# Medicaid Application Fee Rises to $750 for Enrollments and Revalidations in 2026

Canonical URL: https://nemtguide.com/news/medicaid-enrollment-fee-750/ · Updated 2026-09-30

The federal application fee for Medicaid, Medicare, and CHIP is $750 for applications submitted in 2026, up $20 from 2025. The Centers for Medicare & Medicaid Services (CMS) set it on December 3, 2025. States collect it when an institutional provider enrolls, revalidates, adds a location, or adds an owner. Each state decides whether NEMT companies are institutional providers, and Arizona, Ohio, North Carolina, and New York charge them.

## What changed on January 1, 2026

The law set the fee at $500 for 2010. Each year CMS adjusts it by the change in the consumer price index for all urban consumers over the 12 months ending June 30 of the year before. That index rose 2.7 percent from July 2024 to June 2025, so $730 became $749.71, which CMS rounded to $750 (notice CMS-6096-N, 90 FR 55738).

The notice says the fee is required with any enrollment application submitted on or after January 1, 2026, and on or before December 31, 2026. CMS estimated that about 30,000 Medicaid and CHIP institutional providers would pay it in 2026: 9,000 enrolling for the first time and 21,000 revalidating.

| Calendar year | Application fee | CMS notice in the Federal Register |
|---|---|---|
| 2022 | $631 | October 25, 2021 |
| 2023 | $688 | December 5, 2022 |
| 2024 | $709 | November 7, 2023 |
| 2025 | $730 | December 2, 2024 |
| 2026 | $750 | December 3, 2025 |

## Do NEMT companies pay the Medicaid application fee?

In many states, yes, when you enroll directly with your state Medicaid agency. Under [42 CFR 455.460](https://www.ecfr.gov/current/title-42/section-455.460), the state must collect the fee before it signs a provider agreement with a new or re-enrolling provider. Two groups are exempt:

- **Individual physicians and nonphysician practitioners.** A NEMT company is not in this group.
- **Providers already enrolled in Medicare or in another state's Medicaid or CHIP program, or that paid the fee to a Medicare contractor or another state.** Keep your payment receipt. Ohio and Arizona ask for proof.

The fee is meant for institutional providers. CMS's Medicaid Provider Enrollment Compendium, last updated November 17, 2025, lets each state decide which Medicaid-only provider types are institutional. It also says CMS told states in its February 2, 2011 rule that the fee applies to any institutional entity that bills Medicaid fee-for-service, and it names non-emergency transportation providers as an example. Once a state decides, the same answer applies to every company of that type.

The compendium also spells out when the fee applies:

| Situation | Fee? |
|---|---|
| New enrollment | Yes |
| Revalidation | Yes |
| Adding a new practice location | Yes |
| Adding a new owner | Yes |
| One application that lists several locations | One fee |
| Enrolling as two separate provider types | Two fees, unless an exemption applies |
| Simple updates: phone number, bank account, billing address, name | No |

Working only for brokers or health plans does not always avoid it. Federal rules require states to screen and enroll the network providers of Medicaid health plans ([42 CFR 438.602](https://www.ecfr.gov/current/title-42/section-438.602)). In Texas, a transportation company must be enrolled in Texas Medicaid before it signs with a health plan or the plan's ride vendor. New York stopped letting non-medical transportation providers enroll as managed care only providers on March 1, 2024.

## What four states charge NEMT companies in 2026

| State | Your provider type | 2026 fee | Screening that comes with it |
|---|---|---|---|
| Arizona | Provider type 28, non-emergency transportation | $750 at new enrollment, revalidation, and reactivation | High risk: site visit and fingerprint criminal background check (PT-28 packet, rev 09/2026) |
| Ohio | Wheelchair van | $750 per application, not refundable, paid by credit card in the application | High risk at enrollment, moderate at revalidation (OAC 5160-1-17.8 appendix) |
| North Carolina | Non-emergency medical transport van, taxonomy 343900000X | $850: the $750 federal fee plus a $100 state fee | Moderate risk with a site visit, plus a NEMT Driver Attestation form (NCTracks matrix, August 16, 2026) |
| New York | Ambulette, taxi, livery, and other non-medical transportation categories | $750 | A letter of support from Medical Answering Services (MAS), which assigns New York's Medicaid trips, is required with the application (eMedNY, May 2026) |

