NEMT in Orlando: The Orange County Paratransit License, the Lift and Insurance Rules, and Who Books Rides

Orlando’s wheelchair and stretcher companies answer to Orange County’s EMS Office of the Medical Director, and the county commission votes on every license. The code calls the work alternative transportation, and the county’s forms call it paratransit. On May 19, 2026 the commission replaced its 2014 paratransit rules, changing the vehicle, insurance, inspection, and penalty rules. The state steps, Florida Medicaid enrollment and Level 2 screening for owners, are on the Florida guide, and the Florida NEMT license guide compares the counties that license vans.

Who needs an Orange County paratransit license

Section 20-131 requires a license for any business that carries riders confined to wheelchairs or stretchers who do not need, and are not likely to need, immediate medical care on the way. The license covers wheelchair, stretcher car, and other paratransit services. Ambulatory sedan service is not part of it.

Rule 82.52 lists riders a paratransit van may not carry. They include anyone who needs IV fluids, a ventilator, or a cardiac monitor, anyone on oxygen who cannot manage the tank alone, and agitated riders who need restraints. It also bars riders in traction, with an airway problem or an altered level of consciousness, or with a suspected spinal injury, and trips to an emergency room for a first evaluation. Those trips belong to an ambulance.

Running without a license is costly. If the county finds that you knowingly operated unlicensed, it can refuse to process your application for 180 days, and add another 180 days if you keep running.

How to get the license

1. Open an office in the county

From the day you apply, you must keep at least one business office in Orange County that receives mail and has a phone answered by your agent every day (sec. 20-132). Get the business tax receipt of the city your office sits in and an Orange County receipt; the application asks for both.

2. Build the application packet

Use the Paratransit Services application, revised April 2, 2026. Pick wheelchair, stretcher, or both, and list your officers, communication equipment, vehicle count, and every employee with whether they hold a current CPR card. The county’s application instructions add:

1. Five years of work history, with one notarized reference letter.
2. Five personal or business references, with two notarized letters.
3. Five credit references, with two notarized letters.
4. A notarized bank letter confirming the business account, without account numbers.
5. Certificates of insurance for liability, auto, and workers’ compensation.
6. Each driver’s license and class certificates such as CPR and safe driving.
7. A vehicle roster with year, make, model, VIN, color, and tag, plus each registration.
8. The fee, by check or money order payable to Orange County BCC.

Sign and notarize the application, then mail it or drop it off between 8 a.m. and 5 p.m. at the Office of the Medical Director, 4654 35th Street, Orlando 32811.

3. Public notice and the commission vote

Rule 82.67 handles paratransit applications the same way as ambulance certificates. The county publishes notice of the application, and anyone substantially affected has 14 days to file a written objection (sec. 20-94). The medical director then sends a recommendation to the commission, which must issue or deny the license within 60 days of filing (sec. 20-133).

The medical director’s memo to the commission reports whether the notice drew any objections. Between March 10 and September 15, 2026, the commission approved 10 new paratransit licenses and 5 renewals, each three to four weeks after the memo. A new license runs two years from its approval date. If the commission denies you without a hearing, you have 10 days to appeal, and after a denial you wait 90 days to apply again (sec. 20-135).

4. Permit and inspect each van

The county issues a vehicle permit, valid up to two years, to each van that passes inspection. Since May 19, 2026, rule 82.69 requires two checks within 30 days before you file a new or renewal permit application. An ASE certified mechanic certifies the van against the county’s condition standards, and the medical director’s office checks at least the two-way radio and the spill kit. A van made within the last 365 days with fewer than 10,000 miles skips both. The application instructions say inspections are scheduled after the commission approves the license.

What it costs

Fee	Amount
New license, covering up to three vehicles	$200
Each additional vehicle	$30
License renewal, every two years	$125
Reinstating a suspended vehicle decal	Half the decal fee

The first three rows come from the county’s fee directory effective October 1, 2026, and the last from rule 82.64. Government-run services are exempt.

What changed on May 19, 2026

The commission adopted two measures that day. Ordinance 2026-09 moved the insurance amounts out of the code and into the board’s rules. Resolution 2026-M-19 replaced Resolution 2014-M-25 and rewrote the rules for vehicles, fees, drivers, insurance, and enforcement.

Topic	The rule since May 19, 2026
Wheelchair lift	An automatic lift, electric, hydraulic, or mechanical, that raises 600 pounds on a platform at least 30 by 48 inches, for vans first permitted on or after June 1, 2026. All other vans by June 1, 2028.
General liability	$1,000,000 per occurrence, Orange County named as additional insured
Auto liability	$300,000 combined single limit, owned, hired, and non-owned vehicles
Workers’ compensation	Statutory, with $100,000 employer’s liability
Vehicle condition	Tires with at least 2/32 inch of tread, brake pads at least 1/16 inch, and heat and air holding 68 to 78 degrees
Kickbacks	Barred both ways, between providers and hospitals, nursing homes, or doctor offices
Fines	First violation fixed with no fine, up to $100 for the second, $250 to $500 for later ones

The county’s application instructions, posted in April 2025, still list $1,000,000 in auto liability. Ask the office which amount it applies before you buy the policy. See NEMT insurance requirements for how broker minimums stack on top.

