How to Start a NEMT Business in Colorado (2027)

Colorado is moving every Medicaid ride to one broker. MediDrive has run NEMT in the nine Denver metro counties since July 1, 2026, and takes over scheduling and payment in all 64 counties on January 1, 2027. The rules below follow the state’s NEMT rule, 10 CCR 2505-10 section 8.014, in the version in effect since July 10, 2026, the NEMT Billing Manual revised July 17, 2026, and operational memo OM 26-060 of September 23, 2026.

How Medicaid rides work in Colorado

The Colorado Department of Health Care Policy and Financing (HCPF) runs Health First Colorado, the state’s Medicaid program. NEMT covers rides to covered care for members who have no other way to get there, including a free ride from someone else, and pays only for the least costly mode that suits the member’s condition.

HCPF is replacing a split system with one statewide broker. As of September 2026:

Area	Counties	Who arranges rides
Denver metro	Adams, Arapahoe, Boulder, Broomfield, Denver, Douglas, Jefferson, Larimer, Weld	MediDrive, since July 1, 2026
Rest of the state	The other 55 counties	Local enrolled providers, who verify each request and bill HCPF through December 31, 2026
Whole state	All 64 counties	MediDrive, from January 1, 2027

In the metro counties, MediDrive replaced Transdev Health Solutions. See MediDrive’s metro takeover. The statewide dates, from HCPF’s NEMT page and OM 26-060:

Date	What happens
September 1, 2026	Enrolled providers anywhere in Colorado may start contracting with MediDrive
October 1, 2026	New companies can enroll with HCPF, then contract with MediDrive
December 1, 2026	Members start booking through MediDrive for appointments on or after January 1
January 1, 2027	MediDrive schedules and pays every NEMT trip in the state

A member qualifies with Health First Colorado Medicaid State Plan coverage on the date of the trip. These groups get no NEMT: Qualified Medicare Beneficiary only, Special Low Income Medicare Beneficiary only, Qualifying Individual-1, Old Age Pension state only, and the Emergency Medicaid and Reproductive Health Program plan. Child Health Plan Plus (CHP+) members are not eligible, and PACE members ride with their PACE organization.

Covered modes include bus passes, mileage paid to members, ambulatory, wheelchair, stretcher, and taxi rides, ambulances, flights, trains, and rideshare as a backup. Each ride goes to the closest qualified medical provider: one within 25 miles of the member’s home (62.5 miles for providers in HCPF’s designated rural counties), or the nearest one if none is that close.

Members are asked to book two business days ahead, but under HB26-1328 the broker must make reasonable efforts on same-day and next-day requests, including hospital discharges.

How to join MediDrive, Colorado’s Medicaid broker

You need two approvals: HCPF enrollment and a MediDrive contract. HCPF’s September 2026 bulletin and OM 26-060 set the order for a new company:

1. Enroll with HCPF as NEMT provider type 73 through the Provider Enrollment Portal. It opens to new companies on October 1, 2026, ending a pause HCPF imposed on October 1, 2023 under federal rule 42 CFR 455.470 because of fraud risk. See enrollment moratoriums.
2. Pass the state’s screening. NEMT is on HCPF’s list of high categorical risk provider types. Every person with a 5 percent or greater ownership or control interest submits fingerprints within 30 days of the request, through IdentoGO (service code 25YQG9) or Colorado Fingerprinting (CBI unique ID CPACMDCI). The Colorado Bureau of Investigation takes about 30 calendar days to process them. High-risk providers also get a site visit before enrollment.
3. Credential in ProCredEx. Upload your driver and vehicle records to ProCredEx, the credentialing system HCPF and MediDrive use. A new driver or vehicle must be approved there before it carries a member.
4. Apply to MediDrive at medidrive.com/providers/join/company?state=CO. Send one application per company, under the exact business name and NPI or Medicaid ID you enrolled with, never a “doing business as” name. The form asks for your EIN, Medicaid provider ID, fleet, service area, and hours. See how to get an NPI number for NEMT.
5. Finish onboarding. MediDrive credentials your company, drivers, and vehicles, loads your roster, and connects your devices or dispatch system to its trip system. Complete its portal and training steps.
6. Start taking trips. A new company can serve the nine metro counties once contracted, if it lists them when it enrolls with HCPF, and the other 55 counties from January 1, 2027.

