How to Start a NEMT Business in Alabama (2027)

Alabama has no Medicaid ride broker. The Alabama Medicaid Agency runs its Non-Emergency Transportation (NET) program with its own staff, approves the transporters riders can choose, and pays them through each rider’s EBT transportation account. To carry Medicaid riders, you need a registered company, authority from the Alabama Public Service Commission, and approval from the NET program. The rules below follow Appendix G of the July 2026 Medicaid provider manual and the NET procedures dated July 10, 2025.

How Medicaid rides work in Alabama

The Alabama Medicaid Agency runs NET itself, as an administrative service rather than a medical benefit. A state plan change that CMS approved on February 13, 2015 removed the broker model from Alabama’s Medicaid plan, effective December 1, 2014. Today, regional NET coordinators and central office staff approve rides and look for the least costly way to get the rider there.

Riders arrange their own rides. A rider, or someone helping them, calls the NET call center at 800-362-1504 (option 4) at least five days before a scheduled appointment, or within 24 hours after urgent care. The rider gives the appointment details, says whether they will travel by car or van and whether they use a wheelchair, and gets a seven-digit request number. That number is the rider’s receipt, and it goes on your trip log.

A rider qualifies with full Medicaid coverage on the day of the visit, a trip to a service Medicaid covers, and no free ride available. Coordinators look first for a free ride from the rider’s own car, family, friends, or volunteers, unless the program finds a hardship. Next comes public transit, which Medicaid wants used whenever it meets the rider’s needs. A paid transporter comes in when neither works.

The NET modes are volunteer drivers, family and household members, the rider’s own car, minibus, wheelchair van, city or commercial bus, train, and airplane. Ambulance service is a separate program. Under Medicaid’s NET checklist (revised July 2019), a wheelchair van rider must need a wheelchair and have a severe mobility problem that keeps them from riding in, or getting in and out of, a regular car, van, or taxi without special help. Medicaid needs Form 177, a physician’s wheelchair certification revised in November 2025, on file before it approves payment for any wheelchair trip.

The program’s limits shape your trips:

• One round trip a day. Medicaid pays one round trip per rider per date of service unless an exception is approved in advance.
• Distance. Care more than 100 miles from the rider’s area needs approval. Minibus and wheelchair van trips more than 30 miles past the state line are not covered.
• No supplies in use. NET does not cover oxygen or IV fluids used during a trip.
• Methadone clinics. Medicaid does not pay transporters for trips to methadone treatment centers. Those riders use their own transportation and are repaid monthly.
• Overnight trips. Meals and lodging for the rider and one approved escort are paid up to $50 per person per day, with receipts.
• Escorts. One escort per rider. Riders under 21 may have one without extra paperwork, and adults need a medical certification. The escort cannot be your employee.

Under Medicaid’s state plan, rides to mental health services at community mental health centers run through a separate contract with the Alabama Department of Mental Health.

NET splits Alabama’s 67 counties among 10 district offices. The district phone numbers below come from the NET coordinators list dated July 9, 2026:

Office	Phone	Counties
Auburn	334-466-0152	Chambers, Clay, Coosa, Lee, Macon, Randolph, Russell, Talladega, Tallapoosa
Birmingham	205-414-9413	Jefferson
Decatur	256-584-4109	Cullman, Fayette, Jackson, Madison, Marshall, Morgan, Walker
Dothan	334-353-3531	Barbour, Coffee, Covington, Crenshaw, Dale, Geneva, Henry, Houston, Pike
Florence	334-353-4668	Colbert, Franklin, Lamar, Lauderdale, Lawrence, Limestone, Marion, Winston
Gadsden	334-242-4092	Blount, Calhoun, Cherokee, Cleburne, DeKalb, Etowah, Shelby, St. Clair
Mobile	251-472-4370	Baldwin, Clarke, Conecuh, Escambia, Mobile, Washington
Montgomery	334-353-4778	Autauga, Bullock, Elmore, Montgomery
Selma	334-242-1275	Bibb, Butler, Chilton, Choctaw, Dallas, Lowndes, Marengo, Monroe, Perry, Wilcox
Tuscaloosa	205-391-6771	Greene, Hale, Pickens, Sumter, Tuscaloosa

Medicaid tells riders that some counties may have no transporters at all, and that riders there must find their own way. For a new company, those gaps are a place to start. See rural NEMT for how to make long rides pay.