Licenses and decals issued before May 19, 2026 stay valid until they expire (rule 82.66). The lift deadline is the change most owners must plan for. If you run ramp minivans, read ramp or lift before your next renewal.

Rules for Orange County vans and drivers

Wheelchair van	Stretcher van
Four tie-downs for each wheelchair, holding movement to 2 inches	A crash-stable, quick-release litter fastener, side or center mount
A belt for each rider in a chair	At least two restraint straps per stretcher
Lift controls inside and outside, with manual backup	An inside mirror to watch the rider
A non-skid mesh lift platform with reflective tape	Door latches that hold the stretcher in
A one-piece floor sealed with cove molding	A smooth floor that is easy to keep clean
A 5-pound ABC fire extinguisher and 50 inches of height	A 5-pound ABC fire extinguisher and 50 inches of height

Every van carries a two-way radio or phone that can reach 911, a spill kit, and working heat and air. Letter your name and phone on both sides in letters at least 4 inches high and on the rear at least 2 inches high, with a unit number. Nothing may make the van look like an ambulance, including the Star of Life, and no advertising goes inside or on the outside.

Drivers must meet Florida driver license law, know every piece of equipment, and show they can run the lift or stretcher. They announce their name and company at pickup, wear a visible photo ID, and never smoke or vape with a rider aboard. A stretcher or supine rider needs at least two people for loading, and one attendant stays with a rider left on the stretcher. The county encourages CPR and first aid training but does not require it.

Report any emergency during a trip, or any breakdown with a rider aboard, to the medical director within 48 hours. Send the police report for any crash with an injury within 24 hours, with or without a rider. Keep trip records, including riders who travel with their own oxygen, for five years. A company with several vans also agrees to serve as disaster backup for county EMS.

Inside Orlando city limits

Orlando has its own vehicle for hire chapter, run by the police department’s Vehicle for Hire unit at 1250 West South Street (407-246-2855). It permits taxis, limousines, shuttles, luxury vans, and livery vehicles that pick up inside the city. It exempts trips run under a Transportation Disadvantaged contract with LYNX that is on file with the city, in vans marked for that service, and vehicles licensed elsewhere that drop riders in Orlando without picking up there (sec. 55.06). Ask the unit whether your other Orlando pickups need a city vehicle and driver permit.

Who books rides in Orlando and Orange County

Orange County is in Medicaid Region E with Brevard, Osceola, and Seminole (section 409.966). MTM Health books rides for members who are not in a plan under the state’s waiver for July 1, 2025 to June 30, 2027, and its 2025 count listed 75 vehicles in Orange: 43 cab, 26 lift, and 6 stretcher. Plan members book with the plan’s broker. As of August 31, 2026:

Health plan	Orange County members	Broker for its rides
Sunshine Health	81,304	Alivi
Simply Healthcare	35,453	Ride2MD
Humana	25,506	Modivcare
Aetna Better Health	24,196	Modivcare
Community Care Plan	3,309	Modivcare
Florida Community Care	772	Ride2MD

That is 170,648 members. No county has more Sunshine members, and only Miami-Dade has more Aetna members. UnitedHealthcare had just 48 members in the county.

ACCESS LYNX and state-funded trips

The Central Florida Regional Transportation Authority, known as LYNX, has been the Community Transportation Coordinator for Orange, Osceola, and Seminole since October 1, 1992. Medicaid riders left ACCESS LYNX in March 2015, when the health plans took over their rides.

In fiscal 2024-25 the Orange system gave 1,017,661 trips, 187,627 of them medical. Its single contracted operator carried 438,433, nine coordination contractors carried 183,494, and 81,632 went by rideshare. A paratransit trip averaged $54.90. Across the three counties, ACCESS LYNX gave 691,554 trips in calendar 2025, and dialysis and cancer care made up 23.6% of them.

The coordinating board approved the 2026 service plan and its rates on May 14, 2026: $44.84 for an ambulatory trip and $76.87 for a wheelchair trip in fiscal 2026-27. LYNX picks its operator by request for proposals. Before driving for the program, each driver passes a DOT physical and a drug screen, is at least 21, and reads, writes, and speaks English.

An agency that already drives its own clients can request a coordination contract by letter to LYNX’s Director of Mobility Services at 455 North Garland Avenue, Orlando. Orange County agencies holding one in 2025 included Aspire Health Partners, Crystal Lake Supportive Environment, Primrose Center, and Quest in Orlando, and Special Hearts Farm in Gotha.

What to do first

1. Buy lift vans, not ramp vans. Any wheelchair van permitted for the first time on or after June 1, 2026 needs an automatic lift.
2. Rent an Orange County office with a daily-answered phone, and get the city and county business tax receipts.
3. Collect the notarized letters and bank letter early. Reference letters take the longest.
4. Confirm the insurance amounts with the Office of the Medical Director, then bind general liability, auto, and workers’ compensation.
5. File the application and plan on about two months before the commission votes.
6. Enroll with Florida Medicaid and apply to Alivi first, then Ride2MD, Modivcare, and MTM Health.

South of Orlando, Osceola County grants a separate permit for each van after a public hearing, with its own fees and insurance floor.