Monroe County (Florida Keys) Class B Certificate for Wheelchair and Stretcher Companies (2027)

Monroe County licenses wheelchair and stretcher companies through its county commission, not through a permit office. Chapter 11, article V of the county code, adopted as Ordinance 1-1982 and amended in 1983, requires a class B certificate of public convenience and necessity before you advertise or run the service anywhere in the Keys. The state steps, Medicaid enrollment with AHCA and the Level 2 screening for owners, are on the Florida guide, and the Florida NEMT license guide compares the Keys with the other counties that license vans.

Who needs a class B certificate in Monroe County

The code splits medical transport into two certificates. Class A covers ambulance service. Class B covers a nonemergency medical transportation service, which section 11-151 defines by its riders: people confined to wheelchairs or stretchers who do not need, and are not likely to need, immediate medical attention on the way. It covers land, air, and water transport.

Section 11-153 makes the article a uniform law for the unincorporated county and the cities alike, to the extent the state constitution allows. A class B certificate lets you serve the whole county (section 11-174(c)), but only the cities and special taxing districts the county has approved may answer 911 calls at the scene.

Section 11-172 exempts a short list, including:

• Hospitals that move their own wheelchair or stretcher patients to or from a hospital or medical facility, if they charge no fee.
• Public buses, and school buses whose main business is carrying students, when they carry wheelchair riders.
• The county’s own transportation program, run through its social services department (also section 11-154).
• Private cars not ordinarily used to carry sick or disabled people.

Running without a certificate is a code violation. Under section 1-8, each conviction carries a fine of $15 to $500, up to 60 days in jail, or both, and each day of a continuing violation counts separately.

How to apply for the class B certificate

The county administrator, or a designee, supplies the application forms and investigates each one, including whether the public needs another service in the area you ask for (section 11-173(c)). In practice that is Monroe County Fire Rescue in Marathon, 305-289-6004: it is the department that brings certificate applications and renewals to the board, and it must give your business location a life safety inspection before you begin.

The application under section 11-173(b) asks for:

1. Your company name, mailing address, email, and phone. The county sends hearing notices to that email, so keep it current.
2. Each owner’s name, age, address, and phone, or for a corporation each director and stockholder.
3. The date your company was formed, your base station and any substations, and the zones you want to serve.
4. How you will screen calls so you carry only riders who need no more than a wheelchair or stretcher vehicle.
5. A roster of your drivers and any EMTs or paramedics, with certification numbers and expiration dates.
6. Each vehicle’s year, model, type, mileage, passenger capacity, and plate.
7. Your radio and communication systems with any FCC licenses, and three U.S. citizens as references.
8. A schedule of the rates you will charge during the certificate period, and proof of insurance.
9. A sworn affidavit that the application is true, and a $950 nonrefundable fee.

Two continuing duties come with it. You must give the county administrator an independent CPA’s audit of your accounts and records every business year, and you must keep a business location in Monroe County for the whole term. Move it without telling the administrator and the county can cancel the certificate.

Two lines written for ambulances

The roster asks for drivers “qualified under” section 401.281 of the Florida Statutes, the state’s ambulance driver rule, which calls for a first aid card, a CPR card, and an emergency vehicle operator course. The vehicle list asks for a Department of Health vehicle permit number, a permit the state issues to life support vehicles under section 401.26.

Expect Fire Rescue to ask for the driver roster. In an August 21, 2025 letter filed with its class B renewal, National Health Transport wrote that the county was enforcing that line, and asked the county to apply it only to ambulance providers, citing a Department of Health email that section 401.281 does not cover non-medical transport. It filed a roster anyway. Ask Fire Rescue how it wants a wheelchair van company to fill both lines before you file, and price the first aid, CPR, and driving courses in case it applies the driver rule.

The hearing

The board decides every new certificate at a public hearing (section 11-173(d)). At least a week before, the county notifies you and every current class A and class B holder, and at the hearing the board may take testimony from you and any other interested party. It weighs the public’s need for the service in your zone, whether you can deliver it, and the views of any city in that zone, then grants the certificate with conditions or denies it with reasons.

