How to Start a NEMT Business in North Carolina (2027)

North Carolina runs Medicaid rides two ways. Health plans arrange rides for their members through two brokers, Modivcare and MTM Health, and each county’s Department of Social Services (DSS) arranges rides for members in NC Medicaid Direct. Every NEMT company enrolls in NCTracks, the state’s Medicaid provider system, before it carries a Medicaid rider. The rules below follow the state’s managed care NEMT policy (version 12, posted May 7, 2025) and the county manual MA-2910, revised March 16, 2026.

How Medicaid rides work in North Carolina

The NC Department of Health and Human Services runs Medicaid through its Division of Health Benefits, known as NC Medicaid. Most members belong to a health plan: a Standard Plan, a Behavioral Health and I/DD Tailored Plan, or the Children and Families Specialty Plan (CFSP), which launched December 1, 2025. Each plan contracts with a statewide broker that builds a network of transportation providers, trains them, and sets their rates.

Members outside the plans are in NC Medicaid Direct or the Eastern Band of Cherokee Indians (EBCI) Tribal Option. Their rides come from the DSS in the county where the member is, which arranges and authorizes each trip as the state’s agent. NC Medicaid’s May 2026 guide places most dual eligible members, CAP/C and CAP/DA participants, members temporarily excluded from a plan, and formerly incarcerated members in Medicaid Direct.

As of September 2026, the four Standard Plans, the Tailored Plans, and the CFSP use these brokers:

Health plan	Broker
AmeriHealth Caritas (Standard)	Modivcare
Carolina Complete Health (Standard)	MTM Health
Healthy Blue (Standard)	Modivcare
UnitedHealthcare Community Plan (Standard)	MTM Health
Alliance Health (Tailored)	Modivcare
Trillium Health Resources (Tailored)	Modivcare
Vaya Health and Partners (Tailored)	Modivcare
Healthy Blue Care Together (CFSP)	Modivcare

Three changes in 2026 matter to providers. UnitedHealthcare moved its rides from Modivcare to MTM Health on January 1, 2026. WellCare of North Carolina merged into Carolina Complete Health on April 1, 2026, and Carolina Complete Health switched from Modivcare to MTM that same day. Vaya Health and Partners Health Management merge into one Tailored Plan, Vaya Partners, on October 1, 2026. Both use Modivcare, and their September 2026 merger FAQ says existing ride reservations carry over to Vaya Partners automatically. See NEMT brokers by state for how other states split the work.

A member qualifies when they need help getting to a Medicaid-covered service from a North Carolina enrolled provider, usually the nearest appropriate one. Medicaid pays only for the least costly mode that fits, so a member with a car may get mileage reimbursement or a gas voucher instead of a ride. Members with only Medicare Qualified Beneficiary coverage get no NEMT, members in deductible status get none until it is met, and nursing homes arrange rides for their own residents. Rides to some waiver and behavioral health services are not covered because the service rate already includes transportation, such as Innovations Waiver day supports and supported employment. Anyone under 18 rides with an adult.

Health plans cannot require members to book more than two business days ahead, and counties cannot require more than three. Both may ask for up to five days for trips at a greater distance. NC Medicaid also asks Medicaid Direct members to call at least four days before the appointment. Urgent trips need no notice, and health plans must pick up members leaving a hospital or emergency department within three hours of the request. See hospital discharge transportation.

The state policies list public transit, taxis, vans, wheelchair vans, mini-buses, mountain area transports, rideshare companies, and non-emergency ambulances as ride types. Plans must offer each trip to in-network NEMT providers first. Standard Plans may send a trip to a rideshare company first when it is booked less than two days ahead, and Tailored Plans use rideshare only for recovery trips, such as rides home from the hospital.

Which brokers to join

No single contract covers North Carolina. Most companies need three things: an NCTracks enrollment, a contract with each county DSS they serve, and an agreement with each broker. NC Medicaid’s April 29, 2022 bulletin strongly encouraged transportation providers to contract with both brokers so plan members have enough rides.

Enroll in NCTracks

Every NEMT provider enrolls as a Medicaid provider online at NCTracks, including a company that only drives for a broker. The state policies and the NCTracks Provider Permission Matrix generated August 16, 2026 set these steps:

1. Apply as an organization. Choose taxonomy code 343900000X, Non-emergency Medical Transport (Van). No license, certification, or accreditation is required, and you can enroll as an atypical provider without an NPI.
2. Pay the fee. Applications submitted in 2026 cost $850: the $100 North Carolina fee plus the $750 federal fee.
3. Send the driver attestation. The matrix asks for a NEMT Driver Attestation form signed by your office administrator.
4. Complete the required online training.
5. Pass the site visit. NCTracks screens NEMT companies as moderate risk, so the state makes a compliance visit before approval. See Medicaid site visits.