How to enroll with Alabama Medicaid

You do not sign with a broker in Alabama, and you do not bill Medicaid claims the way ambulance services do. The NET program approves transporters itself and pays them through each rider’s EBT account. When it approves you, it adds your contact information to its NET Transporters Directory, and the call center shares that directory with riders who ask for a transporter in their county. The rider picks the transporter.

1. Get licensed first. Form your company, get your county and city licenses, buy insurance, and get your Public Service Commission authority, all covered below. Rule 560-X-18-.19 has the NET program keep information on all certified and licensed transporters.
2. Call the district office for your counties. Use the table above. Ask to be approved as a NET transporter, which documents the office wants, and how it sets up your direct deposit.
3. Screen your company and every driver. Rule 560-X-18-.25, in effect since July 15, 2022, bars any company or driver excluded from federal health care programs or listed on the HHS OIG exclusion list. Every driver needs a valid license. You must also have a process for handling a driver’s violation of state drug laws, and one for disclosing each driver’s driving history, traffic violations included, to Medicaid.
4. Set up payment. Transporters are paid by direct deposit, so have your EIN and a business bank account ready.
5. Get listed and get known. Once you are in the directory, tell dialysis centers, clinics, and riders in your counties. Riders who call the NET line can then choose you.

Check your owners and drivers against the exclusion list before you apply and on a regular schedule after that. See the OIG exclusion list for how the check works. For how enrollment runs in states with brokers and fee schedules, see how to become a Medicaid transportation provider.

The NET call center is 800-362-1504, and the district office numbers are in the table above.

Licenses and registrations

Your company

Reserve your company name with the Alabama Secretary of State first. The state requires a Certificate of Name Reservation before it accepts formation papers, and a reservation costs $25. Then file a Certificate of Formation for an LLC or a corporation, which costs $200, with the original and one copy. The Secretary of State’s office answers at 334-242-7200.

Each year after that, LLCs and corporations file an Alabama business privilege tax return with the Department of Revenue, unless the tax works out to $100 or less. For tax years that began after December 31, 2023, that amount is fully exempt and no return is needed. Since January 1, 2024, only for-profit and professional corporations file a Secretary of State annual report, for $10. LLCs do not file one.

Get your employer identification number (EIN) from the IRS, which issues it for free. Then get a business privilege license from the Probate Judge or License Commissioner in every county where you do business, and a license from each city where you operate. The Department of Revenue does not handle city licenses, so ask each city hall. If a health plan or facility asks for an NPI, see how to get an NPI number.

Alabama Public Service Commission

The Public Service Commission (PSC) regulates for-hire passenger carriers under the Alabama Motor Carrier Act. Its Motor Carrier Services Section requires a PSC certificate or permit to carry passengers for pay from one point in Alabama to another, unless the law exempts you. The PSC’s rules define pay broadly: money, checks, and any other benefit the carrier receives.

