How to Start a NEMT Business in Montana (2027)

Montana is moving its Medicaid rides to one broker. For rides on or after October 1, 2026, Modivcare books every trip, enrolls every NEMT provider, and pays the claims, under a contract DPHHS announced in its July 9, 2026 provider notice. The state rules below come from the Commercial and Specialized Non-Emergency Transportation Services Manual (updated August 8, 2024) and the Administrative Rules of Montana, which still describe the old program in places.

How Medicaid rides work in Montana

The Montana Department of Public Health and Human Services (DPHHS) runs Medicaid as Montana Healthcare Programs. Through September 30, 2026, the Mountain Pacific Medicaid Transportation Center approves every trip, and providers enroll with and bill the state’s claims contractor, Conduent. On October 1, 2026, all of that moves to Modivcare. DPHHS says every NEMT provider must enroll with Modivcare to keep giving Medicaid rides.

Task	Through Sept. 30, 2026	From Oct. 1, 2026
Enroll as a provider	Conduent	Modivcare
Approve trips	Every trip, by Mountain Pacific	Only long, out-of-state, per diem, and attendant trips
Bill and get paid	Claims to the state’s contractor	Modivcare portals or data feeds

See Montana moves Medicaid NEMT to Modivcare for the full switch timeline.

A member qualifies with full (Standard) Medicaid or Healthy Montana Kids Plus. Rides are not covered for members with Qualified Medicare Beneficiary coverage only, Specified Low-Income Medicare Beneficiary coverage, the Mental Health Services Plan, Plan First, or Healthy Montana Kids (CHIP). Rides go to Medicaid-covered services at the closest provider that can give the care, and the member must use the least expensive ride that suits their medical needs.

Montana pays for three kinds of rides:

• Personal transportation. The member, a friend, or a relative drives and gets mileage. From October 1, the member gets a trip ID from Modivcare for each trip and a provider signature to prove the visit.
• Commercial transportation. Taxis, buses, and other common carriers, for members with no special needs.
• Specialized non-emergency transportation. Wheelchair vans and stretcher vans, only for members who cannot move without a wheelchair or must travel by stretcher. The member brings their own wheelchair.

Members book routine rides at least three business days before the appointment, through Modivcare’s 24-hour reservation line, its website, or its app. Since September 1, 2026, Modivcare has taken bookings for rides on or after October 1. Prior authorization is needed only when a member travels over 100 miles one way or 200 miles round trip, travels out of state, asks for meals and lodging, or needs an attendant’s costs covered. The DPHHS NEMT program officer reviews those requests through Modivcare.

Nursing facilities are responsible for residents’ routine trips when the destination is within 20 miles. Medicaid may cover the ride when the resident needs a wheelchair or stretcher, or must travel farther than 20 miles.

The Medicaid advisory committees’ 2026 annual report says DPHHS will recruit providers to improve rural access under the new broker. Our rural NEMT guide covers how to plan long trips so empty miles do not eat the fare.

How to join Modivcare, Montana’s Medicaid broker

You no longer enroll with Montana Medicaid through Conduent. DPHHS says Modivcare subcontracts directly with transportation providers and handles all NEMT enrollment. Modivcare is reaching out to current providers with enrollment steps, and new providers enroll with it the same way.

1. Call the provider line. Modivcare’s Montana Transportation Provider Line is (866) 726-1471. Ask which service levels and parts of the state it needs most, and who handles Montana credentialing.
2. Send the interest form. Fill out the form on Modivcare’s Become a Transportation Provider page.
3. Build your file. Modivcare’s general checklist asks, for each driver, for a PASS wheelchair certificate, First Aid and CPR, a defensive driving certificate, a drug screen, a motor vehicle report, and a background check. For each vehicle it wants current registration, an inspection where the state requires one, and proof of insurance. Ask the Montana team for its exact list.
4. Get on the app. DPHHS says providers get a Modivcare app for ride tracking, appointment confirmation by geofencing, and billing.
5. Sign the subcontract. It sets your rates, service standards, and how you submit trips. Read the billing terms before you sign.

