Who Pays for NEMT in 2027? Medicaid, Health Plans, the VA, and Private Pay

Most NEMT rides are paid for by Medicaid, but the payment can reach you through the state, a broker, or a health plan, each with its own contract, rates, and deadlines. Outside Medicaid, a handful of other payers buy rides too. Knowing who pays for each rider tells you where to apply, what to charge, and who to bill.

Who pays for NEMT: every payer at a glance

Payer	Who rides	Who pays your company	The rule to know first
State Medicaid, fee-for-service	Medicaid members the state serves directly	The state Medicaid agency	You enroll with the state and bill its fee schedule
Medicaid broker	Medicaid members in the broker’s region	The broker, usually from a monthly amount the state pays it per member	You sign the broker’s agreement and bill it per trip
Medicaid health plan	Members of the plan	The plan, or the broker it hires	You still must be enrolled with the state Medicaid program
Medicare Advantage plan	Members whose plan includes rides	The plan or its broker	Rides are an extra benefit, with limits each plan sets
PACE program	PACE participants	The PACE organization	PACE must train and oversee its ride contractors
Department of Veterans Affairs	Eligible veterans who need a wheelchair van, ambulance, or other special mode ride	The local VA medical center	The ride must be medically required and approved first, except in an emergency
Workers compensation	Injured workers going to authorized care	The employer’s insurer or a government program	Each program sets its own rules
Hospitals, clinics, and nursing facilities	Their own patients and residents	The facility	Your contract sets the price
Aging agencies, schools, and waiver programs	Older adults, students, waiver participants	The agency, district, or program	Grant and contract rules apply
Private pay	Anyone	The rider or family	You set the price, and you quote it before the trip

Most small companies start with Medicaid, because that is where the volume is. A second or third payer from this table protects you when a broker cuts trips or a health plan changes brokers. See NEMT payer mix for how to build one.

How Medicaid pays for NEMT

Federal rule 42 CFR 431.53 requires every state Medicaid plan to ensure necessary transportation to and from providers, and Congress wrote that duty into the Social Security Act in December 2020. The rider has to be a Medicaid member going to a covered service with no other way to get there. See what NEMT is for who qualifies.

The federal government pays at least half of the cost. CMS’s Medicaid Transportation Coverage Guide (SMD 23-006, September 28, 2023) explains the two ways a state can claim it:

• As an administrative activity. Federal funds pay 50 percent. The state may also pay members directly, for example to reimburse mileage.
• As an optional medical service. Federal funds pay the state’s regular match rate, which can be higher. The state must pay a provider directly, not the member.

In fiscal year 2021, states claimed 90 percent of the NEMT spending they reported to CMS as a medical service and 10 percent as an administrative cost, according to CMS’s 2023 report to Congress.

Who actually pays you depends on how your state runs rides

How your state runs rides	Who you sign with	Who you bill	Where your rate comes from
State fee-for-service	The state Medicaid agency, through enrollment	The state	The state’s fee schedule
Broker	The broker, through a service agreement	The broker	The broker’s rate sheet
Medicaid health plan	The plan, or the broker it hires	The plan or its broker	The plan or broker contract
County or local agency	The county or its contractor	The county or contractor	The local contract

States mix these models. As of June 2021, 35 states used a broker and 26 states included NEMT in health plan contracts, each for at least some members or areas, according to CMS’s 2023 report. Some states run rides through counties or local agencies. In Pennsylvania’s Medical Assistance Transportation Program, most counties run rides themselves or through a vendor, 13 counties use direct state agreements with transit agencies, and a state broker serves only Philadelphia. A state study dated June 25, 2026 recommended keeping the county model. Check your state guide to see which model applies where you drive, and read how states run NEMT.

State fee-for-service: you bill the state

When the state pays directly, you enroll as a Medicaid provider and bill the state’s fee schedule, usually a base rate per one-way trip plus a rate per loaded mile. Arizona’s fee-for-service schedule, effective October 1, 2026, shows how it adds up:

Arizona fee-for-service, October 1, 2026	Urban	Rural (TN modifier)
Wheelchair van base rate, A0130	$11.15	$12.21
Wheelchair van mileage, S0209	$1.54 a mile	$1.66 a mile
One 10-mile wheelchair trip	$26.55	$28.81
Stretcher van base rate, T2005	$49.09	$86.70

In Arizona, a trip is urban when it starts in the Phoenix or Tucson metro area. Every other trip is rural and is billed with the TN modifier.

Federal rules set the outer limits on timing. The state must require providers to submit claims within 12 months of the date of service. It must pay 90 percent of clean claims from health care practitioners within 30 days, but other claims only have to be paid within 12 months of receipt (42 CFR 447.45). Your state’s provider manual sets its own filing limit and payment cycle, so check it. See fee-for-service Medicaid and how to bill Medicaid for NEMT.

