How to Start a NEMT Business in Rhode Island (2027)

Rhode Island runs every Medicaid ride through one broker. MTM Health arranges NEMT trips statewide for the Executive Office of Health and Human Services (EOHHS), and you sign your agreement with MTM, not with Medicaid. Since a 2024 law, you also need an NEMT certificate from the Division of Public Utilities and Carriers. The rules below follow MTM’s Rhode Island provider handbook as updated July 1, 2026 and the state’s contract with MTM effective July 1, 2025.

How Medicaid rides work in Rhode Island

EOHHS runs Rhode Island Medicaid and pays one broker a monthly capitation rate for each enrolled member, whether or not the member rides. For the year that ended June 30, 2026, that was $1.21 a month per child 18 or younger, $12.65 per adult aged 19 to 64, and $29.64 per member 65 or older. The broker books each trip, assigns it to a transportation provider, and pays the provider.

MTM Health has been the broker since January 1, 2019. Its current contract took effect July 1, 2023, ran to June 30, 2026, and allows yearly renewals through June 30, 2029. In testimony dated April 27, 2026, EOHHS told the state caseload conference it is extending the contract for the fiscal year that began July 1, 2026. It put average Medicaid enrollment at about 293,700 members a month for the year that ended June 30, 2026, and said fewer than 5 percent of enrollees use rides.

The contract covers Medicaid members in managed care and fee-for-service who have no other way to reach a covered service, including Rhode Island’s VA medical centers. It also covers the Elderly Transportation Program (ETP), a non-Medicaid program for Rhode Islanders 60 and older who get no rides from RIPTA’s RIde, free bus, or ADA programs, and RIPTA bus passes for RI Works families.

MTM serves every city and town in Rhode Island, plus border communities that Medicaid treats as in state. Other out-of-state trips need MTM’s prior approval.

State	Border communities
Connecticut	Danielson, Groton, Moosup, Mystic, New London, North Stonington, Pawcatuck, Putnam, Stonington, Thompson, Waterford
Massachusetts	Attleboro, Bellingham, Blackstone, Dartmouth, Fall River, Foxboro, Milford, New Bedford, North Attleboro, North Dartmouth, Rehoboth, Seekonk, Somerset, South Attleboro, Swansea, Taunton, Uxbridge, Webster, Westport, Whitinsville

Members book at least 48 hours (two business days) before a routine appointment, and urgent care rides must be completed within three hours of the request. A member who lives, and has an appointment, within half a mile of a bus stop and can get to the stop gets a bus pass, and a friend or relative who drives gets $0.32 a mile under the July 2026 handbook. Everyone else rides in provider vehicles:

• Ambulatory. Members who can walk to the vehicle. The contract keeps rideshare off dialysis and adult day care trips, children 15 and under without an adult, and members with dementia or disabilities, so those trips go to providers.
• Wheelchair. Members who cannot transfer from a mobility device. A doctor may need to send MTM a Level of Need form.
• Stretcher. Members who cannot sit in a wheelchair and need no medical care on the way, with a driver and an assistant.
• Ambulance. Members who need medical care in transit, carried by licensed ambulance services.

An escort must ride with every child under 18 and brings the car seat.

How to join MTM Health, Rhode Island’s Medicaid broker

You do not enroll with Rhode Island Medicaid to give NEMT rides. The state’s transportation rule says providers join by signing an agreement with the broker, which recruits every provider. As of September 2026, MTM adds Rhode Island providers only as needed, keeps a waitlist, and estimates 8 to 12 months before a new provider gets the chance to contract. See what to do when a broker network is full.

1. Join the waitlist on MTM’s Rhode Island transportation provider page. MTM also holds virtual information sessions twice a year and posts the next date there.
2. Apply and interview. When a spot opens, send MTM’s provider application, and a network representative interviews you.
3. Sign the agreement. The state contract requires a signed agreement before you carry any member, and an MTM inspection of every vehicle before signing.
4. Get credentialed. Upload company, driver, and vehicle documents to the MTM Link portal, including your NEMT certificate.
5. Train and start. Drivers complete the required courses. MTM sends trips through MTM Link, or by API to your own dispatch software.

MTM screens owners, drivers, and employees against federal and state exclusion lists, including the HHS OIG exclusion list. The state contract also requires every provider to keep a physical address in Rhode Island and to register with the Rhode Island Department of State.

The contract protects applicants too: MTM must contract with any provider willing and able to meet the program rules, and if it declines to add you, it must tell you why in writing.

