NEMT in San Diego: The MTS Medical Vehicle Permit and the County NEMT Permit (2027)

San Diego County splits NEMT permits by where the van picks up. The Metropolitan Transit System (MTS) regulates nonemergency medical vehicles in the City of San Diego and nine other cities, and the County EMS Office permits NEMT companies for pickups in unincorporated areas. A company with an MTS permit gets the County permit by endorsement, so most owners start with MTS.

Who books Medi-Cal rides in San Diego County

California has no statewide NEMT broker: each Medi-Cal plan arranges its members’ rides, and every company that drives them enrolls in Medi-Cal with DHCS. The California guide covers that enrollment and the Title 22 van rules.

The Medi-Cal provider manual (page updated December 2023) lists four plans in the county, and as of September 2026 each books rides its own way:

Plan	Who books the ride	Member booking line
Blue Shield of California Promise	Call the Car, which lists this line for the plan	(877) 433-2178, at least one business day ahead
Community Health Group	The plan’s own Member Services	1-800-224-7766
Molina Healthcare	American Logistics	(844) 292-2688, at least 48 hours ahead

Kaiser Permanente is the fourth plan. Community Health Group schedules NEMT and NMT trips so the member arrives within 15 minutes of the appointment, and it arranges another ride when a company does not arrive for the pickup. Its members need a Provider Certification Statement from their doctor before an NEMT ride.

The MTS nonemergency medical vehicle permit

MTS’s For-Hire Vehicle Administration (FHVA) permits taxicabs, charter vans, and nonemergency medical vehicles in San Diego, Chula Vista, El Cajon, Imperial Beach, La Mesa, Lemon Grove, National City, Oceanside, Poway, and Santee. A permitted van may work in all ten. For trips that start in any other city, MTS tells riders to contact that city.

MTS Ordinance No. 11, as amended through July 30, 2026, defines a nonemergency medical vehicle as any vehicle carrying people mainly for medical purposes: to or from hospitals, convalescent and retirement homes, board and care homes, medical or rehabilitation clinics, and senior centers. You decide whether a trip is mainly medical. A trip counts as operating for pay whether the rider or a third party pays, so plan and broker rides need the permit too.

How to apply

1. Email the application to FHVApermits@sdmts.com. FHVA replies by the next business day, and it has you name each officer and LLC member.
2. Pass the background check. Owners take a fingerprint-based California DOJ and FBI check.
3. Get your DBA approved and a business tax license from each city where your vans will work.
4. Send proof of insurance that meets the MTS minimums below, with MTS named as certificate holder and 30 days’ notice before cancellation.
5. Pass inspection. Before a van goes into service and every year after, a certified mechanic at an ASE or Bureau of Automotive Repair facility inspects it, and an MTS inspector checks the ramp or lift, wheelchair restraints, non-skid surfaces, fire extinguisher tag, reflectors, first aid kit, and gurney.

Each van needs its own permit, and the permit holder must own it (Sections 1.2 and 1.8). Report any change of email, address, or business phone within 48 hours, keep trip logs and other operating records at least six months, and file a signed annual statement at each renewal.

MTS fee, calendar year 2026	Amount
New company application	$915, plus $90 for each van permit after the first
Adding a van to an existing company	$90, plus a prorated regulatory fee
Annual regulatory fee per medical van	$490, due March 2, 2026
Late renewal, paid by April 3, 2026	$65
Driver training class	$40
Failing a scheduled inspection	$45
Missing the mechanical inspection due date	$60

What MTS requires of the van

Section 5.2, amended July 30, 2026, sets the medical van rules:

• Ramps, lifts, and other special equipment work whenever the van runs, and every wheelchair on board is secured. See wheelchair securement.
• A gurney van carries gurney seatbelts, floor-mounted gurney retention, single-use linens, and at least one gurney that meets current standards.
• No trip when the rider’s medical care is required, likely, or foreseeable, and no entering a hospital emergency department through the ambulance bay without a hospital staff escort.
• A dry chemical or carbon dioxide extinguisher rated at least 5 B/C with a current tag, three red reflectors, a first aid kit, seatbelts for ambulatory riders, and Cal/OSHA pathogen protection gear.
• You train each driver on the van’s equipment and on helping riders with disabilities, and the van may not wait at the curb except to load or unload.

Fares may be per capita plus per mile, or set by a prearranged written contract per mile or per hour (Section 5.1). MTS sets no maximum fares for medical vans, its May 13, 2026 committee report says.

MTS insurance

MTS requires public liability of at least $350,000 combined single limit for a vehicle seating nine or fewer, driver included, $2,000,000 for 10 to 15, and $5,000,000 for 16 or more (requirements revised June 6, 2025). The insurer needs an A.M. Best or Demotech rating of B- or better and a financial size of VII or higher, and an insurer officer, not your agent, signs the verification form. MTS rejects named-driver policies, aggregate limits, territorial restrictions, and self-insured retentions. See NEMT insurance requirements for what brokers add on top.

