How to Start a NEMT Business in Kentucky (2027)

Kentucky runs Medicaid rides through the Human Service Transportation Delivery (HSTD) program. The Kentucky Transportation Cabinet gives each of 15 regions to one broker, and as of September 2026 eight brokers hold them. You subcontract with the broker for your county and enroll with Kentucky Medicaid. The rules below follow the Cabinet’s regulation, 603 KAR 7:080 (certified April 25, 2025), the Medicaid regulation 907 KAR 3:066 (effective June 18, 2024), and House Bill 2 of 2026.

How Medicaid rides work in Kentucky

The Department for Medicaid Services (DMS), in the Cabinet for Health and Family Services, runs Kentucky Medicaid. Under a federal 1915(b) waiver approved for April 1, 2025 through March 31, 2027, DMS hands NEMT to the Kentucky Transportation Cabinet (KYTC) and pays it a monthly capitation rate for each member, set separately for each region. KYTC’s Office of Transportation Delivery picks one broker per region by request for proposals, on one-year contracts with up to four renewals, each running July 1 to June 30.

The broker takes every reservation, checks eligibility, and sends each trip to its own vehicles or to a subcontractor. DMS and KYTC told lawmakers on November 5, 2025 that the program ran 3,363,272 trips in state fiscal year 2025 (July 2024 to June 2025) for $174,953,006 in capitation. The monthly rates per member in that briefing ranged from $6.88 in Region 11 to $14.69 in Region 5.

Regions and brokers

KYTC lists these brokers and counties as of September 2026. There is no Region 7, since Regions 6 and 7 were combined into one.

• GRITS (Audubon Area), Region 1: Ballard, Calloway, Carlisle, Fulton, Graves, Hickman, Marshall, and McCracken.
• PACS (Pennyrile Allied), Region 2: Caldwell, Christian, Crittenden, Hopkins, Livingston, Lyon, Muhlenberg, Todd, and Trigg.
• GRITS, Region 3: Daviess, Hancock, Henderson, McLean, Ohio, Union, and Webster.
• GRITS, Region 4: Breckinridge, Grayson, Hardin, Larue, Marion, Meade, and Nelson.
• LKLP, Region 5: Adair, Allen, Barren, Butler, Edmonson, Green, Hart, Logan, Metcalfe, Simpson, Taylor, and Warren.
• FTSB, Region 6: Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer, and Trimble.
• BGCAP, Region 8: Anderson, Boyle, Casey, Franklin, Garrard, Jessamine, Lincoln, Mercer, Scott, Washington, and Woodford.
• FTSB, Region 9: Boone, Campbell, Carroll, Gallatin, Grant, Kenton, Owen, and Pendleton.
• FTSB, Region 10: Fayette.
• FTSB, Region 11: Bourbon, Clark, Estill, Harrison, Madison, Montgomery, Nicholas, and Powell.
• RTEC, Region 12: Bell, Clinton, Cumberland, Knox, Laurel, McCreary, Monroe, Pulaski, Rockcastle, Russell, Wayne, and Whitley.
• LKLP, Region 13: Breathitt, Clay, Harlan, Jackson, Knott, Lee, Leslie, Letcher, Owsley, Perry, and Wolfe.
• Sandy Valley (SVTS), Region 14: Floyd, Johnson, Magoffin, Martin, and Pike.
• LKLP, Region 15: Bath, Boyd, Carter, Elliott, Greenup, Lawrence, Menifee, Morgan, and Rowan.
• Licking Valley (LVCAP), Region 16: Bracken, Fleming, Lewis, Mason, and Robertson.

Who qualifies and how members book

A member qualifies when the trip goes to or from a medically necessary, Medicaid-covered service and the member has no vehicle. A member who owns one still qualifies with a note from a clinician, employer, school, mechanic, or transportation authority saying it is not working or not usable for them. Members covered only as Qualified Medicare Beneficiaries (QMB) and KCHIP Phase III children get no NEMT. Under House Bill 2, DMS decides NEMT eligibility at every Medicaid determination and redetermination. See what HB 2 changed.

