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

South Carolina runs Medicaid rides through one broker. Modivcare arranges Healthy Connections Medicaid trips in all 46 counties while the state rebids the contract. To drive those trips, you need a registered company, a Class C Non-Emergency certificate, $1 million in liability cover, and vehicles and drivers that meet the state’s motor carrier rules as amended May 23, 2025.

How Medicaid rides work in South Carolina

The South Carolina Department of Health and Human Services (SCDHHS) runs Healthy Connections Medicaid and provides NEMT through a transportation broker. The broker takes ride requests, assigns each trip to a transportation provider, and pays the provider. It cannot give rides itself or send trips to a company it has a financial relationship with.

Today SCDHHS pays the broker under what its June 26, 2026 bid calls a fee-for-service model. The new contract would pay one broker a fixed monthly amount for each member, a capitation model. See South Carolina’s broker rebid for every date in that process.

Modivcare covers all three regions:

Region	Counties	Includes
Region 1	12	Greenville, Spartanburg, Anderson, Pickens
Region 2	18	Richland, Lexington, York, Aiken
Region 3	16	Charleston, Horry, Berkeley, Florence

A member qualifies for rides to services Medicaid covers when they have no other way to get there: doctor visits, dialysis, x-rays, lab work, and the drug store. Members call at least three days before the appointment, Monday to Friday from 8 a.m. to 5 p.m., and cancel at least 24 hours ahead. Rides are covered anywhere in South Carolina and to places within 25 miles of the state line. If any part of a metro area such as Charlotte, Augusta, or Savannah is within 25 miles, the whole metro area counts.

The state plan’s ride types run from public transit and gas reimbursement to ambulatory, wheelchair, stretcher, bariatric, ambulance, and air trips. Under Modivcare’s policy, a member whose pickup and drop-off are both within a quarter mile of a bus stop gets bus tickets, unless a medical professional certifies that they cannot ride the bus.

Where the rides go

The bid’s own data counts about 3.79 million rides in state fiscal year 2025, July 2024 through June 2025. Adult day care and dialysis made up more than half of them:

Trip purpose	Rides, SFY 2025
Adult day care	1,288,159
Dialysis	731,143
Mental health	248,959
Methadone treatment	230,866
Doctor visit	129,251
All other purposes	1,159,898

Since July 1, 2022, adult day health care rides within 15 miles of a member’s center have gone through Modivcare too. Before that, the center gave those shorter rides itself. Centers may contract with Modivcare to keep giving them. See adult day care transportation and dialysis transportation for how these standing routes run.

Rides outside the broker

Some Medicaid rides never reach Modivcare:

• Emergency ambulance trips, which start with a 911 call.
• Nursing home residents. Nursing homes arrange and pay for their residents’ rides, because their Medicaid rate includes transportation.
• Special needs transportation that certain state agencies, such as the Department of Social Services, give to designated groups under contract with SCDHHS.
• Ambulance trips for managed care members, including non-emergency stretcher trips by ambulance. SCDHHS’s July 1, 2019 ambulance manual puts these on the member’s health plan.

How to join Modivcare, South Carolina’s Medicaid broker

You do not enroll with SCDHHS to give broker trips. The state plan makes the broker responsible for recruiting and contracting transportation providers, checking that they follow its contract, and paying them. On October 2, 2025, the state’s Chief Procurement Officer wrote that Modivcare had been the only company under contract for this work for the past 18 years. The steps:

1. Get your state certificate first. Apply for the Class C Non-Emergency certificate described below. In a letter filed with the Public Service Commission in April 2022, Modivcare’s South Carolina office said one provider’s delayed certificate had forced it to bring in companies from other parts of the state.
2. Contact the network team. SCDHHS’s June 2022 bulletin lists SCNetwork@modivcare.com and 866-910-7684 for companies that want to contract with Modivcare in South Carolina. Modivcare’s provider page also has a join form and a map of the areas where it most needs providers.
3. Meet the credentialing list. As of September 2026, Modivcare’s provider page asks for PASS wheelchair training, first aid and CPR, defensive driving, a drug screen, a motor vehicle report, and a background check for each driver, plus current registration and proof of insurance for each vehicle.
4. Complete compliance training. Under Modivcare’s 2025 attestation, owners and drivers take its compliance training (fraud, waste, and abuse, HIPAA, the ADA, and safety) when you contract and every year, and new hires within 30 days. Keep the records for at least 10 years.
5. Start taking trips. Keep Modivcare’s accident and incident report form in every vehicle, and tell Modivcare right away about any accident, incident, or moving violation.

