How to Start a NEMT Business in California (2027)

California has no single Medicaid ride broker. Each Medi-Cal health plan arranges rides for its members, through a broker such as Modivcare or Call the Car or through its own transportation team, and the plans differ by county. Every company that drives those rides must enroll in Medi-Cal with the Department of Health Care Services (DHCS). The rules below follow DHCS All Plan Letter 22-008 and the ground transportation sections of the Medi-Cal provider manual (pages updated August 2020 to March 2024).

How Medicaid rides work in California

DHCS runs Medi-Cal, California’s Medicaid program, and pays each managed care health plan a monthly rate for every enrolled member. Plans cover two kinds of rides. Non-emergency medical transportation (NEMT) goes by ambulance, litter van, or wheelchair van. Non-medical transportation (NMT) goes by car, taxi, bus, or other vehicle. See NEMT vs NMT.

A plan may hire a transportation broker to take ride requests and send trips to companies in its network. The plan keeps the jobs DHCS will not let a broker do: approving the medical form, enrolling and overseeing providers, and handling grievances. A broker that only schedules does not enroll in Medi-Cal, but every company that drives does.

Who arranges rides for each plan

The counties come from the plan sections of the Medi-Cal provider manual (updated December 2023 to December 2024). The ride arrangers come from each plan’s or broker’s own pages as of September 2026.

Plan	Counties	Rides by
L.A. Care	Los Angeles	Call the Car
Blue Shield Promise	San Diego	Call the Car
Health Net	Los Angeles, Sacramento, San Joaquin, Stanislaus, Tulare, and 5 rural counties	Modivcare
Anthem Blue Cross	15 counties, including Fresno, Kern, Sacramento, San Francisco, Santa Clara	Modivcare
CalViva Health	Fresno, Kings, Madera	Modivcare
CalOptima Health	Orange	Modivcare
Alameda Alliance	Alameda	Modivcare
San Francisco Health Plan	San Francisco	Modivcare
Community Health Plan of Imperial Valley	Imperial	Modivcare
Molina Healthcare	Riverside, San Bernardino, Sacramento, San Diego	American Logistics
Health Plan of San Mateo	San Mateo	The plan for NEMT, American Logistics for NMT
Inland Empire Health Plan	Riverside, San Bernardino	The plan for NEMT, Call the Car for NMT
Partnership HealthPlan	24 Northern California counties	The plan
Central California Alliance	Mariposa, Merced, Monterey, San Benito, Santa Cruz	The plan
CenCal Health	Santa Barbara, San Luis Obispo	Ventura Transit System
Gold Coast Health Plan	Ventura	Ventura Transit System

Two changes are recent. CalOptima Health moved all its rides to Modivcare on April 1, 2024. On May 12, 2026, IEHP began managing every NEMT trip itself instead of through Call the Car, which still handles IEHP’s non-medical rides. See IEHP takes NEMT in-house.

Some Health Net medical groups arrange their own members’ rides, and Call the Car also lists a ride line for Alliance members. Kaiser Permanente, Kern Family Health Care, Santa Clara Family Health Plan, Contra Costa Health Plan, Health Plan of San Joaquin, Mountain Valley Health Plan, and Community Health Group are not in the table, so ask each one who arranges its rides.

Who qualifies and which ride fits

NEMT is covered when a member’s medical and physical condition rules out travel by car, taxi, or bus (22 CCR 51323). A doctor, dentist, podiatrist, or other treating provider prescribes it on a Physician Certification Statement (PCS), and the plan approves the lowest cost ride that meets the member’s needs.

• Wheelchair van. For a member who travels in a wheelchair or needs help from the home to the vehicle. APL 22-008 names dialysis patients, people with paraplegia or severe mental confusion, and people on oxygen who do not need monitoring.
• Litter van. For a member who must lie flat for the trip and is stable enough not to need an ambulance.