Your enrollment is re-verified every five years, with the application fee charged again and a criminal background check on owners and managers. The NCTracks call center is 800-688-6696. For county work, MA-2910 says only in-state providers can enroll as NEMT providers. Health plans may also contract with providers within 40 miles of the state line.

Sign a contract with your county DSS

For NC Medicaid Direct rides, the county DSS is your customer. MA-2910 requires a written contract, signed by you, before a county buys private transportation, and it requires the county to tell vendors to enroll in NCTracks before they give rides. The county where the member is physically located arranges and authorizes the trip, even when the member’s case belongs to another county.

Call the transportation coordinator in each county you want to serve. The state’s local DSS directory lists every office. Ask which service levels the county is short on, how it sends trips, and how quickly it uploads payment authorizations.

Apply to Modivcare and MTM Health

Health plan trips come through the brokers, and each has its own application.

• MTM Health. Apply online through MTM’s provider onboarding page. Carolina Complete Health’s provider page (April 29, 2026) says you must already be registered with NCTracks, or the application is voided. MTM’s steps are an application, an interview, contracting, credentialing, training, and a first trip. Every employee completes fraud, waste, and abuse training and HIPAA training each year.
• Modivcare. Apply through its join-our-network form. Modivcare asks for each driver’s wheelchair transport, first aid and CPR, and defensive driving certificates, a drug screen, a motor vehicle report, and a background check, plus each vehicle’s registration, state inspection, and insurance. NC Medicaid’s April 2022 bulletin lists ncnetwork@modivcare.com for North Carolina contracting.

State policy protects your right to work with everyone. Health plans and their brokers may not put exclusivity or non-compete terms in your contract, or stop you from contracting with any other plan. See our Modivcare and MTM Health guides, and working with multiple brokers.

Licenses and registrations

Your company

Form an LLC or corporation with the NC Secretary of State. Articles of organization for an LLC and articles of incorporation for a corporation each cost $125 on the fee schedule as of September 2026. New company filings take about 5 to 10 business days, and online is faster than paper. Filing within 24 hours costs $100 more, and filing the same business day costs $200 more for documents received by noon.

An LLC files an annual report by April 15 of each year after the year it forms, for $200 on paper or $203 online with a card. A corporation’s report costs $25 on paper or $21 online with a card, and it is due on the 15th day of the fourth month after its fiscal year ends.

Get your employer identification number (EIN) from the IRS, which never charges for one. Taxi insurance and permits are set by local ordinance and vary by county, so ask your city and county what applies before you start. An NPI is optional for NCTracks, but some facilities ask for one. See how to get an NPI number.

NC DMV and NCTracks

North Carolina has no NEMT license. NCTracks enrollment is the state’s own screening, and NC DMV governs your vehicles. State law defines for-hire passenger vehicles as vehicles that carry people for pay (G.S. 20-4.01). Vehicles used for human service transportation are excluded, and G.S. 62-289.3 counts a for-profit company as human service transportation only while it works under an exclusive contract with a human service agency, such as a county DSS.

These are the yearly registration fees as of September 2026 (G.S. 20-87). The next inflation adjustment is due July 1, 2028.

Vehicle	Plate	Yearly fee
Paid rides, up to 15 passengers	For-hire	$128.50
Paid rides, over 15 passengers	For-hire	By weight
One agency’s exclusive contract	Private	$46.25

The weight fee is $2.55 per 100 pounds of empty weight, plus $5. The private plate applies only during an exclusive contract with one human service agency, and $46.25 is the fee for 15 or fewer passengers.

Ask NC DMV to confirm the plate class before you register. A vehicle designed for 16 or more passengers, driver included, is a commercial motor vehicle under state law, and its driver needs a commercial driver license (G.S. 20-37.12). Trips across the state line can bring federal motor carrier rules into play. See NEMT license requirements and rural NEMT.

Vehicle rules

NC DMV requires every registered vehicle to pass a yearly safety inspection at a licensed station before its registration can be renewed, no more than 90 days before the plate expires. Vehicles registered in 19 counties also need an emissions inspection at the same visit. The safety check covers headlights and other lights, turn signals, both brakes, steering, tires, horn, rearview mirror, wipers, exhaust, and emission controls. Window tint checks ended on December 1, 2025.

