# Stretcher Van Requirements in 2027: Vehicle, Equipment, Crew, and Training by State

Canonical URL: https://nemtguide.com/guides/stretcher-van-requirements/ · Updated 2026-09-29

Stretcher van requirements come from your state and your broker, not federal Medicaid law. Where the vans are allowed, expect a wheeled stretcher locked into a crash-stable mount, straps for the rider, two trained crew members with CPR or first aid training, and inspections once or twice a year. Ohio, New Jersey, and Maryland treat stretcher rides as ambulance work, and Louisiana bars the vans.

- No federal Medicaid rule sets stretcher van standards, so your list comes from the state, your county or city, and each broker.
- Illinois, New York, California, and Virginia put two people on every stretcher trip, and Georgia defines the service by the two people it takes to move the rider.
- Buy the stretcher and its mount as one crash-tested set: Virginia wants a mount that passes a 2,200-pound pull test, and New York wants it made by the stretcher's maker.
- Ohio, New Jersey, and Maryland treat stretcher rides as ambulance work, and Louisiana bars stretcher vans from NEMT, so check your state before you buy.
- A stretcher van must not look like an ambulance: Illinois bans red and blue lights, and Virginia and New York keep the Star of Life for emergency vehicles.

A stretcher van carries a rider who has to lie down for the trip but is stable and needs no medical care on the way. No federal Medicaid rule says what a stretcher van must carry or who must ride along. CMS's Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) says that beyond four minimum provider and driver checks, federal Medicaid law sets no basic driver or vehicle standards, and that state agencies generally set them.

So your list comes from three places: your state's health, transportation, or EMS agency, your county or city, and every broker you drive for. This guide lines up the states that write the rules down, so you can build a van that meets the strictest list where you work. For what a stretcher van is and how its trips bill, see [stretcher van](https://nemtguide.com/glossary/stretcher-van/) and [T2005](https://nemtguide.com/glossary/t2005/).

## Where stretcher vans are allowed, and who licenses them

Check this before you buy anything. Some states license stretcher vans, some fold them into another license, and some send every stretcher rider by ambulance.

| State | Stretcher vans in NEMT? | Who licenses or inspects, and the rule |
|---|---|---|
| Illinois | Yes, with a state license | The Department of Public Health licenses stretcher van providers at $25 per vehicle, $2,500 for 100 or more. The license lasts four years if each yearly inspection passes (77 Ill. Adm. Code 515.835, amended November 1, 2024). |
| New York | Yes, as a stretcher ambulette | Ambulettes need NYSDOT operating authority, and their vehicles are inspected twice a year (policy manual effective August 25, 2023) |
| California | Yes, as a litter van | Medi-Cal sets the vehicle, crew, and equipment rules in 22 CCR 51231.1 |
| Virginia | Yes | The fee-for-service broker inspects each stretcher van before its first trip and twice a year (DMAS requirements updated May 26, 2026) |
| Minnesota | Yes | MnDOT certifies special transportation service providers and inspects each vehicle at least yearly, and stretcher transport is its own Medicaid mode (Minn. Stat. 174.30 and 256B.0625) |
| Georgia | Yes | The state manual (version date July 1, 2026) lists stretcher vans as a ride type, and the broker inspects them before service and every six months |
| Wisconsin | Yes, in a specialized medical vehicle | Cot and stretcher trips need a prescription and a vehicle whose restraints hold the cot to the side and the floor (DHS 107.23) |
| Ohio | No, stretcher trips are ambulance trips | The ambulance definition leaves out only vehicles used solely for riders who are not stretcher-bound, and the ambulette license covers wheelchair riders (Ohio Rev. Code 4766.01, effective April 6, 2023) |
| New Jersey | No | A mobility assistance vehicle may not carry a stretcher or a rider who must travel lying down, and those riders go by BLS ambulance (N.J.A.C. 8:40-5.2, 8:40-5.6, and 8:40-6.2) |
| Maryland | Only as an ambulance | The commercial ambulance definition exempts only lift vans used just for riders in wheelchairs (COMAR 30.09.01.02) |
| Connecticut | Ask the state EMS office | An invalid coach, the state's licensed nonemergency vehicle, is defined for nonambulatory riders who are not confined to stretchers (Conn. Gen. Stat. 19a-175) |
| Louisiana | No | Stretcher vans are listed among vehicle types that are not allowed (Medicaid manual section 10.3, issued July 14, 2025) |
| Indiana fee-for-service | No | Since July 1, 2023, a member who needs a stretcher is scheduled directly with an enrolled ambulance provider, not through the broker (provider module version 6.1, August 19, 2025) |

Cities and counties can add their own permits on top. Miami-Dade County, Florida, issues separate non-emergency certificates of convenience and necessity for wheelchair, stretcher, and combined service. As of September 2026, its application costs $300 per certificate plus $25 for the background check of each person listed on it, and it asks for liability insurance of at least $100,000 per person, $300,000 per incident, and $50,000 for property damage.

