How to Start a NEMT Business in Virginia (2027)

Virginia runs Medicaid rides through brokers. Each of the five Cardinal Care health plans uses its own broker, and a separate broker serves members who are not in a plan, a contract that moves from Modivcare to MTM Health on October 1, 2026. The rules below follow the DMAS driver, attendant, and vehicle requirements updated May 26, 2026, and MTM Health’s Virginia provider handbook approved August 10, 2026.

How Medicaid rides work in Virginia

The Virginia Department of Medical Assistance Services (DMAS) runs Medicaid and FAMIS, the state’s children’s health insurance program, under the name Cardinal Care. Most members belong to one of five health plans. DMAS pays each plan a fixed amount per member each month, under rates effective July 1, 2026, and each plan pays a broker to arrange its members’ rides. See capitation and managed care organization.

Members outside a plan ride through the fee-for-service program: people newly enrolled and not yet assigned to a plan, people on a home and community-based waiver who are not in a plan, and FAMIS members not in a plan. Fee-for-service also carries every ride to the three developmental disability waiver services (Community Living, Family and Individual Support, and Building Independence), even for members whose medical care is in a plan. MTM’s handbook puts the split at about 94 percent of members getting rides through a health plan and 6 percent through fee-for-service, as of July 2024.

A DMAS bulletin effective September 15, 2026 lists the broker for each group:

Members in	Broker
Fee-for-service	MTM Health from October 1, 2026 (Modivcare before)
Aetna Better Health of Virginia	MediDrive
Anthem HealthKeepers Plus	MTM Health
Humana Healthy Horizons in Virginia	Modivcare
Sentara Health Plans	Modivcare
UnitedHealthcare	SafeRide Health

Anthem’s member page still names Access2Care, the broker MTM Health finished buying from Global Medical Response in October 2024. The October 1 switch changes only fee-for-service, and plan members keep their brokers. If you drove fee-for-service trips for Modivcare, you need an MTM agreement to keep that work. The broker transition checklist covers final claims and standing orders.

Who qualifies and how rides are booked

A member qualifies when they are going to a Medicaid-covered service and have no other way to get there, and regulation 12VAC30-50-530 requires the most economical ride that meets their medical needs. The broker checks eligibility on every request.

Fee-for-service members book rides at least five business days ahead unless the trip is urgent. Aetna members book at least three business days ahead, and Anthem members at least two, as of September 2026.

Rides go by sedan or minivan, wheelchair van, stretcher van, or non-emergency ambulance. Curb-to-curb is the default level of help, while door-to-door and hand-to-hand service need medical necessity. Many fee-for-service trips repeat, such as dialysis, chemotherapy, and day support, and run as standing orders.

Which brokers to join

You do not enroll with DMAS to give NEMT rides. DMAS’s provider enrollment sheet, updated July 1, 2025, says each broker enrolls providers, trains drivers, inspects vehicles, negotiates rates, assigns trips, and pays providers. Members may ask for a provider by name, but the broker does not have to assign that provider. See working with multiple NEMT brokers.

MTM Health: fee-for-service and Anthem

MTM recruits providers statewide for fee-for-service members. Its steps:

1. Apply. Fill out the questionnaire on MTM’s Join Our Network page.
2. Interview. A network representative contacts you about onboarding.
3. Contract. You sign MTM’s service agreement. Its Appendix B lists every credentialing document.
4. Credential. Submit your company profile, driver roster, and vehicle roster. The profile asks for your business license expiration, DMV operating authority, any FMCSA authority, and your NPI.
5. Train. Drivers finish MTM’s required training, at no cost, before their first trip. Seats are capped, so register early on MTM’s Virginia training calendar.
6. Take your first trip. Trips arrive in the MTM Link portal and driver app, or in your own routing software if MTM connects to it.

MTM’s 24/7 Virginia provider hotline is 866-810-8302, and its field monitors work from Norton, Blacksburg, Manassas, Newport News, and Richmond. MTM also serves Anthem HealthKeepers Plus, so ask whether your agreement covers Anthem trips. Our MTM Health guide covers the company in its other states.

