How to Start a NEMT Business in Maryland (2027)

Maryland runs Medicaid rides without a broker. The Maryland Department of Health (MDH) gives grants to 24 local programs, and each one screens riders and either buys rides from transportation companies or drives them itself. You win Medicaid trips one county at a time, and you need state authority to carry passengers for pay. The rules below follow COMAR 10.09.19, the state plan page CMS approved on May 20, 2026, and MDH’s Guide to the Administration of the Transportation Grant Program (fiscal year 2020 edition), which Washington County’s 2026 ride contract requires its vendor to follow.

How Medicaid rides work in Maryland

MDH’s Division of Community Support Services oversees non-emergency medical transportation (NEMT). Under the state plan page for NEMT (transmittal 26-0002, effective January 1, 2026), Maryland funds rides as an administrative expense through grants to local agencies that act as agents of the State. The grantees are 23 local health departments and the Montgomery County Department of Transportation. Each one serves fee-for-service members and members of HealthChoice, Maryland’s Medicaid managed care program.

A grantee screens each request, picks the least costly mode that fits, and arranges the ride. MDH’s guide says most grantees contract with local transportation providers and some drive the rides themselves. The state plan requires screening and driving to be done by separate entities unless the local program does the driving.

MDH’s October 2019 report to the General Assembly’s budget committees counted these paid trips in fiscal year 2019:

Program	Trips (FY2019)
Baltimore County	203,058
Harford County	80,493
Montgomery County (county DOT)	76,227
Prince George’s County	73,678
Anne Arundel County	65,660
Wicomico County	63,947
Baltimore City	56,863
Howard County	50,403
Dorchester County	36,578
Carroll County	26,275
Worcester County	24,057
Caroline County	23,326
Allegany County	22,658
Washington County	22,097
Cecil County	22,075
St. Mary’s County	19,229
Frederick County	15,132
Queen Anne’s County	13,309
Calvert County	11,745
Charles County	9,131
Kent County	8,254
Somerset County	8,132
Garrett County	7,025
Talbot County	6,942

Counts move. Washington County’s April 2026 bid documents show 17,988 trips in fiscal year 2025, annualized.

Who qualifies and how rides are booked

Riders need full Medicaid. Members covered only for Medicare cost sharing (QMB), Medicare premiums (SLMB), or family planning do not qualify. They must also have no other way to get there: the program asks about household cars, friends, volunteers, free rides, and bus routes, and it checks MVA records for a registered vehicle. The rider’s medical provider completes a Provider Certification Form at entry, after a change in condition, and at least every 12 months.

Members book at least 24 hours ahead, except for hospital discharges, and COMAR 10.09.19.04 lets a program refuse to pay for shorter notice. Anne Arundel County and Baltimore City ask for two business days. The state plan lists wheelchair vans, taxis, ambulances, air medical transportation, and bus passes, and it rules out rideshare companies. Since January 1, 2026, it also covers meals and lodging that the local program approves before travel, such as for an overnight trip.

The program will not pay for a wheelchair van for a rider who can walk, an ambulance for a rider who does not need a stretcher, rides between home and a medical day care or day habilitation program, rides to a more distant provider chosen for convenience, or gratuities of any kind.

A statewide administrator is planned

The Department of Legislative Services’ 2026 analysis of the fiscal 2027 budget describes an MDH project to buy one NEMT dispatching and claims processing system, because each local jurisdiction manages its own contracts. CMS was next to review the request for proposals, and the estimated completion date is 2030. The analysis also flags a planned rule that transportation providers enroll in Maryland Medicaid’s provider system. Until a new model starts, county contracts are the way in.

