# How to Start a NEMT Business in Texas (2027)

Canonical URL: https://nemtguide.com/states/texas/ · Updated 2026-09-28

To start a NEMT business in Texas, form your company with the Secretary of State, get an NPI, and enroll in Texas Medicaid through TMHP. Then apply to SafeRide Health and MTM Health, the ride vendors for the state's Medicaid health plans from October 1, 2026. Texas has no separate NEMT license. TxDMV motor carrier registration applies only to vehicles built for more than 15 passengers.

- Texas Medicaid rides run through health plans, and from October 1, 2026 every plan on the state's list uses SafeRide Health or MTM Health.
- Enroll in Texas Medicaid through TMHP first. Plans and their vendors may not contract with a transportation company that is not enrolled.
- Texas has no separate NEMT license. TxDMV registration applies only to vehicles built for more than 15 passengers, and most vans no longer get a state safety inspection.
- The state handbook sets the floor for drivers, vehicles, and timing, including $750,000 in auto coverage and training within 30 days of hire.
- Fee-for-service trips pay a flat state rate by area type, and every claim is due within 95 days of the ride.

## Texas NEMT at a glance

| Fact | Details |
| --- | --- |
| Medicaid agency | Texas Health and Human Services Commission (HHSC). Health plans cover rides through ride vendors, and HHSC pays fee-for-service rides through TMHP at state rates. |
| How rides work | Each Medicaid health plan hires a ride vendor for its service areas. Members without a plan ride through the state's Medical Transportation Program (MTP). |
| Medicaid brokers | SafeRide Health (6 plans) and MTM Health (8 plans from October 1, 2026, when Blue Cross and Blue Shield of Texas moves from Modivcare) |
| How to join | Enroll your company in Texas Medicaid through TMHP's online PEMS portal, then apply to SafeRide Health and MTM Health for the plans in your counties |
| State registration | No state NEMT license. TxDMV motor carrier registration and a USDOT number only for vehicles built for more than 15 passengers, driver included. |
| Insurance | Plan rules: $750,000 combined single limit auto, $1 million per occurrence and $2 million aggregate general liability, and workers' comp with $1 million employer's liability |
| Drivers | At least 18 with a valid license, no DWI in the 7 years before hire, no more than one moving violation in 12 months, and state and national background checks |
| Vehicle inspections | No state safety inspection for most NEMT vans since January 1, 2025. Vehicles built for more than 15 passengers still need one. Vendors keep, or have you keep, each vehicle's inspection history. |
| Pay | Your ride vendor pays the rate in your contract. State fee-for-service trips pay $33.83 to $79.63 by area type from September 1, 2026. Claims are due within 95 days. |
| EVV | Not required for NEMT. Texas EVV covers Medicaid personal care services and home health care services. |

Texas runs Medicaid rides through its health plans. Each plan hires a ride vendor, and from October 1, 2026 that vendor is SafeRide Health or MTM Health for every plan on the state's list. Members without a health plan ride through the state's Medical Transportation Program, which pays enrolled companies set rates. The rules below follow chapter 16.4 of the Uniform Managed Care Manual (version 2.0.1) and the September 2026 Medical Transportation Program Handbook.

## How Medicaid rides work in Texas

The Texas Health and Human Services Commission (HHSC) runs Medicaid. Members in a managed care program, such as STAR, STAR+PLUS, STAR Kids, or STAR Health, get rides through their health plan. Each plan must approve, arrange, and deliver rides for its members, and it may hire a subcontractor to do it. Texas calls that subcontractor the plan's medical transportation service provider. Most owners call it a [broker](https://nemtguide.com/glossary/nemt-broker/).

A 2025 state audit describes the setup for one plan: the plan pays its vendor for trip costs plus an administrative fee, and the vendor pays the transportation companies. Your contract, trips, and pay all come from the vendor.

