How to Start a NEMT Business in New York (2027)

New York runs Medicaid rides through one broker. Medical Answering Services (MAS) arranges non-emergency Medicaid trips in all 62 counties, and New York Medicaid pays transportation companies directly through its eMedNY claims system. The rules below follow the Department of Health’s Medicaid Transportation Policy Manual, effective August 25, 2023, and the eMedNY transportation billing guidelines dated August 5, 2026.

How Medicaid rides work in New York

The New York State Department of Health (NYSDOH) runs Medicaid and contracts with MAS to manage rides. MAS schedules trips, runs the contact centers, reviews each request, and assigns it to a transportation company in its network. It owns no vehicles and does not compete with the companies it sends trips to.

MAS won the statewide broker contract in a competitive procurement. These are the dates that shaped the current setup:

Date	What changed
December 1, 2015	Rides for mainstream managed care members moved out of the health plans
August 1, 2023	MAS took over every county except Nassau and Suffolk
December 1, 2023	Nassau and Suffolk moved from Modivcare to MAS
March 1, 2024	Rides for Managed Long Term Care members moved to MAS
April 15, 2024	eMedNY began rejecting new applications without a MAS letter of support
April 1, 2026	MAS took over rides for Fidelis Care members in Rockland County

The Rockland change is covered in Fidelis Care Rockland rides move to MAS. MAS runs two regions, each with its own contact center:

Region	Counties	Includes
Downstate	9	The five New York City boroughs, Nassau, Suffolk, Putnam, Westchester
Upstate	53	Albany, Erie, Monroe, Onondaga, Rockland, Orange, and the rest

Medicaid covers rides to and from Medicaid-covered care at no cost to the member. It does not cover trips to non-medical places such as pharmacies, gyms, schools, or grocery stores. Members call MAS at least 72 hours before a routine appointment, and every trip must be approved by MAS first. A member with recurring treatment at the same place, such as dialysis, can get a standing order that covers many trips.

The member’s medical practitioner picks the ride type, and the state pays for the most cost-effective one that fits, so a member who rides transit in daily life usually gets transit. An ambulette trip needs a written order from the practitioner and the state’s Verification of Medicaid Transportation Abilities form (Form 2015). Trips generally stay inside the member’s common medical marketing area, the area where their community usually gets care, a rule the Department restated on May 29, 2025.

The ride types are public transit, taxi or livery, ambulette (wheelchair and stretcher vans), transportation network companies, ambulance, and mileage reimbursement for members who drive. Some rides are paid elsewhere. When the eligibility check shows a managed care plan that covers transportation, you bill the plan instead. Day programs and residences certified by the Office for People With Developmental Disabilities (OPWDD) must provide or pay for their own clients’ rides, and many adult day health care programs arrange and pay for their own.

How to join MAS, New York’s Medicaid broker

You need three things, in this order: a letter of support from MAS, enrollment with New York Medicaid, and a signed MAS network contract. As of September 2026, MAS and eMedNY lay out these steps:

1. Get your licenses first. Pick your category of service: ambulette (0602), taxi outside New York City (0603), livery in New York City (0605), or transportation network company (0609). The next section shows what each one needs.
2. Send the MAS Transportation Provider Network Application, the online form on MAS’s Become a Provider page. MAS reviews it and decides whether to issue a letter of support.
3. Enroll in the eMedNY Provider Services Portal with the MAS letter. Submit within 45 days of starting, and answer any request for more information within 45 days, or the application is deleted or withdrawn.
4. Wait for the decision. MAS says a decision can take 90 days or longer. Questions about the application go to eMedNY at 1-800-343-9000, not to MAS.
5. Call MAS Transportation Provider Relations once you have the approval letter. You sign its contract and set an effective date based on when your drivers and vehicles can meet its credentialing and training rules.
6. Get into the MAS system. Once eMedNY has approved you in writing and the MAS contract is fully signed, MAS sends login instructions and trips appear on your roster.