Modivcare: Humana and Sentara

Modivcare keeps the Humana and Sentara networks after October 1, 2026. Apply with the form on Modivcare’s Become a Transportation Provider page. Each driver needs PASS wheelchair training, First Aid and CPR, defensive driving, a drug screen, a motor vehicle report, and a background check. See our Modivcare guide.

MediDrive: Aetna

MediDrive arranges rides for Aetna Better Health of Virginia members. Apply online from MediDrive’s Virginia provider page. It checks each driver’s drug screen, criminal and sex offender records, motor vehicle report, and the federal OIG exclusion list, and asks for PASS, defensive driving, and First Aid and CPR training. Its provider relations line answers 24/7 at 703-714-6940. See our MediDrive guide.

SafeRide Health: UnitedHealthcare

SafeRide Health arranges rides for UnitedHealthcare members. Apply with the signup form on SafeRide’s NEMT provider page, and see our SafeRide Health guide. For the documents every broker wants, see NEMT broker credentialing.

Licenses and registrations

Your company

Form an LLC with the State Corporation Commission (SCC) through its Clerk’s Information System. Articles of organization cost $100, as of September 2026. An LLC then pays a $50 annual registration fee each year after the year it forms, due by the last day of the month it was formed. A late payment adds $25, and the LLC is canceled automatically if the fee is still unpaid at the end of the third month after the due date. If you use a trade name, file a fictitious name certificate with the SCC, which costs $10 as of September 2026.

Get your employer identification number (EIN) from the IRS, which never charges for one. Then get a business license from your city or county: the DMV application makes you certify that you meet local Business, Professional, and Occupational License (BPOL) tax rules. Get an NPI as well, since MTM’s company profile asks for it. See how to get an NPI number.

Virginia DMV Motor Carrier Services

Virginia law defines a non-emergency medical transportation carrier as one that provides only NEMT, and only through DMAS, a DMAS broker, or a Cardinal Care plan or its contractor. Code of Virginia § 46.2-2099.44 bars such a carrier from carrying passengers in Virginia without a DMV certificate of fitness.

If you	You need
Carry only Medicaid riders sent by DMAS, its broker, or a plan’s broker	A non-emergency medical transportation carrier certificate (form OA 151)
Also carry private-pay or facility riders	A different authority instead, such as a common carrier irregular route certificate (form OA 141)
Take trips that cross a state line	Federal operating authority from FMCSA
Drive a vehicle built for 16 or more people, driver included	A commercial driver’s license

The NEMT certificate application needs:

• Form OA 151, with your SCC entity ID, a street address (no PO box), and every member, manager, officer, or partner. Any of them licensed outside Virginia sends a certified driving record. You also certify that you will provide no other for-hire passenger service.
• Form OA 210, a notarized criminal history request for each business official.
• A $25,000 bond: a surety bond (form OA 435) or irrevocable letter of credit (form OA 447), kept on file for three years from the date the certificate is issued.
• A $50 filing fee, which is not refundable, and your FEIN verification if you have one.

You also need an established place of business, owned or leased, that meets local zoning, holds your records, and has a working phone listed in the company’s name.

Apply online, which DMV requires from February 1, 2027. DMV posts every application on its website, anyone may protest a certificate of fitness on fitness grounds, and DMV decides whether a hearing is needed. Once DMV approves you, your insurer files proof of liability coverage, and the certificate issues. Motor Carrier Services answers at 804-249-5146.

Next, title each vehicle in Virginia and register it for hire with Non-Emergency Medical Transportation For-Hire plates. The plate costs nothing beyond regular registration, and the operating authority adds $3 per vehicle each year. A leased vehicle must carry its lease and be on your fleet insurance, and you may not let another operator run under your authority.