HHSC lists each plan's vendor. As of September 2026:

| Health plan | Ride vendor |
|---|---|
| Aetna Better Health of Texas | MTM Health |
| Blue Cross and Blue Shield of Texas | MTM Health from October 1, 2026 (Modivcare until then) |
| Community First Health Plan of Texas | SafeRide Health |
| Community Health Choice | MTM Health |
| Cook Children's Health Plan | MTM Health |
| Dell Children's Health Plan | MTM Health |
| Driscoll Health Plan | SafeRide Health |
| El Paso Health | MTM Health |
| Molina Healthcare of Texas | SafeRide Health |
| Parkland Community Health Plan | MTM Health |
| Superior HealthPlan | SafeRide Health, since June 1, 2021 |
| Texas Children's Health Plan | SafeRide Health |
| UnitedHealthcare Community Plan of Texas | SafeRide Health, since January 1, 2026 |
| Wellpoint | MTM Health |

Each plan works only in its own service areas. Service areas carry county names, such as Bexar, Dallas, Hidalgo, Lubbock, and Nueces, and rural counties are grouped into Medicaid Rural Service Areas such as MRSA Central and MRSA West. Find out which plans serve your counties before you apply. Blue Cross and Blue Shield of Texas says recurring trips and trips already booked for after October 1, 2026 go to MTM Health.

Members with no health plan get rides through the Medical Transportation Program (MTP), which HHSC runs directly. MTP also serves the Children with Special Health Care Needs (CSHCN) Services Program and Transportation for Indigent Cancer Patients (TICP). MTP [prior authorizes](https://nemtguide.com/glossary/prior-authorization/) every fee-for-service trip. TMHP, the state's claims administrator, enrolls the companies that drive these trips and pays their claims.

### Who qualifies and how rides are booked

A member qualifies when they are enrolled in Medicaid, CSHCN, or TICP and have no other way to reach a covered service, such as a doctor, dentist, hospital, or drug store. Under MTP, members call at least two business days ahead, or five for a trip outside their county. Hospital discharges, pharmacy trips, and urgent care can be booked with less than 48 hours' notice.

The state's NEMT Services Handbook, chapter 16.4 of the Uniform Managed Care Manual, defines demand response transportation as curb-to-curb rides in a standard passenger vehicle, such as a bus, van, or sedan. Texas NEMT does not include ambulance service. Beyond rides, it covers transit passes, mileage for family and friends who drive, airline travel, and meals and lodging for members 20 and younger.

NEMT does not cover trips to or from day activity health services, assisted living facilities, or state institutions, or to or from a nursing facility except for dialysis or a discharge home. Children 14 and younger ride with a parent, guardian, or an adult the parent authorizes in writing, and members 15 to 17 can ride alone with signed parental consent given before the trip. Plans also cover trips to bordering counties in Louisiana, Arkansas, Oklahoma, and New Mexico within 50 miles of Texas when local members usually get care there.

## Which brokers to join

For health plan trips you join the vendors, not the state, but Texas adds one step first: Medicaid enrollment.

1. **Enroll in Texas Medicaid through TMHP.** The handbook says a plan or its vendor must confirm you are enrolled before signing an agreement with you. Apply in the online Provider Enrollment and Management System (PEMS), where you e-sign the HHSC Medicaid Provider Agreement and learn whether an application fee applies. You need an NPI first (see [how to get an NPI](https://nemtguide.com/guides/how-to-get-an-npi-number-for-nemt/)), and the MTP handbook's code table recommends [taxonomy code](https://nemtguide.com/glossary/taxonomy-code/) 343800000X for demand response providers.
2. **Pick your plans.** Use the HHSC list to match the plans in your service area with their vendors.
3. **Apply to SafeRide Health.** Its online form asks for your NPI, EIN, and owner details, and must be finished within 30 days or started again. Credentialing asks for your insurance, vehicle registrations, and driver files: national background and sex offender checks, driving records, pre-hire drug screens, and first aid, defensive driving, and wheelchair securement training. New providers can email team@saferidehealth.com or call (855) 955-7433. See our [SafeRide Health guide](https://nemtguide.com/brokers/saferide-health/).
4. **Apply to MTM Health.** MTM's steps are the provider application, an interview, contracting, credentialing, training, and your first trip. It sends trips through its MTM Link portal and discusses insurance during credentialing. See our [MTM Health guide](https://nemtguide.com/brokers/mtm-health/).
5. **Use the same enrollment for MTP.** TMHP's MTP page says companies that want fee-for-service MTP trips enroll through PEMS too.

