How to Start a NEMT Business in Hawaii (2027)

Hawaii runs Medicaid rides through its five QUEST Integration health plans, and each plan hires its own ride broker. To drive those rides, you need a Public Utilities Commission certificate, enrollment with Med-QUEST, and a contract with each broker you want trips from. The rules below follow Med-QUEST’s QI Health Plan Manual, revision 26.3, and the brokers’ provider pages as of September 2026.

How Medicaid rides work in Hawaii

The Hawaii Department of Human Services runs Medicaid through its Med-QUEST Division (MQD). Most members are in QUEST Integration, the managed care program. MQD pays each health plan a capitation fee for every member it enrolls, and the plan pays for covered services, rides included.

Each plan hires a broker that books trips and assigns them to transportation providers. As of September 2026, Med-QUEST lists these ride vendors:

Health plan	Ride broker	Notes
AlohaCare	Transdev Health Solutions	Formerly IntelliRide, in Hawaii since April 1, 2016
HMSA	Modivcare	Every island, Niihau included
Kaiser Permanente	MTM Health	QUEST on Oahu and Maui only. MTM on Oahu since November 1, 2022
ʻOhana Health Plan	Modivcare	Leaves QUEST after December 31, 2026
UnitedHealthcare	MTM Health	Since January 1, 2026

Med-QUEST pays a few services directly, fee for service, including dental care. Community Case Management Corp (CCMC) arranges rides to those dental visits. For broker models in other states, see NEMT brokers by state.

The ʻOhana change in 2027

ʻOhana Health Plan leaves QUEST after December 31, 2026. Its members choose a new plan during a special open enrollment from October 1 to 20, 2026, and Med-QUEST assigns a plan to anyone who does not choose. New coverage starts January 1, 2027. Med-QUEST memo QI-2608 (March 4, 2026) also stopped the automatic assignment of members to ʻOhana for the rest of 2026.

A rider you drive for Modivcare under ʻOhana this year will come through the broker of whichever plan they join. See ʻOhana Health Plan leaving QUEST.

Who qualifies and how members book

A member qualifies when they have a medically necessary appointment for a covered service and no other way to get there. Free options come first, such as family, friends, or the facility serving the member. Plans consider a bus pass when both ends of the trip are within half a mile of a transit stop. Anything above the bus, Handi-Van, or taxi needs a determination from the member’s doctor or health coordinator.

Members book at least 48 hours ahead, with less notice for urgent visits that need care within 24 hours. Recurring trips, such as dialysis, can be booked a quarter at a time. MTM Health (for UnitedHealthcare) and Modivcare (for HMSA) want two business days for routine trips.

Modivcare’s HMSA guide, dated June 15, 2026, lists the ride types: mass transit (on Oahu only), mileage reimbursement, ambulatory by sedan, van, taxi, rideshare, or boat or ferry, wheelchair and bariatric wheelchair, stretcher with no medical monitoring, and commercial air. Mass transit is the default for members who can use it, and ambulatory is the default for everyone else. Any higher mode needs a medical necessity form. On Transdev’s door-to-door level, the driver helps the member from door to door but does not go inside.

Inter-island and mainland travel

When a member is referred to a provider on another island, the QUEST Integration contract makes the plan pay for airfare, ground transportation, lodging, and meals for the member and one attendant when medically necessary.

Under MQD memo QI-2147 (December 29, 2021), appointments for one-day visits fall Monday through Thursday, no later than 2 p.m., with flights landing at least two hours before the first appointment. Meal allowances run up to $15 a day on one-day trips. Each itinerary names the ground transportation company and its pickup instructions.

For a NEMT company, the work is the ground legs: home to the airport on a neighbor island, then the airport to the clinic on Oahu, and back. Med-QUEST’s dental ride codes bill these legs with their own origin and destination modifiers, such as RI for residence to airport and IP for airport to dental office.

Which brokers to join in Hawaii

Enroll with Med-QUEST before you apply to a broker. The QUEST Integration contract requires every network provider to be enrolled with the Department of Human Services, and Transdev asks for your Medicaid provider ID before it contracts.

Enroll with Med-QUEST in HOKU

1. Create a HOKU account. HOKU is Med-QUEST’s online enrollment system. The paper form, DHS 1139 (Rev. 11/2022), is also accepted by email, fax, or mail.
2. Choose provider type 28, Non-Emergency Transportation Providers. Med-QUEST’s form lists no NPI requirement for this type, but it lists a site visit and the federal application fee, which is $750 for applications filed in 2026.
3. Upload the documents. Med-QUEST’s list, revised October 12, 2023, asks for proof of auto liability insurance, a PUC license for Oahu providers, a fingerprint-based criminal background check, a W-9, and Appendix M of the DHS 1139. Appendix M binds you to Honolulu’s taxi rules and metered rates unless you agree otherwise in writing.
4. Call with questions. Med-QUEST provider enrollment is at 1-833-909-3630.