If you	You need
Carry riders for pay between cities that do not touch, or on trips that start or end outside any city’s limits and police jurisdiction	PSC passenger authority (Form 14), $100 filing fee
Run only inside one city and its police jurisdiction, or between cities whose limits or police jurisdictions touch	No PSC authority under Code section 37-3-4(a)(1)b. Check the city’s own rules.
Drive only for nonprofits, such as churches and other tax-exempt groups	A PSC Certificate for Nonprofits (Form 18), $10 filing fee, unless you already hold passenger authority
Drive a vehicle designed for 16 or more people, driver included	A commercial driver’s license

The PSC’s rules define a taxi carrier as a common carrier of no more than five passengers at a time, and the PSC has a separate taxi form (Form 12, $100). If you run only sedans, ask which form fits. A passenger application comes together like this:

• The form. The PSC sends its application forms on request. Call 334-242-5176 or email MCS.UED@psc.alabama.gov.
• The fee. Pay by cashier’s check or money order. The PSC takes no cash and no personal or company checks.
• Insurance. Your insurance company files proof on Form E. You cannot carry anyone for pay until the PSC has accepted it.
• Vehicles. File Form B-2 for a registration number for each vehicle, at $6 per vehicle.
• Citizenship. Proof of U.S. citizenship is not needed if your company is registered with the Secretary of State.
• Rates. Non-charter passenger carriers keep an approved tariff on file with the PSC, listing their rates, fares, and rules.

Each year, file the PSC annual report, with a financial statement, by April 30 for the year before. Mark each vehicle before it runs. A vehicle that carries five passengers or fewer shows your certificate name, your city and state, “APSC Cert.” with your certificate number, “APSC Reg. No.” with the vehicle’s number, and your fares, in letters at least 1.5 inches tall. Larger vehicles show your name, your city, your certificate number (which may go inside the cab), and the registration number, in letters at least 2 inches tall.

For the layers of licensing NEMT companies deal with in every state, see NEMT license requirements.

Vehicle rules

Alabama’s Medicaid rules set no equipment list for NET vehicles, so the PSC’s safety rules are the state floor for a for-hire van. They start with inspections:

• Scheduled upkeep. Inspect and maintain every vehicle on a schedule. For each one, record its make, model, serial number, and tire count and size, each inspection and repair with its date, lubrication, and what is due next and when. Keep the records while you run the vehicle, for up to three years.
• Daily defect reports. If you run more than one vehicle, each driver reports any defect in writing at the end of the day.
• After damage. A vehicle damaged in an accident stays off the road until a qualified person inspects it and finds it safe.
• PSC inspections. PSC enforcement officers can inspect your vehicles and put an unsafe one out of service. Make the repairs, sign the notice, and return it to the PSC within 15 days.

Before each trip, the driver confirms that the brakes, parking brake, steering, lights and reflectors, tires, horn, wipers, and mirrors work. Every vehicle carries:

• A mounted fire extinguisher rated 5 B:C or more, with a gauge that shows it is charged. Taxis are the one exception.
• A spare fuse for each kind the vehicle uses, unless its fuses reset.
• Warning devices: three red reflectors and two red flags, or one of the other approved sets. Flares are not allowed on vehicles that run on compressed gas.

Medicaid decides which riders need a wheelchair van, so match your vehicles to the riders in your counties. A wheelchair rider needs a van they can board in their chair and a proper tiedown. See wheelchair securement and NEMT vehicle requirements for the equipment facilities and health plans commonly ask for, and use our vehicle inspection checklist for your scheduled checks.

The NET program does not pay for stretcher transport. Medicaid covers stretcher trips only as non-emergency ambulance service. Ambulance providers enroll through Medicaid’s fiscal agent, must be certified for Medicare, and must be licensed in Alabama, and their non-emergency trips of 100 miles or more one way need prior authorization. A van company in Alabama works ambulatory and wheelchair rides.

Driver rules and training

Medicaid’s rule 560-X-18-.25 and the PSC’s safety rules together decide who can drive. A driver cannot carry your riders if they:

• Are excluded from federal health care programs or listed on the HHS OIG exclusion list.
• Lack a valid driver’s license, or do not carry it while driving.
• Are under 18.
• Were convicted in the past year of refusing a blood alcohol test, driving with a blood alcohol level of 0.04 percent or more, driving under the influence of alcohol, amphetamines, or narcotics, or a felony involving a motor vehicle.
• Have a second such conviction. The PSC can lift that bar only when the last conviction is more than 10 years old.
• Have lost the use of a limb in a way that affects driving, or have a condition likely to cause a loss of consciousness or control.