Members call their broker at least 72 hours ahead, weekends and holidays included. Rides run 6 a.m. to 8 p.m. on weekdays and 8 a.m. to 1 p.m. on Saturday, and stop on New Year’s Day, Memorial Day, July 4, Labor Day, Thanksgiving, and Christmas. Urgent care rides, for a member who must be seen within 12 hours, run around the clock. Hospital discharges need no 72-hour notice, and brokers may add after-hours trips for dialysis, chemotherapy, or radiation.

Rides stay within the member’s home county and the counties that touch it. A farther trip needs a referral on the Office of Transportation Delivery’s Medicaid Medical Referral Form, valid for six months, to the closest provider of the service. See rural NEMT for long trips.

Service types

Providers enroll by service type. This table shows the four you can apply for, with each one’s share of the 2,870,995 trips in state fiscal year 2023 (July 2022 to June 2023), when trips averaged 12.8 miles:

Type	Who rides	Share of trips
02	Riders who walk, for-profit carrier	39%
04	Riders who walk, nonprofit carrier	35%
07	Disoriented riders who may need an escort	8%
08	Wheelchair riders, lift or ramp vehicle	15%

A member’s own clinician sets whether they ride as Type 07 or 08, and the broker cannot change it.

Stretcher rides are separate

As of September 2026, stretcher rides are not part of HSTD. Kentucky Medicaid covers them as nonemergency ambulance service, through the member’s health plan or fee for service, and only from a carrier licensed by the Kentucky Board of Emergency Medical Services, such as a Class IIa non-911 service. DMS’s fee schedule effective January 1, 2026 pays fee-for-service stretcher trips a $55 base rate (A0428), $10 for each added patient, and $2 per mile (A0425). See how to start a stretcher transportation business.

How to join the broker for your region

Your contract is with the broker, not the Commonwealth. The broker sends you trips, you invoice the broker, and the broker pays you. KYTC’s steps:

1. Get your operating authority. Earn a Disabled Persons Vehicle or taxicab certificate from the Division of Motor Carriers and qualify each vehicle, as the next section explains.
2. Call the broker for the county you plan to serve. Say you hold a certificate and want to subcontract.
3. Go through the broker’s review. The broker reviews the contract, inspects your vehicles, and collects your insurance, registrations, workers’ compensation proof, certificate, fee receipt cards, vehicle leases, staff HIPAA confidentiality statements, and a list of your safety-sensitive staff.
4. Set up testing and training. Every employee and driver joins a statewide random drug and alcohol pool, safety-sensitive staff pass background checks and pre-employment tests, and drivers finish the required training.
5. Enroll with Kentucky Medicaid. Fill out a MAP-811 for each service type: 02, 07, and 08 for a for-profit company, or 04, 07, and 08 for a nonprofit. Enter provider type 56 in box 7 and the specialty code in box 8 (263, 262, 264, or 265 for Types 02, 04, 07, and 08). The broker signs page 12.
6. File through the Kentucky Medicaid Partner Portal (KY MPPA). Paper is no longer accepted. Upload the broker’s signature page, your operating certificate, and an IRS letter showing your employer identification number (a W-9 does not count). The MAP-811 also asks for your NPI and taxonomy code.
7. Send your welcome letters and wait for approval. Once Medicaid approves you, give the broker the welcome letter for each type, which shows your Medicaid provider number. The broker sends your file to the Office of Transportation Delivery, and you cannot sign the subcontract until the Cabinet approves you. The broker holds your orientation before your first trip and tells you when to start.

KYTC requires every new provider to keep at least three active, approved drivers and three operational passenger vehicles. Provider type 56 is not on DMS’s list of types that pay the federal application fee, which is $750 in 2026.

Broker	Regions	Office line
GRITS	1, 3, 4	270-686-1651
PACS	2	270-886-6641
LKLP	5, 13, 15	606-487-1872
FTSB	6, 9, 10, 11	859-233-0066
BGCAP	8	502-695-4290
RTEC	12	606-256-9835
SVTS	14	606-886-7039
LVCAP	16	606-845-0081

Call the Office of Transportation Delivery at 502-564-7433 with program questions, and Kentucky Medicaid provider enrollment at 877-838-5085 with application questions.