How to join your county’s program

There is no statewide application. Under the state plan, each local program signs its own ride contracts, and MDH tells ambulance companies to contact the local transportation office in each county they want to serve, because counties buy through their own procurement procedures. Start by learning how each county you want to serve buys its rides:

Program	How rides are provided
Washington County	One outside contractor, bid out in April 2026 for a term starting July 1, 2026
Talbot County	A contract with Delmarva Community Transit for ambulatory and wheelchair riders
Baltimore City	Several transportation companies. Each rider is assigned one and books with it after 3:30 p.m.
Anne Arundel County	A transportation company runs the rides and takes same-day changes
St. Mary’s County	Health department drivers, plus a contract with a local ambulance company
Allegany County	Health department vans and drivers
Worcester County	Staff drivers plus taxis, ambulances, buses, and other community providers
Montgomery County	The county Department of Transportation screens riders and schedules trips

Then work through these steps for each county:

1. Call the county program. Ask who holds the ride contract, when it ends, and whether the vendor subcontracts. MDH’s Division of Community Support Services (410-767-7283) oversees every program.
2. Register on eMMA and watch local bid pages. eMaryland Marketplace Advantage is Maryland’s procurement portal, and Washington County’s 2026 request for proposals (RFP) told vendors to register there. That health department also posts bids on its own site and keeps no bidders list.
3. Know the thresholds. Washington County’s health department buys with informal quotes up to $10,000, written quotes from at least three bidders up to $99,999, and formal bids above $100,000.
4. Check the minimum qualifications. Its RFP, issued April 13, 2026, required six years of experience in the last eight with ambulatory, wheelchair, and ambulance trips, and every service level from ambulatory to bariatric ambulance, directly or through subcontractors.
5. Build the proposal. It had technical and financial parts scored equally, and it needed three reference letters, a certificate of insurance, a proposal bond of 5% of the price, and a living wage affidavit.
6. Close the award. Within five business days, the selected company owed a $1,000,000 performance bond, insurance certificates, a HIPAA business associate agreement, an excluded parties attestation, and an ownership disclosure form. Proof of licensing, inspections, and driver first aid and CPR training was due within 60 days.

A new company with one or two vans may not meet a whole-county contract’s experience rule. Washington County allows subcontracting with its prior written approval, and subcontractors meet the same requirements and carry comparable insurance. See how to subcontract NEMT trips, government NEMT contracts, and HIPAA for NEMT.

The State’s own screening

MDH’s guide has your company check every employee, subcontractor, and subcontractor employee against the HHS OIG exclusion list and the Maryland Medicaid sanctioned provider list before hiring and every month after. You send the county a monthly attestation with screenshots and keep them for six years. Each January 15, the county reports to MDH on every vendor’s licenses, insurance, policies, backup plans, drug screening, background checks, training, and maintenance. See the OIG exclusion list and the exclusion screening log.

Licenses and registrations

Your company

Register with the State Department of Assessments and Taxation (SDAT) through Maryland Business Express. SDAT’s fee schedule (revised May 2024) charges $100 for LLC Articles of Organization and $50 more for expedited review in 7 to 10 business days. Standard online filings take 6 to 8 weeks. A certificate of good standing costs $20. The PSC and WMATC ask for one, and county contracts have you affirm that your company is in good standing.

The 2026 annual reports were due April 15, 2026. The 2026 annual report fee for an LLC or stock corporation is $300, and SDAT waives it for employers enrolled in MarylandSaves, the state’s retirement savings program. Get your employer identification number (EIN) free from the IRS. NEMT license requirements covers the licensing layers that apply in every state.

Maryland Public Service Commission

The Public Service Commission (PSC) Transportation Division regulates sedan, van, limousine, and motor coach companies that carry passengers for pay within Maryland, and it licenses drivers of for-hire vehicles for 15 or fewer passengers.

