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

North Dakota runs Medicaid rides without a broker. You enroll with ND Medicaid, a human service zone or tribal office approves each ride in advance, and you bill the state directly at its fee schedule rates. The rules below follow the NEMT Billing and Policy Manual updated January 2026 and the fee schedule updated July 1, 2026. Check one date first: since June 11, 2026, new NEMT agency enrollments are paused statewide.

How Medicaid rides work in North Dakota

North Dakota Health and Human Services (HHS) runs Medicaid through its Medical Services Division. It pays each enrolled ride company fee for service from its own NEMT fee schedule, with no regions and no broker. State rule N.D.A.C. 75-02-02-13.1 requires every transportation provider to be enrolled in Medicaid.

Member	Who approves	Form
Traditional Medicaid	Human service zone or tribal office	SFN 1507
Leaving a hospital	Hospital staff	SFN 249
Medicaid Expansion	BCBSND	BCBSND authorization

Human service zones, formerly county social service offices, have an office in every county. The zone or tribal office picks the most economical and appropriate way to get the member to care and must give you the approved SFN 1507 before the ride. The May 2026 form names you as the provider and lists the vehicle type, dates, pickup, drop-off, and any approved unloaded miles. See prior authorization.

What Medicaid pays for

The manual covers rides by car, taxi, van, bus, airline, or train, plus meals and lodging on overnight trips. It defines the vehicles:

• Minibus. A small bus for 8 to 15 passengers.
• Wheelchair van. Any van that has a wheelchair lift.
• Stretcher van. A vehicle with a stretcher for someone who needs no medical monitoring, aid, care, or treatment on the way.
• Private vehicle. Friends, family, neighbors, foster and kinship caregivers, and guardians can enroll and be paid mileage.

A wheelchair or stretcher van ride needs three things: a mobility impairment that keeps the member from safely using a bus, taxi, car, or other common carrier; a trip to or from a covered service; and an SFN 1507. Rides run from home, school, or work to a medical or dental appointment and back, with documented exceptions for emergencies. Rides to noncovered places, rides ordered by a court or police, and parking fees are not covered.

Distance rules

• Out of state. Travel to a provider more than 50 miles past the nearest North Dakota border needs a service authorization from ND Medicaid first.
• Nursing facilities. An in-state nursing facility cannot bill Medicaid or charge a Medicaid resident for rides it provides. Under N.D.A.C. 75-02-02-13.2 it must take residents to care as far as the nearest medical center city: Bismarck, Devils Lake, Dickinson, Fargo, Grand Forks, Jamestown, Minot, or Williston. Medicaid may pay for rides beyond that distance.

Medicaid Expansion and the 2027 work rules

Medicaid Expansion covers adults 19 to 64 with income up to 138 percent of the federal poverty level. Blue Cross Blue Shield of North Dakota (BCBSND) has administered it since January 1, 2022, and HHS counted roughly 23,000 members in July 2026. Members book through BCBSND, which sends each request to a ride company to accept or decline.

Starting January 1, 2027, Expansion adults must work, train, volunteer, or study at least 80 hours a month unless an exclusion applies. On July 21, 2026, HHS estimated this would affect 5,000 to 7,000 members. See the Medicaid work requirement rule.

How to enroll with North Dakota Medicaid

You contract with the state. Noridian Healthcare Solutions runs provider enrollment for ND Medicaid.

The 2026 enrollment moratorium

Effective June 11, 2026, ND Medicaid placed a temporary enrollment moratorium on new NEMT agencies statewide. Enrolled providers keep working. Applications already in final approval on June 11 continue to approval, and the rest were denied.

Under 42 CFR 455.470, a moratorium runs six months and can be extended six months at a time, so unless it is extended, the first period ends around December 11, 2026. The state’s revalidation strategy (May 5, 2026) proposed an exception for new providers needed to keep access in underserved areas, but the June 11 notice lists no exception. Ask Provider Enrollment before you buy vans.

Tighter rules for every NEMT provider

On June 5, 2026, Governor Kelly Armstrong announced that ND Medicaid would expand oversight of NEMT, qualified service providers (QSPs), and 1915(i) providers starting July 1, 2026. The state’s revalidation strategy (May 5, 2026) counted 80 NEMT groups and 37 individual NEMT providers. HHS’s revalidation Q&A lists the NEMT changes: every driver gets an NPI, enrolls in ND Medicaid, and is linked to an agency; driver license, vehicle registration, and insurance checks become part of enrollment and revalidation; and revalidation moves to every three years instead of five. The strategy also adds site visits and expected current NEMT providers to finish revalidating by October 1, 2026. See Medicaid revalidation and Medicaid site visits.

