How to Start a NEMT Business in Delaware (2027)

Delaware runs Medicaid rides through one statewide broker. Modivcare arranges every NEMT trip for Delaware Medicaid and the Delaware Healthy Children Program under a contract that runs from November 1, 2025 to October 31, 2028. Before Modivcare can sign you, the state’s Office of Public Carrier must certify your company. The rules below follow the state’s 2025 broker request for proposals (HSS-25-051), its July 17, 2025 answers to bidders, and the public carrier law and regulations in force in September 2026.

How Medicaid rides work in Delaware

The Delaware Division of Medicaid and Medical Assistance (DMMA) contracts with one broker for the whole state and pays it a monthly capitation rate for each eligible member. The broker carries the financial risk, and no more than 15% of that payment may go to its administration, overhead, and profit. There are no NEMT regions: one broker covers New Castle, Kent, and Sussex counties.

DMMA rebid the contract in 2025. Ten companies bid by the July 31, 2025 deadline, and the award notice of November 5, 2025 named ModivCare Solutions, which also held the contract awarded in 2019. The new contract runs to October 31, 2028, with two optional one-year extensions at the state’s discretion.

In 2024, members scheduled 1,295,275 trip legs. About 38% were cancelled, leaving 801,339 net legs that averaged 8.3 miles:

Ride type	Net legs, 2024	Share
Ambulatory	685,720	85.6%
Wheelchair	97,617	12.2%
Stretcher	18,002	2.2%

New Castle County had 59% of trip legs in May 2025, Sussex 21%, and Kent 19%. In May 2025, rideshare companies carried about 41% of trips and public transit about 26%. Rideshare may take ambulatory riders only, and in July 2025 the state said it was reviewing whether that use can continue. See NEMT vs rideshare.

All fully eligible Medicaid and Delaware Healthy Children Program members qualify, along with the state’s Chronic Renal Disease Program participants. Rides go only to and from Medicaid covered services, plus employment supports for PROMISE and Pathways participants. A member who can drive their own vehicle, or has a ride in the household, does not qualify. DMMA warns that federal rules change eligibility for some non-citizens from October 1, 2026 and add work requirements for expansion adults from January 1, 2027. See the Medicaid work requirement rule.

Members book at least three work days before a routine appointment, counting the day of the call but not the appointment. Urgent rides, including hospital discharges and same-day appointments, must be completed within three hours of the request. Trips at least three days a week for three months or more, such as dialysis and chemotherapy, run as standing orders that a nurse, social worker, or case manager requests.

The state’s ride modes are car or minivan (taxis count), wheelchair van, mass transit, non-emergency ambulance, and mileage reimbursement. Modivcare’s network also covers stretcher riders and uses DART buses and paratransit. Wheelchair and stretcher rides need a Medical Necessity Form signed by a physician, physician assistant, nurse practitioner, clinical nurse specialist, or registered nurse. One adult escort rides free with a member who is blind, deaf, mentally disabled, or under 18. See escorts and caregivers.

How to join Modivcare, Delaware’s Medicaid broker

You do not enroll with Delaware Medicaid to give NEMT rides. The state plan provides NEMT through a brokerage program, and DMMA told bidders in July 2025 that it contracts with one broker, who then subcontracts providers.

Modivcare may only sign providers certified by the Delaware Department of Transportation, or by the State Fire Prevention Commission for non-emergency ambulances, and you must stay certified for the life of the agreement. So the state certificate comes first:

1. Ask where Modivcare needs providers. Its Become a Transportation Provider page maps its priority areas. The state requires at least three ambulatory and three non-ambulatory providers under contract in each county, not counting DART.
2. Get your state certification from the Office of Public Carrier, covered below.
3. Send the provider form. It asks for your company, owners, NPI, tax ID, services, vehicles, service area, and insurance. See how to get an NPI number.
4. Pass credentialing. For drivers, Modivcare lists a PASS wheelchair certificate, first aid and CPR, defensive driving, a drug screen, a motor vehicle report, and a background check. For vehicles, it wants current registration, inspection, and insurance.
5. Pass the vehicle inspection. The broker inspects every vehicle before it signs you.
6. Attend the provider orientation on vehicle and driver rules, GPS, scheduling, urgent care, billing, grievances, and HIPAA.
7. Sign the service agreement. DMMA approves the standard agreement and its penalties, and your rate must be written into it.