Type 07 and 08 riders may ask the broker for any approved subcontractor by name, and the broker must share the rest of those trips fairly among all providers, itself included. You may never solicit Medicaid trips. See how to get NEMT broker contracts.

Licenses and registrations

Your company

Form an LLC or corporation with the Kentucky Secretary of State. Articles of organization for an LLC cost $40, and articles of incorporation cost $40 plus an organization tax based on shares. Filings are usually processed the day they arrive and can take up to three business days. A sole proprietor files a certificate of assumed name with the county clerk instead.

Every company files a $15 annual report between January 1 and June 30 of each year after the year it forms. A company that misses June 30 can be administratively dissolved, and reinstating it carries a $100 penalty.

Get your employer identification number (EIN) from the IRS, free and issued online right away. Kentucky Medicaid wants the IRS letter that shows it. Check with your city and county for an occupational license; the Secretary of State’s business filings page links to the local list.

Kentucky Division of Motor Carriers

State law says no one may act as a motor carrier without a certificate from the Transportation Cabinet. KYTC names two that fit NEMT:

Certificate	Vehicles	Riders
Disabled Persons Vehicle (DPV)	Lift or ramp, up to 15 regular seats, no stretcher	Wheelchair riders and riders who walk
Taxicab	Up to 8 regular seats	Riders who walk

A DPV meets the federal accessible vehicle rules in 49 CFR part 38, with a built-in lift or ramp. To apply:

1. Have your insurer file Form E with Motor Carriers. It must be an insurer authorized in Kentucky, and it files before you apply.
2. Line up at least one vehicle with a county clerk plate, which every passenger vehicle needs.
3. Finish inspections and background checks. An automotive service technician inspects each vehicle, and everyone who drives passes a nationwide background check from a company on KYTC’s approved list.
4. Apply in the Motor Carrier Portal, and allow up to 14 business days.
5. Qualify each vehicle. Motor Carriers then issues a license plate and a fee receipt card for each one.

Under KRS 281.630 and 281.631 as of September 2026, the certificate costs $250 to apply and $250 to renew every year. Each DPV or taxicab vehicle license costs $30 a year, prorated for vehicles added mid-year, and your city or county may add up to $30 per vehicle. A certificate not renewed within a year of its renewal date is void.

A vehicle rated at 10,001 pounds or more, or built or used to carry more than 8 people including the driver for pay, is a commercial motor vehicle. Kentucky’s 601 KAR 1:005 applies the federal driver, drug testing, hours of service, and maintenance rules to it even on in-state trips, and a carrier that stays in Kentucky gets an intrastate USDOT number. See DOT numbers for NEMT and NEMT license requirements.

Vehicle rules

Inspections come first. The broker inspects your vehicles before it subcontracts with you, and KYTC also inspects vehicles. Under 603 KAR 7:080, each vehicle passes a safety inspection by an automotive technician before its first HSTD rider and every year after. Motor Carriers requires a yearly inspection of every DPV and taxicab on form TC 95-630, completed by an ASE-certified technician and kept for three years. A replacement vehicle gets its inspection before you move a plate to it on form TC 95-37. The broker pulls any vehicle that fails licensing or safety rules right away.

Each vehicle needs:

• A communication system linking the vehicle and dispatch, used in a way that keeps rider information private under HIPAA.
• Working heat and air conditioning. A vehicle without them comes out of service until fixed.
• A clean, working seat belt for every seat, kept off the floor, two seat belt extensions, and a seat belt cutter above the driver’s door.
• Child safety seats as Kentucky law requires.
• A working speedometer, odometer, and interior lights, with sidewall padding and a ceiling covering.
• Two outside mirrors and an inside mirror of laminated or bonded glass for watching riders.
• A clean interior and exterior: no broken glass, torn upholstery, damaged seats, sharp edges, grease, or litter.
• Anti-skid ribbed rubber flooring or carpet that does not block wheelchairs.
• Your company name, vehicle number, and the program’s customer service number inside, plus signs for no smoking, eating, or drinking and for seat belts.
• A fire extinguisher with a current tag, three reflective triangles, a first aid kit, and a spill kit.
• A step or metal step stool when the floor is over 12 inches up. The stool measures 8 1/4 inches high, 15 wide, and 14 deep, and a milk crate never counts.
• A packet with the registration, insurance card, vehicle card, and accident forms, plus maps or GPS.
• Your legal company name on the driver and passenger side doors in 2-inch block letters.

House Bill 2 adds a GPS device in every Medicaid vehicle that shows the broker its exact location during trips, at the broker’s cost. See GPS tracking for NEMT.

Lift-equipped vehicles must meet the Americans with Disabilities Act rules. When a driver steps away to help a rider, the driver turns off the engine or sets a transmission lock, and keeps the key. Use our vehicle inspection checklist before each broker inspection.

Driver rules and training

603 KAR 7:080 and KRS 281.6301 keep a person from driving for you when they:

• Are under 18, or are not licensed in Kentucky for the vehicle.
• Have more than two moving violation convictions in the last three years.
• Have any conviction for a sexual crime, a crime of violence, or a Class A or B felony.
• Were ever convicted of leaving the scene of an accident, causing a death by negligent driving, or using a vehicle in a felony involving making or distributing drugs.
• In the last three years were convicted of driving on a suspended license, driving 26 mph or more over the limit, or racing, or have four speeding or points convictions.
• Have a misdemeanor or felony conviction in the last five years, unless the broker, your company, and the Cabinet approve them first.

Run the nationwide background check before you hire, through a company on KYTC’s approved list, at your own cost. Keep it three years, and repeat it for every driver every three years at renewal.

Every new safety-sensitive employee, meaning anyone who schedules, dispatches, drives, or maintains vehicles, passes a pre-employment drug test. Drivers stay in random drug and alcohol testing, and you need a written policy; our drug and alcohol policy template covers it. Training covers first aid, bloodborne pathogens, and passenger assistance, plus developmental disability awareness when the Cabinet offers it. See NEMT driver training.

On the job, drivers:

• Are courteous, patient, and helpful, and wear a name tag and company photo ID.
• Report any moving violation or accident on a trip to the broker right away. The broker tells the Cabinet within 24 hours.
• Never decide a rider’s eligibility or ride type, and never pass a trip to another provider.
• Walk a Type 07 or 08 rider to and from the vehicle when it takes under five minutes and, with other riders aboard, the vehicle stays in sight. Otherwise one escort per vehicle does it.
• Never stand in for a guardian of a child 12 or under. A parent, guardian, or designee rides with any child under 13.

Brokers and subcontractors keep program records, including trip invoices and encounter data for every trip, for five years. Our driver file checklist tracks each driver’s papers.

Trip rules and how you get paid

Your subcontract must list payment terms, hours, rates, pickup and delivery standards, its length, and its termination and penalty terms. Riders must be ready 15 minutes before pickup and cancel at least 24 hours ahead, and a rider who fails to show gets a letter from the Cabinet. Neither 603 KAR 7:080 nor 907 KAR 3:066 sets a payment for a no-show, so ask how your contract handles one. Where practical, the broker groups riders into shared trips.

KYTC sets the provider rate for each service type in each region, the same for every provider there, including the broker. It weighs terrain, trip distance, population, nearby medical and job sites, labor costs, and use of services, and gives brokers 45 days of notice before a change.

Payment runs on a monthly clock set by KRS 281.875 and 603 KAR 7:080:

1. By the 1st, send the broker a valid invoice for last month’s trips. One dated after the 1st rolls into the next month.
2. By the 7th, the broker sends its reports to KYTC.
3. By the 15th, KYTC pays the broker, once the reports and the DMS eligibility count are in.
4. Within three business days of that payment, the broker pays you.