Before you buy a van, ask each broker's provider relations team whether it contracts stretcher service in your area, and see our [state guides](https://nemtguide.com/states/) and [NEMT license requirements](https://nemtguide.com/guides/nemt-license-requirements/).

## Stretcher van vehicle and equipment requirements by state

The equipment lists overlap more than they differ. Every one of them wants the stretcher locked down and the rider secured.

| State | What the vehicle must have |
|---|---|
| Illinois (515.840) | No sedan, limousine, or recreational vehicle, and no SUV with fewer than three passenger doors and a wheelbase under 100 inches. Room for two attendants and a direct view of the rider. A wheeled litter at least 75 inches long and 22 inches wide on a crash-stable quick-release three-point fastener, three sets of straps plus shoulder straps, and a crash-stable bracket for each oxygen cylinder. A flat non-skid floor, surfaces that can be sanitized, a loading light, a 5-pound ABC fire extinguisher, a flashlight, and voice contact with dispatch. Two pillows, sheets, and blankets, a CPR mask, biohazard bags, and gloves. |
| New York (policy manual) | A wheeled cot used as its maker directs, the maker's restraint straps, and a cot retention device attached to the vehicle and made by the same company as the cot. Oxygen tanks secured, but no oxygen or oxygen delivery supplies carried by the van. |
| California (22 CCR 51231.1) | A loading entrance and a separate emergency exit that each fit a standard gurney. Gurney fasteners strong enough to keep it from rolling, sliding, or lifting, and to hold it if the van overturns. A two-person gurney with a mattress and upper and lower straps, an attendant seat in the patient compartment, heat and air conditioning, washable seats, a 4-B:C extinguisher, an interior light, and a battery light. |
| Virginia (DMAS, May 26, 2026) | A stretcher in one of two styles taken from federal specification KKK-A-1822E, a mattress at least 3 inches thick, a crash-stable mount with a quick-release latch, oxygen secured to AMD Standard 003, a spill kit, safety belts for all passengers, and climate control. The van must comply with the Americans with Disabilities Act. |
| Minnesota (Minn. R. 8840.5925) | Stretcher securement that meets the state's ambulance equipment law (Minn. Stat. 144E.103) and the federal ambulance standards the rule references, plus a 5B:C extinguisher, a labeled first aid kit, a body fluids cleanup kit, two-way communication (hands-free if a phone), and a flashlight |
| Georgia (DCH manual) | An enclosed vehicle that holds a litter, with locking devices to secure it in transit, and fire extinguishers totaling at least 5 pounds. No flashing lights, sirens, or emergency equipment required. |
| Wisconsin (DHS 105.39, 107.23) | A wheelchair lift or ramp, restraints for riders in wheelchairs or on cots, and restraints that secure the cot to the side and the floor of the vehicle |

If you will work in more than one program, buy to the strictest list. The [NEMT vehicle requirements](https://nemtguide.com/guides/nemt-vehicle-requirements/) guide covers the rules every van must meet, and the [vehicle inspection checklist](https://nemtguide.com/templates/nemt-vehicle-inspection-checklist/) helps you prepare.

### The stretcher, the mount, and the straps

Virginia spells out the stretcher most exactly, quoting federal specification KKK-A-1822E (June 1, 2002):

- **Style 1:** an elevating wheeled cot at least 75 inches long and 22 inches wide, no more than 15 inches high when collapsed, measured to the top of a 3-inch mattress.
- **Style 2:** the same cot with front roll-in wheels, at least 79 inches long and 22 inches wide, no more than 13 inches high when collapsed.
- **Mattress:** polyester foam at least 3 inches thick, covered in a non-porous fabric.
- **Straps:** at least three (chest, hip, and knee), plus over-the-shoulder restraints at the head end. Straps are at least 2 inches wide with metal-to-metal quick-release buckles.
- **Mount:** a crash-stable side or center cot fastener with a quick-release latch, tested to a 2,200-pound pull under AMD Standard 004, Litter Retention System.
- **Loading:** riders go in headfirst, and the crew checks every strap and the mount before moving.