Know who will get that notice. National Health Transport’s class B came up for renewal on the September 10, 2025 agenda, for October 19, 2025 to October 18, 2027, limited to nonemergency transfers between facilities. The January 28, 2026 agenda carried Elite Medical Response’s class A, which also covers nonemergency transport, for February 1, 2026 to January 31, 2028, and the June 10, 2026 agenda Southernmost Medical Transport’s class A for July 18, 2026 to July 17, 2028.

The board can also limit where a certificate applies. Both of those 2026 class A renewals leave out the city limits of Marathon, and so did the class B the board granted Aloha Medical Services on February 21, 2024. In November 2024, county staff asked the board to rescind that grant and revoke the certificate after the company told Fire Rescue it had chosen not to pursue one. National Health Transport’s class B, by contrast, covers every part of the county. Ask early whether the county will draw your zone around Marathon.

Keeping the certificate

A class B certificate lasts two calendar years and belongs to the company that applied. It cannot be sold or transferred, and if 25 percent of your ownership changes hands, you must apply for a new one (section 11-174(a)).

File your renewal between 90 and 60 days before the expiration date, with a $475 fee (section 11-175). The board may approve a renewal on the administrator’s recommendation without a hearing, but a change of zone counts as a new application. While you hold the certificate, give the administrator 30 days’ notice before you cut or stop service, report any change to your fee schedule, and open your office to inspection. Charging more than your filed rates is one of the grounds for suspension or revocation in section 11-177, and service complaints go to the county EMS council for investigation (section 11-178).

Who carries the Keys’ rides now

Guidance/Care Center, a behavioral health nonprofit in Marathon, has been the county’s Community Transportation Coordinator since October 1997 and runs the service as Middle Keys Transportation. Its scheduled vans run from Marathon to Key West and to Key Largo on Mondays, Wednesdays, and Fridays, and from Key West to Miami on Tuesdays and Thursdays. Its fares, in effect since August 15, 2009, are $2 a trip in the county and $5 out of it, and in-county trips are free for veterans and riders 60 or older.

The state’s 2025 Annual Operating Report counted 33,272 trips in the county for FY 2024-25, with 43 vehicles and 32 drivers. Cost per trip climbed from $62.00 in FY 2022-23 to $81.65. Coordination contractors carried 30,482 of the trips, including all 13,055 trips Medicaid paid for, and unmet trip requests jumped from 131 the year before to 921. The 2025-2026 service plan names the two contractors as the county’s Social Services transportation and MARC House, which serves adults with developmental disabilities, and lists the coordinator’s FY 2024-25 rates as $3.99 a mile for ambulatory trips and $6.84 a mile for wheelchair trips.

The same plan says nonemergency stretcher transportation is not available through the coordinator. It accepts stretcher trips run by the county EMS as an alternative, and it counted no stretcher trips in any of the five years from FY 2019-20 to FY 2023-24. If you want stretcher work in the Keys, it comes from the Medicaid brokers, hospitals, and private pay, not from this program. See starting a stretcher transportation business.

The coordinator also ran door-to-door rides from the Keys to Miami-Dade medical appointments on a state Innovative Service Development grant: 141 trips for 55 riders in FY 2024-25, and 149 trips for 52 riders in FY 2025-26 through March. On July 1, 2026, the state commission told coordinators that the FY 2026-27 budget did not fund that grant program, so it will not be offered in FY 2026-27. Miami-Dade’s own coordinated area, in its FY 2024-25 plan update, reaches into the Keys from Key Largo to Marathon at Mile Marker 50.

The county ride contract

On October 1, 2025, the county handed its own Social Services ride program to Guidance/Care Center, along with title to three county vans. The FY 2025-26 agreement capped county payments at $842,693, including $600,000 for those rides and $210,740 for Baker Act and Marchman Act transport.

