How to Start a NEMT Business in Nevada (2027)

Nevada runs Medicaid rides through MTM Health, its statewide broker since July 1, 2016, for everyone in urban Clark and Washoe counties and for fee-for-service members across the state. Since January 1, 2026, rural members of the CareSource and SilverSummit health plans get rides through their plans, which use SafeRide Health. The rules below follow the Medicaid Services Manual transportation chapter effective January 1, 2026 (MTL 34/25).

How Medicaid rides work in Nevada

The Nevada Health Authority runs Medicaid through its Division of Nevada Medicaid, formerly the Division of Health Care Financing and Policy. Nevada Medicaid pays one statewide NEMT broker a capitation payment. The broker checks each member’s eligibility and appointment, picks the least expensive ride that fits, and assigns it to a transportation company it contracts with but may not own.

The manual splits Nevada into two urban counties, Clark and Washoe, and 15 rural counties. On January 1, 2026, managed care went statewide, and most rural members moved from fee-for-service into a health plan. That changed who arranges their rides:

Member lives in	Coverage	Ride arranged by
Urban Clark or Washoe	Any	MTM Health
A rural area	Fee-for-service	MTM Health
A rural area	CareSource or SilverSummit	The plan, through SafeRide Health

For 2026, urban members choose among Anthem Blue Cross and Blue Shield, CareSource, Molina Healthcare of Nevada, and SilverSummit Healthplan, plus Health Plan of Nevada in Clark County. Their rides still go through MTM.

SilverSummit’s rural list also takes in some outlying towns in Clark and Washoe counties, such as Laughlin, Mesquite, Moapa, Incline Village, and Gerlach, and Nevada Medicaid says the member’s ZIP code decides who arranges the ride. About 126,000 people were expected to stay in fee-for-service, mainly seniors, people with disabilities, foster children, and waiver members, so MTM still serves rural areas.

Who qualifies

A member qualifies when they cannot provide their own ride and no free ride is available. Members who live within three quarters of a mile of a transit stop must ride the bus unless a medical condition prevents it or the bus cannot carry their wheelchair. Members who qualify for public paratransit must use it, and Nevada Medicaid pays the Regional Transportation Commission directly for those rides. The broker assigns a member to a private NEMT company only when a lower level of service will not work: the member cannot use the bus or paratransit, or the bus does not pass within three quarters of a mile of the doctor’s office.

There is no NEMT for members covered only for Medicare costs (QMB, SLMB, and QI-1), for non-qualified non-citizens, or while an application is pending, and retroactive eligibility does not cover rides. Nursing facility residents get rides from their facility. Emergency-only members approved for dialysis get rides to dialysis only.

The January 1, 2026 chapter adds Nevada Check Up, the state’s children’s health insurance program, to NEMT. Nevada Medicaid’s transportation page, last updated March 25, 2026, still says Check Up members are not eligible, so the broker’s eligibility check decides each ride. See Nevada adds NEMT for Nevada Check Up for the details.

Booking and ride types

Every NEMT ride needs prior authorization from the broker, except rides given by Indian Health Programs. Members book at least three days ahead (MTM asks for three business days) and no more than 60 days ahead. A ride after a hospital discharge must happen within three hours. Care 101 miles or more from home counts as out of area and is booked at least 14 days ahead.

The state plan lists wheelchair vans, taxis, stretcher cars, bus passes and tickets, secured transportation, public paratransit, rideshare, private vehicles with gas mileage reimbursement, and commercial flights. NEMT is for members whose needs stay within an EMT-Basic’s scope. A member who needs medical care on the way can go by ambulance instead.

How to join MTM Health and SafeRide Health

You do not enroll with Nevada Medicaid to give NEMT rides: its provider enrollment booklet, dated September 21, 2026, has no NEMT provider type. The state plan says a NEMT provider needs an agreement with the broker, a state exemption from Transportation Authority rules, liability insurance, driver background checks, drug and alcohol testing, and ADA-compliant vehicles.