HCPF sets no cap on how many qualified providers can contract and no hard deadline, but you get no trips until your contract is complete. Companies already enrolled in the 55 counties keep verifying requests under OM 25-066 and billing HCPF for trips through December 31, 2026, within the 365-day timely filing limit.

MediDrive Colorado provider relations answers 24 hours a day at 720-844-9615, technical support is 703-952-3036, and HCPF takes policy questions at NEMT@state.co.us. See our MediDrive guide and broker credentialing.

Licenses and registrations

Your company

Form an LLC or corporation online with the Colorado Secretary of State for $50, under the fee schedule revised July 1, 2024. Online filings are processed as soon as payment goes through. Name a registered agent with a physical Colorado address; an individual agent must hold a Colorado driver’s license or ID card or verify Colorado residency.

Each year you file a periodic report for $25, from two months before to two months after your periodic report month. A late report costs a $50 penalty, and skipping it makes the company delinquent.

Get your employer identification number (EIN) from the IRS, which issues it free online. Then ask your city or county whether you need a local business license.

HCPF, not the Public Utilities Commission

Colorado does not license Medicaid NEMT through the Public Utilities Commission (PUC). HB21-1206, signed June 29, 2021, moved oversight to HCPF and added C.R.S. 40-10.1-105(1)(l), which takes vehicles used for Medicaid NEMT out of PUC regulation. HCPF’s rule sets what you need:

If you run	You need
Cars, ambulatory vans, wheelchair vans, or stretcher vans for Medicaid	HCPF enrollment, with proof of exemption from PUC licensing
Taxicabs	A PUC common carrier certificate with taxicab authority
Ground or air ambulances	A license from the Colorado Department of Public Health and Environment

Before a wheelchair van goes on the road, its owner must also file a certificate of insurance with the Colorado Department of Revenue showing at least $100,000 per person, $300,000 per accident, and $50,000 for property damage (C.R.S. 42-7-510).

Non-Medicaid rides follow different rules. State law also exempts wheelchair-accessible vehicles used for nonemergency rides of people with disabilities, under C.R.S. 40-10.1-105(1)(e). For private-pay trips in cars or ambulatory vans, ask the PUC transportation team (303-894-2000, option 2) which authority you need: a common carrier certificate, a contract carrier permit, or a limited regulation permit such as luxury limousine, a class that covers executive vans but not minivans. A limited regulation application costs $515, plus $51 for each vehicle stamp, as of September 2026. See NEMT license requirements.

Vehicle rules

Inspections

HCPF’s rule says vehicles must be safe and pass a safety inspection before they carry members, then sets a schedule by age:

Vehicle	Inspection
Made in the last 5 years	No periodic inspection
6 to 10 years old	Every 24 months
11 years or older	Every year
Wheelchair vehicle, any age	Every year

The inspector must be trained, work for an automotive repair company authorized in Colorado, and have no ownership tie to your company. MediDrive also requires an ASE inspection for every wheelchair vehicle and for ambulatory vehicles 5 years or older, plus its own safety inspection. Since July 1, 2026, you schedule that inspection virtually with MediDrive, or in person after an accident.

Equipment

HCPF’s rule ties the inspection to PUC Rule 6104. The PUC’s report for vehicles with 15 or fewer seats, done by an ASE-certified mechanic, checks:

• Brakes, frame, steering, suspension, exhaust, and tires with at least 4/32 inch of tread.
• Glass with no cracks, wipers, all lights and turn signals, the horn, and doors that lock.
• Mirrors or backup cameras, the speedometer, and heat and air conditioning.
• Seat belts for the driver and every passenger in vehicles built for eight or fewer passengers.

MediDrive also wants recording devices, restraints, and GPS working on every trip, and a compatible tablet or phone for each driver or vehicle, which you buy. Run our vehicle inspection checklist before each inspection.

Cameras

Since July 1, 2026, HB26-1328 requires two-way video dash cameras and a recording system that captures each member’s pickup and drop-off in fleets of six or more vehicles. Video may be used in audits, but eligibility checks may not require a member to show an ID card on camera. See Colorado’s NEMT camera law and NEMT dash cameras.