Federal law sets a floor under every Medicaid ride. Under section 1902(a)(87) of the Social Security Act, each provider and driver must not be on the HHS OIG exclusion list, each driver needs a valid license, and each provider needs a process for handling drug law violations and for telling the state each driver’s driving history. See the OIG exclusion list for how those checks work, and our broker credentialing guide for building the file.

If you drove Medicaid trips before October 1, bill those trips under the old rules. Claims are due within 12 months of the date of service, and Montana Provider Relations answers at (800) 624-3958 or (406) 442-1837. For enrollment questions about the new program, DPHHS names its NEMT Program Officer, Bridget Evans, at (406) 444-3337. Our Modivcare guide covers the company in its other states.

Licenses and registrations

Your company

File articles of organization for an LLC with the Montana Secretary of State for $35, or articles of incorporation for a corporation for $35. An assumed business name costs $20 to register. These fees are set in the Administrative Rules of Montana, sections 44.5.114, 44.5.115, and 44.5.119.

An LLC files its first annual report between January 1 and April 15 of the year after it forms, then every year in the same window. The fee is $20 through April 15 and $35 after. Annual reports must be filed online, and online filing for Montana companies closes from the first business day of December to the first business day of January. Reinstating a dissolved LLC costs $35 plus $35 for each year of missed reports.

Get your employer identification number (EIN) from the IRS, which never charges for one. Register with the Department of Labor and Industry’s Unemployment Insurance Division once you hire. Check whether your city or county requires a local business license. For the entity choice itself, see LLC for NEMT.

Montana Department of Transportation and Public Service Commission

Montana has no NEMT license, but two agencies matter for your vehicles.

The Montana Department of Transportation (MDT) applies the federal motor carrier safety rules to intrastate vehicles that are designed or used to carry more than eight people, driver included, for pay (ARM 18.8.1501 and 18.8.1502). MDT assigns those carriers an intrastate USDOT number, which goes on each vehicle followed by “MT”. The carrier files a Motor Carrier Identification Report (form MCS-150) before it starts and every 24 months after. A sedan, a minivan, or a small wheelchair van built for eight or fewer people falls outside that definition.

Montana’s motor carrier law no longer has a Public Service Commission (PSC) certificate for on-demand passenger service like NEMT. The Medicaid rule for wheelchair and stretcher vans, ARM 37.86.2501, still defines the service as transport by a provider with a Class B PSC license, and the August 2024 manual repeats it. The Legislature repealed the Class B certificate in 2021. The PSC now issues passenger certificates only to Class A carriers, which run between fixed points or on a regular route, and to Class E app-based ride companies. Its own page names fixed-route, fixed-rate shuttles and app-based rides as examples of the passenger services it oversees.

Ask Modivcare in writing what it accepts in place of the Class B license before you apply. Whether a service runs on a regular route is a question of fact for the PSC, so call it at (406) 444-6199 if you plan fixed runs.

If you	You need
Run vehicles built for 8 or fewer people, driver included	No MDT safety registration. Register and insure each vehicle.
Run a vehicle built or used for 9 to 15 people for pay	An intrastate USDOT number from MDT and the federal safety rules
Run a vehicle built for 16 or more people	The USDOT number and safety rules above, plus drivers with a CDL and passenger endorsement
Run a fixed route at set rates	A PSC Class A certificate of compliance
Cross a state line	The federal FMCSA rules. No PSC certificate is needed.

A PSC Class A application costs $500, and $300 comes back if it does not go to a hearing (ARM 38.3.402). The motor carrier law exempts public transit systems funded under federal transit grant 5311 and private nonprofits, and Montana’s Medicaid rules let Indian Health Service and tribal carriers enroll without a PSC license. For the layers of licensing NEMT companies face in every state, see NEMT license requirements, and for federal numbers, do you need a DOT number for NEMT.