MTM Health

MTM says it is always recruiting for its statewide Nevada network. It adds providers where it has a need and keeps other applications on file. Its steps:

1. Send the provider application. MTM’s online form asks for your EIN, NPI, ownership disclosure, and dispatch software. See how to get an NPI number.
2. Interview. A network representative calls, and a contract representative guides you through each phase.
3. Contract and credentialing. You sign MTM’s agreement and submit your documents. MTM’s system assigns no trips to a provider whose credentials lapse.
4. Training. MTM teaches its trip process. Every employee completes fraud, waste, and abuse training and HIPAA training each year.
5. First trip. Trips arrive through MTM’s Electronic Trip Download system.

Before your vehicles run, MTM certifies to Nevada Medicaid that you meet the insurance, vehicle, background check, and drug testing rules, and Nevada Medicaid issues your letter of exemption. MTM also sends each subcontract to Nevada Medicaid for approval. MTM’s Nevada program office in Las Vegas is at 702-323-7700. See our MTM Health guide.

SafeRide Health

SafeRide works for health plans, so its Nevada trips come from rural CareSource and SilverSummit members. Its steps, as of September 2026:

1. Fill out the signup form. It requires a real NPI, your EIN, your insurance limits, your fleet and driver counts, the rides per day you can take, and the counties you serve. An application left unfinished for 30 days starts over.
2. Send your credentialing files. For each driver: license, national background and sex offender registry checks, motor vehicle report, pre-hire drug screen, and proof of first aid or CPR, defensive driving, and wheelchair securement training. For each vehicle: registration and insurance.
3. Meet the network standards. A network vendor manager tracks a 100 percent response rate, 95 percent acceptance, 95 percent on time, under 1 percent complaints, and under 5 percent kickbacks.

SafeRide’s line for NEMT providers is 855-955-7433. See the SafeRide Health guide and how to contract with Medicaid health plans.

Screening you and your drivers

Federal law requires states to make sure every NEMT provider and driver paid by Medicaid is off the HHS OIG exclusion list and every driver holds a valid license. Nevada’s Office of the Medicaid Inspector General keeps its own exclusion list and tells employers to check it before they hire. See the OIG exclusion list for how those checks work.

Licenses and registrations

Your company

Form an LLC or corporation with the Nevada Secretary of State. For an LLC, state law sets these fees as of September 2026: $75 for the articles of organization, $150 for the initial list of managers or members, and $200 for the state business license, filed with the initial list. That is $425 to start. A corporation’s state business license costs $500.

Each year, an LLC files its annual list by the last day of the month it was formed, for $150, and renews its business license for $200. A late list adds a $75 penalty, and a late license adds $100. A company left in default for about a year loses its charter.

Get your employer identification number (EIN) from the IRS, which issues it online right away and never charges for it. Then ask your city or county whether you need a local business license.

Nevada Transportation Authority

The Nevada Transportation Authority (NTA) says anyone who provides paid passenger transportation must hold an NTA license or permit. NRS 706.745 makes an exception for carriers working under a Nevada Health Authority contract made under NRS 422.27495. Instead, the broker runs a vehicle inspection program set up with the NTA’s help and certifies you before Nevada Medicaid issues your letter of exemption.

Your work	What you need
Medicaid trips for MTM Health	A letter of exemption from Nevada Medicaid, issued after MTM certifies you
Rural health plan trips for SafeRide	Ask SafeRide and the NTA in writing. The exemption covers work under a Nevada Health Authority contract.
Private pay, facility, and other paid rides	An NTA certificate of public convenience and necessity, or a contract carrier permit
Vehicles built for 16 or more people, driver included	A commercial driver’s license for each driver

Vehicles running under the exemption must carry signs saying so and keep a copy of the exemption on board.

An NTA certificate takes more work. You file an original and three copies of the application under NAC 706.1375 with a $200 filing fee and a publication estimate: $150 for Clark County, $145 for Washoe, Douglas, Carson City, and Churchill together, or $555 statewide, under the fee schedule effective July 1, 2023. A hearing costs more. The NTA runs a criminal history and credit check at your cost, and grants a certificate only if you are fit and the service will not unreasonably hurt carriers already there. Before it issues, you file proof of insurance for each vehicle on Form E.