Steps to enroll a NEMT company

When new agencies are accepted again, the HHS enrollment page and the group checklist revised in June 2026 set out these steps:

1. Get your EIN and NPI. The checklist asks for your IRS letter CP 575 or 147C and your organization NPI. See how to get an NPI number.
2. Apply online in the ND Health Enterprise MMIS portal as provider type 034, Transportation Services, or specialty 389 for a taxi.
3. Gather the documents: SFN 661 for direct deposit, SFN 1168 for owners and managing employees, SFN 615 (the provider agreement) signed by a managing employee, and each vehicle’s insurance and registration. Add a city taxi license for taxi enrollment, and a needs-based justification if the owner has more than one group.
4. Sign the attestation that each vehicle’s brakes, lights, and tires are sound, that your insurance covers paid passengers, and that you keep a copy of every driver’s license.
5. Send the documents to Noridian with the Provider Enrollment Coversheet, by email to NDMedicaidenrollment@noridian.com, fax, or mail. Processing starts only when both parts arrive.
6. Affiliate your drivers. A group cannot bill until a provider is affiliated on SFN 1330. Each driver files the NEMT individual application with an individual NPI, a license copy, and a signed SFN 615, naming your company as the billing group.
7. Get your 7-digit Medicaid ID by letter, or register for portal access once approved.

Your effective date can be up to 90 days before your complete packet arrives, but not before your NPI was issued. New NEMT providers are placed on review and attach the SFN 1507 or SFN 296 to every claim. Report ownership changes of 5 percent or more within 35 days. Provider Enrollment answers at 877-328-7098, 8 a.m. to 5 p.m. Central on weekdays.

No broker hands out trips. Zone and tribal offices name the provider on each SFN 1507, and hospitals pick one for discharges, so your sales work is with those offices, discharge planners, and dialysis centers. See how to become a Medicaid transportation provider.

Joining BCBSND for Medicaid Expansion

After you enroll with ND Medicaid, email BCBSND Provider Contracting at providercontracting@bcbsnd.com. Once you hold both enrollments, call the BCBSND Medicaid Expansion Provider Service Contact Center at 833-777-5779 to set up your contacts, hours, vehicle count, and how ride requests reach you.

Licenses and registrations

Your company

Register with the Secretary of State in the FirstStop Portal before you do business, unless you trade under your own name. As of September 2026, an LLC costs $135 to register and $50 a year for the annual report, due November 15 starting the year after you register. A missed report puts you in Not Good Standing. LLCs and corporations need a registered agent with a North Dakota street address. See LLC for NEMT.

Get your EIN from the IRS, free and at once online. North Dakota has no NEMT license. For taxi enrollment, ND Medicaid asks for a city taxi license where the city issues one, and the Insurance Department notes that taxis and limousines are licensed by a local transportation authority. Ask your city clerk what applies.

North Dakota Highway Patrol

The Highway Patrol’s Commercial Vehicle Regulations guide (May 2026) says North Dakota has no operating authority for in-state carriers, and they need no USDOT number unless they haul hazardous materials. The state applies the federal safety rules to in-state trips (N.D.A.C. 38-04-01-02), but exempts vehicles of 26,000 pounds or less unless they are designed to carry more than 8 passengers, driver included, for pay. Here is what applies to paid rides:

Vehicle	In ND	Out of state
8 or fewer seats, under 10,001 lb	No motor carrier rules	No federal safety rules
8 or fewer seats, 10,001 to 26,000 lb	No motor carrier rules	Federal safety rules, USDOT number
9 to 15 seats	Federal safety rules, state hours limits	Federal safety rules, USDOT number
16 or more seats	CDL, P endorsement, federal safety rules	CDL, federal safety rules, USDOT number

The guide adds that for-hire passenger carriers crossing state lines need FMCSA operating authority. If you take riders into Minnesota, South Dakota, or Montana, read the DOT number guide and the Minnesota, South Dakota, and Montana pages. NEMT license requirements compares other states.

Vehicle rules

ND Medicaid does not inspect vehicles. You attest that each is in good operating order, send copies of its registration and insurance with your application, and keep both current. Lapses can end your enrollment.

Vans built for 9 or more passengers, driver included, that carry riders for pay follow federal rules even on in-state trips:

• Yearly inspection under 49 CFR part 396 by a qualified inspector, valid 12 months from the end of the inspection month, with proof on board and the report kept 14 months.
• Defect reports at the end of each day a driver finds a defect, repairs certified before the next trip, and reports kept three months (49 CFR 396.11), unless you run only one such vehicle.
• Emergency equipment: a mounted fire extinguisher rated 5 B:C, or two rated 4 B:C, and three reflective warning triangles (49 CFR 393.95).