Since December 15, 2021, SCDHHS has also required that no NEMT provider or driver is on the OIG exclusion list, that every driver has a valid license, and that each provider has a process to deal with state drug law violations and to disclose each driver’s driving history to the Medicaid program.

Modivcare’s 2023 presentation, posted by SCDHHS, lists its South Carolina administrative line as 866-910-7684 and its Provider Assist line as 866-910-7690. Our Modivcare guide covers the company in its other states, and broker credentialing shows how to keep your files ready.

Licenses and registrations

Your company

Form an LLC with the South Carolina Secretary of State. Articles of organization cost $110 under S.C. Code section 33-44-1204. A corporation’s articles must be signed by a South Carolina lawyer and filed with the Department of Revenue’s CL-1 form. Then order a Certificate of Existence for $10, because the Public Service Commission asks for it, or your articles, with your application.

Get your employer identification number (EIN) from the IRS, which never charges for one, and a business license from each city or county that requires one. South Carolina business licenses run from May 1 to April 30. The draft contract for the next broker lists a National Provider Identifier among its credentialing papers, so see how to get an NPI number.

Public Service Commission and Office of Regulatory Staff

South Carolina regulates for-hire passenger carriers through two agencies. The Public Service Commission (PSC) decides who gets a certificate. The Office of Regulatory Staff (ORS) issues it, inspects carriers, and collects the vehicle fees. State law bars carrying passengers for pay, or advertising that you do, without a certificate.

If you	You need
Carry riders to or from medical facilities in non-emergency situations	A Class C Non-Emergency certificate
Carry riders on a stretcher who cannot ride in a wheelchair van	A Class C Stretcher Van certificate
Carry prearranged riders on other trips, in vehicles for up to 15 passengers	A Class C Charter certificate

State law exempts a carrier that works only inside one city’s limits. The Non-Emergency application, amended September 26, 2024, asks for:

• Your Certificate of Existence or articles, with your business name written the same way throughout.
• The counties you want to serve, or statewide. You may operate only in the counties you check.
• Each vehicle’s VIN and seating, 1 to 7 or 8 to 15 people with the driver. You can apply before you own a vehicle, but you need one before ORS issues the certificate.
• An insurance quote at the minimum limits. You buy the policy only after approval.
• A notarized signature.

Send the cover sheet, the application, and attachments to both the PSC Clerk’s Office (Contact@psc.sc.gov, 803-896-5100) and the ORS Transportation Department (Transportation@ors.sc.gov, 803-737-0800). Incomplete applications are returned. From there:

1. Notice. The PSC assigns a docket number and posts your application on its website for 15 days.
2. Decision. If no one objects, the Commission decides at a meeting whether you are fit, willing, and able. If someone objects, it must schedule a hearing within 60 days of the objection, and an LLC or corporation needs a lawyer.
3. Compliance. ORS emails a compliance letter within about a week of the PSC order. You then have 90 days from the order to have your insurer file Form E, file your maximum rates with the PSC and ORS, pass the ORS inspection of your vehicles and driver files, and register your vehicles. Extensions of up to a year are possible for good cause.
4. Certificate. ORS mails and emails the certificate. Operating before you have it is prohibited.

A denied applicant waits six months to apply again. Register every vehicle with ORS for $50 a year under S.C. Code section 58-23-560, paid before January 1, through the ORS vehicle registration portal. ORS starts each year’s renewals on November 15. Mark each vehicle with your company name on both sides and the rear and your PSC number on both sides, in letters at least 3 inches high.

The state’s rules define trips between South Carolina and another state as interstate commerce. For rides into Charlotte, Augusta, or Savannah, see DOT numbers for NEMT for when federal rules apply. For how licensing layers work in every state, see NEMT license requirements.