If you	You need
Carry passengers for pay in sedans or vans within Maryland	PSC authority as a charter and contract passenger carrier (Form 28)
Have drivers of for-hire vehicles for 15 or fewer passengers	A PSC passenger-for-hire driver’s license for each driver
Run trips with both ends inside WMATC’s district, which includes Montgomery and Prince George’s	A WMATC certificate of authority, in addition to PSC authority
Carry riders on a stretcher	A MIEMSS commercial ambulance service license
Carry more than 8 people, driver included, for pay, or run a vehicle of 10,001 pounds or more	A USDOT number from FMCSA

The carrier application (packet revised September 26, 2023) asks for your SDAT ID, articles, and good standing certificate, a certificate of insurance naming the PSC, proof of workers’ compensation or an exclusion form, and a rate sheet also filed with the Office of People’s Counsel. It also asks for a vehicle list, a recall self-certification and a Maryland State Inspection Certificate for each vehicle, and your drivers’ PSC license numbers. A vehicle you add can be no more than 12 model years old unless it weighs over 10,000 pounds (COMAR 20.95.01.11). Allow 6 to 8 weeks, and carry no one until you have written approval. Then take the stamped vehicle list to the MVA for for-hire tags and get a PSC decal for each vehicle. The Transportation Division is at 410-767-8128.

Two exceptions in the Public Utilities Article can reach companies that drive only for government programs. Section 9-201 does not require a motor carrier permit for vehicles a private company uses exclusively for transportation system services under a county, city, or State contract. Section 10-102 takes transportation provided solely on behalf of a government unit, for clients of programs such as Medical Assistance, out of the for-hire driver rules if that unit requires criminal and driving record checks. Both depend on your contract’s wording, and both end for any vehicle or driver doing other paid work. Get the PSC’s answer in writing first.

WMATC in Montgomery and Prince George’s counties

The Washington Metropolitan Area Transit Commission (WMATC) issues authority for trips with both ends inside its district: DC, Montgomery and Prince George’s counties, Arlington and Fairfax counties, Alexandria, Falls Church, and Dulles Airport. Even a trip from one point in Montgomery County to another needs a WMATC certificate. WMATC sends a notice of acceptance in about two weeks, posts each application for a 14-day protest period, and usually decides routine cases within 14 days after that. A conditional grant then gives you 180 days to file your vehicles, tariff, and insurance and to pass a WMATC inspection. Operating without a certificate can bring fines of up to $5,000 a day. WMATC is at 301-588-5260.

MIEMSS for stretcher rides

The state plan lists no stretcher van mode. It pays for an ambulance only when the rider must travel on a stretcher, and it requires ambulance providers to be licensed by the State Office of Commercial Ambulance Licensing and Regulation (SOCALR) at MIEMSS, 410-706-8511. COMAR 30.09.01.02 exempts from the ambulance definition only lift vehicles used exclusively for riders who stay in their wheelchairs and need no ambulance equipment or crew. A 1995 Attorney General opinion treats stretcher van service as ambulance service, except where WMATC regulates it in Montgomery and Prince George’s counties. See NEMT vs ambulance and what a stretcher van is.

Vehicle rules

Every used vehicle needs a Maryland State Inspection Certificate before the PSC grants authority and the MVA issues for-hire tags. Under COMAR 20.95.01.11, you then file a new inspection certificate every year, or every six months once a vehicle under 10,000 pounds is more than 10 model years old. The PSC may inspect any vehicle, and a vehicle over 10,000 pounds goes to a PSC inspection when the PSC directs. PSC rules also require heat, factory air conditioning if the vehicle came with it, a distinctive vehicle number, and your company name on the vehicle. Washington County’s contract monitor may also inspect without notice.

Washington County’s 2026 contract requires:

• Working seat belts worn by every passenger, and child safety seats where the law requires them
• Lifts and securement installed to the maker’s instructions, with every wheelchair secured
• Working heat and air conditioning, plus restraints, padding, and blankets as needed
• A two-way radio or an equal way to reach your base
• Your company name and vehicle number outside, and no-smoking signs inside
• Clean vehicles, backup vehicles for breakdowns, and a documented maintenance program

In the WMATC district, vehicles also show your WMATC number, and those seating 9 or more, driver included, carry a fire extinguisher and warning triangles or flares. A Maryland Medicaid wheelchair van has a lift tailgate or side lift (COMAR 10.09.19.02). Use the vehicle inspection checklist before each inspection, and see NEMT vehicle requirements.

