How to Start a NEMT Business in Illinois (2027)

Illinois runs Medicaid rides two ways. Most members belong to a HealthChoice Illinois health plan, and each plan hands its rides to a broker, Modivcare or MTM Health. Members outside a plan get each trip approved by Transdev, and you bill the Illinois Department of Healthcare and Family Services (HFS) directly at its fee schedule rates. The rules below follow the HFS transportation handbook issued March 11, 2024 and the fee schedule effective January 1, 2026.

How Medicaid rides work in Illinois

HFS runs Illinois Medicaid. About 2.4 million of its roughly 3.1 million customers are in HealthChoice Illinois, the managed care program, as of the HFS contract announcement of June 15, 2026. Members choose from at least four plans, depending on where they live. CountyCare serves Cook County only, and YouthCare, run by Meridian, serves youth in care and former youth in care of the Department of Children and Family Services.

Each plan arranges rides through a broker. The HFS subcontractor list of June 2026 shows:

Health plan	Ride broker
Aetna Better Health of Illinois	Modivcare
Blue Cross Community Health Plans	Modivcare
CountyCare (Cook County)	Modivcare, since August 1, 2024
Meridian	MTM Health
YouthCare	MTM Health
Molina Healthcare of Illinois	MTM Health

That list may change. HFS awarded new HealthChoice Illinois contracts on June 8, 2026 to Aetna, Blue Cross and Blue Shield of Illinois, Humana, Meridian, Molina, and CountyCare. Humana joins the program on January 1, 2027, and the June 2026 list does not include it yet. See Modivcare and MTM Health for how each broker works across states.

Members outside a health plan

Members who are not in a plan are fee-for-service customers. HFS contracts with Transdev to run its Non-Emergency Transportation Services Prior Authorization Program (NETSPAP). Transdev approves each trip but does not schedule rides or pay providers. It gives members a random selection of enrolled providers in their area, and the member or a facility books with the provider.

What Medicaid covers

A ride is covered when it goes to a covered medical service, at the nearest appropriate provider, by the least expensive mode that meets the member’s needs. HFS pays only when no free ride is available, and not for a costlier mode when public transit is practical. For fee-for-service members, it does not pay for trips to fill a prescription or pick up supplies. HFS non-emergency categories include:

HFS category	Who rides	Code
Service car	Members who can ride in a regular passenger vehicle	A0120
Medicar	Wheelchair users who need a lift or ramp and a lockdown, with no medical care on the way	A0130
Stretcher in a medicar	Members who must lie down but need no medical monitoring	T2005
Private auto	Family or friends who drive the member	A0090

The medical necessity forms

For medicar, service car, and non-emergency ambulance trips, a medical professional certifies the level of service: the HFS 2270 Physician Certification Statement for trips from a hospital or long-term care facility, and the HFS 2271 Certificate of Transportation Services for trips from home. One form covers recurring medicar or service car trips for up to 180 days, for plan and fee-for-service members alike. If a facility does not complete the form before the ride, it must send it within 10 calendar days of your request. If you cannot get it, keep proof of your attempt, such as a fax or email receipt.

Which brokers to join

In Illinois, you enroll with HFS first, then apply to the brokers. The HFS handbook says both managed care and fee-for-service transportation providers must be enrolled in IMPACT, the HFS provider enrollment system.

Enroll with HFS in IMPACT

HFS classifies NEMT companies as high risk providers, so enrollment includes fingerprints and a site visit:

1. Get a certified W9 on file. Email a W9 to IMPACT.Help@illinois.gov with the subject “W9 approval needed”. The State Comptroller reviews it, which the HFS enrollment manual of 2021 puts at about three weeks.
2. Start the application. Create an IMPACT account and choose the Atypical Agency enrollment type, with provider type Transportation-AA and a specialty that matches your plates: Medicar, Service Car, Taxicab/Livery, or Private Auto. Enter the VIN and plate of every vehicle. Your application ID is valid for 30 calendar days.
3. Upload the checklist documents. Form TR001 (revised June 12, 2024) asks for an ownership chart and staff list, proof of good standing with the Secretary of State, proof of workers’ compensation or an explanation, a sample trip ticket and dispatch log page, a phone bill dated within 30 days, and your lease or deed. For each vehicle, add the registration, insurance, and plate type. For each driver, add the license, a court-certified driving abstract, and the safety training certificate. Every person on the staff list also needs a photo ID.
4. Submit fingerprints. Each owner of 5 percent or more, each managing officer or managing employee, and each dispatcher submits fingerprints through an approved LiveScan vendor within 30 days after the application, using ORI number IL920600Z and purpose code MMV. Your company pays.
5. Pass the site visit. The HFS Office of Inspector General inspects your business before approval.