Vehicle rules

ORS inspects every vehicle and driver file before it issues your certificate. After that, inspect each vehicle every year on the ORS Record of Annual Non-Emergency Vehicle Inspection form, revised July 2021, and keep one form per vehicle at your office for ORS inspectors. The form covers brakes, lights, seat belts, wheelchair tiedowns and lifts, steering, tires, and the first aid kit. ORS can take a vehicle out of service for any defect, and any problem with the wheelchair lift fails the inspection. Drivers also check each vehicle before work every day.

The rules, as amended May 23, 2025, list this equipment for non-emergency vehicles, and you certify on a Commission form that your vehicles meet it:

• A seat belt for every passenger seat.
• Working lights, wipers, horn, hazard flashers, heat, and air conditioning.
• Door locks that work from inside and outside, and clean seat covers.
• A foot stool or extra step for boarding.
• A spare wheel, jack, and tire tools.
• A type ABC fire extinguisher of at least 4 pounds, inspected every year.
• Mirrors on both sides with no chips or cracks.
• A two-way radio or cell phone that reaches a dispatcher.
• Emergency warning devices.
• A No Smoking sign whenever oxygen is carried, with the tanks secured.

ORS’s vehicle checklist, revised July 2021, also lists a first aid kit with a CPR face cover, gloves, gauze, a spill kit, a blanket, two flashlights, and three emergency triangles.

Wheelchair vans need a lift or ramp that meets state and federal standards. Tiedowns must be strong enough to keep the chair from turning and its wheels on the floor, and to hold chair and rider if the van overturns. The inspection form also checks shoulder harnesses at wheelchair and stretcher positions. Run through our vehicle inspection checklist before each ORS visit, and see NEMT vehicle requirements for vehicle types in general.

A stretcher van carries one stretcher passenger at a time, loaded headfirst on an elevating wheeled stretcher with chest, waist, and thigh straps and crash-stable fasteners. It carries no medical equipment or ambulance markings, and it may not carry anyone who needs medical monitoring, IV fluids, or suctioning.

Driver rules and training

The ORS rules for non-emergency carriers, as amended May 23, 2025, and the SCDHHS provider requirements set these limits. A person cannot drive for you if they:

• Are under 18.
• Do not have a valid driver’s license. ORS’s driver file checklist accepts one from South Carolina or the driver’s home state.
• Are registered, or required to register, as a sex offender with the South Carolina Law Enforcement Division (SLED) or any national registry. A driver who is added must tell ORS and you, and stop driving at once.
• Are excluded from federal health care programs or listed on the OIG exclusion list.

Each driver’s file stays at your main place of business in South Carolina and holds:

• A copy of the license.
• A current DOT medical examiner’s certificate.
• Red Cross standard first aid and CPR, or an equivalent.
• A certified three-year driving record from the South Carolina DMV, plus the record from any other state the driver lived in during that time. ORS’s checklist asks you to update it every year.
• A national criminal history background check.
• A sex offender registry search from SLED or the National Sex Offender Public Website.
• Drug test results. Your program must test before hiring, after any accident, and at random.

Drivers complete 12 hours of in-service training every year: 6 in CPR and first aid and 6 in safety. They must know the vehicle’s equipment, be able to physically help riders with disabilities, and follow OSHA rules. Stretcher van crews also train in loading stretcher passengers, renew adult CPR every year, and renew first aid every three years.

On the job, drivers wear a professional uniform and a photo ID badge that shows who they are and who they work for. No driver may drive more than 12 hours in any 24-hour period. A stretcher van runs with a driver and an assistant, who rides in the back and never leaves the passenger alone.

The draft contract for the next broker would add limits: no license suspension for a moving violation in five years, no more than two chargeable accidents or moving violations in three years, and random drug and alcohol tests. Our driver file checklist and drug and alcohol policy keep these records in order.

Trip rules and how you get paid

Modivcare’s published South Carolina rules shape each day’s work:

• Pickup wait. A driver waits no more than 10 minutes past the scheduled pickup time. After that, the rider is a no-show and the ride is canceled.
• Hospital discharges. Only hospital staff book them, at least 3 hours ahead for a same-day discharge, and the provider has 30 minutes to 3 hours to respond and pick up. See hospital discharge transportation.
• Standing orders. A facility can book a member who attends 3 or more days a week for at least 12 weeks in one request, and Modivcare rechecks each order every three months. See standing orders.
• Stretcher and ambulance trips. A medical necessity form is required. On the August 28, 2025 version, a physician, nurse practitioner, or physician assistant can certify up to 90 days, and a registered nurse’s signature covers one trip.
• Riders. You carry the rider and their medical equipment only, no packages. A child under 15 needs an escort, and the provider does not supply one.