A Style 1 cot also meets Illinois's 75 by 22 inch minimum. New York adds that the retention device must be made by the cot's maker, so buy the cot and mount as one matched set. Virginia also makes you supply a scoop, Reeves, or stair chair stretcher when a rider needs one. For heavier riders, see bariatric stretcher.

## Crew and training requirements

Most written rules put a second crew member on every stretcher trip, so plan and price for two people per van.

| State | Who must be on board | Training |
|---|---|---|
| Illinois | At least two trained attendants, one staying with the rider | Every attendant CPR certified and trained to operate stretchers (515.845, amended November 1, 2024) |
| New York | A driver and at least one assistant, who sits in the passenger compartment and tells the driver right away about any change in the rider | Drivers qualified under Article 19-A of the Vehicle and Traffic Law |
| California | A certified driver and an attendant | Each at least 18, with a current standard first aid certificate or equivalent and a physical exam within two years on DMV form DL-51 |
| Virginia | At least two crew members: a driver and an assistant seated in back while moving. The rider is never left alone. | DMAS-approved training in first aid, bloodborne pathogens, and transferring, loading, and unloading stretcher riders |
| Minnesota | No crew size set in the rules | Before service: orientation and emergency training. Within 45 days: 4 hours of first aid, abuse-prevention training, 8 hours of passenger assistance, 2 more hours on stretcher transport, and, for drivers, 4 hours of defensive driving. Drivers carry a DOT medical examiner's certificate or an allowed substitute, such as a commercial license. |
| Georgia | Stretcher service is defined as riders who need at least two people to move them | The manual's rules for all drivers |
| Wisconsin | No crew size set. Medicaid covers a second attendant only when the rider needs another person for restraint or lifting, backed by a prescriber's statement you keep on file (DHS 107.23). | Red Cross or equal first aid and CPR, seizure care, and lift and restraint instruction before driving or attending. Drivers refresh first aid at least every 3 years and keep CPR current. |

New York also expects the crew to move the stretcher over curbs, doorways, and steps when no ramp or elevator is available, with the people or equipment it takes. Plan the crew for the hardest pickup on your schedule. Keep every certificate in each person's [driver file](https://nemtguide.com/templates/nemt-driver-file-checklist/), and see NEMT stretcher training for what the courses cover.

## Oxygen and riders a stretcher van cannot take

Stretcher vans carry stable riders only. The rules draw the line in similar places.

| Rule | Illinois | Virginia | New York |
|---|---|---|---|
| Oxygen | Not for riders whose oxygen is not self-administered | Self-administered oxygen only, secured to AMD Standard 003 | The rider may self-administer. Staff may not help or offer oxygen, and the van may not carry oxygen supplies. |
| Medical monitoring | Not allowed, including isolation precautions and airway care | Not allowed, including mechanical monitoring and respiratory procedures | Not allowed, nor any medical treatment |
| IV lines and devices | No IV fluids on the way | No IV therapy or any temporary invasive device, including a saline lock | Falls under the ban on any medical treatment |
| Other riders you cannot take | Riders going to a hospital for emergency care, or who cannot cooperate with the crew | Riders with an injury not yet seen by a doctor, or an acute infectious illness | Riders who are medically sedated |
| Stretcher riders per trip | One | One | Not stated |

Georgia's manual (July 1, 2026) adds that NEMT vehicles, stretcher vans included, are not equipped to supply oxygen or care for a ventilator-dependent rider. Those riders must bring portable, fully charged equipment and an escort trained to manage it.

Plan for a rider whose condition changes on the way. Virginia's rule is to call 911 first, then your dispatcher, and give first aid until EMS arrives. When a stretcher van is sent to an emergency room or calls for EMS to meet it, the broker files an exception report with the state Office of Emergency Medical Services within two business days.

## Markings, lights, and signs

A stretcher van must never pass for an ambulance.

- **Illinois:** no red or blue emergency lights or other warning devices, "No Smoking" and "Fasten Seat Belt" signs inside, and no advertising that misstates your level of service.
- **Virginia:** the business name on both sides in letters at least 3 inches tall, and no Star of Life, sirens, or flashing lights unless the company holds a state EMS license. An ambulance turned into a stretcher van must lose every ambulance marking and light.
- **New York:** no Star of Life, which the state reserves for emergency vehicles.
- **California:** the business name on both sides and the rear, capital letters at least 4 inches tall, and nothing that identifies the van as an ambulance.
- **Minnesota:** the business name and USDOT number on both sides.