MTM’s 24/7 Rhode Island provider hotline is 888-597-1180, and its provider email is providerinquiries@mtm-inc.net. Our MTM Health guide covers the company in its other states.

Licenses and registrations

Your company

Register an LLC or corporation with the Rhode Island Department of State. As of September 2026, an LLC’s Articles of Organization (Form 400) cost $150, and a business corporation costs $230. Your registered agent needs a Rhode Island street address.

An LLC files an annual report (Form 632) each year after the year it forms, between February 1 and May 1. It costs $50, plus $25 if not filed by May 31. Every LLC and corporation also owes the Division of Taxation a minimum tax of $400 a year, even in a year with no business.

Get your employer identification number (EIN) free from the IRS. The state contract lets EOHHS require an NPI and Medicaid portal enrollment on a timeline it sets, so see how to get an NPI number. Ask your city or town about a local license, because MTM must keep copies of the local permits required where you operate.

Division of Public Utilities and Carriers

The Motor Carriers Section of the Division of Public Utilities and Carriers (DPUC), 89 Jefferson Boulevard, Warwick, regulates for-hire passenger carriers. Chapter 39-14.3 of the General Laws, effective August 1, 2024, made NEMT its own class of carrier. EOHHS required every contracted provider to hold the new NEMT certificate by October 31, 2024, in place of the public motor vehicle (PMV) certificate NEMT companies held before.

If you	You need
Carry Medicaid or ETP riders that MTM assigns	An NEMT certificate from DPUC
Carry private-pay or facility riders for hire	Other DPUC authority, such as a PMV certificate, and separate vehicles
Drive any of those vehicles	A chauffeur license or CDL and a DPUC Blue Card
Carry members who need medical care in transit	An ambulance license from the Department of Health

Under the statute, the NEMT certificate works like this:

• Apply. File a written application with the Motor Carriers Section and the $125 fee. DPUC mails you a hearing notice and posts it online, and its July 2026 notice says applicants must appear in person.
• Prove you are fit. DPUC grants the certificate only if it finds you fit, willing, and able to provide the service.
• Register vehicles and insurance. Before a vehicle carries a rider, list its year, make, model, and plate with DPUC, and file a certificate of insurance.
• Renew every year by the close of business on December 31, for $100, with fresh proof of insurance.

Taxicab companies may give NEMT rides under their taxi certificate, and RIPTA and licensed ambulance companies are exempt. A PMV certificate holder still needs an NEMT certificate for NEMT work. See NEMT license requirements for how licensing works in other states.

Vehicle rules

Every NEMT vehicle carries Public Service plates from the DMV, which inspects it before registering it and every year after, for a fee the DMV sets. MTM inspects each vehicle before your agreement is signed and again within 12 months of the last inspection. A vehicle that fails either one comes out of service until it is fixed.

EOHHS also limits age and mileage, under its policy effective October 31, 2024:

Added to your fleet	At first inspection	Leaves service at
After July 31, 2024	4 model years old or newer, at most 150,000 miles	250,000 miles
Before July 31, 2024	Already approved	300,000 miles

The same policy requires a dedicated fleet: vehicles on your NEMT certificate cannot be used for any other transportation.

Under the state contract, every vehicle needs:

• A two-way phone or radio to your office, and working GPS that reports to MTM.
• Heat that reaches 72 degrees and air conditioning that reaches 68, measured at the rear.
• A seat belt for every seat, two seat belt extensions, and a seat belt cutter within the driver’s reach.
• An accurate speedometer and odometer, an inside mirror, a first aid kit, and a step stool when needed.
• A clean body and interior, and a packet with the registration, insurance card, latest MTM inspection form, and accident forms.
• English and Spanish no smoking and seat belt signs, plus MTM’s phone numbers posted inside.
• No word “Medicaid” on the vehicle or in your business name.

Outside, each vehicle carries the EOHHS sign on each side, centered on the door: black text on white with your NEMT certificate number, “RI EOHHS NON-EMERGENCY MEDICAL TRANSPORTATION,” and your MTM provider code. No company name or logo may be added, and you send receipts for every sign.

Wheelchair vans must meet the ADA rules in 49 CFR Part 38, with at least 56 inches from floor to ceiling, an interlock that keeps the van parked while the lift is out, and a powered lift rated for 600 pounds on a platform at least 30 by 48 inches. Each wheelchair position needs a securement system tested to 30 mph and 20 g, and a seat belt or shoulder harness for the rider.

Under the state rule, wheelchair van drivers do not enter the member’s home, while a stretcher pickup requires the driver to go in. Run the vehicle inspection checklist and the wheelchair securement checklist before each MTM inspection.