Modivcare screens providers and staff against federal exclusion databases, including the OIG exclusion list. Members and facilities can ask for your company, but Modivcare can give the trip to someone else. Providers apply through the Become a Transportation Provider form, ask about applications through the Transportation Provider Support Form, and bill through the Transportation Provider portal. Our Modivcare guide covers the company’s other programs.

Licenses and registrations

Your company

Form an LLC or corporation with the Delaware Division of Corporations, with a registered agent at a Delaware street address. An LLC costs $110 to form under the fee schedule revised August 1, 2026. Every Delaware LLC pays a flat annual tax, $400 as of September 2026, due by June 1 for the year before, with a $200 penalty plus 1.5% monthly interest if late. See LLC for NEMT.

Get your EIN free from the IRS. Then get a Delaware business license from the Division of Revenue through the One Stop portal, which the Office of Public Carrier requires. State law sets the taxicab or bus operator license at $45 a year for the first vehicle and $30 for each added one, so ask the Division of Revenue which category fits you.

Office of Public Carrier (DART)

The Office of Public Carrier (OPC), part of the Delaware Transit Corporation within DelDOT, regulates for-hire carriers. Any company that carries passengers within Delaware for a fee needs a Certificate of Public Convenience and Necessity. The regulations treat a medical transport vehicle, one seating 15 or fewer with the driver for riders who need protective oversight, as a type of limousine.

If you run	You need
Sedans or vans for 15 or fewer	An OPC certificate for non-emergency medical service
Vehicles for 16 or more	A separate OPC application for charter bus rights
Stretcher vans under a broker contract	No certificate, but yearly state checks
A facility’s vans for its own patients	No certificate under a broker contract
Non-emergency ambulances	A State Fire Prevention Commission permit

File form PC-1 with the $400 fee at 119 Lower Beech Street, Wilmington, by mail or email, one application per service type. OPC’s line is 800-652-3278, option 7. The application asks for:

• Formation papers and your Secretary of State registration.
• Vehicle registrations, or a purchase quote or letter of intent to buy within 180 days of approval.
• A license and driving record for each driver.
• A letter of intent for $1,000,000 in general liability, or a $100,000 bond, and an auto insurance quote.
• FBI and State Bureau of Identification background checks for every owner, officer, and member.
• A rate schedule on company letterhead, sample trip and maintenance logs, and the PC-16 recordkeeping form.
• Proof of public demand, such as petitions, surveys, requests for service from Medicaid providers, contracts, or letters of support.

You must also notify existing carriers. If one objects during the 10-day comment period, a hearing may follow, where the objecting carrier must show your service would cause harm, and you pay the court reporter. You have 90 days to finish once OPC date-stamps your application. Before your first trip, send OPC your business license, driver background checks, vehicle registrations, and insurance naming OPC as certificate holder.

Certified vehicles are registered six months at a time. By April 1 each year, file a gross revenue return with a $7.50 fee and pay 4 mills, or $4 per $1,000 of Delaware trip revenue. A late return costs $100. OPC approves your rates too, and changing them takes a $100 filing and a newspaper notice 30 days ahead. OPC’s application allows per-mile pricing only in vehicles with a taximeter, which matters for private pay work. OPC’s February 22, 2023 list of wheelchair-accessible carriers had 25 entries.

A stretcher van, staffed by a driver and an attendant for riders who cannot use a wheelchair and need no care on the way, may run under a broker contract without a certificate. State law requires yearly national background checks, 10-panel drug tests, and training for its crew, a yearly inspection, and public carrier liability insurance. Hospitals, long-term care facilities, treatment facilities, and physical therapy facilities may also carry their own patients under a broker contract without a certificate. Trips into Pennsylvania, Maryland, or New Jersey are interstate: see DOT number for NEMT and NEMT license requirements.

Vehicle rules

Each certified vehicle passes a DMV lane inspection every six months and shows OPC’s inspection sticker on the windshield, and OPC also inspects on the road or by appointment. The broker inspects each vehicle before signing you and within every 12 months after. You inspect each vehicle weekly and keep a signed record. A vehicle with two or more complaints about cleanliness, heat, or air conditioning within five days must be inspected and fixed.