The county then bid the ride program in 2026 as RFP-638. The request asked for 15 years of continuous paratransit or demand-response experience, about 400 one-way trips a month, at least three ADA-accessible vehicles in service at all times, and $1,000,000 combined single limit auto and general liability naming the county as additional insured. Guidance/Care Center was the only proposer when bids opened on July 21, 2026, and on August 19 the board told staff to negotiate with it. Staff put the resulting contract on the September 9, 2026 agenda with a recommendation to approve: October 1, 2026 to September 30, 2027, up to four one-year extensions, paid from the county general fund.

The negotiated price schedule pays $54.25 for an ambulatory one-way trip and $93.01 for a wheelchair trip, with no separate mileage, staging, or overtime charges:

Service	County price
Ambulatory trip	$54.25
Wheelchair trip	$93.01
Group trip, per passenger	$26.16
Evacuation, Key Largo to an out-of-county shelter, per passenger	$128.83
Evacuation, Key West to an out-of-county shelter, per passenger	$373.32

The contract caps spending at $489,468.81: $423,932.11 for rides and $65,536.70 for evacuation trips, which run when the county administrator activates them in a declared emergency. The 15-year minimum keeps a new company out of the prime contract, so your route in is work under the coordinator. See subcontracting NEMT trips before you sign.

Medicaid rides in the Keys

Monroe and Miami-Dade make up Medicaid Region I under section 409.966 of the Florida Statutes. Members in a health plan ride with their plan’s broker, and members outside a plan ride with Modivcare. Plan membership in the Keys on August 31, 2026, with the broker AHCA’s second quarter 2026 report lists for each plan:

Health plan	Keys members	Who books its rides
Sunshine Health	2,690	Alivi
Simply Healthcare	808	Ride2MD
Molina Healthcare	748	MTM Health
UnitedHealthcare Community Plan	713	MTM Health, since March 1, 2026
Humana	424	Modivcare
Aetna Better Health	397	Modivcare
Community Care Plan	106	Modivcare
Florida Community Care	54	Ride2MD

Sunshine alone holds 45 percent of the 5,940 members, so Alivi’s network is the first one to join. The 2025 capacity table in the state’s NEMT waiver lists 11 Modivcare vehicles under Monroe County: 4 ambulatory, 7 stretcher, and none in the wheelchair column.

Distance drives the work. The coordinator’s rider handbook puts Key West 159 miles from Miami. Medicare’s dialysis facility list, updated June 2026, shows one center in the county, in Key West, and the coordinator’s July 2026 proposal to the county puts the next one in Homestead, nearly 129 miles away. The county has three hospitals, in Key West, Marathon, and Tavernier, and its service plan says specialists are scarce, so many trips run to Miami-Dade. Read dialysis transportation before you price standing orders on that run.

Trips into Miami-Dade raise a second permit question. Section 4-44 of the Miami-Dade code lets you drop off there a rider you lawfully picked up in the Keys, but a pickup in Miami-Dade, outside a narrow exception for ADA paratransit riders, needs that county’s certificate, covered on the Miami-Dade County page. Going the other way, Monroe’s exemption for vehicles based outside the county that carry a patient in or out (section 11-172(3)) is written only for ambulances, not wheelchair or stretcher vans.

What to do first

1. Call Fire Rescue at 305-289-6004. Ask for the class B forms, how to fill the driver and vehicle permit lines, and whether your zone will include Marathon. The county’s main line is 305-294-4641.
2. Secure a Keys business location. The certificate depends on it, and Fire Rescue inspects it before you start.
3. Budget the fixed costs. $950 to apply, $475 every two years to renew, and a CPA audit every year.
4. Decide on wheelchair and stretcher service. One certificate covers both, and the state-funded program runs no stretcher trips.
5. Register as a county vendor on the purchasing page so you see the next ride bid, and call Guidance/Care Center at 305-434-7660 about work under its contract.
6. Join the brokers that match the plan mix above, starting with Alivi and Modivcare.