How to Start a NEMT Business in Ohio (2027)

Ohio splits Medicaid rides three ways. Health plans arrange wheelchair van and ambulance rides, longer car rides, and a yearly allowance of short trips through their own brokers, and county job and family services offices arrange the rest. Enrolled wheelchair van companies can also bill Ohio Medicaid directly for members outside a plan. The rules below follow Ohio Administrative Code Chapter 5160-15, whose documentation and payment rules took effect August 1, 2026, and the ambulette rules in Chapter 4766-3.

How Medicaid rides work in Ohio

The Ohio Department of Medicaid (ODM) must make sure members can get to covered care. It does most of that through subgrant agreements with each county department of job and family services (CDJFS), under rule 5160-15-10. Rides cost members nothing.

Ohio’s seven Medicaid health plans cover the other rides. Ohio’s plan comparison for 2027, last updated July 1, 2026, says every plan must cover:

• Necessary ambulance and wheelchair van rides at any distance.
• Rides by standard vehicle, such as a taxi or sedan, when the nearest network provider is at least 30 miles away.
• Standard vehicle rides at any distance for OhioRISE members, the program for children with complex behavioral health needs.

Each plan hires its own ride broker. As of September 2026:

Health plan	Ride broker
AmeriHealth Caritas Ohio	MTM Health
Anthem Blue Cross and Blue Shield	MTM Health
Buckeye Health Plan	SafeRide Health
CareSource	Provide A Ride
Humana Healthy Horizons in Ohio	MTM Health
Molina HealthCare of Ohio	MTM Health
UnitedHealthcare Community Plan	Provide A Ride, for stretcher and ambulance rides

CareSource moved its rides to Provide A Ride on May 1, 2021. UnitedHealthcare’s 2026 manual names Provide A Ride only for stretcher and ambulance rides. Provide A Ride’s ride request page lists UnitedHealthcare Ohio as one of its two plans. SafeRide has run Buckeye’s rides since July 1, 2024, for its Medicaid, OhioRISE, and MyCare members.

Plans also add yearly allowances of shorter trips, and those change. On April 15, 2026, CareSource cut its allowance for trips under 30 miles from 30 round trips a year to 15. Dialysis, prenatal and postpartum care, hospital admissions and discharges, child wellness visits, and wheelchair van rides are unlimited. When a member uses up a plan’s allowance, the plan tries to move that member to the county program.

The county programs choose the most cost-effective ride that fits each member. Rule 5160-15-10 lets a county use contracted livery service, transit fares, fuel vouchers, mileage payments, or its own staff and vehicles. Franklin County books rides through its own Transportation Unit at least 24 hours ahead. Hamilton County wants requests five days ahead, and riders on its program must be able to move from a wheelchair into the vehicle on their own.

A county may decline a ride when a health plan has to provide it, when the member lives in a nursing facility, or when a hospice has to arrange it.

Members outside a health plan who need a wheelchair van may call an enrolled wheelchair van provider directly, as ODM’s July 2025 flyer says. A member qualifies when they must ride in their wheelchair or other mobility device from pickup to drop-off and cannot ride in a standard car. A cane, crutch, or walker alone does not qualify. Non-emergency ambulance service is for members who need an EMT’s care, oxygen given by another person, or supervised restraint during the trip.

Which brokers and county programs to join

For plan trips, you contract with the broker, not with the plan. A Provide A Ride contract reaches CareSource members, and an MTM contract reaches the four MTM plans. See working with more than one broker.

1. Choose your service levels. Ambulatory trips need a PUCO certificate. Wheelchair trips also need an ambulette license, and stretcher trips need an ambulance license. The next section covers each.
2. Get an NPI. Provide A Ride’s questionnaire and SafeRide’s application both require one. See how to get an NPI number.
3. Apply to Provide A Ride. Its online Transportation Provider Questionnaire asks for your EIN, NPI, Ohio Medicaid ID if you have one, yearly trip count, and past broker work. It also asks whether any owner has had a Medicaid contract ended for cause or been excluded. Only complete applications are considered, and Provide A Ride picks partners by network need, operations, experience, and location. For contracting questions, use the contact form on its website and choose contracting for services.
4. Apply to MTM Health. MTM’s steps are an application, an interview, a contract, credentialing, training, and a first trip. MTM’s system will not assign trips to a provider whose credentials have lapsed.
5. Apply to SafeRide Health. Finish its online application within 30 days, or it restarts.
6. Call your county. Ask the county’s Medicaid transportation coordinator how it buys rides and when it next contracts. Find your office in the ODJFS local agencies directory. Hamilton County, for one, sends bid notices to companies that fill out its interested vendor form.
7. Enroll wheelchair vans with ODM if you want fee-for-service trips. Apply online in the Provider Network Management (PNM) module as a wheelchair van provider.

