How to Start a NEMT Business in Mississippi (2027)

Mississippi runs Medicaid rides through two brokers that each cover the whole state. Modivcare arranges rides for fee-for-service members, and MTM Health arranges them for the three MississippiCAN health plans. To get that work, you need a registered company, a State Department of Health permit or registration, the right insurance, and vehicles and drivers that meet the state’s rules. The rules below follow the Division of Medicaid’s Title 23, Part 201, effective August 1, 2026, and Modivcare’s Mississippi provider manual dated February 2024.

How Medicaid rides work in Mississippi

The Mississippi Division of Medicaid (DOM) runs Medicaid. Its members fall into two groups, and each group books rides through a different broker.

Members	Broker	Hired by
Fee-for-service (traditional) Medicaid	Modivcare	DOM
Magnolia Health, Molina Healthcare, TrueCare	MTM Health	Each health plan

DOM pays Modivcare for each trip it arranges, plus a monthly administrative fee capped at 15% of trip costs. For MississippiCAN members, DOM pays each health plan a monthly capitation rate, and the plan pays for rides out of it. The plans’ current state contracts run from August 12, 2024 to August 11, 2028, and DOM lists MTM Health as the NEMT vendor for all three. For how health plans fit in, see managed care organization.

Modivcare took over fee-for-service rides from MTM Health on June 8, 2024. Its contract runs through June 7, 2027, and DOM can extend it twice, one year at a time. Modivcare emerged from Chapter 11 on December 29, 2025. See our report on Modivcare’s bankruptcy for what that meant for providers.

A member qualifies when the ride goes to a covered service from a Mississippi Medicaid provider, the member has a medical need for the ride, and no other transportation is available. Medicaid is the payer of last resort, so other ride programs are used first. The broker authorizes the most economical mode that fits the member’s mobility and assigns the provider closest to the member. Members cannot choose a transportation company.

Members book at least three business days ahead. Hospital discharges and returns from an emergency visit are the exceptions. The broker covers one adult attendant, 18 or older, when the member’s medical provider certifies the need before the trip, and it pays for meals and lodging on medically necessary overnight trips. The broker must allow trips to neighboring counties, including bordering counties and parishes in Alabama, Arkansas, Louisiana, and Tennessee.

These groups get no NEMT through the program:

• Family Planning Waiver, Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualified Working Disabled Individual, and Qualified Individual (QI-1) members.
• CHIP members. The health plan contracts exclude NEMT for CHIP members.
• Residents of nursing facilities, ICF/IID homes, and psychiatric residential treatment facilities. Their facility must provide the ride.

The fee-for-service program is smaller than it once was. The state’s PEER Committee reported 141,254 members eligible for rides in April 2024, down from a peak of 335,914 in December 2022, and trips had held at or below 50,000 a month for three and a half years. Ambulatory trips were 81% to 82% of the total. In April 2024, the top reasons were the ride home (48.6%) and dialysis (28.4%), and the average trip leg was 20.68 miles.

Which brokers to join

You do not bill Mississippi Medicaid for rides. The state only covers a trip when the company that drove it has a contract with the broker. You can hold both agreements, and each broker serves all 82 counties. For running two broker contracts side by side, see working with multiple brokers.

Modivcare, for fee-for-service members

1. Send the form. Fill out the transportation provider form on Modivcare’s “Become a Transportation Provider” page. The page lists the driver, vehicle, and insurance documents it expects.
2. Send your documents. For each driver: a PASS wheelchair certificate, first aid and CPR, a defensive driving certificate, a drug screen, a driving record, and a background check. For each vehicle: current registration and proof of insurance.
3. Meet with the local office. Modivcare’s manual asks you to read the contract and manual, then call the local office to go over your questions. Your staff attend an orientation on vehicles, drivers, scheduling, billing, and trip logs.
4. Pass the vehicle inspection described under vehicle rules below.
5. Wait for approval. The state’s contract requires Modivcare to ask DOM to approve each new provider at least 10 business days before its first trip. Once its corporate office approves you, Modivcare sends a welcome letter with the date it will start assigning trips.