Each driver also needs a DOT medical examination certificate from the past 24 months, carried while driving. Drivers must read and speak English well enough to talk with the public, read road signs, and answer officials.

Before a driver’s first trip, give a road test in the vehicle they will drive and put a certificate in their file. You are also responsible for each driver knowing the PSC safety rules. Chapter 18 of the Medicaid code sets no course of its own. Passenger assistance, wheelchair securement, first aid, and CPR are what riders and facilities expect, and NEMT driver training covers them.

The PSC caps driving time too: no more than 10 hours of driving after 8 hours off duty, no driving after 15 hours on duty, and no more than 60 hours on duty in 7 days or 70 in 8 days. Drivers who stay within 100 air miles of their base can skip the daily log, as long as you keep a record of each driver’s daily on-duty hours and start and end times for one year.

Keep a file for each driver with:

• A signed employment application listing addresses, accidents, moving violations, and employers for the past three years, plus any license suspension or revocation.
• The road test certificate and a copy of the medical certificate.
• The driving history you must be able to disclose to Medicaid.
• Your exclusion list checks.

Our driver file checklist tracks them.

Trip rules and how you get paid

Every NET trip needs approval in advance, except urgent care after hours, which the rider reports afterward. Before you drive, get the rider’s seven-digit request number.

Log each trip on Form 174, the NET Transporter Trip Validation Log dated December 2, 2025. For each rider, it records the time, the request number, the destination, and whether the rider uses a wheelchair, and both the rider and your driver sign it on the same day as the medical visit. For dialysis riders, the dialysis center completes Form 173 each month, listing the rider’s request number for each week and circling the treatment days. Ask your district office how to send in your logs, and keep your own trip log as well.

Alabama Medicaid sets what it pays. Rule 560-X-18-.18 describes a tiered fee based on mileage, the rider’s physical, mental, or medical condition, whether the rider can walk or must lie down, prevailing rates in the region, how many transporters are available, the level of transportation needed, and who provides it. The state plan says Medicaid keeps the rates of major transporters on file and pays the most cost-effective rate for the mode in that area. Get the current rate for your counties from your district office in writing before you take trips.

Medicaid does not pay for:

• Miles with no rider aboard, unless that is the most economical option.
• A second round trip on the same day without approval in advance.
• Trips to services Medicaid does not cover, or to visits beyond the rider’s benefit limit, such as their yearly doctor visits.
• Trips without the required prior approval, or that are not medically necessary.
• Trips to methadone treatment centers.

Your payment waits on the rider’s medical provider. When the doctor, clinic, or dialysis center files its Medicaid claim for the visit, that claim proves the rider went, and Medicaid then pays the ride. NET staff cannot override this or pay a ride by hand, and medical providers have up to one year to file. Medicaid’s payment vendor builds transporter pay files on the 1st and 16th of each month and sends the money to banks on the 2nd and 17th. When a build date falls on a weekend or holiday, pay runs a day or two late, and your bank may hold a deposit.

The money reaches you by direct deposit, funded through the rider’s EBT transportation account. Medicaid’s EBT guide from October 2014 notes that some transporters wait for that deposit while others ask riders to pay up front, and riders who paid are repaid on their EBT card. The card works at ATMs and stores with the Quest logo, not at gas stations. Either way, plan cash to cover the wait. See what it costs to start a NEMT business.

Alabama’s NET rules leave pickup windows, wait times, and return rides to you, the rider, and the facility. Put yours in writing with each dialysis center or clinic you serve. See dialysis transportation for how standing rides usually run.