NMT is for members with full-scope Medi-Cal, and for pregnant members through the end of the month that holds the 365th day after the pregnancy ends. The member attests that they have no other way to get to care. Both kinds of rides go to medical, dental, mental health, and substance use visits and to pharmacies. Booking notice varies by plan: Partnership asks for five calendar days, and Ventura Transit System for two business days.

Fee-for-service members and the January 2027 change

Members who are not in a plan are fee-for-service members. They request rides through a DHCS form or call an enrolled provider directly. Medi-Cal pays enrolled providers from its fee schedule and requires an approved Treatment Authorization Request (TAR) for NEMT.

Starting January 1, 2027, members with unsatisfactory immigration status leave managed care for fee-for-service Medi-Cal, a DHCS notice of September 11, 2026 explains. Providers who bill only through managed care cannot keep serving those members after December 31, 2026, so enroll directly with DHCS and learn the TAR process before January.

Which brokers to join

You join a network one plan at a time, but Medi-Cal enrollment comes first. All Plan Letter 22-008 requires every NEMT and NMT provider in a plan network to meet Medi-Cal enrollment rules. A plan may let you drive for up to 120 days while your application is pending. It must end your contract if DHCS denies you or the 120 days run out.

The Alliance explains that a provider enrolled only through a plan can serve managed care members but not fee-for-service members. Enrolling with DHCS through PAVE keeps both doors open, which matters more after the January 2027 change.

1. Find the plans in your county and confirm who arranges each plan’s rides.
2. Enroll in Medi-Cal through PAVE for NEMT (wheelchair van or litter van), NMT, or both.
3. Apply to each broker or plan with your Medi-Cal number or proof that your application is pending.
4. Pass its credentialing: a vehicle inspection, a review of driver files and insurance, and a contract.

What each arranger asks for:

• Call the Car (L.A. Care, Blue Shield Promise, IEHP non-medical rides). Its online form asks for your NPI, Medi-Cal ID, permits, service area, fleet, and service levels, and whether your enrollment is approved or pending. It books credentialing inspections online. See the Call the Car guide.
• Modivcare (Health Net, Anthem Blue Cross, CalOptima Health, and four more plans). See the Modivcare guide.
• American Logistics (Molina, and non-medical rides for the Health Plan of San Mateo). It contracts only with companies whose drivers are their own employees, asks for commercial auto, general liability, and workers compensation, and requires its trip platform and driver app. See the American Logistics guide.
• Ventura Transit System (CenCal Health, Gold Coast). It takes partner applications through an online form. See the Ventura Transit System guide.
• Plans that run their own rides. IEHP says it contracts with more than 60 transportation companies, takes ancillary contract documents at jointhenetwork@iehp.org, and answers providers at (909) 890-2054. Partnership arranges rides through its own Transportation Services Department. The Alliance takes credentialing applications at credentialing@thealliance.health, and Provider Services is 800-700-3874, ext. 5504. See the IEHP, Partnership, and Alliance guides.

For PAVE questions, DHCS listed its PAVE help desk at (866) 252-1949 and its Provider Enrollment Division at (916) 323-1945 in its June 2023 guide for transportation providers.

Licenses and registrations

Your company

Form an LLC online with the Secretary of State. Articles of Organization (Form LLC-1) cost $70. The Statement of Information (Form LLC-12) costs $20 and is due within 90 days of registering, then every two years. Every LLC organized in California also owes the Franchise Tax Board an $800 annual tax, first due by the 15th day of the fourth month after you file.

Get your employer identification number (EIN) free from the IRS. An LLC or corporation needs a Type 2 NPI, even with one owner, and DHCS lists the wrong NPI type as a common reason for denial. See how to get an NPI number.

Then get a business license from each city or county where you operate, or a written statement from the city that it requires none. File a fictitious business name statement with your county if you use a name other than your legal name. Your name and address must match exactly on the IRS document, licenses, lease, insurance, and application.