Once approved, you get a Provider Information Sheet with the data your claims must match. The first year of enrollment is conditional, and HFS can end it without cause. If HFS denies you, ask for a hearing in writing within 10 calendar days. Update plate expiration dates in IMPACT every year, revalidate at least every five years, and report new owners or managers within 30 days. The IMPACT help desk is 877-782-5565, options 1, 2, and 1.

Apply to Modivcare and MTM Health

Modivcare takes applications through a form on its transportation provider page. It asks drivers for a PASS wheelchair certificate, first aid and CPR, defensive driving, a drug screen, a clean driving record, and a background check, and vehicles for current registration, a state inspection where required, and insurance.

MTM Health lists six steps: application, interview, contract, credentialing, training, and first trip. It does not assign trips to a provider whose credentials are out of date, and every employee completes HIPAA and fraud, waste, and abuse training each year. See NEMT broker credentialing.

For fee-for-service members, sign up for PassPORT, Transdev’s free web portal, with your 12-digit Medicaid provider ID to submit trip requests and check approvals. The Transdev provider line is 866-503-9040, weekdays from 8 a.m. to 5 p.m.

Licenses and registrations

Your company

Form an LLC with the Illinois Secretary of State for $150. The $75 annual report is filed in the 60 days before the first day of your anniversary month. A report still missing by the first day of the second month after your anniversary month adds a $100 penalty, and reinstatement costs $200.

Get your employer identification number (EIN) from the IRS, which never charges for one, and register with your city if it requires it. Transportation companies enrolled as atypical providers can bill HFS with the provider number it assigns, and companies with an NPI bill with that. See how to get an NPI number.

Secretary of State, IDOT, and IDPH

Illinois has no single NEMT license. It licenses the vehicles. Under the Vehicle Code, a medical carrier is a vehicle designed, built, or modified and equipped for non-emergency rides to medical care for pay. HFS accepts these plate types for enrollment:

Vehicle	Plates	Also needed
Wheelchair van	Medical carrier (MC)	IDOT safety test every 6 months
Sedan or minivan	Livery (LY) or PT	Safety test for PT plates over 8,000 pounds
Stretcher van	Medical carrier (MC)	IDPH stretcher van license

PT means public transportation plates. HFS also accepts municipal, charitable, or commercial plates on a wheelchair van.

The Vehicle Code sets the yearly registration fee for a vehicle of 8,000 pounds or less at $148 plus $3 in surcharges. A vehicle designed for 16 or more people, the driver included, needs a driver with a CDL and a passenger endorsement.

The Illinois Department of Public Health (IDPH) licenses stretcher van providers for $25 per vehicle. The application lists each vehicle’s make, model, year, VIN, plate, and proof of liability insurance. The license is valid for four years as long as each yearly inspection passes.

City of Chicago

Chicago licenses each medical carrier vehicle through the Department of Business Affairs and Consumer Protection (BACP) for a July 1 to June 30 term, and the vehicle must carry state MC or PT plates. For the 2025 to 2026 term, BACP asked for a certificate of good standing, a passing IDOT inspection sheet for each vehicle, a certificate of insurance, and the yearly fee, and the city’s Ground Transportation Tax was $3.50 per taxable day for vehicles seating 10 or fewer. HFS also asks Chicago providers to buy city vehicle stickers. The fee and checklist can change each term, so ask BACP’s Public Vehicle Operations Division for the current ones at 312-746-4200 or BACPPV@cityofchicago.org.

For the licensing layers NEMT companies face in every state, see NEMT license requirements.

