# What Is NEMT? How Non-Emergency Medical Transportation Works

Canonical URL: https://nemtguide.com/guides/what-is-nemt/ · Updated 2026-09-28

NEMT, or non-emergency medical transportation, is a planned ride to or from medical care for someone who is not in an emergency and has no other way to get there. Federal rule 42 CFR 431.53 requires every state Medicaid program to make sure members get these rides. States pay ride companies directly or through brokers and health plans, usually a base rate per trip plus loaded miles.

- NEMT is a Medicaid benefit: every state must make sure members with no other way to covered care get a ride.
- About 3.3 million Medicaid members used NEMT in 2021, and nearly half of members with kidney failure did.
- States run it three ways: paying ride companies directly, hiring a broker, or folding it into health plan contracts.
- Each ride must be the least costly mode that fits the rider, and companies are generally paid for loaded miles, not empty ones.
- Original Medicare does not pay for rides to doctor visits. It pays for an ambulance only when other transport would be unsafe.

## What NEMT means

NEMT stands for non-emergency medical transportation. It is a ride to or from a medical service for someone who is not in an emergency and has no other way to get there. The rider might be going to dialysis, a doctor visit, physical therapy, a lab, a pharmacy, or a substance use treatment program.

NEMT is above all a Medicaid benefit. Federal rule [42 CFR 431.53](https://www.ecfr.gov/current/title-42/section-431.53) requires every state Medicaid plan to say the state will ensure necessary transportation to and from providers, and to describe how. Congress wrote the same duty into the Social Security Act in December 2020, in the Consolidated Appropriations Act, 2021.

This duty is a promise of access, not a promise to pay for every trip. CMS's Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) says states must make sure every member with no other means of transportation can get to covered care. States must first use any free ride a member has, such as one from family or friends.

Under federal rule [42 CFR 440.170(a)](https://www.ecfr.gov/current/title-42/section-440.170), covered transportation includes more than the ride:

- **The trip itself,** by ambulance, taxi, common carrier, or another appropriate means.
- **Meals and lodging** on the way to care and while receiving it, when the state finds them necessary.
- **An attendant** when one is needed, including the attendant's travel, meals, and lodging, and a salary if the attendant is not family.

The same assurance covers emergency rides, which usually go by ambulance. A non-emergency ride goes by the least costly mode that is safe for the rider. Where the line falls matters for billing, and the NEMT vs ambulance guide covers it.

## Who rides: who qualifies for NEMT

A member qualifies when three things are true: they are enrolled in Medicaid, the trip goes to a service their coverage pays for, and they have no other way to get there. Most states let members say they have no ride, and some ask a medical provider to confirm it, according to CMS's 2023 report to Congress.

There are a few gaps. CMS's transportation guidance generally does not apply to separate CHIP programs, except those that offer the children's EPSDT benefit. Some states use federal waivers to drop or limit the ride benefit for certain adults. CMS's 2023 report to Congress named Georgia, Indiana, Iowa, Kentucky, and Utah as examples at the time. Kentucky's waiver, for instance, dropped rides to methadone treatment for most members. Waivers change, so check your state's current rules on your [state guide](https://nemtguide.com/states/).

Children and young adults under 21 have an extra protection. Under the EPSDT benefit, the state must offer help with transportation and with scheduling appointments, and provide it when the family asks ([42 CFR 441.62](https://www.ecfr.gov/current/title-42/section-441.62)).

### How many people use NEMT

Medicaid covered about 82.4 million people in fiscal year 2025, according to CMS. Only a small share of them use rides in any year, but those who do often ride again and again.

CMS's expanded 2023 report to Congress counted about 3.3 million members who used NEMT in 2021, on 55.5 million ride days. Before the pandemic, in 2019, it was nearly 3.9 million members on 81.3 million ride days. These counts are low: rides a state pays as an administrative cost may not show up in the claims data CMS used, and a few states were left out.

| Group of Medicaid members (2021) | Share who used NEMT | Average ride days a month per rider |
|---|---|---|
| Kidney failure (end-stage renal disease) | 47 percent | 5.5 |
| Money Follows the Person participants | 41 percent | 1.4 |
| Home and community-based waiver enrollees | 22 percent | 2.6 |
| Opioid use disorder | 17 percent | 2.7 |
| People on both Medicare and Medicaid | 14 percent | 1.7 |
| Intellectual or developmental disabilities | 14 percent | 3.2 |
| All Medicaid members | Slightly less than 4 percent | Fewer than 2 |

Dialysis made up 68 percent of the ride days for members with kidney failure in 2021, which is why dialysis runs are the backbone of many NEMT companies. See the [dialysis transportation guide](https://nemtguide.com/guides/dialysis-transportation/). Across all riders from 2018 to 2021, preventive care visits made up 29 to 31 percent of ride days, and visits for acute and chronic conditions made up 20 to 21 percent. Use also varied widely by state in 2021, from 1 percent of members in Maryland to nearly 11 percent in Alaska.