See becoming a Medicaid transportation provider for enrollment in general.

Transdev Health Solutions, for AlohaCare

Transdev wants all modes, including wheelchair vehicles, vans, sedans, and taxis, on Kauai, Oahu, Molokai, Lanai, Maui, and Hawaii Island. Its steps:

1. Get your Medicaid provider ID from Med-QUEST.
2. Get an approved PUC docket. Taxi companies meet county requirements instead.
3. Send the interest form. Transdev follows up within three business days.
4. Credential your drivers and vehicles. Complete the credentialing request and license agreement, attend the training, and submit your records.
5. Pass the vehicle inspection by Transdev’s network management team, however recent your last inspection was.
6. Sign the provider agreement and business associate agreement, and send a W-9 and a sample invoice.

Transdev’s provider line is (808) 237-2953, 7:45 a.m. to 4:45 p.m., Monday through Friday, and its provider email is us.ths.providers@transdev.com. Transdev also books rides for AlohaCare’s Medicare members. See our Transdev Health Solutions guide.

Modivcare, for HMSA and ʻOhana

Apply with the form on Modivcare’s Become a Transportation Provider page. Modivcare asks drivers for PASS wheelchair training with hands-on practice, first aid and CPR, defensive driving, a drug test, a driving record, and a background check. It covers HMSA members on every island, and ʻOhana members through December 31, 2026. See our Modivcare guide.

MTM Health, for Kaiser Permanente and UnitedHealthcare

Apply on MTM Health’s Join Our Network page. MTM says it replies quickly when it needs providers in your area and keeps your information on file when it does not. UnitedHealthcare lists MTM’s Hawaii community outreach address, co-hi@mtm-inc.net, for questions. See our MTM Health guide, and working with several brokers.

Licenses and registrations

Your company

Form an LLC with the Department of Commerce and Consumer Affairs (DCCA), Business Registration Division. Articles of Organization (Form LLC-1) cost $50, per instructions dated November 2025. Register any trade name too, because the PUC asks for the file-stamped form.

The $15 annual report is due by the last day of the calendar quarter the LLC registered in, starting the year after it forms. Late reports cost up to $100 for each 30 days.

Get your EIN from the IRS, which never charges for one. Then file Form BB-1 with the Department of Taxation for a general excise tax (GET) license, which has a $20 registration fee. Under the department’s brochure revised May 2025, most business income is taxed at 4 percent plus a 0.5 percent county surcharge. Med-QUEST’s health plan manual says plans do not pay GET as a separate charge on NEMT, because it is part of the rate.

Hawaii Public Utilities Commission

The PUC requires a motor carrier certificate from anyone who carries people for pay on a public highway in Hawaii. By law, taxis, rideshare drivers, and ambulances are exempt. Transdev asks non-taxi providers for an approved PUC docket, and Med-QUEST asks Oahu NEMT providers for a PUC license.

If you	You need
Carry riders for pay and serve the public	A PUC common carrier certificate
Carry riders only under ongoing contracts with a few customers	A PUC contract carrier permit, with each contract attached
Run a taxi company	County taxi rules, not a PUC certificate

The PUC authorizes passenger carriers by seating size: 7 or fewer passengers, 8 to 25, or more than 25, not counting the driver.

Apply on Form 92-001, online through the PUC’s filing system or on paper with a notarized oath. The application needs:

• The $30 filing fee, a tax clearance certificate, and your file-stamped articles of organization.
• A vehicle inventory list with each registration. Vehicles an LLC owns must be registered in its name, and leased vehicles need a copy of the lease.
• A current balance sheet and 12-month revenue and income projections for each island.
• Letters from prospective customers for each island, meaning anyone who would use or refer your service.
• A tariff: join the Western Motor Tariff Bureau or, on Oahu, the Hawaii State Certified Common Carriers Association, or file your own.

The PUC publishes a notice, waits out a 20-day intervention period, reviews your finances, and issues a decision. You then have 120 days to file proof of insurance and the vehicle list. Each year by April 30, file the annual financial report and pay the gross revenue fee, 0.25 percent of the prior year’s revenue with a $20 minimum.

Hawaii Department of Transportation

The Motor Vehicle Safety Office treats a company that carries passengers for business as a motor carrier. Under HRS 286-209 and 286-210, its vehicles over 10,000 pounds, and its passenger vehicles of 10,000 pounds or less, must pass a DOT safety check every year. Driving without a current decal costs $100 a day.