DHCS Provider Enrollment Division

California has no separate NEMT license. DHCS enrollment, the DMV, and the Highway Patrol cover it together:

If you run	You need
Cars or minivans for NMT	Medi-Cal NMT enrollment, DMV commercial registration, commercial insurance
Wheelchair or litter vans	Medi-Cal NEMT enrollment, DMV commercial registration, commercial vehicle insurance on each van
A vehicle built for more than 10 people, driver included	All of the above. The Vehicle Code treats it as a bus, and the CHP inspects your terminal at least every 13 months.

Vehicles used only for medical rides do not need a Public Utilities Commission permit, under Public Utilities Code section 5353(i). The commission applies that exemption van by van, not to your whole company. A van that also takes other paid passengers can lose it, even for its medical trips, so keep mixed-use vehicles under charter-party authority.

The PAVE application for NEMT covers the Medi-Cal Medical Transportation Provider Application (DHCS 6206), the Disclosure Statement (DHCS 6207), and the Provider Agreement (DHCS 6208). Upload:

• An IRS document showing your EIN: Letter 147-C, Form 941, Form 8109-C, or the SS-4 confirmation notice.
• Your business license, fictitious business name statement, lease, and Articles of Incorporation if you are a corporation.
• Proof of liability and workers compensation insurance.
• For each van, its DMV commercial registration, proof of commercial vehicle insurance, and a Vehicle Safety Systems Inspection (VSSI) certificate if one applies. For each driver, the files listed under driver rules.

CMS sets the application fee each year: $750 for applications submitted in 2026. You are exempt if you already paid it to Medicare or another state’s Medicaid for the same location. Your place of business must be open, in a building you own or lease, with its permits and workers compensation in place. The owner, a partner, or an officer who can legally bind the company must sign.

To add NMT or vehicles later, file a Supplemental Change (DHCS 6209) in PAVE with each vehicle’s commercial registration and insurance. Report any change to the information in your application to DHCS within 35 days. For the licensing layers that apply in every state, see NEMT license requirements.

Vehicle rules

DHCS may send an inspector to check your place of business, vans, and drivers before it approves you. Brokers and plans may inspect before they contract, and Call the Car books its credentialing inspections online. Title 22 also asks van providers to send the local Medi-Cal field office, every year, a statement of hours and service area and a brake and light certificate.

California ended the brake and light certificate program on September 27, 2024. Since March 27, 2025, DHCS asks NEMT applicants for a Vehicle Safety Systems Inspection (VSSI) certificate from the Bureau of Automotive Repair instead, where one applies. Its June 2023 guide asked for the old certificate only for vans with a salvaged title, so ask DHCS whether yours needs one.

Every wheelchair van needs (22 CCR 51231.2):

• One standard wheelchair on board, and room for two passengers seated in standard wheelchairs.
• A loading entrance and a second emergency exit, each wide enough for a wheelchair.
• A lift or ramp rated for at least 450 pounds that can be secured to the vehicle, and a foot stool or extra step.
• Tiedowns strong enough to stop the chair turning, keep its wheels on the floor, and hold it if the van rolls over.
• Seat belts for the driver and front passengers, and door locks and latches that work from inside and outside.
• Heat and air conditioning in the passenger area, one interior light, and a portable battery light.
• Clean, working seats in washable vinyl, a spare wheel, jack, tire tools, and current street maps.
• A 4-B:C dry powder or carbon dioxide fire extinguisher, never a vaporizing liquid type.
• Your business name on both sides and the rear, in contrasting letters at least 4 inches tall, the same on every van.

A litter van needs the same basic safety equipment, plus a gurney entrance, a second exit that fits a gurney, a two-person gurney with mattress and straps, a floor or wall cot fastener, and an attendant seat (22 CCR 51231.1). It may not be marked as an ambulance. A litter van that also meets every wheelchair van rule can carry wheelchair riders.