TMHP says enrollment typically takes up to 60 days once it has everything it needs. If your application is incomplete, you get 30 business days to send the missing items, or TMHP ends the process. Most providers revalidate every five years in PEMS, which opens the renewal 180 days before the due date. The TMHP Contact Center (800-925-9126) helps with PEMS.

The handbook bars providers and drivers with Inspector General sanctions, exclusions from other health programs, or a lapsed license or permit, and your vendor keeps rosters of your drivers and vehicles by service area. See contracting with Medicaid health plans.

## Licenses and registrations

### Your company

Form an LLC with the Texas Secretary of State by filing Form 205, the certificate of formation, for $300. Online filing moves to the new SOSPortal on September 29, 2026, replacing SOSDirect. Your registered agent needs a Texas street address where papers can be served in person, not only a mailbox service.

If you work under another name, file an assumed name certificate (Form 503) for $25. It lasts up to ten years, and since September 1, 2019 an LLC or corporation files it only with the Secretary of State.

Franchise tax reports are due to the Texas Comptroller each May 15. For the 2026 and 2027 report years, a business with annualized total revenue at or below $2,650,000 owes no franchise tax and skips the No Tax Due Report. It still files a Public Information Report (Form 05-102) or an Ownership Information Report (Form 05-167).

Get your employer identification number (EIN) from the IRS, which issues it online for free. Then ask your city whether it licenses vehicles for hire. For LLC basics, see forming an LLC for NEMT.

### Texas Department of Motor Vehicles

Texas has no separate state license for NEMT companies. The Texas Department of Motor Vehicles (TxDMV) registers intrastate motor carriers, and its rules turn on vehicle size:

| If you | You need |
|---|---|
| Run sedans, minivans, or wheelchair vans built for 15 or fewer people, driver included | No TxDMV motor carrier registration. Register each vehicle like any other. |
| Run a vehicle built for more than 15 passengers, driver included | A USDOT number registered as intrastate, then a TxDMV motor carrier certificate (TxDMV number). See DOT numbers for NEMT. |
| Drive a vehicle built for 16 or more people, driver included | A commercial driver's license with a passenger (P) endorsement. See CDLs for NEMT drivers. |

For the larger vehicles, apply in the Texas Motor Carrier Credentialing System (TxMCCS). TxDMV reviews a first application within 24 to 48 business hours, your insurance company files Form E, and you pay the fees. As of September 2026, that is a one-time $100 application fee, $10 per vehicle for one year or $20 for two, and $100 for the insurance filing. Keep the cab card in the vehicle. TxDMV answers at (800) 299-1700, options 3-3. For licensing in other states, see [NEMT license requirements](https://nemtguide.com/guides/nemt-license-requirements/).

## Vehicle rules

Start with inspections. Since January 1, 2025, Texas no longer requires a state safety inspection for non-commercial vehicles. For inspection purposes, a commercial motor vehicle includes one designed or used to carry more than 15 passengers, driver included. So most NEMT sedans and vans skip the state safety inspection, while larger vehicles still need one. A Texas-registered vehicle rated over 10,000 pounds that makes trips across state lines also still needs the yearly inspection. Owners of the smaller vehicles pay a $7.50 inspection program replacement fee when they register. Vehicles in the 17 emissions counties, such as Harris, Dallas, Tarrant, Travis, and El Paso, still need an emissions test, and Bexar County joins them on November 1, 2026.

Plans still check your vehicles. The handbook requires each vehicle's inspection history and maintenance records, and evidence of registration and inspection in its information packet. Ask your vendor what inspection proof it accepts now that the state no longer inspects most vans. Our [vehicle inspection checklist](https://nemtguide.com/templates/nemt-vehicle-inspection-checklist/) covers the equipment below.

