Suffolk County Medicaid Transportation: County For-Hire Rules, Town Taxi Licenses, and Rates

Suffolk County puts its own for-hire layer on top of New York’s Medicaid ride program. The county’s Taxi and Limousine Commission registers taxis and livery cars and licenses their drivers, towns and villages can license taxis as well, and the state sets Suffolk’s Medicaid rates and ambulette bond rule county by county.

How Medicaid trips reach Suffolk companies

Statewide, Medical Answering Services (MAS) approves every Medicaid trip and assigns it to an enrolled company, and since April 15, 2024 eMedNY has rejected new transportation applications that lack a MAS letter of support. The New York guide and the MAS guide walk through both steps.

Suffolk came to MAS late. The state’s Medicaid transportation manual, effective August 25, 2023, moved every other county to MAS on August 1, 2023 and kept Suffolk and Nassau with their prior manager until December 1, 2023. Suffolk members now book on the MAS Downstate line, 844-666-6270, which also serves Nassau, Putnam, Westchester, and New York City.

The same manual says Medicaid enrollment never replaces local licensing, and a company that breaks local rules can lose its enrollment. For a Suffolk taxi or livery company, local rules mean the county and the towns.

The Suffolk County for-hire vehicle registration

Chapter 571 of the Suffolk County Code, adopted June 17, 2014, makes it unlawful to operate a for-hire vehicle in the county without a county registration. A for-hire vehicle is any vehicle carrying passengers on a prearranged basis for pay, such as a taxi, limousine, commuter van, or private livery car. The Suffolk County Taxi and Limousine Commission (SCTLC), part of the Department of Labor, Licensing and Consumer Affairs in Hauppauge, runs the program.

Each vehicle needs its own application, signed by its primary owner and notarized. As of October 2026, the county’s vehicle checklist asks for:

• DMV registration showing livery or TLC plates only.
• Insurance at the state no-fault levels of Insurance Law 5102 and the for-hire liability levels of Vehicle and Traffic Law 370. See NEMT insurance requirements.
• A state safety and emissions inspection passed within the last 12 months, and repeated at least every 12 months.
• Two forms of ID for each owner, one of them a government photo ID.
• Fingerprints for every owner, and for every officer, member, or holder of 10% or more of a company, taken after you file.
• A letter from each base station the vehicle works with, notarized or under corporate seal, naming it by VIN.
• A sworn affidavit that every driver you employ holds a county for-hire driver license, or a town license where the county does not require one, with a new affidavit within 10 days of each new hire.

The application also asks for your federal tax ID or state sales tax number, your workers’ compensation number, and every other address you use, such as a parking lot or a satellite dispatch office. A registration lasts one year and expires on the last day of its 12th month. A county hearing officer can fine up to $1,500 per violation, counted for each day it continues, or suspend or revoke the registration. Running a for-hire business without the registration is also a misdemeanor, punishable by a fine of up to $5,000, up to a year in jail, or both.

What the county charges

These are the fees in Chapter 571 and on the county’s forms as of October 2026. Pay the county by certified check or money order made out to Suffolk County Consumer Affairs.

Item	Fee	Paid to
Vehicle registration, first year	$300 per vehicle	Suffolk County Consumer Affairs
Vehicle registration renewal	$250 per vehicle each year	Suffolk County Consumer Affairs
Prearranged permit for trips to NYC and nearby counties	$50 per vehicle each year, on top	Suffolk County Consumer Affairs
For-hire driver license	$50 a year	Suffolk County Consumer Affairs
Fingerprint background check	$99.75 per person	IdentoGO
Driver drug test	$26 each year	Labcorp

Which vehicles skip the county registration

Section 571-6 lists the vehicles that need no county registration. Two matter most to a Medicaid company:

• Medical provider vans. A van that is not wheelchair accessible, seats 8 to 14 passengers, carries riders only to and from medical appointments, and is paid only through contracts with health or social service programs, such as Medicaid, the state Department of Social Services, or the Suffolk County Department of Social Services.
• Town-licensed taxis that stay in Suffolk. A taxi that operates only inside the county and holds a valid license from each town or village it works in. Its drivers skip the county driver license if they hold those towns’ taxi driver licenses.

The code also leaves out ambulances certified by the state Department of Health, funeral cars, buses on fixed routes, and any vehicle the county has no power over under state or federal law.

No section of the code speaks to wheelchair vans directly. The medical van exemption covers only vans that are not wheelchair accessible, the code never names ambulettes, and the county’s vehicle checklist has a box for accessible vehicles. Before a wheelchair van carries anyone for pay, email Consumer.affairs@suffolkcountyny.gov and get the commission’s answer in writing.

Town taxi licenses in Suffolk

Suffolk’s towns and villages can license taxis themselves, and the county application asks whether each vehicle already holds a town, hamlet, or village registration, license, or permit. Brookhaven shows what a town license involves.

Brookhaven’s Department of Public Safety licenses taxicab and livery businesses under Chapter 67 of the town code. As of October 2026, its application costs $200 for the business plus $125 for each vehicle medallion, with late fees of $50 for the business and $15 per vehicle on renewals filed after January 31. The business must keep an office in Brookhaven. The application asks for the property’s tax map number and whether the premises has a certificate of occupancy or zoning permit, and a renter must show a lease that allows a taxi or livery business there. The checklist also asks for your business certificates, insurance certificates, your driver’s license, each vehicle’s title, registration, and state inspection certificate, and the fares you will charge.

