Medicaid Transportation in Buncombe County, NC: The County NEMT Contract and How Ride Companies Join

North Carolina puts NC Medicaid Direct rides in the hands of each county’s social services agency. Buncombe County contracts the whole job out. One organization decides who qualifies, books every trip, and hands it to a network of ride providers, so it works much like a NEMT broker for one county. For an Asheville-area company, the way in is that provider network, not the county itself.

Statewide rules for county trips (NCTracks enrollment, the county manual MA-2910, driver screening, and billing) are on the North Carolina guide. When a county contracts out its NEMT administration, MA-2910 makes the contractor carry out every duty the county would have and log each trip on the state’s DHB-2056 transportation log.

Who arranges Medicaid rides in Buncombe County

Since 2015, the contractor has been Land of Sky Regional Council, whose Transportation Resource Center also administers Mountain Mobility, the county’s community transit system. Riders call 828-552-5486 and pick an extension by last name. As of September 2026, the county’s transportation page sends Medicaid riders to that number. Health plan members ride through Modivcare or MTM Health instead.

The program is small. In a May 2025 question-and-answer document for a new scheduling system, Land of Sky reported:

Measure	May 2025
Contracted ride providers	12
Levels of service	Ambulatory and wheelchair only
Active cases	780
Trips booked a month	About 4,133 (three-month average)
Trips taken a month	About 3,032 (three-month average)
Rideshare planned for the network	No

Each one-way leg counts as a trip. Under the May 2025 rider guidelines, riders who live on a bus route get Asheville Redefines Transit (ART) bus passes, and riders who drive get mileage at 35 cents a mile.

How trips reach ride providers

The office books a trip, and it lands in a web portal where each provider sees the trips assigned to it. The May 2025 scheduling system request asked for a portal where providers view, accept, deny, and verify trips, and for pricing by in-county and out-of-county provider rates and by mobility type, with the least costly provider chosen under Medicaid and county rules. Providers send invoices, and the office converts them for NCTracks.

The rider guidelines (revised May 1, 2025) set the day-to-day rules your drivers work under:

• Booking. Riders cannot book directly with a provider. In-county trips are booked three business days ahead by 3 p.m., and out-of-county trips five business days ahead with extra paperwork.
• Pickups only as booked. Providers pick riders up and take them only to the prearranged destination.
• No wait time. Drivers may not wait at the drop-off, and wait time is never paid. The rider or the doctor’s office calls the dispatcher for the return.
• Proof of visit. The rider has the medical office sign a DHB-5118 form and gives it back to the provider.
• Cancellations. Riders cancel with the provider at least two hours before pickup.
• No-shows. A provider that arrives and finds no rider reports a no-show to the office. After a third no-show, the rider loses rides for 30 days, except dialysis and chemotherapy riders.

The office also asked for a scheduling system that books standing orders for dialysis riders. See NEMT standing orders and dialysis transportation.

The FY27 county contract

Buncombe County Health and Human Services issued a request for proposals on November 10, 2025, also posted as the “FY27 NEMT RFP.” Proposals were due December 16, 2025, the county planned to award by December 30, 2025, and the contract was set to take effect July 1, 2026, for one year with renewals for up to three years. The county said it could contract with one or more firms.

The contractor must:

• Deliver every NEMT service for the county under MA-2910, for an estimated 4,300 trips a month.
• Decide who qualifies, keep case records, and hold eligibility accuracy at 95% or better.
• Repay the county for any overpayment to providers that monitoring finds was its error.
• Work Monday through Friday, generally 8 a.m. to 5 p.m., and other hours only when the county asks.
• Count a pickup as on time from 45 minutes before to 15 minutes after the scheduled time. See pickup window.
• Provide no service on 11 listed holidays, handle holiday requests only as providers are available, and run no trips at all on Thanksgiving Day or Christmas Day.
• Make sure every transportation provider carries commercial general liability of at least $1,000,000 combined single limit.

The county scored proposals this way:

Criterion	Weight
Organizational qualifications and NEMT experience	15%
Cost proposal	15%
Driver and vehicle standards	15%
Service delivery plan	10%
Customer service and accessibility	10%
Program compliance and quality assurance	10%
Technology and data systems	10%
Cultural and community understanding	10%
Value add and innovation	5%

Bidders had to name every subcontractor and the share of the work each would do. The contractor itself carries $1,000,000 per occurrence and $2,000,000 aggregate general liability, $1,000,000 combined single limit auto liability with uninsured and underinsured motorist coverage, workers’ compensation for itself and its subcontractors, and $500,000 employer’s liability, with the county named as additional insured. Because the contractor also decides eligibility and keeps case records, a company bidding for the whole contract needs caseworkers, not just vans and drivers. Read how to answer a NEMT broker RFP before you consider one.

What ride providers need

• NCTracks enrollment as a NEMT provider, like every county vendor in the state.
• $1,000,000 in general liability, the floor the county set for every provider.
• Ambulatory or wheelchair vehicles. The program scheduled only those two levels of service in May 2025.
• On-time pickups inside 45 minutes early to 15 minutes late. See improving on-time performance.
• A daily portal check, since that is where assigned trips appear.

Mountain Mobility is one of the providers. The county says it is operated by McDonald Transit Associates under contract and runs Monday through Saturday from 5:30 a.m. to 7:30 p.m. In May 2025 the office said no part of its area was hard to find providers for, so ask what it needs from a new provider before you apply.

What to do first

1. Enroll in NCTracks as a NEMT provider.
2. Call 828-552-5486 and ask how to join the ride provider network, whether it is adding providers, and what the in-county and out-of-county rates are.
3. Buy the insurance before you apply: at least $1,000,000 combined single limit general liability.
4. Set up your office for the portal, DHB-5118 collection, and monthly invoices.
5. Apply to Modivcare and MTM Health for plan trips in the same area.

Compare Mecklenburg County, where the county runs its own fleet and buys vendor trips, and Wake County, where one transit operator drives every van trip.