For March trips, that means an invoice by April 1, the state paying the broker by April 15, and your payment within three business days after. Every invoice must reach the broker within six months of the date of service.

The Cabinet investigates complaints about brokers and settles disputes over a rider’s choice of provider. A Medicaid provider appeals a negative action by DMS under 907 KAR 1:671. NEMT is not on Kentucky’s electronic visit verification (EVV) list, which covers personal care, home health, private duty nursing, and certain 1915(c) waiver services.

Under House Bill 2, 2% of each broker’s capitation is withheld and earned back on measures such as trips completed, canceled, and delayed, average trip time, and miles per trip. Accurate pickup and drop-off times protect you; see NEMT trip documentation.

Insurance requirements

KRS 281.655 sets the minimum liability on each vehicle, by its regular seats:

Limit	Up to 7 seats	8 or more
Injury to one person	$100,000	$100,000
All injuries, one accident	$300,000	$600,000
Property damage	$50,000	$50,000

The policy comes from an insurer authorized in Kentucky, carries the state insurance endorsement, is in the certificate holder’s name, and covers every vehicle under the certificate. The insurer files it on Form E and must give Motor Carriers 30 days of notice before canceling. Your operating rights stop the moment coverage is canceled.

The broker collects proof of vehicle liability coverage for your company and any independent contractor who drives for you, proof of Kentucky workers’ compensation, registrations, leases, your certificate, and fee receipt cards. Ask your broker for its insurance limits in writing before you buy a policy. See NEMT insurance requirements.

Kentucky requires workers’ compensation once you have one employee, counting family members, part-time workers, and temporary workers. The policy must provide Kentucky coverage, since an “all states” endorsement does not qualify. Owners and qualified LLC members are covered only if they elect it by endorsement. An employer without coverage faces a fine of $100 to $1,000 per employee for each day, and may not take the premium out of workers’ pay.

What it costs and how long it takes

These are the fees Kentucky sets as of September 2026. Vehicles, premiums, background checks, 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	$40	Secretary of State
Annual report	$15 a year	Secretary of State
DPV or taxicab certificate	$250, then $250 a year	Motor Carriers
Vehicle license	$30 per vehicle a year	Motor Carriers
Local vehicle fee	Up to $30 per vehicle a year	City or county
Medicaid enrollment, type 56	No fee	DMS

A workable order, from first call to first trip:

1. Call the broker for your region. Ask whether it is adding providers and which service types it needs.
2. Form your company, usually within three business days, and get your EIN online the same day.
3. Get your NPI and local licenses.
4. Buy insurance that meets KRS 281.655 and your broker’s limits, and have your insurer file Form E.
5. Line up three vehicles and three drivers, with county clerk plates, ASE inspections, and background checks.
6. Apply for your DPV or taxicab certificate in the Motor Carrier Portal, and allow up to 14 business days.
7. Finish the broker’s review, testing, and training.
8. File a MAP-811 for each service type through KY MPPA, track it on the portal dashboard, and send the broker your welcome letters. The broker then gets KYTC’s approval and holds your orientation before your first trip.

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

Work beyond Medicaid

The same brokers carry more than Medicaid riders. Under 603 KAR 7:080, HSTD also serves the Kentucky Works program, vocational rehabilitation, services for the blind, mental health and developmental disability services, and the Office of Aging Services. Ask your broker which programs its subcontract covers.

• Public transit grants. KYTC’s Public Transit Branch oversees the federal Section 5310 and 5311 transit grants, which go to nonprofit and public operators. See Section 5310 grants.
• Veterans. The VA pays for special mode transportation, a specially equipped vehicle, when a VA provider decides a veteran’s condition requires it and the trip is approved in advance. Ask your nearest VA medical center how it arranges these rides.
• Hospitals and nursing homes. Under House Bill 2, a hospital or skilled nursing facility may drive its own patients and residents and be paid by the broker at the mileage rate the broker would pay a contracted driver for the same trip. See how to get NEMT facility contracts.
• Private pay. Riders who pay for themselves add work that does not depend on one broker. See private pay NEMT.