Modivcare’s Mississippi provider line is 866-333-1043, and its provider complaint line is 866-381-4852. Our Modivcare guide covers the company in its other states.

As of August 7, 2024, Modivcare had an average of 3.5 providers per county, and 15 counties had only one. When an area lacks providers, the broker must tell DOM within 24 hours and recruit enough providers within seven business days. Ask the local office which counties and service levels it is short on.

MTM Health, for MississippiCAN members

MTM Health’s onboarding has six steps: the provider application, an interview with a network representative, contracting, credentialing, training, and your first trip. A network representative helps you through each one. The plans’ state contracts require their rides to follow the same Part 201 rules as the fee-for-service program. If a plan declines to add you to its network, it must tell you in writing why. Our MTM Health guide covers the company in other states.

What the state checks

Both brokers may only contract with companies that are eligible to be Mississippi Medicaid providers. The broker’s enrollment forms ask you to disclose your full ownership and control. The state’s contract requires Modivcare to check its network against the federal exclusion list (LEIE) and the System for Award Management at enrollment and at least monthly after, and to report any match, including a provider or driver, to DOM within two business days. See the OIG exclusion list for how those checks work.

Licenses and registrations

Your company

Form an LLC or corporation with the Mississippi Secretary of State, online. As of September 2026, a certificate of formation for an LLC costs $50, and articles of incorporation cost $50. Some online filings are approved at once, and those that need staff review should come back within 24 hours. Business Services answers at 601-359-1633.

Corporations and LLCs file an annual report online between January 1 and April 15 each year. A Mississippi LLC’s annual report is free, and a corporation’s costs $25. Skipping it can lead to administrative dissolution. Reinstating a Mississippi LLC or corporation costs $50. Corporations, and some LLCs, first need a tax clearance letter from the Department of Revenue.

Get your employer identification number (EIN) from the IRS, which never charges for one. If a health plan or facility asks for an NPI, see how to get an NPI number.

Mississippi State Department of Health

Mississippi permits NEMT companies through the State Department of Health (MSDH). Section 41-55-71 lets MSDH go to court to stop anyone who provides NEMT without a current permit, unless an exemption applies. Companies already running had until July 1, 2024 to get one, and the section was last amended effective July 1, 2025. The permit comes from the Bureau of Emergency Medical Services, whose Non-Emergency Vehicle Coordinator answers at 601-933-7656.

If you	You need
Drive Medicaid trips for a broker that inspects and certifies your drivers and vehicles	An MSDH registration, not a permit
Give NEMT rides for pay without that certification	An MSDH permit for each vehicle
Carry more than seven passengers in one vehicle	MDOT authority, below
Drive a vehicle built for 16 or more people, driver included	A CDL with a passenger endorsement

The exemption covers a Medicaid provider under contract with a broker that serves DOM. MSDH will not inspect drivers and vehicles the broker has certified. If you drive only for MTM Health’s plan members, or you also plan facility and private pay rides, ask MSDH to confirm in writing whether the broker’s certification covers you. The law also exempts ambulatory rides by a transportation network company or an MDOT-permitted contract carrier working under contract.

To get a permit, send the application to the Bureau of EMS in Pearl, or email it to EMS.support@msdh.ms.gov. It lists your operations site, every vehicle, and every driver. MSDH then visits your site, inspects each vehicle, and approves your driver list. The State EMS Director approves a first permit. Each permit lasts one year and is reissued after the vehicle’s yearly inspection. As of September 2026, MSDH charges $138 per vehicle permit and $138 to reinspect a vehicle that fails. You cannot put a new vehicle in service before its permit arrives, or let a new driver drive before MSDH approves an updated driver list.

