How to Become a Waiver Non-Medical Transportation Provider in 2027

Waiver rides are the Medicaid trips that are not about medical care. They take an older adult to the grocery store, a young man with a disability to his job, or a woman who uses a wheelchair to her day program. Rides to a job or a day program repeat on the days the member goes, which can fill the hours between dialysis runs.

What waiver non-medical transportation is

Home and community-based services (HCBS) waivers let states pay for care at home and in the community instead of in a nursing home or institution. Many run under section 1915(c) of the Social Security Act. As of September 2026, Medicaid.gov counts about 257 active HCBS waiver programs, and nearly every state and DC runs at least one. Each waiver serves a target group, such as older adults, people with intellectual or developmental disabilities, or people with a brain injury.

Federal rule 42 CFR 440.180 lists the services a waiver may cover and adds “other services” that CMS approves. Non-medical transportation is one of those. The CMS technical guide for 1915(c) waivers (version 3.6, January 2019) defines it as a service that lets waiver participants reach waiver services and other community services, activities, and resources, as the service plan specifies. It adds that family, neighbors, friends, or community agencies that can give the ride for free should be used first.

CMS’s Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) confirms that states may cover non-medical transportation under a 1915(c) waiver, a 1915(i), 1915(j), or 1915(k) state plan option, or a section 1115 demonstration. North Dakota, for example, covers it under 1915(i). The program name and its rules change from state to state, so always read the rules for the program you want to join.

How waiver rides differ from NEMT

The biggest difference is the purpose of the trip. The CMS technical guide says waiver transportation may not replace the rides a state must provide under 42 CFR 431.53. A waiver participant’s ride to a doctor is billed as NEMT, not as a waiver service. Missouri’s developmental disabilities waiver manual, in the version posted in September 2026, says the reverse is also true: its NEMT program does not cover rides to waiver services.

	NEMT	Waiver non-medical transportation
Trip purpose	Rides to Medicaid-covered medical care	Rides to waiver services and community places in the service plan: work, stores, day programs, worship
Federal rule	42 CFR 431.53 and 440.170	42 CFR 440.180 and the waiver CMS approves
Who can ride	Medicaid members who need a ride to covered care	Only people enrolled in that waiver, for the trips in their plan
Who approves the trip	The member books with the state, broker, or health plan	A case manager or care coordinator writes it into the service plan
Who you sign with	A broker, health plan, or the state	The state agency that runs the waiver, and often its managed care plans
Who can join	The broker can close its network when it has enough providers	Generally any willing and qualified provider, with some exceptions
How it pays	Usually a base rate per trip plus loaded miles	Set by each waiver: per mile, per trip, per zone, per day, or per 15 minutes

Two federal rules shape the business side. First, every waiver service must be delivered under a written person-centered service plan approved by the Medicaid agency (42 CFR 441.301). You drive only the trips in that plan. Second, members may choose any qualified provider (42 CFR 431.51), and the CMS technical guide says a state must offer continuous, open enrollment to every willing and qualified waiver provider. A state may not cap the number of providers through a bid unless it has a 1915(b) waiver that restricts provider choice. That is different from broker networks, which can close when full. See what to do when a broker network is full.

States can still pause enrollment for provider types at high risk of fraud under 42 CFR 455.470. Indiana did. Its moratorium on new 1915(c) waiver providers took effect August 1, 2026, for an initial six months, and can be extended six months at a time. Transportation is on the list, for the PathWays for Aging, Health and Wellness, Traumatic Brain Injury, Community Integration and Habilitation, and Family Supports waivers. It also blocks changes of ownership and adding counties or services. Indiana will consider limited exceptions where members lack access, with a written explanation of the need. Ohio’s Medicaid agency has a similar pause: it is not accepting new enrollments of waivered services organizations or individuals from May 14 to November 14, 2026, unless CMS authorizes an extension, and applications it had not processed by May 14 were denied.

For a plain comparison of the two terms, see NEMT vs NMT. For every payer a ride company can bill, see who pays for NEMT.

Who can become a waiver transportation provider

Each state writes its own provider qualifications, and they can differ by waiver in the same state. Four examples show the range.

State and program	Who qualifies	Key requirements
Iowa, HCBS waivers (brain injury, intellectual disability, elderly, physical disability)	Area agencies on aging and their subcontractors, community action agencies, regional transit agencies, certified supported community living providers, licensed nursing facilities, and transportation providers that contract with the NEMT broker (Iowa rule 441-77.38(10), May 2026)	Form 470-2917 with proof of the qualification, such as your NEMT welcome letter or contract
Ohio, PASSPORT waiver	Agency and non-agency providers certified by the Ohio Department of Aging (rule 173-39-02.18, effective February 1, 2025)	Backup plan, yearly mechanic inspection, driver training and drug testing, trip verification
Wisconsin, Family Care, Family Care Partnership, PACE, and IRIS	Common carriers under Wis. Stat. chapter 194, mass transit under Wis. Stat. 85.20 and 85.23, specialized transport under Wis. Stat. 85.21 and 85.22 and DHS 61.45, and specialized medical vehicle providers that add waiver transportation to their enrollment	Enroll with Wisconsin Medicaid, then get services authorized by a managed care organization or IRIS consultant agency
New Hampshire, Choices for Independence	Licensed home health or home care agencies, agencies certified under RSA 161-I, or agencies with a state contract for Older Americans Act or Social Services Block Grant rides (He-E 801.22)	Drivers 18 or older with auto insurance of at least $100,000 per passenger and $300,000 per occurrence, plus uninsured motorist coverage