Driver rules and training

Federal law, which Maryland’s state plan attests it meets, requires every NEMT driver to hold a valid license and stay off the federal exclusion lists. Every company needs a process for state drug law violations and one for reporting each driver’s driving history to Medicaid.

MDH’s vendor criteria add driving record and criminal background checks, rechecked at least once a year, substance abuse screening, and training in safety restraints, safe and defensive driving, and passenger assistance. Washington County’s 2026 contract adds a State and federal fingerprint check through CJIS before anyone drives, written approval for anyone with a criminal record, and Red Cross first aid and CPR.

Drivers of PSC-authorized vehicles need a PSC passenger-for-hire license. The packet revised October 2024 asks for six months of consecutive Maryland driving or one year in any state, and full driving records from every state where the driver held a license in the past 10 years. It also needs your company’s signature as the driver’s carrier and a State and FBI fingerprint check, which costs $51.25 at CJIS in Baltimore. Since April 1, 2026, applications are online only. Under COMAR 20.95.01.26, the PSC may deny a license for:

• A crime of violence, a traffic conviction for a fatal crash, or a sex offender registry listing, with no time limit
• Any other felony in the last 7 years
• A misdemeanor crime of violence in the last 3 years
• Driving under the influence, leaving the scene, or fleeing police in the last 7 years
• Reckless or negligent driving, or speeding 31 mph or more over the limit, in the last 3 years
• Four moving violations in the last 4 years

MDH forbids every vendor to deny or suspend an eligible rider under any circumstances. Under Washington County’s contract, drivers also wear company name badges, never charge riders or accept tips, and report incidents within 24 hours. Keep records in a driver file, and see NEMT driver background checks.

Trip rules and how you get paid

MDH’s guide caps the pickup window at 90 minutes in peak hours, 7 to 10 a.m. and 3 to 6 p.m., and one hour at other times. Long trips out of the region, such as the Eastern Shore to Baltimore, may run once a day or on set days. Rural NEMT covers planning those runs. Washington County’s 2026 contract adds these standards:

• Reach the pickup no more than 60 minutes before the appointment time for trips inside the county, or 90 minutes for trips outside it
• Pick up returns within 60 minutes of the scheduled time inside the county, or 90 minutes outside
• Wait at least 7 minutes before recording a no-show
• Reach after-hours hospital discharges within two hours of the call
• Run from 5 a.m. to 9 p.m., Monday through Saturday, with discharges around the clock

Who sets the rate

Rates are set county by county. MDH’s 2019 report says local health departments negotiate them with local providers, and Washington County sets them by competitive bid. Its 2026 bid sheet asks for a base rate per rider that covers the first mile, a mileage rate billed to a tenth of a mile for one rider at a time, and a base rate for each added rider with no extra mileage. The contract treats billing mileage for two riders at once as an overpayment under COMAR 10.09.36.01.

For scale, MDH’s 2019 report put the average cost per trip in fiscal 2019 between $17.08 in Caroline County and $126.23 in Baltimore City, whose figure includes statewide air ambulance trips. Those averages come from each program’s total costs, so they are not vendor rates.

No program may pay for no-shows. MDH told every grantee so in March 2013 and later demanded repayment from a program that kept paying them. Washington County also pays nothing for trips cancelled before the vehicle arrives. See billing for no-shows.

Invoices and payment

Washington County’s contract wants a monthly invoice by the 15th with trip manifests showing each rider, date, addresses, mode, and mileage. It also wants weekly lists of completed trips, no-shows, and cancellations, and a proper invoice under COMAR 21.06.09. The county pays within 30 days of a proper invoice. If it pays late, you can claim 9% yearly interest by invoicing for it within 30 days of the late payment.

Keep trip records for at least six years, as MDH requires, on a trip log. If a county’s year-end reserve falls short, MDH lets it pay last year’s invoices from this year’s grant, but only invoices you sent within your contract’s deadline (memo of June 10, 2021).