The eMedNY application, last updated May 2026, asks for:

• The $750 application fee for 2026, waived if you are already enrolled in Medicare or another state’s Medicaid program.
• An electronic funds transfer authorization, an ETIN certification statement (form EMEDNY-490602), and a Transportation Information Request.
• Copies of the licenses and permits your category needs.
• The IRS letter that assigned your EIN. A W-9 is not accepted.
• The MAS letter of support and the signed Attestation for Non-Medical Transportation Providers, which says local licensing is your job alone and enrollment does not guarantee trips.
• A compliance program certification if you expect at least $1,000,000 in Medicaid claims or payments in any 12 months, under Social Services Law 363-d.

Since March 1, 2024, transportation companies cannot enroll as managed care only (non-billing) providers. For the federal side of enrollment, see how to become a Medicaid transportation provider.

MAS screens every owner, key manager, and driver against the Death Master File, the federal System for Award Management, and the exclusion lists of HHS OIG and New York’s Office of the Medicaid Inspector General (OMIG). See the OIG exclusion list. Its provider hotline is 866-242-2578, business days 8:00 am to 5:00 pm, or email tpissues@medanswering.com. Letter of support questions go to tprelations@medanswering.com. Our MAS guide covers the broker in more depth.

New York is revalidating every Medicaid provider through June 2028, after a CMS directive in April 2026. You get 123 calendar days from the notice, and you need a new MAS revalidation letter, which is valid for 90 days. See Medicaid revalidation.

Licenses and registrations

Your company

Form an LLC by filing Articles of Organization with the New York Department of State, for $200. Within 120 days, you must publish a notice of the LLC in two newspapers chosen by your county clerk for six weeks in a row, then file a Certificate of Publication for $50. Miss the deadline and the state suspends the LLC’s authority to do business. The members also adopt a written operating agreement within 90 days of filing.

A corporation files a Certificate of Incorporation instead, for $125. Both file a biennial statement every two years, in the month the company was formed, for $9.

Get your employer identification number (EIN) from the IRS for free, and keep the IRS letter that confirms it. New York requires every enrolled provider to have an NPI, so get a Type 2 NPI for the company too. See how to get an NPI number. The Department of State sends local license questions to your county clerk and your city, town, or village clerk.

NYSDOT, DMV, and the taxi commissions

New York Medicaid checks your licenses by category of service, using the eMedNY enrollment chart. NYSDOT is the state Department of Transportation, DMV is the Department of Motor Vehicles, and a TLC is a local Taxi and Limousine Commission.

If you run	You need	From
Ambulettes (0602)	A common carrier certificate or contract carrier permit, and Article 19-A compliance	NYSDOT, DMV
Taxis outside NYC (0603)	Local licensing, with a TLC base license in Westchester or Nassau	County or city
Livery in NYC (0605)	A livery, for-hire, paratransit, or black car base license	NYC TLC
App-based rides (0609)	A TNC license outside NYC, or a TLC for-hire license in the city	DMV or TLC

Ambulette applicants send a DMV Article 19-A compliance letter dated on or after the most recent July 1. App-based ride companies also need a letter of support from the Department of Health’s Bureau of Medicaid Transportation.

NYSDOT operating authority. A common carrier certificate is for carriers that serve the public, and NYSDOT lists ambulette service as an example. A contract carrier permit is for fixed-price contract work, such as for a health care facility. Apply online through NYSDOT’s Carrier Certification System, with statements from people or organizations in your area that show a need for the service. NYSDOT publishes each complete application in its Weekly Bulletin, others have 30 days to protest, and the process usually takes 6 to 16 weeks.

Before your first trip, NYSDOT needs proof of liability insurance, workers’ compensation and disability coverage, a NYSDOT inspection of every vehicle, and an active USDOT number, and common carriers file a tariff. Filing an application does not let you operate. Call 518-457-6512 or email operating.authority@dot.ny.gov.

Article 19-A. Vehicles run by a carrier with NYSDOT authority count as buses under Article 19-A of the Vehicle and Traffic Law, so ambulette drivers must be 19-A qualified. Register with the DMV Bus Driver Unit on form DS-879, open the accident and conviction notice account on form DS-19, and file a DS-870 for each driver. After that, file the Annual Affidavit of Compliance by July 1 each year. Incomplete 19-A records can bring civil penalties of $500 to $2,500 per violation.