Two more rules show how specific states get. Alaska pays for waiver rides in a vehicle owned or commercially leased by a waiver provider agency, allows an employee’s or volunteer’s car only when the state finds no other option, and will not certify an agency that uses only employee- or volunteer-owned vehicles (7 AAC 130.290). Missouri requires a transportation provider to be licensed under its driver licensing law (RSMo chapter 302) and to hold a Department of Mental Health contract for rides under its four developmental disabilities waivers.

The driver and vehicle rules you can expect

Ohio’s rule for ODA-certified providers spells out driver and vehicle requirements in detail. It makes a good checklist even if you work in another state.

• Backup plan for when a driver or vehicle is unavailable.
• Hands-on help. The driver helps the rider move between the pickup point and the vehicle, get in and out, and reach the destination.
• Two-way communication, by radio or cell phone, on every trip.
• Vehicles maintained on the manufacturer’s schedule, with a yearly inspection by an ASE-certified mechanic on an ODA form. A current ambulette license counts instead.
• Wheelchair vehicles checked before the first trip each day: fasteners, belts, and the ramp or lift, with a record kept.
• Drivers licensed for at least two years, with first aid and CPR from a state-approved trainer, a drug test from a CLIA-certified lab, and background checks. Each driver completes approved passenger assistance training within six months of hire. Licensed ambulette drivers, EMTs, and transit drivers can show their license or certificate instead.

Oklahoma’s developmental disabilities waiver rule adds liability insurance large enough to cover injuries or losses from the provider’s negligence, seat belts on every rider, and a current Oklahoma license for every driver (OAC 317:40-5-103, revised September 11, 2023).

Every Medicaid provider is also screened at a risk level of limited, moderate, or high (42 CFR 455.450). Moderate adds site visits, and high adds fingerprint-based criminal background checks. As of September 2026, Wisconsin lists waiver transportation at limited risk, with no application fee. It lists a new specialized medical vehicle (NEMT) enrollment at high risk.

How to enroll as a waiver transportation provider

1. Find the waivers in your state that cover transportation. Start with your state Medicaid agency’s HCBS or waiver page. The agency that runs each waiver may be the aging department, the developmental disabilities agency, or the Medicaid agency itself. In Ohio, the Department of Aging certifies PASSPORT providers, while rides on the Individual Options, Level One, and SELF waivers for people with developmental disabilities follow a separate rule, 5123-9-18 (effective January 2, 2025).
2. Read the service definition and provider qualifications. They are in the approved waiver (Appendix C) and the state’s rules or provider manual. Note the trip purposes, limits, codes, and rates.
3. Get an NPI for your company if you do not have one. Ohio requires an NPI from every provider with an available taxonomy, and its guidance lists taxonomy 343900000X, non-emergency medical transport (van), as a choice for non-medical transportation. See how to get an NPI number.
4. File the application. In Iowa, a first-time enrollee files form 470-2917 (the HCBS waiver provider application, revised February 2026), the provider agreement (470-2965), the EFT form (470-4202), an IRS W-9, and the designated contact form (470-5112). A company already enrolled adds waiver services with 470-2917 alone. In Wisconsin, you sign the standard waiver provider agreement, F-00180C.
5. Pass screening. Expect database checks for every owner and managing employee, plus any background checks the program requires for drivers.
6. Finish the second step with the program’s plans or agencies. Iowa says approved providers must also complete each managed care organization’s credentialing. Wisconsin requires a managed care organization or IRIS consultant agency to authorize your services. Missouri requires a DMH contract. In Oklahoma, individual transportation providers send proof of vehicle licensure, insurance, and capacity to the DDS area office before a contract is set up.
7. Wait for approval before you drive. Iowa’s form says you cannot bill or be paid for services before approval, and the effective date cannot be earlier than the first of the month in which the application is approved.
8. Introduce your company to case managers. Members choose their providers with their case manager or care coordinator, so the people who write service plans need to know your service area, hours, vehicles, and phone number.

If you are not yet a Medicaid provider at all, read how to become a Medicaid transportation provider first. Many of the same documents carry over.

What waiver transportation pays

Every state sets its own rates, and one state can pay several ways across its waivers. These are the published payment rules and rates.