Mississippi Department of Transportation

Mississippi’s Motor Carrier Regulatory Law requires MDOT authority for companies that carry passengers for hire: a certificate of public convenience and necessity for a common carrier, or a permit for a contract carrier (Section 77-7-49). Section 77-7-9 leaves out “motor vehicles transporting people where not more than seven (7) passengers are carried.” A vehicle that carries more than seven passengers at a time needs that authority.

Apply to MDOT’s Permits and Motor Carrier Division with its application form, your USDOT number, and the $50 filing fee MDOT charges as of September 2026. The exhibits include a highway map marking your territory, a list of every vehicle, a financial statement, a schedule of operations, a binder from your insurance agent, and, for a contract carrier, a copy of the signed contract. For a certificate, MDOT sets a hearing at least 20 days after you file. Carriers based outside Mississippi also file a BOC-3. The division answers at 601-359-1717, option 2.

Trips that cross into Alabama, Arkansas, Louisiana, or Tennessee can bring in federal rules. See DOT numbers for NEMT and NEMT license requirements.

Vehicle rules

The broker inspects each vehicle before it carries a rider and at least every six months after, in person. A vehicle that passes gets the Medicaid-approved sticker on the outside of the passenger-side rear window. A vehicle or driver out of compliance comes out of service until the broker verifies the fix. Under Modivcare’s manual, a vehicle with minor problems gets a yellow provisional sticker and must be reinspected within 10 days. A vehicle that fails again is redlined, and Modivcare pays for no trips in it.

Part 201 requires every vehicle to have:

• Working heat and air conditioning, a speedometer, and an odometer.
• Working seat belts, stored off the floor, with a sign reading “ALL PASSENGERS MUST WEAR SEAT BELTS”, two seat belt extensions, and a seat belt cutter within the driver’s reach.
• Two outside mirrors and an inside mirror for the passenger area.
• A clean body and interior with no torn seats or sharp edges.
• Your business name and phone number on both sides in letters at least 3 inches high, and no words suggesting that Medicaid members ride inside.
• The broker’s toll-free and local numbers and complaint steps posted inside, and a “NO SMOKING” sign.
• A packet with the registration, insurance card, and accident forms, and a current map of the area.
• A stocked first aid kit, a fire extinguisher, and a spill kit.
• A real-time link to your office by phone or two-way radio. Pagers do not count.
• Compliance with the ADA vehicle specifications.

Modivcare’s manual adds inward- and outward-facing cameras with real-time driver coaching, a CPR pocket mask, three reflective triangles (no flares), spare fuses, a flashlight, and front tires with at least 4/32 inch of tread. A boarding step must hold 300 pounds and sit no more than 12 inches above the ground. A milk crate never counts. You may use only vehicles you own or lease. The state’s broker contract terms and MSDH’s permit rules also call for a placard on each door and on the rear reading “Non-emergency medical transport vehicle” and “This service does not provide medical care.”

Modivcare’s wheelchair rules call for at least 56 inches from floor to ceiling, an interlock that holds the van while the lift is out, ramps and lifts rated for 600 pounds, and a forward-facing tiedown at each position tested to 30 mph and 20 g. A stretcher vehicle carries one stretcher rider at a time, with a driver and an attendant, and never a rider who needs medical monitoring or an IV. Brokers must have providers who can carry riders up to 800 pounds. See bariatric transportation and our vehicle inspection checklist.

Driver rules and training

Part 201 removes a driver from NET service who:

• Fails a yearly random drug test.
• Is convicted of two moving violations or accidents on NET trips.
• Had a license suspended or revoked for moving violations in the last five years.
• Is convicted of a crime listed in Section 43-13-121, such as offenses tied to Medicaid or Medicare services, patient abuse or neglect, controlled substance distribution, fraud or theft, and offenses punishable by a year or more that involve moral turpitude or acts against the elderly, children, or infirm.

Modivcare’s manual goes further. It bars a driver with two moving violations or at-fault accidents in 36 months, a DUI in three years, or a felony involving sex, children, the elderly, domestic abuse, drugs, weapons, or violence in seven years.