Wheelchair and stretcher vans

A wheelchair van ride needs the member’s medical professional to state in writing that the member uses a wheelchair and cannot use a cheaper mode. The Rule 6104 report requires:

• A lift rated for at least 600 pounds, with handrails on both sides and controls interlocked with the brakes or transmission, or a ramp rated for 300 pounds (under 30 inches long) or 600 pounds (30 inches or longer).
• Entrance doors at least 56 inches high on vehicles 22 feet long or shorter.
• Slip-resistant floors, contrasting color bands on step and ramp edges, and signs marking wheelchair positions.
• Forward-facing tiedowns with four floor anchor points that allow no more than two inches of movement, and a webbing cutter within the driver’s reach.

Since November 1, 2025, an XL or bariatric wheelchair trip that uses two attendants is billed as A0130 with modifier U9. A stretcher van carries a member lying down who needs no medical care on the way, and the member’s medical professional must certify that need in writing. See wheelchair securement.

Driver rules and training

HCPF’s rule sets the floor for every driver:

• At least 18, with at least one year of driving experience and a valid Colorado driver’s license.
• A current Colorado driving record showing the last seven years.
• A Colorado or national criminal history check.
• A 10-panel drug screen and state and national sex offender checks, before hire and every year after.
• Training and certification in CPR and naloxone administration.

These convictions disqualify a driver, counted back from the date of the criminal history check:

Look-back	Conviction
Any time	A Colorado class 1 or 2 felony, or an unlawful sexual offense against a child anywhere
7 years	Substance abuse, or a crime of violence
4 years	Certain class 4 felonies under Colorado’s criminal code
2 years	Driving under the influence or with excessive alcohol content

Comparable offenses in other states count for the same periods, and a deferred judgment counts as a conviction while it lasts.

MediDrive’s contracting list is stricter on timing. Each driver needs a 10-panel drug screen and a federal criminal background check within 30 days, an FBI fingerprint check, OIG and SAM exclusion checks, a driving record for the current year plus two, and a national sex offender check. Training covers first aid, CPR, and AED; defensive driving from a third party; passenger assistance, safety, and sensitivity; and wheelchair securement for wheelchair service. See NEMT driver background checks.

MediDrive expects drivers to arrive within the pickup window, finish every accepted trip or tell dispatch at once, report incidents, and give door-to-door help to members with limited mobility. You may not solicit another provider’s riders, and Medicaid does not pay you to drive your own family or household members. Keep written policies, and train staff, on fraud, waste, and abuse, HIPAA, and vehicle safety. See HIPAA for NEMT.

Keep each driver’s license, screens, and checks on file for HCPF or MediDrive. Our driver file checklist tracks them.

Trip rules and how you get paid

On the trip

• One member at a time. You may not carry more than one member at once unless the others are escorts, or children or at-risk adults in their care who come along because the member or escort has no one to watch them. Bill only one member ID for such a trip.
• Escorts. A member under 13 needs an escort. A member aged 13 to 17 may ride alone with a signed release from a parent or guardian and an adult waiting at each end.
• Late returns. A return pickup more than one hour late counts as urgent NEMT, which a medical facility may arrange directly.
• Routes. Mileage is paid for the shortest route by internet map or GPS.
• Rideshare backup. A transportation network company may take a trip only when the assigned provider cannot and no other enrolled provider can, or when no provider serves the area.

What the trip record needs

HCPF’s rule requires a trip report with the pickup and destination addresses, the date and time, the member and any extra passengers, and the driver’s check of the member’s identity. It also needs confirmation that the trip happened, the actual pickup and drop-off times, the driver, and the vehicle. Under MediDrive, you close out each trip in its system with GPS data. Keep the same details on your trip log.

Rates

HCPF’s NEMT fee schedule for dates of service from July 1, 2026, after a targeted cut and a 2 percent across-the-board cut, in dollars:

Code	Service	Rate
A0120	Ambulatory van, one way	$12.15
A0100	Taxicab, one way	$12.15
S0215	Ambulatory van or taxi mileage, per mile	$2.74
A0130	Wheelchair van, one way	$34.14
A0130-U9	XL or bariatric wheelchair van, two attendants	$63.70
S0209	Wheelchair van mileage, per mile	$2.74
T2005	Stretcher van, one way	$49.42
T2049	Stretcher van mileage, per mile	$1.86

The ambulatory base rate was $36.40 from October 1, 2025. A 10-mile ambulatory leg now pays $39.55, and a 10-mile wheelchair leg $61.54. HCPF says the legislature set the cuts to close a budget shortfall. Confirm what MediDrive pays for each code in your contract, and price trips with the trip price calculator.