Driver rules and training

Every driver needs three approvals before carrying riders for pay:

1. A chauffeur license or a CDL. The DMV’s checklist (revised July 2020) asks for the application, your license, your Social Security card, and a BCI criminal record report from the Attorney General’s office no more than 30 days old.
2. A DPUC Blue Card, the hackney operator’s license. Apply with a certified driving record and a BCI report, both from the last 30 days. DPUC decides within 10 business days, or up to 30 more days for cause, and the card lasts one year.
3. MTM approval, before the first trip and again every year.

DPUC turns down a Blue Card for anyone under 21, and for anyone with:

• Two moving violations within 12 months, or three in all, in the last 36 months.
• Three non-moving violations within 12 months in the last 36 months, not counting parking tickets.
• Three accidents in the last 24 months.
• An alcohol-related offense, or a District Court traffic conviction, in the last five years.
• A misdemeanor in the last year, a series of misdemeanors in five years, or a felony in 10 years.

MTM’s handbook adds its own rules:

• No license suspension or revocation for moving violations in the last five years.
• No conviction for health care fraud, patient, child, or elder abuse, domestic violence, sexual misconduct, theft or other financial misconduct, assault and battery, drugs, or weapons.
• No other felony, and no sex offender registry listing, in the last 10 years.
• A state BCI check before hire and every year, or a national NCIC check for a driver who has not lived in Rhode Island for five straight years.
• A five-panel drug test before hire and after an accident, with random tests covering more than 25 percent of drivers each year. See NEMT driver drug testing.

Each year, every driver completes CPR, first aid, defensive driving, passenger assistance, HIPAA, cultural competence, sexual harassment, and wheelchair and stretcher training, the CTAA PASS course, and at least 12 hours of in-service training. MTM adds fraud, waste, and abuse training. Track each course on a driver training log.

Your company calls each rider 24 hours ahead to confirm the pickup. Drivers wear a photo nametag, keep their DPUC ID visible, and see each rider safely inside before leaving. They never smoke, eat, text while driving, or carry a private-pay passenger on a Medicaid or ETP trip.

Two contract rules reach payroll. Pay drivers and staff on time, and only under the standard driver pay method EOHHS approved: paying per rider carried or per mile driven is prohibited. Read 1099 or W-2 drivers before you set pay, and keep program records open to EOHHS for 10 years after your agreement ends.

Trip rules and how you get paid

Your MTM agreement carries the state’s service standards:

• Pickup. The rider does not have to board before the scheduled time, and you do not have to wait more than 10 minutes after it, but call or text before you leave. A pickup more than 15 minutes off the stated time is not on time.
• Will-call returns. Arrive within 45 minutes of the call. See will-call trips.
• Shared rides. The contract allows 45 minutes over the direct trip, but the state rule says adding riders may not lengthen a trip by more than 30 minutes. Plan to 30. See multiloading.
• Addresses. Drive only to the addresses on the manifest, and call MTM before any change.
• Turnbacks. You cannot turn back a same-day trip or one you took from the Marketplace. Turn back others at least 24 hours before the appointment. See broker trip offers.

MTM does not guarantee payment for a trip without its trip ID. Submit claims in MTM Link within 90 days of the date of service. A clean claim carries an electronic trip log with the trip ID, scheduled pickup, actual pickup, departure, and arrival times, the member’s signature, and the driver’s printed name. The MTM driver app or approved dispatch software fills in the log, but drivers keep paper trip logs as a backup.

The state contract and the handbook’s claims section give you 365 days from a denial to appeal, but the handbook’s portal guide says 90 days, so appeal within 90. See how to appeal a denied claim.

The state contract also sets MTM’s payment clock. MTM runs at least one payment cycle a week, by check or direct deposit, and must pay clean claims within 30 days of receipt. A clean claim left unpaid after 30 days earns 12 percent a year in interest.

Rhode Island does not leave rates to negotiation. The state contract requires one rate sheet for all providers, posted publicly, and MTM cannot lower it without EOHHS approval. MTM’s Schedule A, effective July 1, 2023 and still current in September 2026, pays per one-way trip, with the base covering the first 5 loaded miles:

Ride type	Base	Per mile
Ambulatory	$17.75 ($21.75 after hours)	$1.75
Wheelchair	$28.50 ($34.50 after hours)	$2.50
Stretcher	$175.00 ($190.00 after hours)	$4.50
Bariatric stretcher	$300.00 ($315.00 after hours)	$4.50

After-hours rates apply to appointment times from 5:00 p.m. to 4:59 a.m. The table covers pickups within 40 miles of where you keep your vehicles, and each rate is $1.31 higher beyond that. Attendants and door-to-door help earn no extra fee. Schedule A also lists lower ambulatory group rates for riders going to or from the same place with appointments within the same hour: $15.75 when they share both pickup and drop-off, and $16.75 when they share one.