Every vehicle must display your company name and vehicle number in letters at least six inches high, plus a "How is my driving?" sticker with a phone number. It needs:

- Clean, working seat belts for every seat, stored off the floor when not in use.
- A working speedometer, odometer, interior lights, heat, air conditioning, and windows.
- Two outside mirrors and an inside mirror for watching the passenger area.
- Interior padding, and a clean inside and outside with no broken glass, heavy rust, or major dents.
- A fire extinguisher within the driver's reach and visible to passengers.
- A first aid kit with latex gloves, hazardous waste bags, a scrub brush, disinfectant, protective equipment, and deodorizer.
- Three reflective triangles on stands. Flares are not allowed.
- A retractable step or step stool if there is no running board. A milk crate never counts.
- Signs reading "No Smoking, Eating, or Drinking," "All passengers must wear seat belts," and "Weapons Prohibited."
- An information packet with the registration, inspection proof, insurance card, accident forms, and a service area map. Voice navigation is allowed.

A vehicle with two substantiated complaints about cleanliness, temperature, or other problems within 10 days comes out of service until the fix is documented. The handbook also requires providers to follow the federal ADA vehicle specifications in 36 CFR Part 1192, which cover lifts, ramps, and securement systems, and the federal motor vehicle safety standards in 49 CFR Part 571. See [wheelchair securement](https://nemtguide.com/guides/wheelchair-securement/) and [NEMT vehicle requirements](https://nemtguide.com/guides/nemt-vehicle-requirements/).

## Driver rules and training

Every driver must be at least 18 and hold a valid driver's license. Each gets a state criminal history check through the Department of Public Safety (DPS), a national criminal history check, and a DPS driving record check. State and national sex offender registries are checked before hire and every year. So are the exclusion lists: the [OIG exclusion list](https://nemtguide.com/glossary/oig-exclusion-list/), the HHSC Inspector General list, the Comptroller's vendor debarment list, the Social Security Death Master File, and SAM, with the OIG list and SAM checked monthly. The registry and exclusion checks also cover staff who work with members or their records.

A driver cannot give rides with:

- A DWI or driving under the influence conviction, including deferred adjudication, in the seven years before hire or any time after.
- More than one moving violation, on or off the job, in any rolling 12 months.
- A felony or misdemeanor conviction at any time for abuse, neglect, or exploitation of children, older adults, or people with disabilities.
- A felony or misdemeanor conviction in the seven years before hire, or any time after, for a Penal Code offense against a person, a family, property, public order or decency, or public health, safety, or morals, or for a drug offense.
- A conviction or finding of liability for Medicaid fraud under chapter 36 of the Human Resources Code.

A driver convicted of one of these after hire is out for seven years from the conviction date. Tell your vendor in writing within 10 business days if a driver or staff member is convicted, charged with a felony, or added to a sex offender registry. Drivers also fall under a drug and alcohol testing program that follows 49 CFR Parts 40 and 655.

Drivers complete each of these within 30 days of hire, then repeat it on this schedule:

| Training | Repeat |
|---|---|
| Non-discrimination, sensitivity, and diversity | Every year |
| Passenger safety | Every year |
| Assistive devices: lifts, tie-downs, child safety seats | Every year |
| Defensive driving | Every 2 years |
| Driver qualifications and conduct | Every 2 years |
| Passenger assistance techniques | Every 3 years |

On the job, drivers get out to open doors and help riders, announce themselves at pickup, and confirm every wheelchair and seat belt is secured before driving. They never wear headphones, use a phone while driving except for directions, use tobacco near riders, or ask riders for money. They never install a child safety seat either: a parent does, and with no seat the trip is canceled as a member no-show.

Keep a driver list with each legal name, license number, hire and end dates, and every training with its effective and renewal dates. Our [driver file checklist](https://nemtguide.com/templates/nemt-driver-file-checklist/) and [NEMT driver training guide](https://nemtguide.com/guides/nemt-driver-training/) help you keep it current.

## Trip rules and how you get paid

The handbook sets the timing standards your vendor passes to you:

- **Arrivals.** Members arrive 15 minutes to one hour before the appointment. For a clinic's first or last appointment, drop-off is no more than 15 minutes before it opens, and pickup no more than 15 minutes after it closes.
- **Returns.** Pick up within one hour of the return call. Hospital discharges allow up to three hours. See [will-call trips](https://nemtguide.com/glossary/will-call-trip/).
- **Shared rides.** No member rides more than one hour longer than a direct trip would take.
- **Late vehicles.** A vehicle more than 30 minutes late, or 30 minutes past a return call, triggers a backup ride from the vendor.
- **Confirmations.** Confirm each ride with the member 24 hours ahead, never after 9 p.m. local time, and keep a record of the contact. Add-on trips and hospital discharges are the exceptions.
- **No-shows.** Wait at least 10 minutes past the scheduled pickup before calling a [no-show](https://nemtguide.com/glossary/no-show/), and document every cancellation, no-show, and reschedule.