Taxi and livery. Outside New York City, taxi drivers need a Class E license and the cars need livery plates. Inside the city, all for-hire service runs through a TLC-licensed base with TLC-licensed drivers and vehicles. Base licenses renew every three years, and bases send trip records to TLC every month. Since January 28, 2016, New York City ambulette companies with a NYSDOT contract carrier permit do not also need a TLC license.

Surety bond. New ambulette applicants in Nassau, Westchester, Monroe, Erie, Orange, and Suffolk counties must post a bond before enrollment, as must a new owner buying an ambulette company there or in New York City. It is $100,000 a year or $25,000 a year per ambulette, whichever is lower. You can ask OMIG for an exception if you expect under $500,000 in Medicaid billing in your first full year. Anywhere in the state, an ambulette company whose Medicaid billing passes $500,000 in a year or $42,000 in a month must post the same bond within 90 days to stay enrolled. For how these layers fit together in every state, see NEMT license requirements.

Vehicle rules

NYSDOT inspects every ambulette before DMV registers it, then at least every six months. You provide the inspection site, and NYSDOT bills $85 per vehicle for each inspection. A serious defect takes the vehicle out of service until it is fixed and inspected again. MAS also requires drivers to inspect each vehicle before every shift and document it, and it can audit those records. NYSDOT does not inspect the sedans and minivans an ambulette company uses for livery-level trips.

Ambulette and taxi companies must own each vehicle or lease it in the company’s name, with the registration, insurance, and maintenance in that name too. Borrowing or subcontracting another company’s vehicles is not allowed. If you run short, tell MAS so it can reassign the trip. Livery and transportation network companies may use drivers who own their cars.

The state manual requires every vehicle to have:

• A DMV registration in the right class, and a current registration and insurance card on board.
• A two-way radio or cell phone.
• Working air conditioning, heat, defrosters, speedometer, and odometer.
• A way to secure a child safety seat that a rider brings.
• A posted no-smoking notice and a clean inside and outside.
• A packet with the registration, insurance card, and accident procedures and forms.
• Protective equipment for drivers under OSHA’s bloodborne pathogens and respiratory rules.
• GPS that sends trip data to MAS.

A stretcher ambulette carries riders who cannot sit in a wheelchair and need no medical care on the way. It needs a wheeled cot with its maker’s straps and a cot retention device from the same maker. At least two employees staff it, with the assistant seated in the passenger area. It may not carry oxygen supplies, though a rider may bring and manage their own, and it may not carry a sedated rider. Never put the Star of Life emblem on a non-medical vehicle. See stretcher van requirements and run our vehicle inspection checklist before each NYSDOT visit.

Driver rules and training

The state manual sets the floor for every Medicaid driver: at least 18, with a valid license from New York or another state for the vehicle driven. Drivers may not use alcohol or impairing drugs on duty or smoke near riders.

Ambulette drivers also meet Article 19-A. DMV’s license chart puts drivers who carry passengers under Article 19-A in Class C commercial or higher, and its 19-A guide says these drivers need a CDL with a passenger endorsement. The carrier keeps a driver file with:

• Before hire: a driving record from every state the driver lived, worked, or held a license in over the last three years, and a medical exam on form DS-874 or MCSA-5875.
• Every year: a new driving record, a review and interview on form DS-872, and a defensive driving observation by a DMV certified examiner.
• Every two years: a medical exam, a behind-the-wheel road test (within 30 days of hire for a driver with no 19-A driving in the past year), and an oral or written test.

Section 509-c of the Vehicle and Traffic Law disqualifies a driver:

• Permanently, for certain sex offenses.
• For five years, after certain drunk or drugged driving convictions, such as one while driving a bus or two within ten years, or after leaving the scene of a crash that caused injury or death.
• For one year, after gathering nine or more license points in 18 months.
• For as long as a license is revoked or suspended for drunk or drugged driving.

Taxi and livery drivers need a Class E license or a commercial license. In New York City, the TLC licenses them. Carriers must drug and alcohol test drivers of taxi or livery vehicles that seat nine or more, including the driver, before hire and at random, and file an affidavit with DMV by August 3 each year.

MAS adds its own rules. Every driver completes the Community Transportation Association of America’s PASS program, or an equal program MAS approves, by the date MAS sets when you contract (its 2023 manual allowed 3 months). MAS watches each driver’s license through DMV’s License Event Notification Service (LENS), and a driver may work for only one MAS provider at a time. Federal law also requires a process for drug law violations and one for reporting each driver’s driving history to Medicaid, documented and ready to show. Our driver file checklist keeps it together.