Brokers: the state pays per member, the broker pays per trip

A NEMT broker is a company the state hires to book rides, assign them to ride companies, and pay them. Under 42 CFR 440.170(a)(4), the state must pick its broker by competitive bid and audit it regularly, and the broker generally may not give rides itself or send trips to companies it has a financial tie to.

States that use brokers typically pay them a fixed amount per member each month, called capitation, according to CMS’s 2023 report. A smaller number pay a lump sum or per service. The broker then pays you per trip. Georgia’s NEMT policy manual (version date July 1, 2026) spells out both halves:

• The state to the broker. The Department of Community Health pays the broker a monthly rate per member for each member eligible for NEMT in its region. The broker must accept it as payment in full for transportation, overhead, and profit (section 711).
• The broker to you. The broker pays transportation providers under the terms of its service agreement with each one. If the agreement sets no terms, it must pay within 15 business days of receiving an undisputed invoice (section 702.1).
• When the rider does not show. If a member fails to board within the pickup window, the broker must still pay you for the trip’s “A” leg (section 702.7), usually the ride to the appointment. See trip legs and billing for no-shows.

Your broker agreement sets your rate and your deadlines. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, pays at the rates in its Schedule A. It pays uncontested invoices within 30 days of online submission, pays nothing for claims submitted more than 90 days after the ride unless its client sets another limit, and promises no minimum number of trips.

Some states now set floors on what brokers must spend. Kentucky’s House Bill 2, which became law April 14, 2026 (Acts chapter 179), requires its regional brokers to meet a medical loss ratio of at least 85 percent for the state fiscal year starting July 1, 2026, rising each year to 90 percent from July 1, 2029. A broker that falls short must pay back the excess capitation. See Kentucky’s HB 2 and how to bill NEMT brokers.

Medicaid health plans: the plan or its broker pays you

When a state folds NEMT into its managed care contracts, the health plan covers rides out of its monthly payment from the state. Many plans hand rides to a broker, and they switch brokers:

Plan	Change	Date
UnitedHealthcare Community Plan of Texas	SafeRide Health provides NEMT	January 1, 2026
UnitedHealthcare, Florida Medicaid	MTM Health arranges NEMT	March 1, 2026
Blue Cross and Blue Shield of Texas, Medicaid	Moves from Modivcare to MTM Health	October 1, 2026
Blue Cross and Blue Shield of New Mexico, Medicaid	Moves from Modivcare to MTM Health	November 1, 2026

Two federal rules follow the plan. The state must screen and enroll every network provider of a Medicaid health plan, although the plan may sign you for up to 120 days while your enrollment is pending (42 CFR 438.602(b)). And the plan’s contract with the state must require it to pay practitioners’ clean claims on the same federal schedule, 90 percent within 30 days and 99 percent within 90 days, unless you and the plan agree to another schedule set out in the contract (42 CFR 447.46). When a plan changes brokers, you need a contract with the new one to keep those riders. See NEMT broker transition, UnitedHealthcare Texas’s move, and Blue Cross and Blue Shield of New Mexico’s move.

What a Medicaid member can be asked to pay

Very little, and usually nothing. Medicaid providers must accept the program’s payment, plus any copay the state plan requires, as payment in full (42 CFR 447.15).

• Copays are narrow. CMS’s guide allows cost sharing for NEMT only when a state covers rides as a medical service, and it must be nominal. No copay is allowed when the state runs rides as an administrative activity. Starting October 1, 2028, federal law requires states to charge expansion adults with income above the federal poverty level cost sharing of up to $35 on services each state chooses (CMS bulletin, November 18, 2025).
• You usually cannot refuse the ride over a copay. A state may let a provider deny service for inability to pay only when the member’s family income is above the federal poverty level and the member is not in an exempt group (42 CFR 447.52(e)).
• Broker agreements go further. MTM Health’s standard agreement says you must look only to MTM for payment and may never bill a member, even if MTM or its client does not pay you. It allows a copay only when MTM or its client authorizes one.
• Retroactive coverage can reverse a private payment. If someone paid you for a ride and is later found eligible for Medicaid on that date, the state must pay for the covered ride, and it may require you to refund the rider first (SMD 23-006). For applications made on or after January 1, 2027, federal law limits that look-back to one month before the application month for expansion adults and two months for others (CMS bulletin, November 18, 2025). See the retroactive coverage change.

Medicare and Medicare Advantage

Original Medicare does not pay for car, van, wheelchair van, or stretcher van rides. Part B covers ambulance transport only when other transportation would endanger the patient. For a non-emergency trip, the patient must be bed-confined, meaning unable to get up without help, walk, or sit in a chair or wheelchair, or the condition must otherwise require an ambulance (42 CFR 410.40).