Ohio shows the other side of the line. A basic life support ambulance licensed for non-emergency transports only must carry "Non-emergency transports only" in 3-inch letters on the rear and both sides, and it may not use emergency lights or sirens (Ohio Adm. Code 4766-2-08 and 4766-2-11).

## How stretcher van rules differ from ambulance rules

An ambulance is built and staffed to give care on the way. A stretcher van is not, and the rules show it.

| | Stretcher van | Basic life support ambulance |
|---|---|---|
| Crew | Two trained attendants in Illinois, a driver and an assistant in New York and Virginia | Medicare: at least two people, one at least an EMT-Basic (42 CFR 410.41). Illinois and New Jersey: two EMTs or higher. Ohio non-emergency only: one EMT and a trained driver. |
| Training | CPR or first aid and stretcher handling | EMT certification, plus an emergency vehicle operator course for non-EMT drivers in Ohio |
| Equipment | Stretcher, mount, straps, linens, extinguisher, and a radio or phone | Medicare: a stretcher, linens, emergency medical supplies, oxygen, and lifesaving equipment. Illinois lists suction, an AED, splints, spine boards, airways, and more (515.830). |
| Lights and siren | None | As state law requires |
| Medicare | Not paid. Medicare's October 2026 code file lists the stretcher van code, T2005, as not payable by Medicare. | Paid when medically necessary. On Medicare's 2026 ambulance fee schedule, the urban base rate for a non-emergency BLS trip (A0428) runs $261.60 to $380.05 by area, plus $9.33 a mile (A0425) in urban areas. |

Medicare's line shows who belongs in each. A rider counts as bed-confined only if they cannot get up from bed without help, cannot walk, and cannot sit in a chair or wheelchair. Even then, bed confinement is one factor in whether an ambulance is necessary, not the whole test (42 CFR 410.40). A Medicare patient who needs no care on the way can still ride by stretcher van, but Medicare will not pay for it, so the family, a facility, or another payer does. See NEMT vs ambulance and [does Medicare cover NEMT](https://nemtguide.com/guides/does-medicare-cover-nemt/).

## Paperwork for each stretcher rider

Medicaid pays for the stretcher level only when the rider needs it, and several programs want it in writing.

- **California (Medi-Cal fee-for-service):** a treatment authorization request with a legible prescription stating the purpose of the trip, how often it is needed, and the condition that rules out ordinary transportation. The only exception is a transfer from an acute care hospital to a long term care facility.
- **Georgia:** the broker must get a medical necessity certification or letter of medical necessity, and should have it in place before the third scheduled stretcher trip.
- **Wisconsin:** cot and stretcher trips must be prescribed by a physician, physician assistant, nurse midwife, or nurse practitioner.
- **New York:** stretcher mode should not be requested just so your crew can move the rider onto an exam table, and you are not required to leave your stretcher at the facility.
- **Georgia again:** facilities may not treat members on your stretcher.
- **Medicare ambulance:** a scheduled, repeating non-emergency ambulance trip needs a physician certification statement dated no more than 60 days before the service.

See [medical necessity form](https://nemtguide.com/glossary/medical-necessity-form/) for what the form contains.

## How to set up a stretcher van that passes inspection

1. **Confirm your state uses stretcher vans.** Check the table above, find T2005 on your state fee schedule, and ask each broker whether it contracts stretcher service where you are.
2. **Find the licensing office.** It may be the health department (Illinois), the transportation department (New York and Minnesota), the EMS office (Ohio and Maryland), or your county.
3. **Buy a matched stretcher and mount.** Pick a cot in one of Virginia's KKK-A-1822E styles, at least 75 by 22 inches, with a crash-tested quick-release mount from the same maker, and keep the test paperwork.
4. **Fit the rest of the equipment.** Add an oxygen bracket for each cylinder, straps, linens, a fire extinguisher, a flashlight and loading light, a first aid kit, a CPR mask, gloves, biohazard bags, and a cleanup kit.
5. **Mark the van.** Put your business name on both sides, and leave off the Star of Life, sirens, and emergency lights.
6. **Hire and train two people.** Cover CPR, first aid, stretcher handling, stairs, and bloodborne pathogens, and keep every certificate on file.
7. **Insure it.** Price commercial auto coverage for stretcher work, and meet the higher of the state and broker minimums. See [NEMT insurance requirements](https://nemtguide.com/guides/nemt-insurance-requirements/).
8. **Pass the inspections.** Expect yearly state inspections in Illinois and Minnesota, twice-yearly checks in New York, Virginia, and Georgia, and a yearly brake and light certificate in California. Minnesota also wants a written daily check that includes the stretcher securement.
9. **Write your emergency plan.** Train the crew to call 911 first when a rider's condition changes, then dispatch, and to log what happened.