Vendors send each trip on a secure manifest with a unique number for every [trip leg](https://nemtguide.com/glossary/trip-leg/) and a line for the member's signature, though a vendor may accept a digital signature or GPS instead. The plan or its vendor must monitor trips against these standards:

| Measure | Standard |
|---|---|
| Trips completed | 99% of accepted trips, not counting member cancellations and no-shows |
| On-time arrival | 95% arrive 15 minutes to 1 hour early |
| Return pickups | 95% within 1 hour of the call |
| Hospital discharges | 95% within 3 hours of the call |
| Vehicles and drivers | 99% meet every rule and check |
| Complaints | 98% resolved within 30 days |

### Health plan trips

Your vendor sets your rate in your agreement, and MTM Health says it sets rates with each provider. Claims are due within 95 days of the date of service, and the plan or its vendor must decide each one within 30 days of receiving it. See [timely filing limits](https://nemtguide.com/glossary/timely-filing-limit/). MTM Health says it does not pay for no-shows.

Get every rate and add-on in writing. In an audit report dated September 4, 2025, and announced July 21, 2026, the Texas HHS Office of Inspector General found that one ride vendor paid providers extra amounts above their contracted rates for long waits and long trips, without records to back them. The state counted them as overpayments, since vendors may not pay more than contracted rates. Record every time and signature on your [trip log](https://nemtguide.com/templates/nemt-trip-log-template/).

### Fee-for-service trips

MTP pays demand response providers a flat rate per trip under code [T2003](https://nemtguide.com/glossary/t2003/), with a modifier for the type of area. The rates, in dollars per trip, for dates of service from September 1, 2026:

| Area type | Modifier | Rate |
|---|---|---|
| Metro (urban) | U1 | $33.83 |
| Micro (suburban) | U3 | $62.31 |
| Rural | U2 | $79.63 |

Those replaced rates of $32.38, $59.64, and $76.22. Family and friends who drive members get $0.76 a mile under S0215 for dates of service from July 1, 2026. See Texas's MTP rate update.

Every MTP claim needs the prior authorization number MTP issued, diagnosis code Z753, and place of service 09 on paper or 99 in TexMedConnect. File within 95 days of the ride, or 365 days if you are out of state. Submit through TexMedConnect, TMHP's free web tool, or software connected to the TMHP EDI Gateway, and TMHP pays weekly with a Remittance and Status report. EDI submitters must file a new EDI Trading Partner Agreement, available December 1, 2026, by May 15, 2027, or TMHP deactivates the account.

You cannot bill Texas Medicaid or a member for a missed appointment. HHSC and TMHP review claims after payment and take money back when records do not support the service billed, and you can appeal a denied claim through TexMedConnect. NEMT is not on Texas's electronic visit verification lists, which cover personal care and home health care. See [Medicaid audits for NEMT](https://nemtguide.com/guides/medicaid-audit-for-nemt/).

## Insurance requirements

Chapter 16.4 sets insurance for plans, their vendors, and the transportation providers in their networks. The minimums:

| Coverage | Minimum |
|---|---|
| Business auto, owned, hired, and non-owned vehicles | $750,000 combined single limit |
| Commercial general liability | $1,000,000 per occurrence, $2,000,000 aggregate |
| Umbrella or excess liability | $1,000,000 per occurrence |
| Workers' compensation | Statutory limits |
| Employer's liability | $1,000,000 each accident, $1,000,000 disease each employee, $1,000,000 disease policy limit |

Insurers must be rated A or better, in size class VII or better, by A.M. Best, and licensed in Texas. Policies must be primary and noncontributory, waive subrogation for the State of Texas, and, except workers' compensation, employer's liability, and professional liability, name the State of Texas as an additional insured. The section also lists $1,000,000 in identity theft coverage. It is written mainly for plans and their vendors, so ask your vendor in writing which lines and terms apply to you.