Use the vehicle inspection checklist and, before the snow, the winter vehicle checklist.

Wheelchair and stretcher rules

ND Medicaid’s wheelchair van is a van with a wheelchair lift. Federal ADA rules require every private transportation company to keep lifts and securement devices working and repair them promptly (49 CFR 37.161). You must use a securement system, may not refuse a rider because the chair cannot be secured satisfactorily, and your driver must help with securement, ramps, and lifts when needed (49 CFR 37.165). See wheelchair securement.

On the hospital discharge form, SFN 249 (February 2026), stretcher van service is for a member who must travel reclining, is medically stable, and needs no monitoring. It lists oxygen given by medical staff, IV fluids, and cardiac monitoring as reasons for a non-emergency ambulance instead. See NEMT vehicle requirements.

Driver rules and training

Every provider and hired driver needs a valid government-issued driver’s license, and you keep a copy in each driver’s personnel file. As of September 2026, HHS also requires every NEMT driver to get an NPI, enroll with ND Medicaid, and be linked to your agency, so every driver goes through the same screening as the company.

The state screens providers, owners, and managing employees monthly against federal exclusion lists. Medicaid pays nothing for a service an excluded person furnishes (42 CFR 1001.1901), so check each driver against the OIG exclusion list before hiring and regularly after.

Drivers of vans for 9 or more

The federal driver rules in 49 CFR part 391 apply to vans built for 9 or more riders for pay. Each driver needs a medical certificate from a National Registry examiner, and you keep a qualification file for the job plus three years. The Highway Patrol guide lists these disqualifying offenses:

• A revoked, suspended, or denied license.
• Driving a commercial vehicle with a blood alcohol level of .04 or more, or refusing a test.
• Driving under the influence of a Schedule I drug, amphetamine, or narcotic, or having or using one on duty.
• Leaving the scene of a crash, a felony involving a commercial vehicle, or violating an out-of-service order.
• Two or more convictions for texting, or for a hand-held phone, while driving one.

CDL drivers, for vehicles built for 16 or more, also need pre-employment, random, post-crash, and reasonable suspicion drug and alcohol testing.

Hours and conduct

Drivers of vehicles of 26,000 pounds or less that are not built for more than 8 riders for pay have no hours-of-service limits when they drive only within North Dakota. Drivers of vans built for 9 or more riders for pay who stay in the state may not drive more than 12 hours after 10 hours off duty, after the 16th hour on duty, or after 70 hours on duty in 7 days (N.D.C.C. 39-32-02). In a commercial vehicle crossing a state line, federal limits apply: 10 hours of driving after 8 hours off, and none after 15 hours on duty. See rural NEMT on long days.

The provider agreement, SFN 615, bars abandoning a member or refusing service because of race, color, national origin, age, or disability. See the driver file checklist and NEMT driver training.

Trip rules and how you get paid

Before and during each ride

• Authorization first. Get the SFN 1507 before the ride and keep it for the claim. Hospital discharges use the SFN 249.
• Urgent rides. On a weekend, evening, or holiday when the office is closed, give the urgent ride and request a retroactive authorization within 72 hours. The office has five business days to answer.
• Trip ticket. For taxi, minibus, wheelchair van, and stretcher van codes, the driver fills in an SFN 296 for each leg: actual times, addresses, odometer readings, and miles, with the facility’s or member’s signature.
• Records. Keep the member’s name and Medicaid ID, times, addresses, odometer readings, and mileage for 7 years, even after you close. Record the facility, never the member’s doctor. The trip log template covers each item.

What ND Medicaid pays

HHS sets the rates in its NEMT fee schedule, updated as of July 1, 2026:

Service	Code	Rate
Wheelchair van trip	A0130	$18.05
Wheelchair van mile	S0209	$2.57
Stretcher van trip	T2005	$97.37
Stretcher van mile	T2049	$2.57
Taxi trip	A0100	$27.06
Minibus trip	A0120	$18.05
Mile, other NEMT	S0215	$0.72
Volunteer driver mile	A0080	$0.72

That is about 2 percent above the April 5, 2026 schedule. A one-way wheelchair van trip of 30 loaded miles pays $18.05 + (30 × $2.57) = $95.15.

Medicaid pays the lesser of your usual charge and the fee schedule, and you cannot charge Medicaid more than other riders. See A0130 and NEMT billing codes.