For the business side, including which states pay enough to cover the second crew member, see [how to start a stretcher transportation business](https://nemtguide.com/guides/start-a-stretcher-transportation-business/).

## Frequently asked questions

### Does a stretcher van need two people on board?

In most states that write rules for them, yes. Illinois requires at least two trained attendants, with one staying with the rider (77 Ill. Adm. Code 515.845). New York requires a driver and at least one assistant riding in the back, and Virginia requires at least two crew members. California requires a certified driver and an attendant for each litter van. Georgia defines stretcher service as riders who need at least two people to move them.

### Do I need a special license to run a stretcher van?

It depends on the state. Illinois requires a stretcher van provider license from the Department of Public Health, at $25 per vehicle for four years. New York stretcher ambulettes need NYSDOT operating authority. Minnesota vehicles need a MnDOT special transportation service decal. In Ohio a stretcher trip needs a basic life support ambulance license. Some counties, such as Miami-Dade, issue their own stretcher certificates.

### What kind of stretcher and mount does a stretcher van need?

A wheeled stretcher locked into a crash-stable mount with a quick release. Illinois requires a litter at least 75 inches long and 22 inches wide on a three-point fastener. Virginia requires a stretcher in one of two styles from federal specification KKK-A-1822E and a mount tested to a 2,200-pound pull under AMD Standard 004. New York requires the mount to be made by the same company as the stretcher.

### Can a stretcher van have emergency lights or a siren?

No. Illinois bars red or blue emergency lights and other warning devices on stretcher vans. Virginia bars the Star of Life, sirens, and flashing lights unless the company holds a Virginia EMS license, and ambulances turned into stretcher vans must remove every ambulance marking. New York reserves the Star of Life for emergency vehicles, and California bars a litter van from showing itself as an ambulance.

### Can a stretcher van carry a rider on oxygen?

Only oxygen the rider manages alone. Illinois bars riders who need oxygen that is not self-administered and requires a crash-stable bracket for each cylinder. New York lets riders bring their own oxygen, but the crew may not help with it and the van may not carry oxygen supplies. Virginia requires the tank secured to AMD Standard 003.

### How is a stretcher van different from an ambulance?

An ambulance carries a medical crew and emergency equipment. Medicare requires at least two people on an ambulance, one of them at least an EMT-Basic, plus oxygen and lifesaving equipment (42 CFR 410.41). A stretcher van carries stable riders who need no care on the way, with trained attendants and no medical gear. Medicare pays for a medically necessary ambulance ride but not for a stretcher van.

### Can a stretcher van also carry wheelchair riders?

Often, if it meets the wheelchair rules too. Virginia lets a stretcher van carry riders in wheelchairs when the proper anchorages and securement devices are installed. California lets a litter van work as a wheelchair van if it meets every wheelchair van requirement in 22 CCR 51231.2. Wisconsin requires every specialized medical vehicle to have a lift or ramp.

## Official resources

- [Illinois: 77 Ill. Adm. Code 515.840, Stretcher van requirements](https://www.ilga.gov/commission/jcar/admincode/077/077005150F08400R.html)
- [Virginia DMAS: NEMT driver, attendant, and vehicle requirements (stretcher van section)](https://www.dmas.virginia.gov/media/1sdhbgj4/dmas-nemt-driver-attendant-and-vehicle-requirements-05-26-2026.pdf)
- [New York: Medicaid Transportation Policy Manual (stretcher ambulette rules)](https://www.emedny.org/ProviderManuals/Transportation/PDFS/Transportation_Manual_Policy_Section.pdf)
- [Minnesota Rules chapter 8840, special transportation service (training and equipment)](https://www.revisor.mn.gov/rules/8840.5910/)
- [Ohio Administrative Code chapter 4766-2, ambulance licensing and staffing](https://codes.ohio.gov/ohio-administrative-code/chapter-4766-2)
- [CMS: Ambulance Fee Schedule public use files](https://www.cms.gov/medicare/payment/fee-schedules/ambulance/ambulance-fee-schedule-public-use-files)
- [CMS: Medicaid Transportation Coverage Guide (SMD 23-006)](https://www.medicaid.gov/federal-policy-guidance/downloads/smd23006.pdf)