Trip rules and how you get paid

MAS and the state manual set these service standards:

• Pickup. On time means at the scheduled time or up to 15 minutes before or after. A rider does not have to board early unless both of you agree.
• No-shows. Wait at least 15 minutes past the pickup time and document every no-show. Medicaid does not pay for them.
• Ride length. Rides should last under one hour, barring weather, traffic, or distance.
• Returns. With no set return time, arrive within one hour of the call. See will-call trips. Same-day hospital discharges are picked up within three hours.
• Changes. Never change a time or address because a rider or clinic asks. Changes go through MAS first.
• Children. Riders under 18 travel with a parent or guardian.

MAS assigns trips to its Preferred Provider Opportunity partners first, then to the company the member picks, then to the one the medical office picks, and then at random among companies with the right mode and open availability. Keep your MAS availability profile accurate, because MAS can change it to stop a pattern of refused trips.

Since April 3, 2023, every trip must send its start point, end point, and GPS trail to MAS. If the GPS does not match the pickup, drop-off, or miles on the trip, the attestation cannot generate an authorization. MAS offers a free GPS app that meets the minimum, and any billing or routing company working for you must register with MAS. See NEMT GPS tracking.

Each trip leg needs a record with the member’s name and Medicaid ID, the date, pickup and drop-off places and times, the plate number, the driver’s license number, and the driver’s printed name, signature, and attestation. An electronic signature with GPS coordinates counts. Keep records for six years from payment. Our trip log template has every field.

How you get paid

1. Check eligibility on the day of the trip.
2. Do the trip as the trip invoice in your MAS roster shows.
3. Attest it in the MAS system within 30 days. For members approved late, you have up to 120 days from the date eligibility appears.
4. Get the authorization. Attestation with matching GPS creates an 11-digit prior authorization number.
5. Bill eMedNY within 90 days of the date of service, on an 837P electronic claim or paper Form A (eMedNY-000201), with the plate and driver’s license number.
6. Wait before fixing rejections. MAS asks you to wait until the third business day, since its systems fix most of them.

Bill loaded miles only, to the tenth of a mile, a rule since August 1, 2019. When riders share a vehicle, bill the base rate for each rider but mileage once, from the first pickup to the last drop-off. People who live together and go to the same place count as one trip. Bill a toll once per crossing, not per rider. See NEMT multiloading.

MAS negotiates rates with each company, and negotiated rates replace the state fee schedule. Ask for a rate change through the MAS provider hotline. The eMedNY fee schedule file dated April 5, 2026 lists the amounts by county, and the file notes they may reflect network negotiations. The amounts below carry effective dates from April 1, 2022 to August 16, 2024. Wheelchair ambulette base rates (A0130) and per-mile rates (S0209), in dollars:

County	Base	Per mile
New York City	52.90	3.60
Nassau and Suffolk	64.00	3.00
Westchester	47.00	3.50
Albany	43.00	3.00
Erie	41.00	3.00
Monroe	44.00	3.00
Onondaga	40.00	3.75

Taxi and livery base rates (A0100) and per-mile rates (S0215), in dollars:

County	Base	Per mile
New York City	22.97	2.93
Nassau	7.38	3.62
Westchester	7.41	2.34
Albany	7.52	1.34
Erie	7.36	2.66
Onondaga	3.01	3.40

The stretcher base rate (T2005) is $230 in New York City, Nassau, and Suffolk, $200 in Westchester, $101 in Albany, Erie, and Monroe, and $280 in Onondaga. At these rates, a New York City wheelchair trip with 5 loaded miles pays $52.90 plus $18.00, or $70.90. See NEMT billing codes for the codes.

Complaints about MAS go to the Department of Health at medtrans@health.ny.gov or 518-473-2160. Requests to change an authorization more than 90 days after the trip go to that email address or by eFax to 518-486-2495.