## Who pays for NEMT

In Medicaid, the federal government covers at least half the cost of rides. When a state runs rides as an administrative activity, federal funds pay 50 percent. When it covers rides as a medical service, federal funds pay the state's regular match rate, which is higher in many states. For every payer you can bill, see who pays for NEMT.

States then choose how to run the benefit. Many combine models, for example a broker for fee-for-service members and health plans for everyone else.

| Model | How it works | States using it (June 2021) |
|---|---|---|
| In-house fee-for-service | The state enrolls ride companies and pays their claims directly | 12 states for at least some members, 5 of them for all members |
| Broker | The state hires a [NEMT broker](https://nemtguide.com/glossary/nemt-broker/) that books rides, assigns them to ride companies, and pays them | 35 states for at least some members or areas |
| Managed care | Health plans cover rides as part of their contract, and some hire a broker to run them | 26 states for at least some members or areas |

Those counts come from CMS's reports to Congress and describe June 2021, and states can change models. Health plans also switch brokers: starting October 1, 2026, Blue Cross and Blue Shield of Texas Medicaid members get their rides through MTM Health instead of Modivcare. Your state guide shows who runs rides there today, and [NEMT brokers by state](https://nemtguide.com/guides/nemt-brokers-by-state/) lists the brokers.

Brokers have their own federal rules. Under 42 CFR 440.170(a)(4), a state must pick its broker by competitive bid and audit it regularly. The broker generally may not give rides itself or send trips to a company it has a financial tie to. The exceptions cover rural areas with no other qualified provider, very specialized rides, too few providers, and government brokers.

Outside Medicaid, other payers buy rides too. CMS notes that the Department of Veterans Affairs provides non-emergency rides to certain veterans and that Medicare Advantage plans increasingly offer transportation. PACE programs for older adults provide rides as part of their care and may hire contractors to run them ([42 CFR 460.76](https://www.ecfr.gov/current/title-42/section-460.76)). Hospitals, clinics, and private pay riders can also buy trips directly. See Medicare Advantage transportation and [private pay NEMT](https://nemtguide.com/guides/private-pay-nemt/).

## Who drives: the companies behind NEMT rides

NEMT rides are given by taxi and van companies, non-emergency ambulance services, public transit, and, in a small but growing number of states, rideshare companies, according to CMS. States also pay volunteers, family members, and friends mileage to drive members, especially in rural areas.

Federal law sets a short list of minimums for every NEMT provider and driver paid by Medicaid, except public transit authorities. Section 1902(a)(87) of the Social Security Act, added in 2020, requires states to have a way, which can be an attestation, to make sure that:

1. Neither the company nor any driver is on the HHS OIG [exclusion list](https://nemtguide.com/glossary/oig-exclusion-list/) or barred from any federal health program.
2. Every driver has a valid driver's license.
3. The company has a process to deal with any violation of a state drug law.
4. The company has a process to disclose each driver's driving history, including traffic violations, to the state Medicaid program.

Everything else comes from your state and your broker. CMS says states may require a chauffeur's license, limits on license points, driver health checks, liability insurance, and vehicle inspections. States also screen transportation companies when they enroll. The federal floor is the "limited" risk level, with license and database checks, and a state can raise it to "moderate," which adds a site visit, or "high," which adds fingerprints and a criminal background check ([42 CFR 455.450](https://www.ecfr.gov/current/title-42/section-455.450)). See [NEMT driver requirements](https://nemtguide.com/guides/nemt-driver-requirements/) and [NEMT vehicle requirements](https://nemtguide.com/guides/nemt-vehicle-requirements/).

## Levels of service and billing codes

Every ride is assigned a mode, the kind of vehicle, and often a level of help. CMS requires the least costly mode that fits the rider's physical and emotional condition, and generally a trip to the nearest qualified provider unless there is a medical reason to go farther.

MTM Health's handbook for Virginia's fee-for-service program (approved August 10, 2026) shows how a program sorts riders:

- **Sedan or minivan** for riders who walk and get in and out on their own. Credentialed rideshare and volunteer drivers can take these trips.
- **Wheelchair van** for riders who stay in their wheelchair and can sit upright, with a certified ramp or lift and securement.
- **Stretcher van** for riders who must lie down but need no medical monitoring on the way.
- **Ambulance** only when a lower mode cannot safely meet the rider's needs.
- **Bus or rail passes** when the rider can use public transit and the schedule fits the appointment.
- **Gas money** when a family member or friend drives.

The level of help is separate. Curb-to-curb is the default, with the driver at the vehicle. Door-to-door means the driver walks the rider between the vehicle and the building door. Hand-to-hand means the driver hands the rider to a staff or family member at each end, which some riders with dementia or developmental disabilities need.

