law enforcement as the primary model.

Who pays for IVC transport

The respondent’s county of residence pays the cost of IVC custody and transport that a third-party insurer does not reimburse (G.S. 122C-251(h)). A city, another county, or the state that does the transport can recover its reasonable cost from the county of residence. That county may then recover from a respondent who is not indigent, or from anyone legally or contractually responsible, after giving notice and a chance to object.

That makes the county your main buyer. Hospitals are the second: they pay for transfers they contract for, and the February 2026 state advisory committee minutes say larger hospital systems run their own non-law enforcement transport but will not serve patients outside their systems because of liability concerns. When a clerk, magistrate, or judge lets a health care provider or family transport a respondent whose danger is not substantial, they bear the cost themselves.

Discharges are often a separate, calmer ride. A respondent leaving a facility may use their own transportation at their own expense, and many of those rides look like ordinary hospital discharge transportation.

What is changing in 2026 and 2027

The state wants more IVC rides done without police, and the General Assembly put $20 million toward that goal.

• December 20, 2024. NCDHHS announced $20 million for non-law enforcement transportation from emergency rooms to treatment, starting in two regions chosen through a competitive bid.
• December 17, 2025. NCDHHS told the House Select Committee on Involuntary Commitment and Public Safety that the bid responses did not meet the state’s needs, and that it was pursuing contract options, especially for counties and hospitals with no alternative transport.
• February 5, 2026. Executive Order 33 directs NCDHHS and the Department of Public Safety to recommend ways to improve mental health transport, including civilian transport positions and crisis training for anyone who transports.
• July 6, 2026. Session Law 2026-38 (House Bill 1104) orders a study of the IVC system, including transport guidance written with the UNC School of Government. Progress reports are due December 1, 2026 and the final report by March 1, 2027.

No bidder met the standards the first time, so be ready to show your training, vehicles, insurance, and round-the-clock coverage if the state bids the work again.

How to pursue IVC transport work in your county

1. Get your county’s agreement. Ask the clerk to the board of commissioners or the sheriff’s office for the current involuntary commitment transportation agreement and any city agreements in the county.
2. Find out who does the rides today. Ask the sheriff’s transport supervisor how many IVC transports the office makes, how far they go, and which legs it would hand off first, such as transfers from an emergency department to a 24-hour facility.
3. Meet the hospitals. Emergency department, case management, and security leaders know which transfers wait longest for a deputy.
4. Take the LME/MCO’s training. Ask your county’s LME/MCO which program its crisis plan identifies, and put every driver and attendant through it before you ask to be designated.
5. Line up staff and insurance. Plan for a same-sex attendant where feasible, a response within six hours, and written insurer confirmation for custody transports.
6. Offer a specific, written scope. Propose the exact services you will provide, in writing, because that is all a designation can cover. Ask the county to send the amended agreement to the magistrates, clerks, LME/MCO, and state division at least 10 days before you start.

The same county relationships help with other public contracts too. See government NEMT contracts for how counties buy rides, and the Mecklenburg County page for how the county’s own Medicaid ride system uses private companies.