Insurance requirements

MAS checks your coverage in its system. Its 2023 manual and contracting FAQ ask for:

Item	What MAS looks for
General liability	Proof on an ACORD form uploaded to the MAS system
Workers’ compensation	An ACORD form or state form C-105.2 or U-26.3
Disability benefits	An ACORD form or state form DB-120.1
Description box	Your provider ID
Additional insured	Medical Answering Services, LLC, P.O. Box 12000, Syracuse, NY 13218

The limits are in item 13 of the contract’s Scope of Work, and MAS revised that insurance section in late 2023. Ask Transportation Provider Relations for the limits in writing before you buy a policy. See NEMT insurance requirements for what brokers ask for elsewhere.

State law sets for-hire auto minimums by seating capacity. Section 370 of the Vehicle and Traffic Law, as amended effective January 1, 2020, requires:

Seats	Minimum coverage
Up to 7	$25,000/$50,000 for injury, $50,000/$100,000 for death, and $10,000 for property damage
8 or more	$1.5 million combined single limit for injury, death, and property damage

DMV needs a for-hire insurance certificate (FH-1) to register a for-hire vehicle, and any lapse revokes the registration and plates for 30 days. Carriers with NYSDOT authority also need a Form E filed by the insurance company itself, in the exact company name. NYSDOT does not accept ACORD forms.

Workers’ compensation is mandatory for most employers with one or more employees. Virtually every employer must also carry disability and Paid Family Leave benefits (Workers’ Compensation Law 202). NYSDOT will not issue authority without proof of both, with NYSDOT as the certificate holder. A company with no employees files a Certificate of Attestation of Exemption (form CE-200) instead, and each one is good only for the license, permit, or contract it names. See workers’ comp for NEMT.

What it costs and how long it takes

These are the fees New York sets as of September 2026. Vehicles, insurance premiums, the surety bond, and newspaper publication charges depend on your quotes. See what it costs to start a NEMT business for those.

Item	Cost	Paid to
EIN	Free	IRS
LLC Articles of Organization	$200	Department of State
LLC Certificate of Publication	$50	Department of State
Certificate of Incorporation	$125	Department of State
Biennial statement	$9 every two years	Department of State
Medicaid application fee	$750 for 2026	New York Medicaid
NYSDOT vehicle inspection	$85 per vehicle, each time	NYSDOT

A workable order, from forming the company to the first trip:

1. Form your company, get your EIN and NPI, and start the LLC publication so it is done within 120 days.
2. Apply for your licenses. For ambulettes, file for NYSDOT authority (6 to 16 weeks) and register with DMV under Article 19-A. For cars, get your local or TLC licenses.
3. Buy insurance that meets the state minimums and MAS’s list, with a Form E for NYSDOT.
4. Register and inspect your vehicles, then hire and qualify your drivers.
5. Send the MAS network application and wait for the letter of support.
6. Enroll in the eMedNY portal within 45 days of starting the application. The decision can take 90 days or longer.
7. Sign the MAS contract, credential drivers and vehicles, finish PASS training, set up GPS, and take your first trip.

Two steps set the pace: NYSDOT authority and the Medicaid enrollment decision. In the six bond counties, OMIG also gives you 90 days to post the bond once it finds you otherwise eligible. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

Other programs buy rides too, and some fit a New York company well.

• Section 5310 providers. NYSDOT runs the federal Section 5310 program, which funds rides for seniors and people with disabilities. Nonprofits and local public bodies are the main recipients, and buying transportation under a contract is an eligible cost, so they may hire you. Questions go to ptb.5310@dot.ny.gov.
• Adult day health care and OPWDD programs. Many adult day health care programs contract with Medicaid-enrolled transportation companies and pay them directly. OPWDD day programs and residences must provide or pay for their clients’ rides, and companies that serve them enroll in category 0606 without billing Medicaid. A NYSDOT contract carrier permit fits this fixed-price work. See how to get NEMT facility contracts.
• Veterans. The VA pays for special mode transportation, such as a wheelchair van, when a VA provider decides the veteran’s condition requires it and the trip is approved in advance. See VA special mode transportation.
• Health plans and private brokers. Medicare Advantage and other plans buy rides outside Medicaid. In the New York City area, Sentry manages trips for health plans, clinics, and institutions, and registers transportation providers online. See our Sentry guide and Medicare Advantage transportation.
• Private pay. Riders and families who pay for themselves add work that does not depend on one broker.