Every driver must be at least 18 with a valid license for the vehicle. At hire, each driver needs a one-time fingerprint background check, national and state background checks, a Mississippi Sex Offender Registry check, and a driving record check. The broker repeats all but the fingerprint check every year. The broker cannot pay for trips by a driver whose fingerprint check is not on file. Your outside deadline is 90 days from your contract start or the driver’s hire date. See NEMT driver background checks and drug testing.

The state’s broker contract terms require drivers to keep a current CPR certification. Modivcare’s manual adds NEMT orientation, customer service and sensitivity, defensive driving, passenger assistance, wheelchair securement, spill kit use, first aid, and HIPAA training, with a PASS certificate, or an approved substitute, for every driver and PASS wheelchair training for companies that carry wheelchairs. A driver who fails to secure a wheelchair is suspended until retrained. MSDH-permitted companies must also repeat the fingerprint check, driving record check, drug screen, and OIG check every year.

On the job, drivers wear a name tag with their name and your company’s, and high-visibility safety apparel. They help riders curb to curb, door to door, or hand to hand as needed, secure mobility devices, and make sure each rider is inside before leaving. They never leave a rider alone, smoke, or wear headphones, except a hands-free set for calls to your office or 911. They report no-shows and accidents to you at once, and you report them to the broker. Report any allegation of sexual harassment or physical abuse to the broker too.

Keep a file for each driver: date of birth, Social Security number, a license copy, a five-year driving record, the background check, the drug screen, training certificates, and any complaints or accidents. MSDH-permitted companies keep driver records for at least five years. Our driver file checklist tracks them.

Trip rules and how you get paid

Modivcare’s Mississippi standards:

• On time. Pick up within 15 minutes before or after the scheduled time. Drop off no later than the scheduled time and no earlier than one hour before it. Pick up a scheduled return within 15 minutes, and a will-call within 45 minutes of Modivcare’s call. Modivcare expects 98% of trip legs on time.
• No-shows. Wait at least 10 minutes past the scheduled time, then call Modivcare’s provider line before you leave. See no-shows.
• Delays. Call waiting riders once you run 15 minutes late.
• Shared rides. Carry up to four adults or nine children at once. No ride may take more than 45 minutes longer than a direct trip.
• Trip changes. Modivcare sends manifests at least 48 hours ahead. Send a trip back at least 24 hours before pickup, or you may pay for the replacement ride. Report the previous day’s cancellations by noon.

The health plans’ state contracts, in force as of September 2026, set these monthly averages for plan rides: a 15-minute wait at home, 30 minutes for a scheduled return, 60 minutes for a will-call, and pickup within three hours of a hospital discharge. The plan tells you about a trip at least two business days ahead when it can, and at least one, except for urgent trips.

Each trip log records the date, the driver’s name and signature, the rider’s signature, the last six digits of the VIN, the service level, the trip number, and actual pickup and drop-off times in military time. The state’s contract also calls for scheduled times and odometer miles. If a rider cannot sign, a facility staff member signs their own name. If no one can, the driver writes “unable to sign” with initials and the reason. Use our trip log template.

Mississippi does not set provider rates. Your broker negotiates them in your agreement. Modivcare measures miles as the shortest route from pickup to drop-off, rounded to the nearest mile. For context, DOM pays Modivcare the rates it bid in 2023: $37.55 per one-way ambulatory trip and $74.29 per one-way advanced trip, which covers wheelchair, stretcher, and non-emergency ambulance rides.

Modivcare’s payment rules:

• Invoice within 60 days of the trip, through approved software or its web portal. Paper claims are not accepted.
• Late invoices lose 10% after 60 days and are denied after 120 days. A claim returned for missing information loses 10% if you fix it after 30 days, and is denied after 60.
• Pay comes twice a month, within 30 days of an uncontested invoice. The state contract requires Modivcare to pay 90% of clean claims within 30 days and 99% within 90 days.