Vehicle rules

Every medical carrier passes an IDOT safety test at an official testing station within 6 months before registration, then at least every 6 months. The test covers brakes, lights, horn, mirrors, windshield and wipers, frame, body, wheels, and steering. IDOT’s rules for medical carriers add:

• No siren, whistle, or bell. A backup alarm is fine.
• An amber flashing light is allowed, visible at 500 feet.
• A van with a lift or ramp must have wheelchair securement anchorages and devices, or it fails.

HFS pays only for trips in vehicles your company owns or leases and operates. Parents supply car seats, though you may provide one, so settle it at booking. A rider may bring extra passengers at no charge if you have room, seat belts, and car seats.

A stretcher van must meet the IDPH list:

• No sedans, limousines, or recreational vehicles, and no SUV with fewer than three passenger doors and a wheelbase under 100 inches.
• Two-way voice contact with dispatch, and room for two attendants who can see the passenger.
• A stretcher at least 75 by 22 inches on a crash-stable three-point fastener, with three straps plus shoulder straps.
• Seat belts, a 5-pound ABC fire extinguisher, a flashlight, a loading light, heat and air conditioning, and no red or blue lights.
• Pillows, sheets, blankets, a CPR mask, biohazard bags, and gloves, with one stretcher passenger at a time.

Before each inspection, use our vehicle inspection checklist.

Driver rules and training

HFS rules for drivers center on licensing, records, and training:

• License and record. Each driver needs a valid license, and HFS gets a copy and a court-certified driving abstract at enrollment.
• Safety training. Every medicar and service car driver and employee attendant completes an HFS-approved safety program before driving Medicaid riders, and again every three years.
• Exceptions. A driver with an active EMT license, or a school bus permit used for a local education agency, is exempt while it lasts. So is a company that receives federal transit funding under 49 U.S.C. 5307 or 5311.
• Stretcher crews. A stretcher van runs with two attendants, both CPR certified and trained on stretchers, and one stays with the passenger.

The program covers passenger assistance, vehicle safety, and emergency procedures. HFS keeps the list of approved trainers, which includes the Illinois Rural Transit Assistance Center at Western Illinois University. Since January 1, 2022, companies licensed by IDPH may train in-house once HFS approves the curriculum (HFS.Transportation@illinois.gov). If you cannot produce a driver’s certificate, HFS takes back all payments for that driver’s trips.

In Chicago, medical carrier drivers need a city public chauffeur license or a CDL. BACP’s January 6, 2025 checklist requires chauffeurs to be at least 21, to have held a license for at least one year, to pass a BACP-approved course and exam, and to pass a fingerprint background check. See NEMT driver training, and track each driver’s papers with our driver file checklist.

Trip rules and how you get paid

Fee-for-service trips

Every fee-for-service trip needs Transdev’s approval first. Ask at least seven business days ahead. Standing approvals cover trips to the same place more than three times a month, for up to six months, and go by fax to 630-873-1450 or through PassPORT, not by phone. If you could not get approval first, ask Transdev within 30 calendar days of the trip. See prior authorization.

Check eligibility on the day of each trip through the HFS MEDI system or the automated line at 800-842-1461, because an approval does not confirm it. The claim must match the approval or it rejects.

HFS pays the lower of your usual charge to the public or its maximum rate, and your base rate follows the county where you are registered with HFS. Under the fee schedule effective January 1, 2026:

Code	Service	Rate
A0120	Service car base	$20 per trip
A0130	Medicar base	$30 per trip
T2001	Service car or medicar attendant	$20
T2005	Stretcher	$9.31 in Cook and collar counties, $11.64 elsewhere
A0090	Private auto	$0.23 a mile

Mileage (A0425) for service cars and medicars depends on the county:

County	Per loaded mile
Cook, DuPage, Kane, Lake, McHenry, Will	$1.03
Madison, St. Clair	$1.61
All other counties	$0.80

HFS raised the service car and medicar base rates and the attendant rates on January 1, 2023. A 12-mile medicar trip pays $42.36 in Cook County and $39.60 in Peoria County. See NEMT reimbursement rates for other states.

• Shared rides. Each rider gets a claim and a base rate, but only the first rider picked up gets mileage.
• Not paid. No-shows, waiting time, meals, lodging, parking, tolls, and miles without the rider. If a doctor cancels and the rider learns of it on arrival, you can bill the trip there and back. See no-shows.
• Filing deadline. Bill electronically within 180 days of the trip, or 24 months when Medicare must decide it first.
• Records. Keep a dispatcher’s log and a trip ticket for each ride naming the rider, the requester, the vehicle and plate, and the driver. Our trip log template covers these.