The state does not set your rate. SCDHHS publishes an ambulance fee schedule, but Modivcare negotiates each provider’s rate in its provider agreement and pays you, and bidders for the next contract must propose their own fee schedules for transportation providers. The draft contract posted June 26, 2026 would set these terms, and the final contract can still change:

Topic	Draft terms
Pay	At least weekly, with undisputed invoices paid within 30 days
New providers	Claims from providers enrolled under six months reviewed first
On time	90% of non-urgent trips to appointments picked up within 15 minutes
Ride time	85% of rides no more than 30 minutes over the direct route time
Tracking	GPS in every vehicle
Stretcher vans	Allowed with prior authorization, billed per mile

The draft lets the broker pay only 12 billing codes, including A0130 for wheelchair vans and T2049 for stretcher vans. If the broker changes, our broker transition checklist covers final claims and credentialing.

Insurance requirements

The state’s minimums for non-emergency and stretcher van carriers are set in rule 103-133 and repeated on both applications:

Coverage	Minimum
Liability, combined, each occurrence	$1,000,000
Medical payments, each person	$1,000

Your insurer must be licensed or admitted in South Carolina, and it files Form E with ORS itself. ORS accepts only a Form E as proof of commercial insurance, and the name on it must match your PSC order.

Modivcare’s provider page, as of September 2026, asks for:

Cover	What Modivcare asks for
General liability	Bodily injury, property damage, and personal injury
Sexual abuse and molestation	Listed, with higher limits if needed
Auto liability	At least your state’s minimum limits
Workers’ compensation	Where your state requires it

Modivcare says its limits vary by state, so ask the network team for South Carolina’s numbers in writing before you buy. For what brokers ask for elsewhere, see NEMT insurance requirements.

South Carolina’s workers’ compensation law does not apply to an employer that regularly employs fewer than four people in the business in the state, or that paid less than $3,000 in total payroll in the previous calendar year. Once you pass both marks, you need coverage. See workers’ comp for NEMT.

What it costs and how long it takes

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

Item	Cost	Paid to
EIN	Free	IRS
LLC articles of organization	$110	Secretary of State
Certificate of Existence	$10	Secretary of State
Vehicle registration	$50 per vehicle a year	ORS
Business license	Set by each city or county	City or county

A workable order, from first call to first trip:

1. Call Modivcare’s network team. Ask which counties and service levels it needs.
2. Form your company, get your EIN, and order a Certificate of Existence.
3. Get an insurance quote for $1,000,000 combined liability and $1,000 medical payments.
4. File the Class C Non-Emergency application. It posts for 15 days, and an objection adds a hearing, scheduled within 60 days.
5. Comply within 90 days of the order. Have your insurer file Form E, file your maximum rates, equip and mark your vehicles, pass the ORS inspection, and register each vehicle.
6. Hire drivers and build each file, and get your city or county business license.
7. Send Modivcare your documents, finish its training, and sign the provider agreement.

Two steps set the pace: an objection to your application, and Modivcare’s need for providers where you are. 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.

• Nursing homes. Each nursing home arranges and pays for its residents’ rides, so you can contract with homes directly, along with dialysis centers, hospitals, and private pay riders. See how to get NEMT facility contracts. Your Non-Emergency certificate covers trips to or from medical facilities only; other rides need a Class C Charter or Taxi certificate.
• Public transit programs. In rural areas and cities under 200,000 people, the SCDOT Office of Public Transit passes federal Section 5310 funds to nonprofits and public bodies serving older adults and people with disabilities, and the money can buy transportation service contracts. See Section 5310 grants.
• Veterans. The VA pays for special mode transportation, such as a wheelchair van, when a VA provider decides a veteran needs it and the trip is approved in advance. Ask the beneficiary travel office at your nearest VA facility how it buys these rides.
• Other plans through Modivcare. Modivcare’s South Carolina facility page, as of September 2026, lists ride lines for several Medicare Advantage and group retiree plans. Ask the network team whether your agreement can include those trips.