Ride companies bill each mode with an HCPCS code, usually a base rate per trip plus a rate per [loaded mile](https://nemtguide.com/glossary/loaded-miles/). The descriptions below come from the CMS HCPCS file for October 2026. The pay column shows Arizona's urban fee-for-service rates, effective October 1, 2026, for a one-way trip of 10 loaded miles.

| Mode | Base code | Mileage code | Arizona pay for a 10-mile trip |
|---|---|---|---|
| Ambulatory van or car | A0120 (mini-bus, mountain area, or other transportation systems) | S0215 | $6.64 + 10 × $1.28 = $19.44 |
| Wheelchair van | [A0130](https://nemtguide.com/glossary/a0130/) | S0209 | $11.15 + 10 × $1.54 = $26.55 |
| Stretcher van | [T2005](https://nemtguide.com/glossary/t2005/) | T2049 | $49.09 + 10 × $1.54 = $64.49 |
| Volunteer driver | None | [A0080](https://nemtguide.com/glossary/a0080/), per mile | 10 × $0.44 = $4.40 |
| Member, family, or neighbor | None | [A0090](https://nemtguide.com/glossary/a0090/), per mile | 10 × $0.44 = $4.40 |

Other codes cover taxis (A0100), buses (A0110), air travel (A0140), tolls and parking (A0170), an attendant (T2001), a trip billed as one encounter (T2003), and waiting time in half hours (T2007). Your state decides which codes it pays and how much, and states differ widely. South Dakota pays $5.20 for a one-way in-town trip in community transportation (July 1, 2026). See the full list in [NEMT billing codes](https://nemtguide.com/guides/nemt-billing-codes/).

## How one NEMT ride works, from booking to payment

Programs differ in the details. Virginia's fee-for-service program, run by MTM Health under its handbook approved August 10, 2026, shows the usual steps.

1. **The member asks for a ride.** They tell the broker about any special needs or an extra passenger when they schedule. Members are asked to cancel at least 24 hours ahead.
2. **The broker approves the trip.** It reviews the request against the program's rules, then sets the mode and level of help from the member's medical needs, abilities, and safety.
3. **The trip goes to a ride company.** Standing orders go straight to the company already assigned. Other trips are sent to eligible companies 7 days before the appointment. At 5 days, any trip still open shows on a marketplace for every company in the area, and at 4 to 5 days dispatchers start calling companies. A company that cannot run a trip must hand it back at least 24 hours before pickup.
4. **The driver gets a manifest.** It lists the trip ID, the rider's name and phone, addresses and times, the mode, the level of help, any escort, and the rider's weight with equipment.
5. **The driver runs the trip.** The first pickup has a window of 15 minutes before to 15 minutes after the scheduled time, and the rider must arrive by the appointment time. A [will-call](https://nemtguide.com/glossary/will-call-trip/) return must be picked up within 45 minutes of the call, and a hospital discharge within three hours.
6. **The company records and bills.** Within 6 months, it submits a claim under the trip ID with an electronic trip log: scheduled and actual pickup times, departure and arrival times, and the member's signature. A missing item means a denied claim. Pay follows the broker's Virginia rate sheet, by miles driven, mode, and shared rides.

Two federal payment rules shape every trip. Miles with no rider on board, including the drive back after a rider does not show, generally cannot be paid, though states may build their cost into the rates. And no one is paid when the ride company fails to show up, because no service was given. For the billing side, see [how to bill Medicaid for NEMT](https://nemtguide.com/guides/how-to-bill-medicaid-for-nemt/).

## NEMT compared with ambulance, paratransit, and rideshare

People mix these services up, and each one has its own payer and rules.

| Service | Who it is for | Who usually pays | Key rule |
|---|---|---|---|
| NEMT | Medicaid members with no other way to covered care | Medicaid, through the state, a broker, or a health plan | Least costly mode that fits the rider |
| Non-emergency ambulance | Patients whose condition makes other transport unsafe | Medicare Part B, Medicaid, and other insurers | Medicare requires medical necessity, and a physician certification for scheduled repeat trips (42 CFR 410.40) |
| ADA paratransit | People with disabilities who cannot use the bus, for any trip | The public transit agency, plus the rider's fare | Next-day booking within three-quarters of a mile of bus routes, fare up to twice the bus fare (49 CFR 37.131) |
| Rideshare | Anyone | The rider, or a program that buys trips | CMS lets states use rideshare companies as NEMT providers, as long as each ride is still the least costly, most appropriate one for the member's medical needs |

For people on both Medicare and Medicaid, Medicare pays first for the services it covers. But its non-emergency benefit is limited to ambulances, so the state must still arrange rides to any Medicaid-covered service that full-benefit members of both programs need, CMS says.