Insurance requirements

Alabama’s NET rules list no insurance amounts of their own. The PSC’s minimums apply to for-hire passenger carriers, and your insurer must file proof on Form E before you run. The limits depend on seats, and rule 770-X-10-.04-.03 draws the seat bands this way:

Vehicle seats	Injury limits	Property damage
5 or fewer	$25,000 per person, $50,000 per accident	$10,000
5 to 20	$50,000 per person, $200,000 per accident	$30,000
More than 20	$100,000 per person, $500,000 per accident	$50,000

Alabama’s mandatory liability law for private vehicles sets $25,000 for injury to one person, $50,000 for two or more, and $25,000 for property damage. The Department of Revenue lists vehicles covered under a commercial auto liability policy among those exempt from that law, so for a for-hire fleet the PSC limits above are the state’s floor.

Carriers for nonprofits have their own minimums. Certificate B covers vehicles with 14 or fewer passengers:

Limit	Certificate A	Certificate B
Injury to one person	$100,000	$50,000
All injuries in one accident	$500,000	$200,000
Property damage	$50,000	$30,000

These are floors. Facilities, health plans, and private customers often ask for more, so get their limits in writing before you buy a policy. See NEMT insurance requirements for what buyers commonly ask for.

Alabama requires workers’ compensation once you have five or more employees, counting full-time and part-time workers, corporate officers, and LLC members. With fewer than five, the law generally does not require it. The workers’ compensation division of the Alabama Department of Workforce answers questions at 1-800-528-5166.

What it costs and how long it takes

These are the fees Alabama sets as of September 2026. County and city license fees vary by place, and vehicles, insurance, and equipment depend on your quotes.

Item	Cost	Paid to
Name reservation	$25	Secretary of State
LLC or corporation formation	$200	Secretary of State
EIN	Free	IRS
Passenger authority (Form 14)	$100 filing fee	PSC
Vehicle registration number (Form B-2)	$6 per vehicle	PSC
Certificate for Nonprofits (Form 18)	$10 filing fee	PSC
Corporation annual report	$10 a year	Secretary of State
Business privilege tax	None if $100 or less	Department of Revenue

A workable order, from first call to first trip:

1. Call the NET district office for your counties. Ask where riders need transporters and what approval takes.
2. Reserve your name and form your company, then get your EIN.
3. Get your county privilege license and city licenses.
4. Buy insurance and have your insurer file Form E with the PSC.
5. Apply for PSC authority, register and mark each vehicle, and file your tariff.
6. Hire drivers who meet the rules: application, road test, medical certificate, exclusion checks, and driving history.
7. Get approved by the NET program and set up direct deposit.
8. Tell clinics and dialysis centers that you are in the directory, and log every trip on Form 174 from day one.

Two things set the pace. The PSC must accept your insurance filing before your first paid ride, and Medicaid pays each ride only after the rider’s medical provider files its claim. Ask the PSC and your district office how long their reviews are running when you apply. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

Four other sources of rides are worth a call.

• Public transit and human services programs. The Alabama Department of Transportation (ALDOT) runs the federal grant programs for rural public transit (Section 5311) and for transportation of seniors and people with disabilities (Section 5310), each with a yearly application. It has designated 12 regional planning councils to coordinate transportation services in their regions. Ask yours which agencies buy rides from private carriers.
• Nonprofits. Churches and other tax-exempt groups can hire you to drive their members once you hold a PSC Certificate for Nonprofits or passenger authority. Carriers for nonprofits file a quarterly report with the PSC within 30 days after each quarter, listing each group and the dates of its trips.
• Veterans. The VA pays for special mode transportation, such as a wheelchair van, when a veteran’s condition makes regular transportation unsafe and the trip is approved in advance. Ask the beneficiary travel office at your nearest VA medical center how it books these rides.
• Facilities and private pay. Dialysis centers, hospitals, senior living communities, and riders paying for themselves add work that does not depend on the NET directory. See how to get NEMT facility contracts and private pay NEMT.