Chapter 67 exempts vehicles used only for trips that start or end outside the town, and it does not reach areas inside incorporated villages. Other towns and villages may license taxis on their own terms, so call the clerk or public safety office of every town where your trips start before you buy plates.

Put together, a taxi company whose Medicaid riders never leave Suffolk can rely on town licenses in each town it works in. Once its riders cross into Nassau or New York City, it needs the county registration as well.

Medicaid trips to Nassau and New York City

When a Suffolk rider’s appointment is in Nassau or New York City, the county code adds three duties. They apply the same way to trips into Westchester and Rockland, which also fit the code’s definition of a licensing jurisdiction.

1. Mark the trip type on your county application. A vehicle that runs between Suffolk and one of those places gets a prearranged for-hire permit for its windshield, good for one year, for $50 more each year.
2. License the driver with the county. A driver on those trips needs the county for-hire driver license, even if a town license covers local work.
3. Log each trip before it starts. Record the pickup and drop-off locations in the log kept in the vehicle, show it to police on request, and keep it for at least one year. A missing log counts as evidence of an illegal trip.

Section 571-12 says a vehicle with the county registration and this permit may, under state Vehicle and Traffic Law 498, drop off Suffolk riders in those places and bring riders from there back to Suffolk without a second license. Nassau’s commission still says it registers every for-hire vehicle that picks up or drops off there, so confirm with the Nassau TLC before your first Nassau drop-off and read the Nassau County page. The New York City page covers city rules.

Ambulettes in Suffolk: open enrollment, with a bond

New York Medicaid once refused new ambulette companies in Suffolk, Nassau, and New York City because the Department of Health found those areas had enough of them. eMedNY’s enrollment chart says that moratorium lifted on December 1, 2021, so ambulette companies may enroll in category 0602 in every county if they meet the other criteria. Applications denied before then were not reopened, and those companies had to reapply.

Suffolk is one of six counties where a new ambulette company posts a surety bond before it enrolls, a rule the Office of the Medicaid Inspector General (OMIG) applies to applications filed on or after March 1, 2011. The policy manual effective August 25, 2023 sets these terms:

• Amount. $25,000 a year for each ambulette you own or use, or $100,000 a year, whichever is lower. Three vans means a $75,000 bond.
• Timing. OMIG contacts you once you are otherwise eligible, and you have 90 days to post the bond, or the application is denied.
• Term. At least one calendar year, renewed every year while you stay enrolled.
• Exception. If you expect under $500,000 in ambulette billing in your first full year, file a letter with your application asking for an exception. Include your billing estimate and the number of ambulettes you own, lease, and plan to add.

An insurance company issues the bond, and the manual notes that your cost is far below the bond amount. See Medicaid surety bond. The ambulette still needs NYSDOT operating authority, inspections every six months, and Article 19-A drivers, which the ambulette business guide covers.

What Medicaid pays in Suffolk County

The eMedNY fee schedule file dated April 5, 2026 lists these Suffolk rates. MAS negotiates rates with each company, and the state manual says a negotiated rate supersedes the schedule, so treat these as your starting point.

Service	Code	Suffolk rate	Effective
Wheelchair van, per trip	A0130	$64.00	May 20, 2024
Wheelchair van, per loaded mile	S0209	$3.00	May 20, 2024
Stretcher van, per trip	T2005	$230.00	May 20, 2024
Taxi, per trip	A0100	$6.89	April 1, 2022
Taxi, per loaded mile	S0215	$3.87	April 1, 2022

Two Suffolk numbers stand out in the statewide file. The $64.00 wheelchair base ties Nassau for the highest of any county, and the $3.87 taxi mile is the highest standard taxi mileage rate in the state. With a base under $7, a Suffolk taxi trip earns most of its pay from loaded miles, which you bill to the tenth of a mile.

At these rates, a 12-mile taxi trip pays $6.89 plus $46.44, or $53.33. A 12-mile wheelchair trip pays $64.00 plus $36.00, or $100.00.

How to start taking Suffolk Medicaid trips

1. Pick your service. Taxi (category 0603) is curb-to-curb service at $6.89 plus $3.87 a mile. Ambulette (0602) carries wheelchair and stretcher riders at $64.00 plus $3.00 a mile, or $230 per stretcher trip.
2. License the vehicles locally. Get a license from each town where your taxis work, and register each vehicle with the county unless those town licenses cover it and it never leaves Suffolk.
3. License the drivers. Each taxi driver needs a Class E license or higher and a county or town taxi driver license. Ambulette drivers qualify under Article 19-A.
4. Settle the ambulette pieces. File for NYSDOT authority, then plan for the OMIG bond or send the exception letter with your Medicaid application.
5. Ask the SCTLC about wheelchair vans in writing before they carry anyone for pay.
6. Apply to MAS for a letter of support, then enroll with eMedNY and sign the MAS contract, as the New York guide explains.