A company that buys another enrolls with its own NPI or provider number and requests new approvals, because enrollment does not transfer. See how to sell a NEMT business.

Health plan trips

Your broker agreement sets your rates, trip standards, and payment dates. Separately, Illinois law requires HealthChoice Illinois plans to pay a claim billed to them within 30 days once they have all the information needed to decide it, with interest on late payments. If a dispute with a plan is not settled after you finish the plan’s own dispute process, submit it to HFS through its Managed Care Provider Resolution Portal. See how to bill Medicaid for NEMT.

Insurance requirements

The Secretary of State’s notices of September and October 2023 set these minimums for medical carrier, public transportation, and livery plates:

Coverage	Minimum
Injury to one person	$250,000
Injuries in one crash	$250,000
Property damage	$50,000
Or one combined limit	$300,000

Those notices ask for a certificate of insurance that lists each vehicle, is dated within 90 days, and promises the Secretary of State 10 days’ notice before cancellation. The policy runs through June 30 for medical carrier plates or December 31 for livery plates, unless it is continuous.

Chicago asks for more. For the 2025 to 2026 term, BACP required $350,000 combined per occurrence for vehicles with up to 9 seats and $1,000,000 for 10 or more, with the City of Chicago named as additional insured.

Modivcare asks for general liability, sexual abuse and molestation coverage, auto liability, and workers’ compensation, with limits that vary by state. Get each broker’s Illinois limits in writing before you buy. See NEMT insurance requirements.

Illinois requires workers’ compensation once you have one employee, even part time. Sole proprietors, partners, corporate officers, and LLC members may exempt themselves. The Workers’ Compensation Commission can fine an employer that knowingly skips coverage up to $500 a day, with a $10,000 minimum.

What it costs and how long it takes

These are the fees Illinois sets as of September 2026. Vehicles, insurance, training, and equipment depend on your quotes. See what it costs to start a NEMT business.

Item	Cost	Paid to
EIN	Free	IRS
LLC articles of organization	$150	Secretary of State
LLC annual report	$75 a year	Secretary of State
Registration, 8,000 pounds or less	$148 plus $3	Secretary of State
Stretcher van license	$25 per vehicle	IDPH
Fingerprints	Set by the vendor	LiveScan vendor

A workable order, from first call to first trip:

1. Contact Modivcare and MTM Health. Ask where they need providers and which service levels they are short on.
2. Form your LLC, get your EIN, and send your W9 to IMPACT.
3. Register locally. In Chicago, start the BACP medicar license.
4. Buy insurance that meets the state, city, and broker limits, plus workers’ compensation.
5. Register your vehicles with the right plates, and pass the IDOT safety test.
6. Get the IDPH license if you will run stretcher trips.
7. Train your drivers in an HFS-approved program, and order their driving abstracts.
8. Enroll in IMPACT. Upload the TR001 documents, send fingerprints within 30 days, and prepare for the site visit.
9. Finish broker credentialing and set up PassPORT.

The W9 review, about three weeks in the 2021 HFS manual, and the fingerprint check and site visit set the pace. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

• Human services transportation. In the six Chicago area counties, the RTA adopted a new human services transportation plan in May 2026 that guides federal Section 5310 funds to nonprofits, local governments, and transit agencies. Every county there except Cook runs a county-led coordinated service, so ask each one how it buys rides. Statewide, IDOT gives technical help and funding to public transportation providers.
• Veterans. For veterans eligible for travel pay, the VA pays for special mode transportation, an ambulance or a specially equipped vehicle, when a VA provider decides the veteran needs it and the trip is approved in advance. Ask the beneficiary travel office at your nearest VA health facility.
• Facilities and private pay. A hospital inpatient taken elsewhere for outpatient care is the sending hospital’s bill under HFS rules, and residents of state-operated facilities are the facility’s. Medicaid does not pay for rides to day training or sheltered workshops, so confirm who pays first. Dialysis centers, senior living communities, and private pay riders add work that does not depend on one broker. See how to get NEMT facility contracts.