The state’s NEMT policies make counties and health plans confirm the rest:

• Every vehicle has a valid North Carolina registration and a current state inspection.
• Your staff files hold each driver’s license, the vehicle’s current registration and inspection, a current driving record, and proof of liability insurance.
• Your contract guarantees that you meet every safety and liability requirement for your vehicles and staff, and that you keep records to prove it.

The state policies do not list vehicle equipment. The brokers set it in their agreements, and both check vehicles in the field. Before your first broker visit, run our vehicle inspection checklist and read NEMT vehicle requirements.

For county trips, bill A0130 only when a wheelchair van is medically necessary. A wheelchair van trip that is not medically necessary bills as A0120. Modivcare asks every driver for a hands-on wheelchair transport training certificate. The county code list has no stretcher van code. On the rare occasions when an ambulance is the only way a member can travel but the trip is not medically necessary, the county contracts with an ambulance company at a negotiated rate without life support services, billed as A0999. Health plan encounters do include stretcher van codes, T2005 and T2049.

Driver rules and training

North Carolina’s NEMT policies set the same driver floor for county and health plan work. A driver cannot carry Medicaid riders if the driver:

• Is under 18, or is not licensed for the vehicle they drive.
• Has more than two chargeable accidents or moving violations in the last three years.
• Has had a license suspension or revocation in the last five years.
• Was convicted of, or pleaded guilty or no contest to, any of these in the 10 years before the background check: murder, rape or aggravated sexual abuse, kidnapping or hostage taking, assault inflicting serious bodily injury, a federal crime of terrorism, unlawful possession, use, sale, or manufacture of an explosive device or a weapon, elder abuse or exploitation, child abuse or neglect, illegal sale or possession of a Schedule I or II controlled substance, or conspiracy to commit any of them.

Run a North Carolina criminal background check on every driver before hire and every three years after. A driver who has not lived in the state for five years in a row gets a National Crime Information Center check instead. Applicants hand in their driving record for the last three years, and you review every driver’s record every 12 months. The health plan policy ties these limits to the federal NEMT driver rule, in force since December 27, 2021. See NEMT driver background checks.

You must also run a random alcohol and drug testing program that meets Federal Transit Administration requirements, and you pay for it. See NEMT driver drug testing.

Required training comes from NCTracks, for your company, and from each broker, which trains you on its trip process and asks for the driver certificates listed above. Keep every certificate current.

Riders must follow your conduct policy, and a county or plan can suspend a rider’s transportation for 30 days after conduct that puts other passengers or the driver at risk. Every county and plan contract also requires written policies on how your drivers handle and report emergencies, breakdowns, accidents, and delays. Our driver file checklist tracks the records for each driver.

Trip rules and how you get paid

Service standards

Every county and health plan contract must include these obligations:

• Missed trips. You may miss no more than one quarter of one percent of your trips in a contract year.
• Late drop-offs. No more than 5% of trips in a month may arrive after the appointment time.
• Reports. Report no-shows every day and cancellations every month, and log each rider complaint about something you control.
• Changes. Tell the county or plan when your insurer, ownership, or enrollment status changes.

The health plan policy adds timing rules:

• Arrival. Get the rider there on time, but no more than one hour before the appointment.
• Return. The rider waits no more than one hour after treatment ends and is never picked up before it ends. See will-call trips.
• Shared rides. With more than one rider aboard (family members excepted), or on a long distance or coordinated trip, both windows stretch to two hours. See multiloading.

Health plans report every leg as its own encounter, with the time your driver arrived at the pickup, left it, and reached the drop-off. Record all three on your trip log.

County trips

The county negotiates your rate in its contract. After a trip, it uploads a payment authorization to NCTracks with the amount it approved, and you submit a professional claim that must match it: member, provider ID, billing code, amount, and date of service. NCTracks prices the claim at the authorized amount. See prior authorization.

Claims use taxonomy 343900000X, place of service 99, and a diagnosis code, with Z76.89 recommended. Bill one unit per one-way trip, and put each date of service on its own line. The codes are A0100 for a taxi, A0110 for a bus, A0120 for a mini-bus, van, or mountain area transport, A0130 for a medically necessary wheelchair van, A0140 for air travel, and A0999 for an ambulance trip that is not medically necessary.

Medicaid does not pay for miles to or from your garage, so the state tells counties to build them into mileage rates. It does not pay for no-shows either. If a county agrees to pay you for no-shows or waiting time, invoice those charges separately.