The NTA’s Las Vegas office is at 702-486-3303 and its Reno office at 775-687-9790. For licensing in every state, see NEMT license requirements.

Vehicle rules

The broker inspects every vehicle each year, on top of any state inspection, checking brakes, tires, signals, horn, seat belts, heat, and air conditioning. A vehicle out of compliance comes out of service until the broker confirms the fix, and the problem goes into its permanent record.

Every vehicle needs:

• A two-way communication system linking it to your main place of business. Pagers do not count.
• Working heat, air conditioning, speedometer, and odometer, and a clean seat belt for every seat where the law requires one.
• Two outside mirrors and an inside mirror for watching the passenger area.
• A clean interior with no torn upholstery, broken seats, or sharp edges, and no broken windows or major dents outside.
• Your company name, the vehicle number, and the broker’s toll-free and local numbers posted inside, with written complaint procedures for riders who ask.
• “NO SMOKING” and “ALL PASSENGERS MUST USE SEAT BELTS” signs.
• A packet with the registration, insurance card, and accident procedures and forms.
• A fully equipped first aid kit and a current, detailed map of the area you serve.

Under NRS 484B.157, a child under 6 and under 57 inches tall rides in an approved child seat, and a child under 2 rides rear-facing, in the back seat in most cases. The manual expects members to bring equipment providers are not required to supply, so settle with the broker who brings the seat.

Vehicles must meet ADA rules, and drivers must secure every wheelchair and wheelchair passenger properly. Run through our vehicle inspection checklist before each broker inspection, and see NEMT vehicle requirements for vehicle types in general.

Driver rules and training

The manual sets these minimums for every driver:

• At least 18, with a current, valid Nevada driver’s license for the vehicle they drive.
• No more than one chargeable accident and two moving violations in the last three years.
• No suspended or revoked license, commercial or other, in the last five years.
• No conviction for substance abuse, sexual abuse, or a crime of violence. A driver with any felony conviction needs Nevada Medicaid’s approval before you hire them.
• No use of alcohol, narcotics, illegal drugs, or impairing drugs on duty, and no abuse of alcohol or drugs at any time.

You also need an alcohol and drug testing program that meets the standards of 49 CFR Part 382, the federal rules written for commercial drivers. Those rules cover pre-employment, post-accident, random, reasonable suspicion, return-to-duty, and follow-up tests, a written policy, and supervisor training. Our drug and alcohol policy template is a starting point. Repeat criminal background checks from time to time.

Within 30 days of starting service, each driver completes classroom and behind-the-wheel training. It covers defensive driving, wheelchair securement and lift operation, cultural and disability sensitivity, passenger assistance, first aid, and customer service, and Nevada Medicaid approves the curriculum. See NEMT driver training.

On the job, drivers:

• Stay courteous, neat, and clean, and wear visible company identification.
• Never smoke in the vehicle or near a rider.
• Never wear headphones or use a phone while driving, and use a phone on duty only for dispatch.
• Help riders get seated, check every seat belt, secure each wheelchair, and store mobility aids.

Keep each driver’s license, driving record, background check, drug tests, and training certificates on file with our driver file checklist. Deficiencies the broker finds go into the driver’s permanent record.

Trip rules and how you get paid

The manual sets these trip rules:

• Pickup window. Members must be ready 15 minutes before the scheduled pickup and up to 30 minutes after it.
• No-shows. Wait at least 15 minutes past the scheduled pickup time before marking a no-show. Never charge a member for a ride or a no-show.
• Discharges. Hospital discharge rides happen as soon as possible, within three hours.
• Shared rides. When two or more members make the same trip in a private vehicle or van, Nevada Medicaid pays for only one. Ask your broker how your contract pays shared rides.