North Carolina's state fee comes from its own law, G.S. 108C-2.1, which adds $100 to the federal amount and charges it again at re-credentialing every five years. NCTracks does not start processing an application until both fees are paid. Arizona revalidates every four years, and Ohio exempts companies that paid the fee to Medicare or another state's Medicaid program within the past five years.

For the rest of each state's process, see the [Arizona](https://nemtguide.com/states/arizona/), [Ohio](https://nemtguide.com/states/ohio/), [North Carolina](https://nemtguide.com/states/north-carolina/), and [New York](https://nemtguide.com/states/new-york/) guides. For any other state, check its enrollment portal or provider manual.

## When you can get the fee back or have it waived

Under the Medicare rule that sets the fee, [42 CFR 424.514](https://www.ecfr.gov/current/title-42/section-424.514), the fee is not refundable except when a hardship exception is approved, the application is rejected before screening starts, or it is denied because of an [enrollment moratorium](https://nemtguide.com/glossary/enrollment-moratorium/). Arizona's refund list, as of September 2026, adds a fee already paid to Medicare or another state. Arizona refunds by paper check, which can take 30 to 60 days.

A hardship exception is decided case by case:

1. **Write a letter** that describes the hardship and why it justifies an exception. Send it to your state Medicaid agency the way your state asks.
2. **Attach proof.** The compendium recommends your most recent business tax returns, profit and loss reports, and three or more bank statements.
3. **Wait for the decision.** Your state can deny the request on its own, but only CMS can approve it. CMS decides within 60 days of the state's recommendation and answers the state, not you.

States can also ask CMS to waive the fee for a whole provider type or area when the fee would keep Medicaid members from getting care.

## What NEMT owners should do now

1. **Check your state's rule.** Look up your provider type in the state's enrollment portal, fee FAQ, or provider type profile.
2. **Budget per application, not per van.** One application with several locations pays one fee. Adding an owner or a new location later can trigger another.
3. **If your revalidation window is already open, consider filing before December 31, 2026.** The fee is the amount in effect in the year you submit, so a 2026 filing pays $750. See [Medicaid revalidation for NEMT](https://nemtguide.com/guides/medicaid-revalidation/) for your state's window.
4. **Keep your receipt.** It is your proof of exemption if you enroll in a second state.
5. **Fix problems before you file.** The fee is not refunded when an application is denied after screening starts. Our guide to a [denied Medicaid application](https://nemtguide.com/guides/medicaid-application-denied/) covers the common causes.

The fee is only one part of enrollment. The full sequence, from NPI to site visit, is in [how to become a Medicaid transportation provider](https://nemtguide.com/guides/how-to-become-a-medicaid-transportation-provider/), and the other startup costs are in [how much it costs to start a NEMT business](https://nemtguide.com/guides/how-much-does-it-cost-to-start-a-nemt-business/).

## What the 2027 fee will be

As of September 30, 2026, CMS has not announced the 2027 amount. It will be the $750 fee adjusted by the change in the consumer price index for the 12 months ending June 2026. The notices for 2022 through 2026 appeared between October 25 and December 5 of the year before. The 2027 fee will apply to applications submitted on or after January 1, 2027.

## Key dates

| Date | What happened |
|---|---|
| February 2, 2011 | CMS rule sets up the application fee for Medicare, Medicaid, and CHIP |
| December 2, 2024 | CMS sets the 2025 fee at $730 |
| December 3, 2025 | CMS sets the 2026 fee at $750 |
| January 1, 2026 | The $750 fee takes effect |
| December 31, 2026 | Last day to submit an application at the 2026 amount |