Program	Code	How it pays	Rate
Iowa HCBS waivers	S0215	Per loaded mile	Capped at $1.70 to $10.10 a mile, by the region where the member lives (limits effective July 1, 2024)
Iowa HCBS waivers	T2003	Per one-way trip	Your per-mile rate times the door-to-door miles
Ohio PASSPORT	Non-medical transportation	Per trip, one way or round trip	Rate negotiated with ODA or its designee. Billing maximum $653.11 one way, $1,306.24 round trip (appendix effective April 17, 2026)
Ohio PASSPORT	Adult day transportation	Statewide rate	Billing maximums of $3.12 a mile, $23.21 one way, or $28.61 round trip (April 17, 2026)
Missouri DD waivers	A0110, T2002, T2003	Per trip by distance zone: up to 10 miles, over 10 to 20, over 20, plus a monthly component billed separately	Up to two per-trip units a rider a day. Modifier HE for a vehicle modified for riders who cannot walk (September 2026 manual)
Louisiana New Opportunities Waiver	T2002	Per day, billed by the member’s supported employment, day habilitation, or prevocational provider	$20.00 on each day that provider delivers one of those services in person (issued March 13, 2026)
North Dakota 1915(i)	T2001	Per 15 minutes	Up to 8 hours a day. No service authorization needed (April 2026 manual)

Iowa’s example shows how the per-trip code works. A member in Clay County lives in a region with a $1.70 cap. If your cost is $1.70 a mile and the trip is 10 miles, you bill $17.00 for that one-way trip. Iowa also says your per-mile rate may not exceed the cap, you charge your cost if it is lower, and you must be able to prove your costs on review. Its fee schedule effective October 1, 2026 still uses the July 1, 2024 limits, and Iowa Medicaid says it will set all HCBS waiver rates through a uniform fee schedule starting January 1, 2027.

Shared rides pay less or not at all, depending on the program. Ohio pays 75 percent of your bid rate when you carry more than one PASSPORT member from the same home, in the same vehicle, to the same place. Oklahoma will not pay for more than one member per vehicle for the same miles, except on public transit.

Some waivers also cap what each member’s services can cost. Iowa caps the total monthly cost of services on several waivers. On its physical disability waiver, the cap for a member at the nursing facility level of care is $889.97 a month from October 1, 2026. Rides compete with the member’s other services for those dollars, and the case manager decides how many trips fit. For the codes themselves, see T2003, S0215, and T2002.

Trips a waiver will not pay for

The limits are as important as the rates. These come straight from the rules above.

• Rides to medical care. Bill them as NEMT, under CMS guidance. North Dakota and New Hampshire say so in their own rules.
• Rides already paid through another service. When another waiver service’s rate includes transportation, such as adult day health, the state must prevent double billing. Missouri says a group home’s rate includes rides into the community, and a day habilitation provider’s rate covers its community outings. The ride from home to day habilitation is not in that rate, so Missouri lets it be billed separately as waiver transportation. See adult day center transportation and group home transportation.
• Errands without the rider. Alaska and Oklahoma do not pay for trips when the member is not in the vehicle. North Dakota requires the member to be present.
• Waiting. North Dakota does not pay for time spent waiting for a member. Alaska does not pay for waits longer than 15 minutes, except at a set rate for trip segments under 20 miles.
• Long trips outside the plan. Alaska does not pay for destinations more than 20 miles from home unless the support plan approves them.
• Rides from family or free sources. Ohio excludes rides that family, neighbors, friends, or community agencies are willing or legally responsible to give at no charge. Oklahoma excludes rides by the member’s spouse, or by a minor member’s parents.

Trip records and billing

Waiver trip records look like NEMT trip logs, with a few additions. Ohio’s rule lists the items for each trip: the rider’s name, the date, the pickup point and time, the destination and drop-off time, the driver’s name, and a unique identifier for both the driver and the rider to attest to the trip. Alaska’s travel log adds any escort’s name, the start and end time of each trip segment, and the start and end of any wait. Oklahoma accepts either odometer readings at the start and destination or trip miles from GPS, and asks for the purpose of each trip.

North Dakota adds reporting. Providers send a written monthly update to the member’s care coordinator and document that no family, friends, neighbors, or community agencies could give the ride for free. Claims for dates of service on or after January 1, 2026 must go through the state’s required online billing module. North Dakota must receive the claim within 180 days of the date of service and wants records kept for at least 7 years after the claim is paid or denied. The free trip log template has columns for most of these items, and NEMT trip documentation covers what auditors look for.

Is waiver transportation worth adding?

It can be, if the state’s rate covers your cost per trip. Rides to a job or day program repeat on the days the member attends, which fits a schedule built around standing orders. The work also spreads your revenue beyond one broker.

Check four things before you apply:

1. The rate against your cost. Use the NEMT cost per trip guide to find yours, then compare it with the state’s rate for the distances your riders travel.
2. The paperwork load. A separate enrollment, separate authorizations, and sometimes a separate billing system add office time.
3. The vehicle and driver rules. Some programs require an agency license or certification you may not have, as New Hampshire does.
4. Whether enrollment is open. The 2026 pauses in Ohio and Indiana show it can close for months.

If older adults are your focus, the area agency on aging transportation guide covers the non-Medicaid side of the same riders. Waiver rules also appear on several state guides, including Iowa, Ohio, and Missouri.