Rules that limit pay

• One member per trip. For private vehicles, minibuses, wheelchair vans, and stretcher vans, you bill for one member however many ride.
• Loaded miles only, by map miles from pickup to facility. Deadhead miles are paid only if HHS approves them: email the NEMT Administrator with the authorization and the miles, then attach the approval to the claim.
• No-shows are not billable to Medicaid. You may bill the member only under a policy that bills every rider the same way and is posted or given in writing. See billing for no-shows.

Medicaid Expansion rides through BCBSND

BCBSND pays under your contract with it. Its provider page sets these rules: authorization before every ride, or the claim is denied; one base rate each way; mileage codes only on trips over 15 miles one way; and unloaded miles (TP modifier) only when you drive more than 15 miles outside your home town, after the first 15 miles. Claims go in electronically within 180 days, with a member’s same-day rides on one claim.

Deadlines, payment, and appeals

• Filing. ND Medicaid must receive a claim within 180 days of service (N.D.A.C. 75-02-05-04.7). See timely filing limit.
• Billing. Use the portal’s Travel, Meals, and Lodging claim page or, if you have an NPI, the portal’s professional claim in the CMS-1500 or 837P format. See the CMS-1500 guide.
• Payment. Payment runs are weekly in 2026: claims in by the cutoff, usually Friday at 5 p.m., usually have funds released the next Tuesday.
• Appeals. Appeal in writing, on form SFN 168 if you like, within 30 days of the remittance advice. HHS must decide within 75 days. See how to appeal a denied NEMT claim.

Insurance requirements

ND Medicaid sets no dollar minimum. Its forms require insurance that covers carrying passengers for payment, kept in force at all times. State law sets the floor for every vehicle registered in North Dakota, business vehicles included, as of September 2026:

Coverage	State minimum
Injury to one person	$25,000
All injuries, one accident	$50,000
Property damage	$25,000
Uninsured motorist	$25,000 per person, $50,000 per accident
Underinsured motorist	Equal to uninsured
Basic no-fault	$30,000 per person

For-hire passenger carriers crossing state lines also need federal minimums, which depend on how many passengers the vehicle seats. See NEMT insurance requirements.

Workers’ compensation

Workforce Safety and Insurance (WSI) is the only workers’ compensation insurer in North Dakota, and private insurers may not write it. You must insure every employee before they start, while owners, officers, and their spouses may opt in. As of September 2026, the minimum premium is $250 per period, and an uninsured employer can face a $10,000 penalty plus $100 a day. Anyone you pay is presumed an employee unless you prove they are an independent contractor (N.D.C.C. 65-01-03), so see 1099 or W-2 NEMT drivers.

What it costs and how long it takes

These are the fees North Dakota sets, as of September 2026:

Item	Cost	Paid to
EIN	Free	IRS
LLC registration	$135	Secretary of State
LLC annual report	$50 a year	Secretary of State
Workers’ comp minimum	$250 per period	WSI

Vehicles and insurance depend on your quotes. See what it costs to start a NEMT business.

A workable order, from first call to first ride:

1. Check the moratorium on the HHS Provider Updates page before you buy vehicles.
2. Form your company in FirstStop, then get your EIN and NPI.
3. Insure your vehicles for paid passengers, and open a WSI account before your first hire.
4. Meet the offices that approve rides: zone offices, tribal offices, and discharge planners.
5. Apply to Noridian once new agencies are accepted, then enroll and affiliate each driver.
6. Contract with BCBSND and bill your first trips with the SFN 1507 and SFN 296 attached.

The moratorium sets the pace: its first six months run to around December 11, 2026. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

Other work is worth a call while Medicaid enrollment is paused:

• Rural transit. About 31 bus programs serve rural North Dakota, and NDDOT lists Medical Rides among their services. Under NDDOT’s State Management Plan (February 2021), transit agencies may hire a private operator through open competition, and drivers in safety-sensitive jobs fall under FTA drug and alcohol testing (49 CFR part 655). See NEMT grants.
• Veterans. The VA pays for special mode transportation when a VA provider decides a veteran needs it and the trip is approved in advance. The ND Department of Veterans Affairs gives veterans in highly rural counties free rides to VA-authorized appointments through contracted transit providers. See VA special mode transportation.
• Other Medicaid programs. The 1915(i) program pays non-medical rides to places in a member’s plan of care, such as a job interview. QSPs give non-medical rides to older adults and adults with physical disabilities under EVV, though QSP agencies in Burleigh and Cass counties are also under a moratorium.
• Facilities and private pay. Nursing facilities must provide residents’ rides to care as far as the nearest medical center city, so ask how they handle those trips. See how to get NEMT facility contracts, hospital discharge transportation, and private pay NEMT.