Before a county signs with a private company, rule 5160-15-14 requires federal ownership disclosures and, for every driver, a valid license and a certified driving record from the Bureau of Motor Vehicles. Every direct-service employee needs a BCI criminal background check, and the company, its owners, and its staff must clear the SAM and OIG exclusion lists. These checks repeat at each renewal and each new hire.

ODM’s enrollment has its own screening. The 2026 application fee is $750 and is not refundable. You skip it if you paid the fee to Medicare or another state’s Medicaid program within the past five years. Wheelchair vans are high risk at first enrollment, so each owner of 5 percent or more submits fingerprints for a background check within 30 days of applying. ODM or its contractor visits your site before and after enrollment, and may inspect unannounced once you are enrolled. NEMT is not an EVV service, so you upload form ODM 10376 in place of the EVV training certificate. Revalidate at least every five years. See Medicaid provider risk levels.

Licenses and registrations

Your company

File Articles of Organization (Form 610) for an LLC, or Articles of Incorporation (Form 532A), for $99 through Ohio Business Central. Ohio LLCs and for-profit corporations file no annual report. A trade name costs $39 (Form 534A), lasts five years, and renews for $25.

The ambulette application asks for copies of every trade name you use, and one license covers one EIN. Get your EIN free from the IRS. The Secretary of State issues no business license, so ask your city what it requires.

State Board of EMFTS and PUCO

The State Board of Emergency Medical, Fire, and Transportation Services (EMFTS) licenses medical transportation, and the Division of EMS inspects. PUCO registers for-hire passenger carriers. Which you need depends on your riders:

If you carry	You need
Riders who walk, for pay	A PUCO certificate (CPCN)
Wheelchair riders to or from care	The CPCN, an ambulette license, and a permit per van
Riders on a stretcher	A basic life support ambulance license and a permit per ambulance

The Division of EMS says every medical transportation service in Ohio, ambulettes included, must be licensed unless a listed exemption applies. An ambulette service regularly carries riders who use a wheelchair or other mobility aid to health care for a fee, and Ohio Medicaid pays only for trips in permitted vans. Chapter 4766 has no stretcher van license, and its definition of an ambulance leaves out only vehicles used solely for riders who are not on a stretcher, so stretcher trips fall under ambulance licensing. A basic life support non-emergency ambulance carries at least one certified EMT and a qualified driver, and it bills Ohio Medicaid only if the service is also enrolled in Medicare. See starting a stretcher transportation business.

Apply for the ambulette license in the board’s online Medical Transportation Licensing System (MTLS). Paper is not accepted, and you pay by card or ACH. Registering for a login can take up to 24 hours. The application needs your EIN, trade names, headquarters street address (no post office box), each driver and hire date, your Medicaid numbers, and the counties you serve. It also needs each van’s year, make, model, VIN, odometer reading, and a color photo, plus an insurance certificate naming the board as certificate holder with 30 days’ notice of cancellation.

The board must approve or deny a complete license application within 60 days, and each van permit within 45 days. You may ask for a hearing within 10 days of a denial. Licenses and permits last one year. Report changes in owners, officers, or EIN in MTLS within 10 days, and note that a buyer with a new EIN applies from scratch. The Medical Transportation Section is at (614) 466-9447.

PUCO requires every for-hire passenger carrier, whatever the vehicle size, to hold a Certificate of Public Convenience and Necessity (CPCN) and carry liability insurance. Ambulances and taxis are exempt, and the Division of EMS reminds ambulette services of this rule. Get an intrastate USDOT number from FMCSA, apply online, and have your insurer file Form E. You pay $30 per passenger vehicle, then renew each year between May 1 and June 30. PUCO’s transportation line is 800-686-8277.

PUCO counts Medicaid trips as directly compensated. That brings its safety rules for vehicles that carry more than 8 people, driver included, or are rated at 10,001 pounds or more. A vehicle over 10,001 pounds or built for more than 15 people also needs a State Highway Patrol inspection. Trips that cross state lines can bring federal rules; see DOT numbers for NEMT. For how these layers compare with other states, see NEMT license requirements.