Modivcare pays only for trips it assigned, with a valid trip number, run by approved drivers and vehicles. If you disagree with how it resolved a complaint, ask for a review in writing within 20 calendar days. If the answer still goes against you, DOM may overturn it when you contact DOM within 30 calendar days of the broker’s letter. A broker must also notify DOM in writing 15 days before it ends a provider’s contract. NEMT is not on Mississippi’s electronic visit verification list, which covers personal care, in-home respite, home and community supports, supported living, private duty nursing, and home health services.

Insurance requirements

Part 201 requires insurance on every vehicle at all times under state law and local ordinances. Modivcare’s provider page lists:

Coverage	What Modivcare asks for
General liability	Bodily injury, property damage, and personal injury. Limits vary by state.
Sexual abuse and molestation	Required, with higher limits if needed
Auto liability	At least your state’s minimum
Workers’ compensation	Where your state requires it

Send each renewed policy to Modivcare’s credentialing team when it renews. MTM Health checks insurance as part of credentialing, so ask its network representative for its Mississippi limits before you buy a policy. See abuse and molestation coverage and NEMT insurance requirements.

The state minimums, in dollars:

Rule	Minimum
Any vehicle, Section 63-15-3	25,000 per person, 50,000 per accident, 25,000 property
MDOT certificate, 15 or fewer seats	1,500,000
MDOT certificate, 16 or more seats	5,000,000

Mississippi requires workers’ compensation once you have five or more workers regularly in the same business (Section 71-3-5). See workers’ comp for NEMT.

What it costs and how long it takes

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

Item	Cost	Paid to
EIN	Free	IRS
LLC formation or corporation articles	$50	Secretary of State
Annual report	$0 for an LLC, $25 for a corporation	Secretary of State
NEMT vehicle permit	$138 per vehicle	MSDH
Reinspection after a failed inspection	$138	MSDH
Passenger carrier authority (over seven passengers)	$50 filing fee	MDOT

A workable order, from first call to first trip:

1. Call Modivcare’s provider line (866-333-1043) and ask where it needs providers, and send MTM Health its application.
2. Form your company and get your EIN.
3. Buy insurance that meets each broker’s limits.
4. Apply to MDOT if any vehicle will carry more than seven passengers. For a certificate, the hearing comes at least 20 days after you file.
5. Equip your vehicles to Part 201 and your broker’s list.
6. Hire drivers who meet the rules. Run the fingerprint check, background checks, driving records, and drug screens, and book CPR, first aid, defensive driving, and PASS training.
7. Finish credentialing. Send your documents, pass the inspection, and attend orientation. Modivcare asks DOM to approve you at least 10 business days before your first trip.
8. Register with MSDH once the broker certifies your drivers and vehicles, or get a permit for each vehicle before its first ride if the broker exemption does not cover you.

The brokers set the pace, since they add providers where they need them. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

Four sources of rides do not run through the Medicaid brokers.

• Nursing homes and other facilities. Nursing facilities, ICF/IID homes, and psychiatric residential treatment facilities must provide non-emergency transportation for residents and cannot use the broker. They may hire a company that also drives for the broker, as long as the facility arranges each trip and pays the company directly. Ask MSDH whether these rides need a permit for your vehicles. See how to get NEMT facility contracts.
• Public transit programs. MDOT’s Public Transit Division runs Mississippi’s federal Section 5311 rural transit and Section 5310 senior and disability programs, and answers at 601-359-7800. Under its State Management Plan, revised January 2026, private for-profit companies take part in Section 5311 service only through contracts with an eligible agency or MDOT’s intercity bus program. 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 the beneficiary travel office at your nearest VA health facility how it books these rides.
• Private pay and clinics. Riders who pay for themselves, dialysis centers, and hospitals add work that does not depend on a broker’s assignments. Medicaid hospital discharges still go through the broker. See private pay NEMT.