For example, a 12-mile daytime wheelchair trip picked up near your garage pays $28.50 plus 7 miles at $2.50, or $46.00. The same trip for an ambulatory rider pays $30.00.

As of September 2026, MTM does not pay for no-shows or cancellations at the door, so confirm each ride the day before. See billing for no-shows. NEMT is not on Rhode Island’s electronic visit verification (EVV) list, which covers personal care and homemaker services (since January 1, 2021) and home health care services (since January 1, 2023).

MTM grades providers every quarter. Green means late trips under 4.99 percent, turnbacks under 3.99 percent, and GPS compliance above 90.01 percent, among other measures, and falling short can bring an improvement plan or removal. MTM’s Q4 2024 scorecard listed about 90 providers, and most ran three vehicles or fewer.

Upload renewed credentials at least 10 business days before they expire. Report injuries and other serious incidents by phone right away and in writing within 24 hours. A missed reporting rule costs $500, so keep an incident report form in every vehicle.

Insurance requirements

MTM’s Rhode Island page lists these, as of September 2026:

Item	What MTM asks for
General liability	At least $1.5 million
Auto liability	At least $1.5 million
Both policies	MTM as certificate holder and additional insured
Workers’ compensation	Coverage that meets state requirements

State law sets its own floor. The owner of each NEMT vehicle files a certificate of insurance with DPUC, from an insurer authorized in Rhode Island, and files it again at each yearly renewal:

Coverage	Minimum
Injury to persons	$1,500,000
Damage to property	$100,000

Ask your agent for both MTM’s limits and the certificate of insurance DPUC needs. See NEMT insurance requirements for what brokers ask elsewhere.

Rhode Island’s workers’ compensation law covers every employer that regularly employs employees. Its definition of employee leaves out sole proprietors and LLC members, unless a member also works under a contract of service. Once you hire drivers or dispatchers, you need a policy.

What it costs and how long it takes

These are the fees Rhode Island sets, as of September 2026. Vehicles, premiums, and equipment depend on your quotes; see what it costs to start a NEMT business.

Item	Cost	Paid to
EIN	Free	IRS
LLC filing	$150	Department of State
LLC annual report	$50, plus $25 after May 31	Department of State
Minimum business tax	$400 a year	Division of Taxation
NEMT certificate	$125	DPUC
NEMT certificate renewal	$100 a year	DPUC

A workable order, from first call to first trip:

1. Join MTM’s waitlist. At 8 to 12 months, estimated in September 2026, it is the longest step, so start it first.
2. Form your company with a Rhode Island address, and get your EIN.
3. Apply for your NEMT certificate and attend the DPUC hearing.
4. Line up vehicles and insurance that meet the age, mileage, and $1.5 million limits. Hold off on buying until MTM’s timing is clear.
5. Register each vehicle on Public Service plates, pass the DMV inspection, list it with DPUC, and file your insurance.
6. Hire drivers and get each one a chauffeur license, a Blue Card, a BCI check, and a drug test.
7. When MTM calls, interview, pass MTM’s vehicle inspection, sign, upload credentials, order the EOHHS door signs, and train.

For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

• Elderly Transportation Program. ETP rides come through MTM under the same agreement, including wheelchair trips but never stretcher or ambulance trips. ETP riders owe a co-pay for each trip segment, set by EOHHS ($2.00 each way in its August 2023 rider FAQ), with some exemptions, and the driver collects and keeps it.
• Private pay and facilities. The 2024 law says a facility arranging a patient’s discharge is not NEMT, and EOHHS keeps NEMT vehicles for NEMT only. Rides you sell to the public or to facilities need other DPUC authority. The public motor vehicle (PMV) certificate covers prearranged rides: it costs $250, needs its own hearing, and renews by December 31 for $100. PMV vehicles must be unmarked, no more than four model years old when first put in service, and charge at least $40 a trip unless a state agency books the ride by the day before. See private pay NEMT and facility contracts.
• Veterans. Medicaid members’ rides to Rhode Island’s VA medical centers go through MTM. For other veterans, VA pays for special mode transportation when the trip is medically required, the veteran cannot pay for it, and VA approved it in advance. Ask the beneficiary travel office at your nearest VA medical center how it books these rides.
• Neighboring states. Connecticut and Massachusetts run their own programs and licensing.