Vehicle rules

The Division of EMS inspects each ambulette before its first permit and every year after, and it may inspect unannounced, nights and weekends included. A van with a violation notice stays out of service until it passes reinspection. For a 72-hour notice, it returns once the fix is documented.

A mechanic with manufacturer, EVT, or ASE certification also inspects each van, and signs a Periodic Mechanical Safety Report. The inspection happens before the first permit when the odometer reads 12,000 miles or more, then yearly within six months before your license expires. Past 150,000 miles, it repeats every 25,000 miles.

Every ambulette needs:

• A fire extinguisher, blanket, disinfectants, oxygen equipment, isolation equipment, and first aid equipment.
• Two-way communication with the office, with a 110 volt or 12 volt backup power source.
• A ramp or hydraulic lift, four-point permanent wheelchair fasteners, and a restraint for each rider.
• Secure, mounted storage for equipment and bags. Bungee cords are not allowed.
• Your company name on both sides in 3-inch letters and on the back in 1.5-inch letters.
• The permit decal on the outside of the right rear window, and Ambulette license plates from the BMV.

Door clearance above the raised lift or ramp must be at least 56 inches for vans 22 feet or shorter, and 68 inches for longer vans. Each day, check and log the ramp or lift, securement straps, seat belts, heat, and air conditioning, and clean the passenger area.

Keep maintenance records for 12 months after a van leaves your fleet. Run the vehicle inspection checklist before each state visit, and see wheelchair securement for the tie-down steps.

Driver rules and training

Ohio sets these rules for every ambulette driver:

• At least 18, with a valid license and two years of driving experience.
• A BMV driving record no more than 14 days old at hire, then every year. Six points or more disqualifies a driver.
• A BCI criminal background check, or an FBI check for anyone who has not lived in Ohio for the last five years. Certain convictions under Ohio law disqualify a driver.
• A signed statement from a physician, nurse practitioner, or physician assistant, or a DOT physical, clearing the driver to drive and help riders.
• A drug and alcohol test from a CLIA-certified lab, repeated after any crash in which the driver was driving.

Drivers also hold CPR and first aid cards with hands-on training. The board approves the American Red Cross, American Heart Association, ASHI, National Safety Council, and EMS Safety courses. Every three years, drivers finish a passenger assistance course covering transfers, wheelchair securement, lift operation, and emergencies. The approved commercial courses are the Community Transportation Association of America’s PASS and the Area Agency on Aging’s DRIVE training, and your own course needs board approval.

A new driver may work provisionally for up to 60 days while CPR, first aid, training, and the background check are finished, and up to 14 days for the other items. Each driver wears an ID card showing a first name and last initial, or an ID number, and your company name.

Keep a copy of every driver’s current licenses and certificates, as Medicaid requires. The driver file checklist tracks them, and NEMT driver background checks explains the screening.

Trip rules and how you get paid

Booking notice sets how far ahead your schedule fills. Members book at least:

Plan or county	Book ahead
CareSource	2 business days
Anthem	2 full business days, up to 30 days out
AmeriHealth Caritas, Humana	48 hours
Buckeye	48 business hours
UnitedHealthcare	48 hours
Franklin County	24 hours
Hamilton County	5 days

Anthem lets members book standing rides, such as dialysis, 90 days at a time. AmeriHealth Caritas approves trips of 75 miles or more in advance. Pickup windows and late penalties come from each broker’s agreement and manual, so ask for the manual before you sign. SafeRide asks for a 95 percent on-time rate and a 95 percent ride acceptance rate.

For fee-for-service members, ODM pays the lower of your charge or its maximum. The appendix to rule 5160-15-28, effective August 1, 2026, lists these maximums, all last changed January 1, 2024, in dollars:

Code	Service	Maximum
A0130	Wheelchair van trip	$31.00
S0209	Wheelchair van mileage	$1.30 a mile
T2001	Wheelchair van attendant	$15.00
A0428	BLS ambulance, non-emergency	$203.75
A0425	Ambulance mileage	$5.05 a mile

The same rules set what counts:

• Loaded miles only. Driving to a pickup or back from a drop-off is not paid, and you cannot bill the rider for it. Mileage past 50 miles is capped at 50 unless you document the need.
• Shared rides. Split the shared miles among riders in a reasonable, consistent way.
• Trip codes. Each claim carries origin and destination modifiers, and pairs off ODM’s exempt list go to manual review. UA and UB mark extra same-day trips of the same kind.
• Canceled appointments. You are paid if nobody warned you, using the U6 modifier, with a signed statement from the medical office. An empty vehicle is never paid, so a no-show earns nothing.
• Certification. Wheelchair van trips for these members need form ODM 03452, signed before you bill, for up to 90 days or one year. No one tied to your company may sign it. Health plans may use their own process.