Riders stay secured to the wheelchair or strapped to the gurney from loading to unloading. A van registered as a regular automobile instead of a commercial vehicle is a common reason DHCS denies an application. Use our vehicle inspection checklist before each inspection, and see NEMT vehicle requirements for vehicle types in general.

Driver rules and training

Title 22 sets these rules for every wheelchair and litter van driver and attendant. Litter vans always carry both.

• At least 18 years old.
• A current California driver license or a California ambulance driver certificate.
• At least a current Red Cross standard first aid certificate or its equal. DHCS also asks for a CPR certificate.
• A physical exam within the past two years.

A person may not drive or attend if they:

• Must register as a sex offender for an offense involving force, duress, threat, or intimidation.
• Habitually use or are addicted to narcotics or dangerous drugs.
• Were convicted of a drug or alcohol felony in the past seven years.
• Habitually or excessively use alcohol.

For each driver, DHCS asks for the license, a DMV driving record printout, first aid and CPR certificates, a pre-employment drug test listing the drugs tested, alcohol test results, and the medical examination report (MCSA-5875) with the examiner’s certificate (MCSA-5876). NMT drivers need the license, driving record, and medical forms. Expired documents are a common reason DHCS denies an application.

Drivers employed mainly to carry people with developmental disabilities, such as regional center clients, need a special driver certificate (Vehicle Code 12523.6). Mainly means at least half their work time or 20 hours a week, whichever is less. It takes a Department of Justice fingerprint check through the CHP, which charges $25, or $12 to renew. Drivers who already passed a background check required by law are exempt.

On every NEMT ride, give door-to-door help, from the home entrance to the entrance of the destination. Never smoke in the van. A minor rides with a parent or guardian unless the plan has the written consent the law requires. Partnership records the driver of every trip, so keep a trip log for every ride. The Medi-Cal manual lets you record odometer readings at each pickup and drop-off with GPS or digital mapping.

Trip rules and how you get paid

All Plan Letter 22-008 sets the service standards plans enforce on their brokers and providers:

• On time. Plans review their brokers at least every quarter, and the review can include whether providers arrive within 15 minutes of the scheduled time and how often they miss rides. If you are late or do not show, the plan must authorize an urgent replacement ride.
• Hospital discharges. A ride from an acute hospital to a skilled nursing or psychiatric facility must happen within 3 hours of the request, or the hospital can call an out-of-network company.
• The prescribed ride. A plan or broker cannot change the ride type on the PCS form or downgrade NEMT to NMT, unless the prescriber checked more than one type.
• Standing orders. For recurring visits such as dialysis, the plan approves NEMT for the length of the treatment, up to 12 months.

Plans and brokers set your rate in your contract. The fee-for-service schedule applies to fee-for-service members and is a benchmark when you negotiate. Medi-Cal pays your usual charge to the public or these maximums, whichever is lower, and the Medi-Cal rates file dated August 15, 2026 shows the same base amounts. Amounts are in dollars:

Code	What it pays for	Maximum
A0130	Wheelchair van trip	20.30
A0130 with UJ	Wheelchair van trip at night, 7 p.m. to 7 a.m.	26.43
A0380	Wheelchair or litter van mile	1.50
T2005	Litter (stretcher) van trip	26.29
T2005 with UJ	Litter van trip at night	32.42
T2001	Attendant or escort	5.52
T2007	Waiting time, per half hour after the first 15 minutes	11.30
A0120	NMT trip	17.65
A0390	NMT mile	1.30

How fee-for-service billing works:

• Authorization. Every NEMT trip needs an approved TAR, except a transfer from an acute hospital to a Level A or B nursing facility, billed with modifiers HN and QN.
• The claim. Put the full pickup and drop-off addresses with city and ZIP in Box 19 of the CMS-1500 and the loaded miles in Box 24G. Mileage is paid only while the member is on board.
• Shared rides. For riders picked up at one place and taken to one place, add UN, UP, UQ, UR, or US to A0130 for two to six or more riders, and bill mileage only on the first rider’s claim. Two riders pay up to $16.22 each.
• Waiting. Waiting pays for up to 90 minutes past the first 15, only while you wait to load the patient.
• NMT limits. A0120 pays for eight one-way trips a month per member unless the claim documents the need for more.
• Dry runs. When you arrive and the member is not transported, bill the trip code with modifiers DS and QN. See no-shows.
• Deadlines. Claims are due within six months after the month of service. Medi-Cal pays 75 percent for claims sent in months 7 to 9 and 50 percent in months 10 to 12, and denies them after 12 months (W&I Code 14115).