Under the state’s 2025 broker requirements, every vehicle needs:

• A two-way communication system linking it to your office (pagers do not count) and GPS that can recall where it has been.
• Working heat, air conditioning, speedometer, odometer, and interior lights.
• A seat belt for every seat, two extensions, a seat belt cutter above the driver’s door, and child safety seats as Delaware law requires.
• Two outside mirrors, an inside mirror for the passenger area, anti-skid rubber flooring or carpet, and seats with no tears or sharp edges.
• Fire extinguishers totaling at least 5 pounds, each at least 2.5 pounds with a current tag, within the driver’s reach.
• Three reflective triangles (no flares), a first aid kit, and a retractable step or approved step stool where riders step up.
• Your company name, vehicle number, and the broker’s phone number inside, no smoking and seat belt signs, and an insurance card and accident forms.

OPC requires your name and phone number outside in letters at least 3 inches tall. The word “Medicaid” may not appear on the vehicle or in your business name.

Wheelchair vans must meet ADA rules: 56 inches from floor to ceiling and of door height, a 30-inch door, a lift rated for at least 600 pounds with a manual backup, an interlock that stops the van moving while the lift is out, and a forward-facing ADA tiedown at each position. Use our vehicle inspection checklist before each inspection, train drivers on wheelchair securement, and see NEMT vehicle requirements.

Driver rules and training

The state’s 2025 broker requirements keep these people off Medicaid trips:

• Anyone under 21, or without a current Delaware license for the vehicle.
• Any driver or attendant with a conviction for substance abuse, a sexual crime, or a crime of violence.
• Anyone with a felony in the last three years, until the broker and DMMA clear it.
• Anyone whose license was suspended or revoked in the last three years, except for unpaid child support.
• Any driver with two moving violations or at-fault accidents on contract trips.

The regulations treat medical transport vehicles as limousines and require each driver to hold the endorsement for the service type. OPC’s FAQ tells certificate holders to confirm that each Delaware-licensed driver has the taxicab and limousine (“Z”) endorsement. It has cost $10 since October 10, 2025, and needs state and federal background checks, the Class D knowledge test, and a defensive driving course within 30 days. It is refused for a crime against a child, a class A or B felony, or a felony homicide or sex offense, and for a DUI, felony, hit and run, or reckless driving within 7 years.

Within 30 days of hiring, send OPC each driver’s details and FBI and State Bureau of Identification checks no more than 180 days old. Fingerprinting is by appointment through IdentoGO, and Z applicants first get an authorization form from the DMV. As of September 2026, the State Police charge $85 for a state and federal check required by law, and OPC’s form says each report takes 2 to 4 weeks. Send OPC your driver list by April 1 each year.

Drivers complete training within 90 days of assignment on the vehicle’s equipment, first aid with CPR, spill kits, passenger assistance, safety and sensitivity, defensive driving, and HIPAA. Attendants take first aid, passenger assistance, and safety and sensitivity training. See NEMT driver training.

On the job, drivers wear a visible company ID, never wear headphones, and do not smoke, eat, or drink near riders. They open doors, help riders to the building, check every wheelchair and seat belt, and confirm each rider is inside before leaving. Two substantial grievances in 90 days mean retraining or removal, and four in 12 months mean removal. The broker reports your driver roster, with Delaware license numbers, to DMMA every quarter. Our driver file checklist tracks the documents.

Trip rules and how you get paid

Your service agreement carries the state’s standards:

• On time. Within 15 minutes before or after the scheduled pickup. You need not wait more than 10 minutes past it. See pickup window.
• Returns. Pick up a will-call return within 45 minutes of the call.
• Shared rides. No rider rides more than 45 minutes longer than a direct trip. See maximum ride time.
• Delays. Call waiting riders. A vehicle 20 minutes late is excessively late, and the broker must have a backup there within 30 minutes.
• The target. DMMA holds the broker to no late or missed rides on 99% of trips, a standard it told bidders in July 2025 could be discussed in contract talks.