For each trip, keep the vehicle, any attendant’s name, the rider’s Medicaid ID, and the rider’s signature. The ambulette rules add the pickup and drop-off addresses, arrival times, and driver, kept for seven years. Log all of it on a trip log. ODM must receive each claim within 365 days of the ride.

Plan trips pay what your broker agreement says, under rule 5160-15-28, and county trips pay the county contract rate. For a claim ODM routes to manual review, send the certification form and a full description of the trip.

Insurance requirements

The state’s minimums, in dollars:

Rule	Minimum
PUCO, 15 or fewer seats	$1.5 million liability
PUCO, 16 or more seats	$5 million liability
Ambulette license, liability	$500,000 per occurrence and aggregate
Ambulette license, each vehicle	$100,000 a person, $300,000 an accident, $50,000 property

The PUCO limits count the driver’s seat. PUCO insurance must come from an insurer licensed in Ohio, and your insurer files it. If it lapses, you must stop all trips until a new filing is in place. The ambulette certificate lists each van by VIN unless it covers any auto or all owned autos.

Brokers add their own terms. SafeRide asks for $1 million in general liability per occurrence, $2 million aggregate, $500,000 in auto liability, and SafeRide as an additional insured. Ask Provide A Ride and MTM for their limits in writing. See NEMT insurance requirements.

Workers’ compensation comes only from the Ohio Bureau of Workers’ Compensation (BWC), the exclusive provider in Ohio. You need it from the day you hire your first employee. Apply on form U-3 with a $120 minimum fee. An LLC owner taxed as a sole proprietor or partnership may choose coverage. See workers’ comp for NEMT.

What it costs and how long it takes

These are the fees Ohio 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	$99	Secretary of State
Trade name	$39, then $25 every 5 years	Secretary of State
CPCN vehicle tax	$30 per vehicle a year	PUCO
Ambulette license	$100 a year	EMFTS board
Van permit and inspection	$100 per van a year	EMFTS board
Ambulance license	$100 a year, plus $100 per permit a year and $100 per inspection	EMFTS board
Medicaid enrollment	$750 in 2026	ODM
Workers’ compensation	$120 minimum to apply	BWC

A workable order, from first call to first trip:

1. Call the brokers and your county. Ask where they need rides and which service levels they are short on.
2. Form your company, and get your EIN and NPI.
3. Buy insurance that meets PUCO, the ambulette rules, and the broker’s terms.
4. Get your USDOT number and CPCN. Your insurer files with PUCO.
5. Apply in MTLS for the ambulette license and van permits, then pass the inspections.
6. Get BWC coverage before your first hire.
7. Hire and train drivers, with their checks and courses done.
8. Apply to the brokers, the county, and ODM.

The EMS board’s 60-day deadline sets the pace for the state steps, and brokers add providers where they need them. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

• Waiver transportation. PASSPORT and other Ohio Department of Aging programs buy non-medical rides from ODA-certified providers. Rule 173-39-02.18 asks for a backup plan, a yearly ASE mechanic inspection, and drivers who meet the ambulette checks, and a current ambulette license covers the inspection. Developmental disability waivers buy rides under rule 5123-9-18. ODA certification starts with an ODM application, and ODM is not taking new applications from waiver organizations or individuals from May 14 to November 14, 2026, unless CMS extends the pause. Wheelchair van and ambulance enrollment is not paused. See waiver transportation.
• Facilities and hospices. Nursing facilities arrange their residents’ rides, and hospices arrange rides for care related to a terminal illness. See how to get NEMT facility contracts.
• Veterans. The VA pays for special mode transportation, such as an ambulance or a specially equipped vehicle, when the local VA health facility approves the trip in advance.
• Private pay. Riders who pay for themselves, plus dialysis centers and hospitals, add work that does not depend on one broker.