Vehicle rules

Montana’s Medicaid rules set no inspection schedule for NEMT vehicles. The federal rules decide it for larger vans. A vehicle built or used for nine or more people, driver included, for pay must pass a periodic inspection at least once every 12 months, with proof carried on the vehicle (49 CFR 396.17). Modivcare checks current registration for every vehicle, and an inspection where the state requires one.

Every vehicle needs:

• The right seat for young children. Montana’s child restraint law, updated in 2025, requires a rear-facing seat under age 2, a harnessed seat from 2 to 4, and a harnessed seat or booster from 4 to 8. Taxicabs, school buses, and ambulances are exempt. NEMT vans are not on that list.
• Wheelchair or stretcher equipment for specialized trips. Montana covers specialized rides in vehicles specially equipped for people with disabilities, such as wheelchair vans and stretcher vans.
• Current registration and insurance for the vehicle, which Modivcare checks.

Vehicles built for nine or more also need, under the federal rules Montana adopts:

• A fire extinguisher rated 5 B:C or more, or two rated 4 B:C, mounted and within reach (49 CFR 393.95).
• Three reflective warning triangles, or at least six fusees.
• Your company name and USDOT number, followed by “MT”, marked on the vehicle.

For wheelchair lift, ramp, and securement rules, see ADA requirements for NEMT. Walk through our vehicle inspection checklist before Modivcare looks at your vans. For vehicle types in general, see NEMT vehicle requirements.

Driver rules and training

Montana’s Medicaid transportation rules set no driver age or record minimum. The floor comes from federal law and from Modivcare:

• A valid driver’s license.
• No listing on the HHS OIG exclusion list, for the driver or the company.
• A company process for drug law violations and for reporting each driver’s driving history to the state.
• Modivcare’s checks: background check, motor vehicle report, and drug screen.

Before driving Modivcare trips, each driver completes the training on Modivcare’s checklist: a PASS certification for wheelchair passengers, First Aid and CPR, and defensive driving. Keep each certificate current.

Drivers of vehicles built for nine or more people, driver included, fall under the federal driver rules Montana adopts. Each needs a current medical examiner’s certificate (49 CFR 391.41). You keep a driver qualification file for each one, with the application, driving records from each state that licensed the driver, the road test certificate, and an annual driving record review (49 CFR 391.51). A vehicle built for 16 or more people also needs a CDL driver in a drug and alcohol testing program.

Keep a file on every driver, whatever the vehicle. Our driver file checklist tracks the licenses, checks, and certificates Modivcare asks for, and NEMT driver requirements covers them across states.

Trip rules and how you get paid

From October 1, 2026, your Modivcare subcontract sets the on-time, wait, and return standards. Montana’s rules and manual add three more:

• Dispatch records. Keep the original record of each trip: the rider’s name, pickup and drop-off addresses, date, time, authorized units, charges, and authorization number (ARM 37.86.2402 and 37.86.2502). Our trip log has a column for each.
• Payment in full. When Medicaid covers a ride, you accept its payment as payment in full and never bill the member for the difference.
• No-shows. Under the state manual, neither Medicaid nor the member may be billed when a member cancels or does not show. Check what your subcontract says about no-shows.

Modivcare sets your rate. DPHHS says clean claims are paid automatically by electronic funds transfer or mailed check within seven days of batch processing, with a report of billed and paid amounts.

The state’s own rates show what Montana pays today. For trips through September 30, 2026, DPHHS pays the lower of your usual charge or its fee schedule (ARM 37.86.2505). Its schedule dated July 1, 2025, is still the current one, because DPHHS said on May 29, 2026 that it is making no provider rate adjustments for state fiscal year 2027, which began July 1, 2026. The same rates apply to commercial and specialized trips:

Code	What it pays for	Rate
A0140	One-way trip under 16 miles	$15.30
A0100	Each loaded mile, trips over 16 miles	$1.18

The manual lists A0130 for wheelchair van trips under 16 miles, so bill the code on the Transportation Center’s approval list. Montana’s rule limits specialized trips to mileage fees, with no other fees, and rounds miles to the nearest whole mile (ARM 37.86.2502). On those rates, a 60-mile one-way trip to a regional hospital pays $70.80, and the empty drive home pays nothing. That is why loaded miles and deadhead miles matter so much here. Use these numbers as a reference point when you talk rates with Modivcare.