MTS counted 656 nonemergency medical vehicle permits on May 7, 2026, 641 of them active, far more than its 92 charter permits. In the renewal round that report covered, 621 of 655 medical van permits billed were renewed. From January to March 2026, medical and charter vans drew 1,043 of the 1,289 field checks its inspectors made.

Drivers: the Sheriff ID card and MTS training

Every driver of an MTS-permitted van carries a for-hire driver ID card from the San Diego County Sheriff, renewed each year, or a VDDP certificate with a commercial license (Section 1.12). The Sheriff starts a driver’s application only after your company holds its MTS permit, and a driver who works for more than one permit holder files a separate application for each. As of September 2026, the Sheriff’s License and Registration Division, at 9621 Ridgehaven Court, processes for-hire drivers on a walk-in basis Tuesdays and Wednesdays from 8 to 11 a.m. and 1 to 3 p.m., and by appointment Thursday mornings, and it takes original documents only.

Drivers also finish MTS’s safety training. As of September 2026, the class for medical van and charter drivers runs by webinar on the first Friday of each month at 10 a.m., for a one-time $40 fee. Sign up at MTSFHVDTraining@sdmts.com or 619-235-2651 with the driver’s name, phone, email, license number, and your DBA.

Drivers keep first aid and CPR proof, and since the July 30, 2026 amendment so does any driver assistant who rides along to help passengers (Section 5.3). MTS’s May 2026 committee report says driver assistants also need a Sheriff ID card.

The County NEMT permit for unincorporated areas

County Code Section 610.301, last amended effective January 10, 2025, requires a County NEMT permit to operate or advertise NEMT service in the unincorporated areas of the county. The code does not apply to a van operating only inside incorporated cities or to a trip that starts outside the county (Section 610.102). Applications and fleet updates go through the County’s online permitting system, LEMSIS, and questions go to the EMS Permitting Unit by email.

There are two ways in (Section 610.303):

• Endorsement of your MTS or city permit. Send a copy of your approved MTS application, your owners, officers, and 10% shareholders, a statement of fact and good faith from the principal owner, proof of workers compensation and liability insurance, each van’s make, model, year, mileage, and VIN, and proof your staff hold CPR and first aid certificates. Section 610.102 waives the County permit fees for a company another government has permitted.
• Direct application to the County. Add a legal history and a Sheriff criminal history check with a DOJ fingerprint card for each owner and officer, a resume, your maintenance program, a staff roster with license and first aid expiration dates, a County van inspection, proof you can operate for six months with profit and loss figures and current taxes, and business licenses for every area you serve.

The Permit Officer decides within 30 days of a complete application (610.304). A denied applicant may request a hearing within 10 days and cannot reapply for 12 months (610.305). Permits last one year (610.307), changes are reported within 10 days (610.308), and renewals are due 30 days before expiration (610.311).

Inspections may be announced or unannounced (610.803), and Policy N-841 (July 1, 2015) lists what the County checks:

• The County NEMT decal on the lower right rear, and proof of a mechanical inspection within the last six months, or 12 months for an MTS-permitted company.
• $2,000,000 combined single limit auto liability and $2,000,000 general liability, plus workers compensation.
• Drivers at least 18 with a Class C license or higher and first aid certification, in clean uniforms showing the company and their name, wearing their MTS driver ID card. No one required to register as a sex offender or convicted of a crime of force, duress, threat, or intimidation in the last five years may drive or attend.
• One extra wheelchair, a blanket, a County map published within two years, a right-side mirror, a mirror for watching passengers, a floor mount for each oxygen cylinder carried, a two-way communication device, wheelchair seatbelts and tie-downs, and a body number on the left front, right front, and rear.

The County’s NEMT permit list, current as of September 1, 2026, shows 15 companies, one of them pending, five based in El Cajon.

What to do first

1. Map your pickups. The ten MTS cities need an MTS permit, unincorporated areas need the County permit, and other cities set their own rules.
2. Enroll in Medi-Cal through PAVE as the California guide explains, and see the NEMT license requirements guide for the rest of the paperwork.
3. Buy insurance to the higher County limits if you will serve unincorporated areas, then apply to MTS with every van you own.
4. Get the County permit by endorsement in LEMSIS once your MTS permit issues.
5. Book each driver into the MTS class and the Sheriff’s walk-in hours.
6. Apply to Call the Car, American Logistics, and Community Health Group for plan rides.

North of the county line, see Riverside County, where medical vans are permitted as taxicabs, and Los Angeles County.