SafeRide Health's own checklist, as of September 2026, asks for $1 million general liability per occurrence, $2 million aggregate, and $500,000 auto liability, with SafeRide listed as an additional insured. The state's $750,000 auto floor sits above that. MTM Health sets its limits during credentialing. For what brokers ask elsewhere, see [NEMT insurance requirements](https://nemtguide.com/guides/nemt-insurance-requirements/).

State law sets separate floors:

| Vehicle | Minimum | Rule |
|---|---|---|
| Any vehicle | $30,000 per person, $60,000 per accident, $25,000 property | Transportation Code 601.072 |
| Built for 16 to 26 people, driver included | $500,000 | TxDMV |
| Built for 27 or more people | $5,000,000 | TxDMV |

Workers' compensation is optional for most private employers in Texas. An employer without it, a non-subscriber, files a notice of no coverage with the Division of Workers' Compensation each year between February 1 and April 30, after hiring its first employee, and after ending a policy, and posts the notice in English and Spanish. For Medicaid ride work, though, the handbook requires network providers to carry it. See workers' comp for NEMT.

## What it costs and how long it takes

These are the fees Texas sets as of September 2026. Vehicles, insurance, and equipment depend on your quotes; see [what it costs to start a NEMT business](https://nemtguide.com/guides/how-much-does-it-cost-to-start-a-nemt-business/).

| Item | Cost | Paid to |
|---|---|---|
| EIN | Free | IRS |
| LLC filing (Form 205) | $300 | Secretary of State |
| Assumed name (Form 503), if used | $25 | Secretary of State |
| Franchise tax, revenue at or below $2,650,000 (2026 and 2027) | $0, file a report | Comptroller |
| Inspection program fee, most vans | $7.50 each time you register | TxDMV |
| Motor carrier fees, larger vehicles only | $100, plus $10 a vehicle a year and $100 insurance filing | TxDMV |

A workable order, from first call to first trip:

1. **Match plans to vendors.** Check which plans serve your counties and which vendor each uses.
2. **Form your company** on SOSPortal and get your EIN.
3. **Get your NPI** so you can start the Medicaid application.
4. **Buy insurance** that meets the chapter 16.4 limits.
5. **Enroll in Texas Medicaid** through PEMS. Allow up to 60 days after TMHP has everything.
6. **Hire and screen drivers.** Run the criminal, driving record, registry, exclusion, and drug checks, and schedule training inside 30 days of hire.
7. **Equip your vehicles** to the handbook list.
8. **Apply to SafeRide Health and MTM Health.** Finish SafeRide's form within 30 days, then complete each vendor's credentialing and training.

Medicaid enrollment and vendor credentialing set the pace, and only larger vehicles add the TxDMV steps. For the same steps in any state, see [how to start a NEMT business](https://nemtguide.com/guides/how-to-start-a-nemt-business/).

## Work beyond Medicaid

Four other sources of rides are worth a call.

- **Transit and grant programs.** TxDOT's Section 5310 grants for seniors and people with disabilities go to nonprofits and local public entities in rural areas (under 50,000 people) and small urban areas (under 200,000). Grantees can use the money to buy transportation services under contract, so ask the ones near you whether they buy rides. See Section 5310 grants.
- **Dual plans.** MTM Health's Texas page lists ride lines for D-SNP members of Community Health Choice and El Paso Health, and UnitedHealthcare says its D-SNP members may get rides as value-added services. Ask each vendor whether those trips go to its network.
- **Veterans.** The VA pays for special mode transportation, such as a specially equipped vehicle, when a VA provider decides an eligible veteran's condition requires it and the VA approves the trip in advance. Ask your nearest VA health facility how it books these rides. See VA transportation contracts.
- **Facilities and private pay.** Dialysis centers, hospitals, and senior living communities, along with riders who pay for themselves, add work that does not depend on one vendor. See [how to get NEMT facility contracts](https://nemtguide.com/guides/how-to-get-nemt-facility-contracts/) and [private pay NEMT](https://nemtguide.com/guides/private-pay-nemt/).