New motor carriers sign the office’s safety acknowledgement form and send a Vehicle Identification Card for each vehicle, which the office validates before the safety check. Call 808-692-7661 with questions.

A commercial motor vehicle also needs a USDOT number, marked on both sides. That includes vehicles designed or used for 9 or more people, driver included, for pay, or rated 10,001 pounds or more. Employers whose drivers operate vehicles over 10,000 pounds need a yearly Driver Improvement Program, about 10 hours per driver. See USDOT numbers for NEMT and NEMT license requirements.

Vehicle rules

Inspections come first. The state DOT safety check is yearly. Transdev inspects every vehicle before it assigns trips and at least once a year after, and wants the inspection sticker on the rear passenger-side window. Taxi companies carry a county inspection instead.

PUC rule HAR 6-62-20 also requires your company name and PUC number on both sides of each vehicle, in letters at least 2.5 inches tall. A vehicle seating 7 or fewer may use an approved removable side sign, or show the PUC number on the front and rear bumpers.

Transdev’s vehicle checklist (July 2024) requires:

• A 2.5-pound fire extinguisher, flashlight, first aid kit, biohazard kit, spare fuses, three reflective triangles, two seat belt extensions, a seat belt cutter, a running board, and a wheelchair harness.
• Working heat, air conditioning, speedometer, odometer, and interior lights, and a real-time link, phone, or two-way radio. Pagers do not count.
• A clean seat belt for every seat, child seats as state law requires, and two outside mirrors plus an inside mirror.
• Your company name, vehicle number, and Transdev’s numbers inside, with no smoking, no eating, and seat belt signs.
• No words on the vehicle, or in your company name, suggesting riders travel for medical reasons.
• A packet with the registration, insurance card, and accident forms, and a GPS or current map.

Wheelchair vehicles must meet ADA and federal transit accessibility standards, and members travel in their own wheelchairs. Stretcher trips carry members who need no monitoring. Modivcare’s HMSA guide allows oxygen the member manages at 2 liters or less and battery equipment the member or caregiver runs, and sends anyone who needs clinical care by ambulance.

Use our vehicle inspection checklist before each inspection, and see wheelchair securement.

Driver rules and training

Federal law, repeated in Med-QUEST’s health plan manual, bars excluded providers and drivers and requires a valid license. Each provider needs a process for state drug law violations and one to report each driver’s driving history to Medicaid.

A regular Hawaii category 3 license covers vehicles built for 15 or fewer people, driver included, and rated 18,000 pounds or less. Vehicles built for 16 or more need a commercial license.

Transdev’s driver checklist (July 2024) asks for a clean check against the federal SAM and OIG lists and the Hawaii Medicaid exclusion list (see the OIG exclusion list). It also asks for a license showing the driver is at least 21, a yearly 10-panel drug test, Hawaii and national sex offender checks, a criminal background check, and a medical exam. The five-year driving record may show none of these:

• A moving violation or a suspension for one in the past year.
• Any DUI, DWI, OWI, or OUI conviction, or a refusal to test.
• Leaving the scene of an accident, or using a vehicle in a felony.
• A preventable major accident, or more than two preventable accidents, in the past three years.
• A serious violation in the past three years, such as reckless driving.

Training covers PASS with in-person wheelchair securement, first aid, defensive driving, and a yearly civil rights course the state requires of contractors who handle health information.

On Transdev trips, drivers wait 15 minutes before reporting a no-show through the broker’s tablet, collect the member’s electronic signature at pickup, and file an incident report right away after any accident or incident with a member on board.

The DOT’s general requirements for motor carriers, which include passenger vehicles of 10,000 pounds or less, call for a driver qualification file for each driver, a maintenance file for each vehicle, and an accident register. Keep records current with our driver file checklist.

Trip rules and how you get paid

Med-QUEST’s health plan manual and NEMT page set these standards for every plan:

• Shared rides. No member rides more than 30 minutes longer than a direct trip, and a member with signs of a contagious illness does not share.
• Escorts. One attendant rides only when the doctor or health coordinator finds it medically necessary. Minors ride with a person who can sign consent forms.
• No side trips. The pharmacy exception applies only when a member needs medicine right away.

Each broker adds its own timing rules:

Broker	Rule
Transdev (AlohaCare)	Drivers wait 15 minutes, and a will-call return may take up to 60 minutes
MTM Health (UnitedHealthcare)	Will-call pickups within 60 minutes, discharge pickups within 180 minutes
Modivcare (HMSA)	Four hours to find a ride for an ambulatory or wheelchair discharge

Hawaii does not set broker rates. Each broker sets your rate in its agreement. Transdev pays loaded miles only, keeps mileage at or below Med-QUEST’s fee schedule maximum, and negotiates the rest. The state contract makes plans pay 90 percent of their providers’ clean claims within 30 days, but your broker agreement sets your own payment terms.