Nevada Medicaid does not cover deadhead miles, waiting time, stairs, no-show charges, or attendants’ wages. Nevada Medicaid pays the broker, and the broker pays you. MTM sets rates with each provider one at a time and does not pay for no-shows, so confirm each trip with the member the day before.

The broker must have a process for provider disputes, and Nevada Medicaid refers disputes to it. The broker tries to answer by phone within 24 hours and acknowledges written disputes within 72 hours. Keep a trip log with pickup and drop-off times for every leg so you can back up your claims.

NEMT is not part of Nevada’s electronic visit verification (EVV) program. EVV covers state plan personal care, home health care, and some personal care services in the Frail Elderly and Physically Disabled waivers.

Insurance requirements

Three sets of rules apply as of September 2026:

Who sets it	What it requires
State manual	At least $1.5 million combined single limit on every vehicle, following NAC 706.191
MTM Health	General and auto liability of at least $1.5 million each, with MTM as certificate holder and additional insured
SafeRide Health	$1 million general liability per occurrence, $2 million aggregate, and $500,000 auto liability, with SafeRide as additional insured

If NAC 706.191 rises, the higher amount applies, and the policy must notify Nevada Medicaid when it expires or ends. Rural health plans follow the same transportation chapter, so ask SafeRide in writing which limit it applies to Nevada trips before you buy.

NAC 706.191 sets $1.5 million for NTA carriers’ vehicles carrying up to 15 passengers, driver included, and $5 million for 16 or more. For what brokers ask elsewhere, see NEMT insurance requirements.

Nevada requires workers’ compensation from the first employee, family members included, from the day of hire. A sole proprietor with no employees does not need it. An uninsured employer can be fined up to $15,000 and ordered to close.

What it costs and how long it takes

These are the fees Nevada 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 articles of organization	$75	Secretary of State
Initial list of managers or members	$150	Secretary of State
State business license	$200, or $500 for a corporation	Secretary of State
Annual list and license renewal	$350 a year for an LLC	Secretary of State
NTA application (private pay work only)	$200, plus $145 to $555 in publication costs	NTA

A workable order, from first call to first trip:

1. Call MTM’s Nevada office. Ask where MTM needs providers and which service levels it is short on. In a rural county, ask SafeRide too.
2. Form your company, get your EIN and NPI, and get any local business license.
3. Buy insurance that meets the $1.5 million state minimum and your broker’s checklist, plus workers’ compensation.
4. Set up your Part 382 testing program and write your policy.
5. Equip your vehicles to the manual’s list.
6. Hire drivers who meet the state rules, with background, exclusion, drug, and driving record checks.
7. Apply to MTM, finish the interview, contract, credentialing, and training, and wait for your letter of exemption before your first trip.

Two steps set the pace. MTM adds providers where it needs them, and your vehicles cannot run until MTM certifies you and the exemption arrives. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

Other rides are worth a call, but most need NTA authority.

• Nursing facilities. A nursing facility’s all-inclusive Medicaid daily rate already covers its residents’ rides to appointments, so the facility, not the broker, arranges them. See how to get NEMT facility contracts.
• Private pay riders. Paid rides outside the Medicaid contract need an NTA certificate or permit. See private pay NEMT.
• Veterans. The VA pays for special mode transportation, a specially equipped vehicle, when a VA provider decides an eligible 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.
• Senior and disability programs. In Washoe County, the RTC’s Senior/Disabled Transportation Grant Fund Program funds rides for seniors and people with disabilities on the federal Section 5310 model. Current projects run to September 30, 2027, and the next call for projects is planned for early summer 2027. A nonprofit carrier of elderly or disabled riders needs no NTA certificate in counties under 700,000 people, under NRS 706.745, but still gets NTA safety inspections.
• Secure behavioral health transports. This Medicaid service moves people in a mental health crisis. Providers are accredited through the Division of Public and Behavioral Health and enroll with Nevada Medicaid directly. Staff need four hours of de-escalation training, eight hours of behavioral health training, and CPR, and vehicles need a driver partition, doors that lock while moving, and gurney space.

For long rural runs across Nevada’s open counties, see rural NEMT.