Rates changed twice in 2025. From October 1, 2025, NC Medicaid paid 97% of the September 30, 2025 rate, and each county chose whether to cut its vendors’ rates or cover the 3% itself. The state announced the reversal on December 10, 2025. Payment authorizations submitted from December 17, 2025 use the September 30 rates. The December 19, 2025 bulletin said NCTracks would correct authorizations made from October 1 through December 16, counties that had cut the amount themselves would send updated ones when told to, and claims already filed on those authorizations would be reprocessed automatically. See North Carolina reverses its NEMT rate cut.

Questions about an authorization go to the county that sent the trip. If NC Medicaid itself makes an adverse determination about your enrollment or payment, you can appeal to the Office of Administrative Hearings, which must decide within 180 days of your filing unless the state causes a delay (G.S. 108C-12).

Health plan trips

For plan trips, the broker is the billing provider and you are the rendering provider. The broker sets your rate in its agreement, along with its terms for vehicles, drivers, timeliness, and no-shows. If a plan agrees to pay for no-shows or waiting time, those charges are invoiced separately too. UnitedHealthcare’s notice on its move to MTM asks providers to pick up a discharged member within three hours and a will-call return within one hour. See how to bill NEMT brokers.

Insurance requirements

The state’s NEMT policies tell counties and health plans to use the NC Utilities Commission’s limits for common carrier passenger vehicles (Rule R2-36) as a guide, and they list these amounts:

Vehicle	Minimum liability
For-hire, 15 or fewer seats with driver	$1,500,000
For-hire, 16 or more seats with driver	$5,000,000
Taxi	The local ordinance minimum

When you use a vehicle for 16 or more passengers, the county or plan asks for a certificate of insurance naming its transportation coordinator or DSS director as additional insured, with 30 days’ notice before any coverage drops.

Every North Carolina auto policy issued or renewed after July 1, 2025 must carry at least $50,000 for injury to one person, $100,000 for all injuries in one accident, and $50,000 for property damage, plus uninsured and underinsured motorist coverage. NC DMV accepts only insurers licensed in North Carolina.

Modivcare’s provider requirements list comprehensive general liability, sexual abuse and molestation coverage, auto liability, and workers’ compensation, with limits that vary by state. Ask each broker for its North Carolina limits in writing before you buy a policy. See NEMT insurance requirements.

North Carolina requires workers’ compensation once you regularly employ three or more people. Corporate officers count toward the three, so a corporation with two officers and one employee needs coverage, though officers can exclude themselves from the policy. Sole proprietors, partners, and LLC members are not counted, but they can choose to be covered. See workers’ comp for NEMT.

What it costs and how long it takes

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

Item	Cost	Paid to
EIN	Free	IRS
LLC or corporation filing	$125	Secretary of State
LLC annual report	$200 a year, $203 online	Secretary of State
Corporation annual report	$25 a year, $21 online	Secretary of State
NCTracks enrollment, 2026	$850	NC Medicaid
For-hire registration, up to 15 passengers	$128.50 per vehicle a year	NC DMV

A workable order, from first call to first trip:

1. Call the counties and the brokers. Ask each county DSS transportation coordinator, and Modivcare and MTM Health, where they need providers and which service levels they are short on.
2. Form your company and get your EIN.
3. Buy insurance that meets the state policy and each broker’s limits, and add workers’ compensation if you will have three or more employees.
4. Register and inspect your vehicles with NC DMV under the right plate class.
5. Hire drivers who meet the state rules. Run background checks and driving records, and set up your random drug and alcohol testing program.
6. Enroll in NCTracks. Pay the $850 fee, send the driver attestation, finish the online training, and pass the site visit.
7. Sign your county contracts and apply to MTM Health and Modivcare. Finish each broker’s credentialing and training.

A new company filing takes about 5 to 10 business days. After that, the NCTracks site visit and each broker’s credentialing set the pace, and MTM voids applications from companies not yet registered in NCTracks. 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.

• Community and human service transportation. Every county DSS has a Community Transportation Services Plan tied to its local community transportation system, which works within NCDOT and Federal Transit Administration funding. State law counts councils on aging, local health departments, community action agencies, sheltered workshops, and group homes as human service agencies too. Ask your county’s transit system and these agencies whether they contract out trips.
• Facilities. Nursing homes must arrange transportation for their Medicaid residents who lack family help, and they may contract with transportation providers to do it. Dialysis centers, hospitals, and assisted living communities are worth a call too. See how to get NEMT facility contracts and dialysis transportation.
• Veterans. The VA pays for special mode transportation when a VA provider decides a veteran’s condition requires an ambulance or a specially equipped vehicle and the trip is approved in advance. Ask your nearest VA health facility how it books these rides, and see VA transportation contracts.
• Private pay. Riders who pay for themselves add work that does not depend on one broker or county. See private pay NEMT.