Plans and brokers set their own claim deadlines and no-show terms, so read them before you sign. See the timely filing limit.

Insurance requirements

Medi-Cal enrollment sets the floor, and plans and brokers add to it:

Who asks	What they require
DHCS (Medi-Cal enrollment)	Commercial liability of at least $100,000 per claim and $300,000 a year, and commercial vehicle insurance on each van
Central California Alliance (December 2021 form)	Commercial liability of $1,000,000 per claim and $3,000,000 aggregate, plus commercial vehicle liability
American Logistics	Commercial auto, general liability, and workers compensation, with the amounts on its form

The name and address on every certificate must match your application exactly, suite number included. Ask each broker for its current limits before you buy a policy, and see NEMT insurance requirements.

California requires workers compensation insurance even if you have only one employee. DHCS asks for proof of it with your application, or an explanation if you have no employees. See workers comp for NEMT.

What it costs and how long it takes

These are the fees California and CMS set. Vans, insurance, and equipment depend on your quotes. See what it costs to start a NEMT business for those.

Item	Cost	Paid to
Articles of Organization (LLC-1)	$70	Secretary of State
Statement of Information (LLC-12)	$20 within 90 days, then every two years	Secretary of State
LLC annual tax	$800 a year	Franchise Tax Board
EIN	Free	IRS
Medi-Cal application fee	$750 in 2026	DHCS
Special driver certificate, if needed	$25, $12 to renew	CHP

A workable order, from first call to first trip:

1. Call the brokers and plans in your county. Ask which service levels they need and whether their networks are open.
2. Form your company, then get your EIN and a Type 2 NPI.
3. Get your local business license and fictitious business name, if you use one.
4. Buy or lease vans, register them as commercial vehicles, and equip them to Title 22.
5. Buy insurance, including workers compensation.
6. Hire drivers and build each driver’s file.
7. Enroll in Medi-Cal through PAVE and pay the application fee.
8. Apply to each broker or plan, pass its inspection, and sign its contract.

Enrollment sets the pace. State law gives DHCS 180 days to act on a complete application, and if DHCS sends no notice by then, you become a provisional provider on day 181. If DHCS returns it as incomplete, you have 60 days to fix it, and DHCS then has 60 days to respond. New providers start as provisional providers for 12 months. An approved NMT enrollment takes effect from the date you sent a complete application.

Work beyond Medicaid

Medi-Cal is not the only source of rides in California. Four others are worth a call.

• Regional centers. Regional centers, which contract with the Department of Developmental Services (DDS), pay transportation companies to carry people with developmental disabilities. Since January 1, 2025, those companies bill total vehicle miles at a rate set by vehicle size, with a separate rate for lift-equipped vans, under a DDS directive last revised October 28, 2025. Their drivers may need the special driver certificate above.
• Section 5310 grants. Caltrans runs the federal Section 5310 program for seniors and people with disabilities in rural, small urban, and several large urban areas. Only nonprofits and qualifying public agencies can apply. See Section 5310 grants.
• Veterans. The VA pays eligible veterans for special mode transportation, such as an ambulance or a specially equipped vehicle, when the local VA health facility approves the trip in advance. Ask your nearest VA health facility how it books these rides. See VA transportation contracts.
• Facilities and private pay. Dialysis centers, hospitals, nursing facilities, and families who pay for themselves give you work that does not depend on one plan. See how to get NEMT facility contracts.