Fee-for-service rides Med-QUEST pays

Med-QUEST’s dental ride memo, QI-2408, treats these trips as taxi service, with add-ons for a wheelchair lift or stretcher van. CCMC gives the transportation provider a prior authorization code with each trip. Call the member at least two business days ahead, and tell CCMC about any change. Med-QUEST pays nothing for a no-show or a side trip. Bill the Medicaid fiscal agent on a CMS-1500. Med-QUEST’s fee schedule as of June 1, 2026, which lists rates without modifiers, shows:

Code	What it covers	Rate
A0100	Pickup, the base code	$5.25
S0215	Each mile	$2.75
A0130	Wheelchair add-on, one way	$50.00
A0120	Stretcher van add-on, one way	$107.00

The dental ride memo, effective April 15, 2024, lists the same base and add-on rates but $4.48 a mile for S0215 billed with the KZ modifier. Confirm the mileage rate with Med-QUEST before you price these trips. Fee-for-service claims are due within 12 months of the service, and you have 60 days from a payment to ask for reconsideration. See NEMT billing codes and the CMS-1500 guide.

Insurance requirements

The PUC sets liability minimums for every certificate holder by seating size:

Coverage	7 or fewer seats	8 to 25 seats
Injury to one person	$100,000	$100,000
All injuries in one accident	$200,000	$500,000
Damage to others’ property	$50,000	$50,000

Vehicles seating more than 25 need $1,000,000 per accident. Coverage must come from an insurer authorized in Hawaii, a surety bond, or approved self-insurance.

Transdev asks for more:

Coverage	Transdev minimum
General liability	$500,000 per occurrence
Auto liability	$300,000 per person, $600,000 bodily injury, $50,000 property
Workers’ compensation	$500,000 each accident, $500,000 disease per employee, $500,000 disease policy limit

Transdev wants a certificate of insurance naming Transdev Health Solutions as certificate holder. Modivcare lists general liability, sexual abuse and molestation, auto, and workers’ compensation coverage, with limits that vary by state. Ask Modivcare and MTM Health for their Hawaii limits before you buy. See NEMT insurance requirements.

Hawaii employers carry three coverages. Workers’ compensation is required once you have one employee, full-time or part-time, and the employer pays the whole premium. Temporary disability insurance covers eligible employees’ off-the-job illness or injury. Prepaid health care is owed to employees who work 20 or more hours a week and earn at least $1,387 a month in 2026, after four straight weeks on the job. See workers’ comp for NEMT.

What it costs and how long it takes

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

Item	Cost	Paid to
EIN	Free	IRS
LLC articles of organization	$50	DCCA
LLC annual report	$15 a year	DCCA
GET license	$20	Department of Taxation
PUC application	$30	PUC
PUC gross revenue fee	0.25 percent of revenue, $20 minimum, yearly	PUC
Medicaid application fee	$750 in 2026	Med-QUEST

A workable order, from first call to first trip:

1. Call the brokers’ provider teams. Ask which islands and service levels each needs.
2. Form your company, get your EIN, file Form BB-1, and get a tax clearance certificate.
3. File the PUC application. The PUC says it takes 6 to 12 weeks or longer and cannot be rushed.
4. Buy or lease vehicles in the company’s name, and get each DOT safety check and Vehicle Identification Card.
5. Buy insurance that meets the PUC and broker limits, and file proof with the PUC within 120 days of its decision.
6. Enroll with Med-QUEST in HOKU with your PUC license, insurance, fingerprint check, and W-9.
7. Hire and train drivers, then credential with each broker and sign the agreements.

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

Work beyond Medicaid

• Home and community-based services rides. QUEST plans authorize non-medical rides to places in a member’s care plan. MQD memo QI-2611 (May 8, 2026) bills them with A0100 and S0215 and the U7 and U8 modifiers for trips to and from the destination.
• Kupuna Care and county aging offices. Honolulu’s Elderly Affairs Division contracts with agencies for services that include door-to-door and curb-to-curb rides for older adults, and the Maui County Office on Aging contracts for transportation too. See Area Agency on Aging transportation.
• Veterans. VA pays for special mode transportation, a specially equipped vehicle, when the veteran’s local VA health facility approves it in advance. See VA beneficiary travel.
• Facilities and private pay. Dialysis centers, hospitals, and care homes, along with riders who pay for themselves, add work that no broker controls. See how to get NEMT facility contracts and private pay NEMT.