Payment and disputes

MediDrive pays completed and verified trips every two weeks, as of September 2026. Colorado does not pay for waiting time, cancellations, or charges while the member is not in the vehicle, so a no-show pays nothing under state rules. You may never bill a member for a covered ride.

Under HB26-1328, HCPF may not deny payment only because broker or state information later proves wrong, if you followed the rules in good faith, though an ineligible member can still mean a take-back. HCPF must give 30 days’ notice of new billing rules and set up a way to resolve billing issues. Trips by uncredentialed drivers or vehicles are never paid.

Insurance requirements

HCPF’s rule and MediDrive’s provider page set the same auto liability minimums, in dollars:

Coverage	Company vehicles	Drivers’ own cars
Injury to one person	$300,000	$25,000
All injuries in one accident	$600,000	$50,000
Damage to property	$50,000	$15,000

The rule calls for commercial liability insurance. MediDrive also asks for general liability coverage and an insurer rated A or better, and coverage must stay active the whole time you are enrolled. See NEMT insurance requirements.

Colorado requires workers’ compensation once you have one employee, part-time and family workers included, and MediDrive asks for proof of it. LLC members and corporate officers count as employees, but an LLC member or a corporate president, vice president, secretary, treasurer, or board chair who owns at least 10 percent may reject coverage for themselves on the state’s form. Pinnacol Assurance must offer coverage to any Colorado employer. See workers’ comp for NEMT.

What it costs and how long it takes

These are the fees Colorado sets, as of September 2026. Vehicles, insurance, cameras, and tablets depend on your quotes; see what it costs to start a NEMT business.

Item	Cost	Paid to
EIN	Free	IRS
LLC or corporation filing, online	$50	Secretary of State
Periodic report	$25 a year, $50 penalty if late	Secretary of State
Owner fingerprint check, state and FBI	$38.50 to $39.50, plus the vendor’s fee	CBI and the vendor
PUC limited regulation permit, private pay only	$515, plus $51 per vehicle	PUC

A workable order, from first call to first trip:

1. Call MediDrive provider relations and ask which counties and service levels need providers.
2. Form your company, name a registered agent, and get your EIN and NPI.
3. Buy insurance, and file the wheelchair van certificate with the Department of Revenue.
4. Get vehicles inspected, and fit cameras if you will run six or more vehicles.
5. Hire drivers who meet the state rules, with CPR and naloxone training done.
6. Enroll with HCPF as provider type 73, then complete owner fingerprints and the site visit.
7. Credential in ProCredEx and apply to MediDrive. Finish onboarding and take your first trips.

The state steps are quick. Online filings post at once, and HCPF averaged about eight business days for new enrollment applications in September 2026. Fingerprints take about 30 calendar days once CBI has them. MediDrive gives no timeline, so its credentialing sets the pace. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

The broker change covers Health First Colorado NEMT only. HCPF says it does not by itself affect your other transportation business, and MediDrive does not require exclusivity.

• Medicaid waiver rides. Non-Medical Transportation (NMT) takes members on several home and community-based services waivers to adult day programs, shopping, and community activities. It is a separate enrollment as provider type 36 that starts with a Certificate of Compliance request, which HCPF answers within 10 business days. See NEMT vs NMT.
• Older adults. Colorado’s State Unit on Aging funds 16 Area Agencies on Aging, whose services include senior transportation. Ask your local agency how it buys rides.
• Transit grants. The Colorado Department of Transportation runs the state’s calls for federal Section 5310 and 5311 transit funds. Ask your county’s transit agency whether it buys service from private operators.
• Veterans. The VA pays for special mode transportation, such as a specially equipped vehicle, for veterans eligible for travel pay, with approval from their VA facility. Requests go through VetRide or the VA facility’s transportation representative. See VA special mode transportation.
• Facilities and private pay. Dialysis centers, hospitals, senior living communities, and riders who pay for themselves add work that does not depend on the broker, once the PUC question above is settled. See how to get NEMT facility contracts and private pay NEMT.