Medicare Advantage plans can add rides. CMS’s Medicare Managed Care Manual (chapter 4, revised April 22, 2016) says a plan does not have to provide rides to non-emergency Part A and Part B services but may offer them as a supplemental benefit. The rides must be used only for the member’s health care needs, and the plan must arrange or provide them. Plans often use brokers: HealthSpring moved its Medicare Advantage members’ rides from Modivcare to MTM Health on March 1, 2026, making MTM its sole NEMT provider for them. See Medicare Advantage transportation and HealthSpring’s change.

Riders with both Medicare and Medicaid

For a dual eligible rider with full Medicaid, Medicaid still pays for rides. CMS’s guide says Medicare pays first for services both programs cover, but because Medicare’s ride benefit is limited, the state must ensure the ride to any Medicaid-coverable service. Riders with only partial Medicaid are different. Georgia’s manual, for example, says members who are Qualified Medicare Beneficiaries only are not eligible for NEMT, while a Qualified Medicare Beneficiary who also has full Medicaid is.

When a rider has another plan that covers rides, Medicaid generally pays last. If the state knows another payer is probably liable when you file, it must return the claim so you can bill that payer first, and then it pays any amount its own rate allows above the other payment (42 CFR 433.139). See third party liability and does Medicare cover non-emergency transportation.

PACE programs

The Program of All-Inclusive Care for the Elderly must cover all Medicare-covered and Medicaid-covered services for its participants (42 CFR 460.92), and a PACE organization may hire a contractor to run its rides. Under 42 CFR 460.76, the PACE organization must make sure a contractor’s vehicles are maintained to the manufacturer’s recommendations and can communicate with the PACE center. It must train all transportation staff, contractors included, to manage participants’ special needs and handle emergencies, and tell drivers about relevant changes in a participant’s care plan. The PACE organization pays you under your contract. See PACE transportation contracts.

The VA: mileage for veterans, special mode rides for vans

The Department of Veterans Affairs pays for travel to VA care and VA-approved community care for eligible veterans. As of its July 24, 2026 update, VA’s travel pay page lists veterans who qualify with a disability rating of 30 percent or more, travel for a service-connected condition, a VA pension, income below the maximum annual VA pension rate, inability to afford the travel under VA guidelines, or a scheduled claim exam.

How VA pays depends on the kind of trip:

What VA pays for	Who gets the money	The rule
Mileage in the veteran’s own car	The veteran	41.5 cents a mile, minus a deductible of $3 each way, up to $18 a month (VA, July 24, 2026)
Bus, train, taxi, or other common carrier	The veteran	The actual cost of the most economical common carrier (38 CFR 70.30)
Special mode: ambulance, wheelchair van, or another vehicle designed for disabled persons	The ride company or the veteran	The actual cost, with no deductible (38 CFR 70.30 and 70.31)

Special mode is the part for NEMT companies. VA’s definition in 38 CFR 70.2 covers ambulances, ambulettes, wheelchair vans, and other vehicles specially designed to carry disabled persons. It excludes taxis, buses, and a privately owned vehicle fitted with adaptive equipment. Under 38 CFR 70.4(d), VA approves payment for a special mode ride when all three are true:

1. The travel is medically required.
2. The veteran is unable to pay for it.
3. VA approved the ride before it happened, or it was for a medical emergency.

In practice, VA’s travel pay page (July 24, 2026) says a VA provider decides whether the veteran’s condition requires an ambulance or a specially equipped vehicle, and veterans can request a preapproved non-emergency ride online.

VA may pay the company that gave the ride directly, on evidence that it provided the travel (38 CFR 70.32). A VA rule published February 16, 2023 would set rates for special mode rides bought without a contract: the lesser of the actual charge or the Medicare ambulance fee schedule for ambulances, and a method based on states’ posted rates or the actual charge for other modes. VA has delayed that rule to February 16, 2029 (89 FR 88888, November 12, 2024). Until then, VA pays the actual cost of approved special mode rides (38 CFR 70.30), and the beneficiary travel office at the nearest VA health care facility handles approvals. See VA transportation contracts and VA special mode transportation.

Workers compensation, schools, waivers, and aging programs

Several smaller programs buy rides, often under contracts with local companies:

• Workers compensation. The employer’s insurer or a government program pays for an injured worker’s rides to authorized care, under each program’s rules. For federal employees, the Department of Labor’s program pays reasonable and necessary transportation to authorized treatment. It considers a round trip of up to 100 miles reasonable, requires prior approval for longer non-emergency trips, and may authorize a taxi or special conveyance when the worker cannot use public transit (20 CFR 10.315). See workers comp transportation.
• Home and community-based waivers. States may cover non-medical transportation so waiver participants can reach community services, activities, and resources, separate from NEMT (SMD 23-006). See non-medical transportation waiver providers.
• School districts. Ordinary school buses are not a Medicaid service, but Medicaid can pay for specialized transportation to and from school on days a child gets a Medicaid-covered service, when the child’s education plan lists the need (SMD 23-006). Ask the district how it arranges these rides.
• Area agencies on aging. The Older Americans Act lets states spend supportive services grants on rides that help older adults reach supportive and meal services, including rides area agencies on aging arrange with local transportation providers and public transit agencies (42 U.S.C. 3030d). See area agency on aging transportation.