If Modivcare denies or short-pays a claim, your subcontract sets the steps to dispute it. For trips before October 1, 2026, call Montana Provider Relations.

Insurance requirements

Modivcare’s general provider checklist asks for four policies. Its page says limits vary by state, so get the Montana limits in writing before you buy.

Policy	What Modivcare looks for
Commercial general liability	Bodily injury, property damage, and personal injury
Sexual abuse and molestation	Cover for work with vulnerable riders
Auto liability	Bodily injury and property damage, at least the state minimum
Workers’ compensation	Where the state requires it for employees

Montana’s own floor is low. Its minimum auto liability policy (MCA 61-6-103) covers the amounts below, and MDT’s rule makes this the minimum for for-hire carriers that stay inside Montana:

Coverage	Minimum
Injury to one person	$25,000
All injuries in one accident	$50,000
Damage to others’ property	$20,000

Trips that cross a state line put you under the federal limits for for-hire passenger carriers: $1,500,000 for a vehicle seating 15 or fewer, driver included, and $5,000,000 for 16 or more (49 CFR 387.33T). Taxicab service in a vehicle seating fewer than 7, off a regular route, is exempt (49 CFR 387.27). For what brokers ask for elsewhere, see NEMT insurance requirements.

Montana requires workers’ compensation for any employer with even one employee. You insure through a private carrier, Montana State Fund, or self-insurance. Sole proprietors, working partners, and working members of a member-managed LLC are exempt unless they choose coverage. A driver you pay as an independent contractor must hold an Independent Contractor Exemption Certificate, which costs $125, or carry their own coverage. See 1099 or W-2 NEMT drivers before you decide.

What it costs and how long it takes

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

Item	Cost	Paid to
EIN	Free	IRS
LLC or corporation filing	$35	Secretary of State
Annual report	$20, or $35 after April 15	Secretary of State
Assumed business name	$20	Secretary of State
Contractor exemption certificate (paid by the contractor)	$125	Labor and Industry
PSC Class A certificate (fixed routes only)	$500, $300 back without a hearing	PSC

A workable order, from first call to first trip:

1. Call Modivcare’s provider line. Ask where it needs providers and which service levels it is short on.
2. Form your company and get your EIN.
3. Ask Modivcare what it accepts in place of the Class B license, and get the answer in writing.
4. Buy insurance that meets Modivcare’s Montana limits.
5. Set up your vehicles. Get an intrastate USDOT number and a yearly inspection for any van built for nine or more people.
6. Hire and train drivers. Run background checks, driving records, and drug screens, and finish PASS, CPR, and defensive driving.
7. Register as an employer for unemployment insurance and workers’ compensation.
8. Send your file to Modivcare, sign the subcontract, and set up the app.

Ask the provider line how long credentialing takes, because Modivcare checks every driver, vehicle, and policy before you get trips. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

Four other sources of rides are worth a call.

• Public and nonprofit transit. DPHHS counts 40 public transit agencies in Montana. MDT gives federal and state grants to local public bodies, private nonprofits, tribal governments, and public transit operators to carry the rural public, including older and disabled riders. Ask your local agency whether it contracts out rides.
• Veterans. The VA pays for special mode transportation, such as a specially equipped vehicle, when the veteran’s local VA facility approves it in advance. VA Montana Health Care is based at Fort Harrison. Ask its beneficiary travel office how it books these rides.
• Nursing facilities. Montana makes nursing facilities responsible for residents’ routine medical trips within 20 miles, unless the resident needs a wheelchair or stretcher. Offer the facility a private rate for those trips.
• Facilities and private pay. Dialysis centers, hospitals, and senior living communities, along with riders who pay for themselves, add work that does not depend on one broker. See how to get NEMT facility contracts and private pay NEMT.