Insurance requirements

Every vehicle registered in Maryland needs at least $30,000 per person and $60,000 per accident for bodily injury, $15,000 for property damage, matching uninsured motorist coverage, and $2,500 of personal injury protection. The PSC sets higher per-accident minimums for for-hire vehicles by passenger seating, as split limits for one person, two or more people, and property, or as one combined limit:

Seats	Split limits	Combined
7 or fewer	$50,000 / $100,000 / $20,000	$120,000
8 to 15	$75,000 / $200,000 / $50,000	$250,000
16 or more	$75,000 / $400,000 / $100,000	$500,000

WMATC carriers restricted to vehicles seating 15 or fewer, driver included, need a $1,500,000 combined single limit per accident. The insurer files WMATC’s own endorsement form, because WMATC does not accept ACORD certificates.

Washington County’s 2026 RFP required:

Coverage	Minimum
General liability	$1,000,000 per occurrence, $3,000,000 a year
Professional liability	$1,000,000 per claim, $3,000,000 a year
Crime (employee theft)	$1,000,000 per loss
Cyber, if you host county data	$10,000,000 per occurrence
Workers’ compensation	$1,000,000 per occurrence
Auto	Maryland’s required limits or more, for owned, leased, hired, and non-owned vehicles

The State is an additional insured except on workers’ compensation and professional liability, and insurers must give 30 days’ notice by certified mail before cancelling. See NEMT insurance requirements and certificate of insurance.

The PSC needs workers’ compensation coverage, a Certificate of Compliance from the Workers’ Compensation Commission, or a signed exclusion form. Only a sole proprietor with no employees, a partnership with no employees but its partners, a close corporation with no employees but its officers, or an LLC whose only workers each own at least 20% may sign the exclusion. See workers’ comp for NEMT.

What it costs and how long it takes

These are the fees the agencies set as of September 2026. Vehicles, insurance, and bonds depend on your quotes; see what it costs to start a NEMT business.

Item	Cost	Paid to
EIN	Free	IRS
LLC Articles of Organization	$100, plus $50 to expedite	SDAT
Certificate of good standing	$20	SDAT
Annual report (LLC)	$300 a year	SDAT
Driver fingerprint check	$51.25 per driver	CJIS
WMATC certificate (DC area)	$300, then $175 a year	WMATC

A workable order, from first call to first trip:

1. Call the programs in your counties and learn when each contract ends.
2. Form your company with SDAT, 7 to 10 business days if expedited, and get your EIN.
3. Insure and inspect your vehicles. The PSC needs an insured vehicle you own or lease, with a state inspection certificate.
4. Apply to the PSC, and to WMATC in Montgomery or Prince George’s. Allow 6 to 8 weeks for the PSC, which says its applications take from 2 weeks to 60 days.
5. License, screen, and train your drivers, with fingerprints, record checks, drug screens, first aid, and CPR.
6. Register on eMMA and bid, or subcontract. Washington County took proposals from April 13 to May 14, 2026, for a term starting July 1, 2026.

Washington County’s contract runs one base year plus two one-year options, so a missed bid can mean up to three years until the next one. See how to start a NEMT business and how to become a Medicaid transportation provider.

Work beyond Medicaid

If you rely on the Section 9-201 exception, any vehicle you also use for other paid work needs full PSC authority. Four other sources of rides are worth a call:

• County transit. Locally operated transit systems, supported by the Maryland Transit Administration, run door-to-door demand-response rides in some counties. Ask whether they buy trips from private operators.
• Developmental disabilities services. NEMT excludes rides between home and day habilitation, but the Developmental Disabilities Administration’s Community Pathways Waiver covers its own Transportation Services to community activities.
• Veterans. The VA pays for special mode transportation, an ambulance or specially equipped vehicle, when a VA provider decides a veteran needs it and the trip is approved in advance. See VA special mode transportation.
• Facilities and private pay. Dialysis centers, hospitals, senior living communities, and riders who pay for themselves add work beyond county contracts. See how to get NEMT facility contracts.