Hospitals, clinics, and nursing facilities

Facilities pay for rides they need for their own patients and residents, such as hospital discharges, trips between sites, and appointments for residents without Medicaid rides. They pay you under a facility contract at a price you negotiate.

Federal anti-kickback rules allow free local rides for patients when the facility follows a safe harbor (42 CFR 1001.952(bb)). The facility’s policy must apply uniformly, the ride cannot be air, luxury, or ambulance level, and the facility cannot publicly market or advertise it. The rider must be an established patient going within 25 miles, or 75 miles in a rural area, but a patient going home after an inpatient stay, or after at least 24 hours in observation, has no mileage limit. The facility must bear the cost itself and cannot shift it to any program, other payer, or the rider. Drivers and anyone arranging the rides cannot be paid per patient carried, so ask the facility’s compliance team how it structures payment before you sign.

Kentucky also lets facilities give Medicaid rides themselves. Under its HB 2, a hospital or skilled nursing facility may give Medicaid rides to its own patients or residents and be paid by the regional broker at the same mileage rate the broker pays its contracted drivers. See NEMT facility contracts and hospital discharge transportation.

Riders and families who pay privately

Private health insurance generally does not pay for NEMT. CMS’s 2023 report to Congress says private insurance and Medicare generally cover emergency transport and do not cover NEMT, which sets Medicaid apart. That leaves riders with only Original Medicare or private coverage, and their families, as buyers.

Two tax rules help them. IRS Publication 502 (2025) counts transportation primarily for and essential to medical care as a medical expense, including taxi and ambulance fares. And money in a health savings account can pay qualified medical expenses, which IRS Publication 969 (2025) defines as medical care under the same tax code definition. Give private riders a receipt that shows the date, the pickup and drop-off addresses, and that the trip was to medical care. For pricing and payment, see private pay NEMT.

Never charge a Medicaid member privately for a ride Medicaid covers. If a member wants a trip Medicaid will not pay for, such as one to a service it does not cover, check your state’s rules and your broker agreement first.

How fast each payer pays

Payer	Filing deadline	When you are paid
State fee-for-service	Up to 12 months after the date of service under federal rules. Your state may set a shorter limit.	90 percent of clean practitioner claims in 30 days, other claims within 12 months, per federal rule. States set their own cycle.
Medicaid health plan	Set by your contract	Set by your contract. Plans must pay practitioners’ clean claims on the federal schedule unless the contract sets another one.
Georgia’s broker	Set by the service agreement	As the agreement says, otherwise within 15 business days of an undisputed invoice (July 1, 2026 manual)
MTM Health, standard agreement	90 days after the date of service, unless its client sets another limit	Within 30 days of online submission of an uncontested invoice (January 1, 2023 version)
Facility or agency contract	Set by your contract	Set by your contract
Private pay	Not applicable	At booking or on your invoice terms

Payment timing drives your cash needs. See how long Medicaid takes to pay and NEMT cash flow.

How to find out who pays before you accept a ride

1. Ask for every card. Get the rider’s Medicaid, Medicare, Medicare Advantage, PACE, VA, and private insurance cards. Many riders carry more than one.
2. Check Medicaid eligibility for the date of the trip. Use your state’s eligibility system or your broker, and note whether the rider has full Medicaid. See eligibility verification.
3. Book Medicaid rides through the Medicaid system. If the rider has Medicaid and the trip is to covered care, it goes through the state, the broker, or the plan, with a trip number. Do not take it as private pay.
4. Call the plan if there is one. Ask a Medicare Advantage plan whether it covers rides, how many are left this year, and which company books them.
5. For veterans, call the VA first. Ask the beneficiary travel office at the local VA medical center whether the veteran qualifies for special mode travel and how it approves and pays vendors.
6. Get facility rides in writing. Use a signed agreement or purchase order that names the rider, the trip, and the price before you drive.
7. Quote private pay last. If no program covers the ride, give the price and payment terms before the trip, and take payment the way you agreed.
8. Write down what you checked. Keep the eligibility result, the plan’s answer, the authorization, and the trip number with the trip record.

Rules and payers differ by state, so check your state guide and the broker directory for who pays where you drive.