The broker verifies at least 10% of trips before and after they happen and sends DMMA encounter data for every trip. OPC’s trip log records the date, vehicle, origin and destination, times, passengers, odometer readings, distance, and fare, kept at least four years. Our trip log covers those fields.

Delaware does not set provider rates. Modivcare may pay per mile, per zone, per hour, per trip, or per month, with the method approved by DMMA and the rate stated in your agreement. Undisputed claims are paid on the agreement’s schedule, or within 15 working days of receipt if it sets none. Your agreement with Modivcare decides whether and how no-shows are paid, so get that term in writing.

The broker acknowledges a mileage or billing dispute within 5 business days and aims to resolve it within 60 days, and both sides copy DMMA on the correspondence. If Modivcare defaults, your agreement passes to DMMA or its agent on the same terms and rates. NEMT is not on Delaware’s electronic visit verification (EVV) list, which covers in-home personal care and home health and community services.

Insurance requirements

The state confirmed on July 17, 2025 that transportation providers must carry the broker contract’s limits. Public carrier law sets its own minimums (the state law column), so carry the higher of each:

Coverage	Broker	State law
General liability	$1M per occurrence, $3M aggregate	$1M, or a $100,000 bond
Auto liability	$1M combined single limit	$1M including damage
Property damage	$250,000	Inside the $1M
Uninsured motorist	$25,000 per person	$1M
Personal injury protection	$25,000 per person, $300,000 per accident	Required on every vehicle

Modivcare also asks for sexual abuse and molestation coverage. Your auto policy names OPC as certificate holder, and no vehicle may carry riders without the required coverage. Get each limit in writing from Modivcare before you buy. See NEMT insurance requirements.

Delaware requires workers’ compensation once you have one employee. Up to eight stockholder officers or eight LLC members may exempt themselves in writing, and sole proprietors are not covered unless they choose to be. File a first report of injury within 10 days of learning of it. See workers’ comp for NEMT.

What it costs and how long it takes

These are fees Delaware sets, as of September 2026. For vehicles, insurance, and equipment, see what it costs to start a NEMT business.

Item	Cost	Paid to
EIN	Free	IRS
LLC formation	$110	Division of Corporations
LLC annual tax	$400 a year	Division of Corporations
Certificate application	$400 per service type	DelDOT (OPC)
Vehicle inspection	$20 per vehicle, twice a year	OPC
Adding vehicles	$200 per amendment	OPC
Background check	$85 per person, state and federal	State Police
Z endorsement	$10 per driver	DMV
Vehicle title	5.25% document fee since October 1, 2025	DMV

A workable order, from first call to first trip:

1. Ask Modivcare which counties and service levels are short.
2. Form your company, get your EIN, and get your business license through One Stop.
3. Get insurance quotes that meet both the broker and state law columns above.
4. Get fingerprinted. Every owner needs state and federal checks, 2 to 4 weeks each.
5. File PC-1 with your proof of demand, and allow for the 10-day comment period and a possible hearing.
6. Buy, register, equip, and inspect your vehicles, and bind your policies.
7. Hire drivers with the Z endorsement, and send their checks to OPC within 30 days.
8. Send Modivcare’s form, then pass credentialing, inspection, and orientation, and sign.

For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

• DART Mobility (Section 5310). The Delaware Transit Corporation passes federal transit grants, mainly for vehicles, to groups serving seniors, people with disabilities, and low-income riders. Eligible recipients include private nonprofits, governments, transit operators, and private shared-ride transportation companies.
• Health plan rides. Delaware First Health gives Medicaid members extra rides, including four round trips a month for health-related social needs. Modivcare’s Delaware page lists ride lines for Delaware First Health, a HealthSpring Medicare Advantage plan, and a retiree plan, so Modivcare books those rides too.
• Veterans. The VA pays for special mode transportation when a VA provider decides a veteran needs it and the trip is approved in advance. Ask VA Wilmington health care’s beneficiary travel office how it books these rides. See VA beneficiary travel.
• Facilities and private pay. Dialysis centers, hospitals, senior communities, and private pay riders add work beyond one broker, at the rates you filed with OPC. Medicaid discharges still go through Modivcare. See how to get NEMT facility contracts.

If you also drive across state lines, see the Maryland, Pennsylvania, and New Jersey guides.