## What NEMT means if you want to start a company

For most owners, NEMT is a contract business. Most of the work is not selling rides to the public but running trips at rates a state, broker, or health plan sets. That makes the first steps different from a taxi business:

1. **Learn how your state runs NEMT.** Find out if trips come from the state, a broker, health plans, or a mix, on your [state guide](https://nemtguide.com/states/).
2. **Pick your levels of service.** Ambulatory trips need the least equipment. Wheelchair and stretcher trips pay more and need specialized vans and training.
3. **Set up the business.** Form your company, get an EIN and an [NPI number](https://nemtguide.com/guides/how-to-get-an-npi-number-for-nemt/), and buy the insurance your state and brokers require.
4. **Enroll and contract.** Apply to your state Medicaid program, then to each broker or plan. See [how to become a Medicaid transportation provider](https://nemtguide.com/guides/how-to-become-a-medicaid-transportation-provider/) and [NEMT broker contracts](https://nemtguide.com/guides/how-to-get-nemt-broker-contracts/).
5. **Meet the driver and vehicle standards** before your first trip, and keep every file current.

The full sequence is in [how to start a NEMT business](https://nemtguide.com/guides/how-to-start-a-nemt-business/). Before you spend money on a van, read [is NEMT a good business](https://nemtguide.com/guides/is-nemt-a-good-business/) for the costs, payment timing, and risks.

## Frequently asked questions

### What does NEMT stand for?

Non-emergency medical transportation. It means a planned ride to or from a medical service for someone who is not in an emergency and has no other way to get there. In Medicaid, the term covers everything from bus passes and mileage paid to a family driver up to wheelchair vans, stretcher vans, and non-emergency ambulances.

### Who qualifies for NEMT?

Medicaid members who have no other way to get to a service their coverage pays for. Depending on the state, that can mean no license or working car, being unable to travel or wait alone, or a physical, cognitive, mental, or developmental limitation. Some states use federal waivers to drop or limit the benefit for certain adults. CMS's 2023 report to Congress named Georgia, Indiana, Iowa, Kentucky, and Utah as examples at the time.

### Is NEMT free for the rider?

Almost always. A state may charge a small copay only when it covers NEMT as a medical service, and the amount must be nominal. When the state runs NEMT as an administrative activity, no copay is allowed. A provider also cannot refuse a ride because a member cannot pay the copay, unless the member's family income is above the federal poverty level and the member is not in an exempt group.

### Does Medicare cover NEMT?

Original Medicare does not pay for rides to regular doctor visits. Part B pays for a non-emergency ambulance only when other transport would endanger the patient, such as a bed-confined patient who cannot get up without help, cannot walk, and cannot sit in a chair or wheelchair (42 CFR 410.40). Medicare Advantage plans increasingly add rides as an extra benefit, CMS notes. For full-benefit members of both programs, Medicaid must still arrange rides to Medicaid-covered care.

### What is the difference between NEMT and non-medical transportation?

NEMT takes a member to a medical service Medicaid covers. Non-medical transportation takes people in home and community-based programs to community services, activities, and resources when they have no other way to go. States cover it separately, under a home and community-based services waiver, a state plan option, or a demonstration project.

### Can a family member get paid to drive a Medicaid member?

Often, yes, through mileage reimbursement. The driver is paid per mile, not a trip fee. Arizona pays $0.44 a mile under code A0090 (October 1, 2026 rates), and South Dakota pays $0.70 a mile to a member, escort, or volunteer driver (effective December 1, 2025). In Virginia's fee-for-service program, family and friends can get gas money, but contracted drivers cannot use that option.

### Is NEMT the same as paratransit?

No. ADA paratransit is a public transit service for people with disabilities who cannot use the bus, and it may not limit trips by purpose. It must serve areas within three-quarters of a mile of bus routes, take next-day reservations, and charge no more than twice the bus fare (49 CFR 37.131). Medicaid can buy paratransit trips for members, but NEMT is its own benefit with its own rules.

## Official resources

- [Medicaid.gov: Assurance of Transportation](https://www.medicaid.gov/medicaid/benefits/assurance-of-transportation)
- [CMS: Medicaid Transportation Coverage Guide (SMD 23-006)](https://www.medicaid.gov/federal-policy-guidance/downloads/smd23006.pdf)
- [CMS: Expanded NEMT Report to Congress, 2018 to 2021](https://www.medicaid.gov/medicaid/benefits/downloads/nemt-rtc-2018-2021.pdf)
- [eCFR: 42 CFR 431.53, Assurance of transportation](https://www.ecfr.gov/current/title-42/section-431.53)
- [eCFR: 42 CFR 440.170, Transportation and the NEMT brokerage program](https://www.ecfr.gov/current/title-42/section-440.170)
- [HHS OIG: List of Excluded Individuals and Entities](https://oig.hhs.gov/exclusions/)