## Frequently asked questions

### Do I need a license to start a NEMT business in Texas?

Not a separate NEMT license. You need a company registered with the Secretary of State, an NPI, and enrollment in Texas Medicaid through TMHP before a health plan or its ride vendor can contract with you. TxDMV motor carrier registration and a USDOT number apply only if you run a vehicle built for more than 15 passengers, driver included. Ask your city whether it licenses vehicles for hire.

### Who are the Medicaid NEMT brokers in Texas?

Texas calls them the health plans' medical transportation service providers. As of September 2026, SafeRide Health books rides for Community First, Driscoll, Molina, Superior, Texas Children's, and UnitedHealthcare. MTM Health books rides for Aetna, Community Health Choice, Cook Children's, Dell Children's, El Paso Health, Parkland, and Wellpoint, and adds Blue Cross and Blue Shield of Texas on October 1, 2026, taking over from Modivcare.

### Do I have to enroll in Texas Medicaid to drive for SafeRide or MTM?

Yes. Chapter 16.4 of the Uniform Managed Care Manual says a plan or its vendor must make sure a demand response transportation provider is enrolled in Texas Medicaid through the state's claims administrator, TMHP, before signing an agreement with it. The Texas Medicaid Provider Procedures Manual (September 2026) also says every provider must be enrolled in Texas Medicaid before it can be approved for managed care.

### How much does Texas Medicaid pay for a NEMT trip?

For health plan trips, the ride vendor sets your rate in your agreement, and MTM Health says it sets rates with each provider. For fee-for-service trips in the Medical Transportation Program, TMHP pays a flat rate per trip under code T2003. From September 1, 2026 it is $33.83 in metro areas (U1), $62.31 in micro areas (U3), and $79.63 in rural areas (U2).

### How long does it take to start a NEMT business in Texas?

Mostly as long as Medicaid enrollment and vendor credentialing take. TMHP says enrollment typically takes up to 60 days once it has everything it needs, and it gives you 30 business days to fix an incomplete application. Vendor credentialing comes after that, and SafeRide Health asks you to finish its signup form within 30 days. TxDMV reviews a motor carrier application within 24 to 48 business hours, but only larger vehicles need one.

### Do I need workers' compensation insurance in Texas?

State law lets most private employers choose, and those without it must file a notice of no coverage with the Division of Workers' Compensation each year between February 1 and April 30. Medicaid ride work is different. The state's NEMT handbook requires providers in a health plan's network to carry workers' compensation at statutory limits, with $1 million in employer's liability.

### Does Texas Medicaid pay for no-shows?

No. The Medical Transportation Program Handbook says providers cannot bill Texas Medicaid or its clients for missed appointments, and MTM Health says it does not pay providers for no-shows. Drivers must wait at least 10 minutes past the scheduled pickup before calling a member no-show, and you must document every cancellation and no-show.

## Official resources

- [Texas HHSC: Which ride vendor each health plan uses](https://www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/nonemergency-medical-transportation-program/health-plan-transportation-contact-information)
- [TMHP: Medical Transportation Program and PEMS enrollment](https://www.tmhp.com/programs/mtp)
- [TMHP: PEMS step-by-step guide](https://www.tmhp.com/topics/provider-enrollment/pems/start-application)
- [Texas HHSC: NEMT Services Handbook, Uniform Managed Care Manual chapter 16.4 (PDF)](https://www.hhs.texas.gov/sites/default/files/documents/16-4.pdf)
- [TMHP: Medical Transportation Program Handbook, September 2026 (PDF)](https://www.tmhp.com/sites/default/files/file-library/resources/provider-manuals/tmppm/pdf-chapters/2026/2026-09-september/2_14_med_transport_program.pdf)
- [SafeRide Health: Join the NEMT provider network](https://www.saferidehealth.com/what-to-expect-nemt-provider)
- [MTM Health: Provider application and onboarding](https://www.mtm-inc.net/driverswanted/)
- [TxDMV: Motor carrier registration (TxDMV Number)](https://www.txdmv.gov/motor-carriers/txdmv-number)
- [Texas Secretary of State: SOSPortal business filings](https://www.sos.state.tx.us/corp/sosda/index.shtml)
- [Texas Division of Workers' Compensation: Non-subscriber notices](https://www.tdi.texas.gov/wc/nonsubscriber.html)