The certificate runs 12 months and renews at no fee. Report a new address within 30 days. If you stop Medicaid work, tell DMV in writing within 30 days and turn in the NEMT plates. Put your certificate number in any newspaper or other published ad. For licensing in other states, see NEMT license requirements.

Vehicle rules

The broker inspects every vehicle in person before it carries members and again every six months, wheelchair and stretcher vans included. The broker puts a sticker on the outside of the passenger-side rear window, lower right corner, showing the plate and VIN. Different stickers mark a pass, a provisional pass, or a fail, and a failed vehicle stays out of service until it is fixed. Keep the Virginia State Police annual safety inspection current as well.

The DMAS list of May 26, 2026 requires:

• Heat that reaches 74 degrees and air conditioning that cools to 68 degrees, measured at the rear of the vehicle.
• A seat belt for every passenger, stored off the floor, belt extensions (MTM asks for two), and a seat belt cutter within the driver’s reach.
• An accurate speedometer and odometer, two outside mirrors, and an inside mirror for watching passengers.
• An unexpired first aid kit, a spill kit, a Class A, B, C fire extinguisher within the driver’s reach, and a GPS or current map.
• A packet with the registration, insurance card, and the broker’s accident forms, plus the lease if the vehicle is leased.
• Your business name and phone number on both sides, in permanent letters at least 3 inches tall. Never show “Medicaid” or “FAMIS” on the vehicle or in your business name.
• Inside, the plate number, the broker’s toll-free and TTY numbers, complaint steps, and “NO SMOKING” and “ALL PASSENGERS WILL USE SEAT BELTS” signs.

Wheelchair vans must meet the ADA vehicle rules in 49 CFR Part 38. Each station needs four working securements, a working interlock, and a lap and shoulder belt mounted to the vehicle. A van that takes hospital discharges carries a spare wheelchair with a seat at least 20 inches wide. See wheelchair securement.

Stretcher vans carry two crew members trained in first aid, bloodborne pathogens, and stretcher transfers, and one stretcher passenger at a time. They never carry a rider with an IV, saline lock, or airway device, or one who needs medical monitoring. See stretcher van requirements.

Run through our vehicle inspection checklist before each broker inspection.

Driver rules and training

The DMAS requirements of May 26, 2026 bar any driver or attendant who:

• Is under 18, or has held a driver’s license for less than two years.
• Has more than two chargeable accidents or moving violations in the last three years, or a DMV point balance below minus 2.
• Had a license suspended or revoked for moving violations in the last five years.
• Was convicted of a barrier crime under Virginia Code § 19.2-392.02, a list that includes murder, abduction, malicious wounding, assault and battery, robbery, sexual assault, arson, burglary, felony drug offenses, and crimes that require sex offender registration.
• Uses alcohol or illegal drugs on duty, or is a known abuser of alcohol or drugs.

MTM goes further: its drivers must be at least 21 with two years of driving experience. Get a Virginia State Police or national background check, with a sex offender registry check, before each driver’s first trip. The broker reviews every driver’s credentials at least once a year. See NEMT driver background checks.

DMAS requires every driver and attendant to finish the broker’s driver training program before carrying any member, and a provider that trains its own drivers needs the broker’s written approval of the course. See Virginia’s driver training change. MTM’s handbook lists PASS, HIPAA, defensive driving, and, where they apply, first aid and wheelchair securement. See PASS certification.

On the job, drivers wear a company uniform shirt or the broker’s NEMT Program ID badge, never use a phone while moving, and confirm each rider is inside before leaving.

MTM tracks each driver’s training dates, license expiration, and last background check, drug screen, and driving record review, and trips by a driver with expired documents go unpaid. Our driver file checklist keeps them current.

Trip rules and how you get paid

MTM’s Virginia handbook sets these standards:

• Pickup. On time means 15 minutes before to 15 minutes after the scheduled time on the first leg, and the member never has to board early. See pickup window.
• Drop-off. No later than the appointment time, with time to check in.
• Returns. Arrive within 45 minutes of a will-call and within three hours for a hospital discharge.
• Shared rides. No member rides more than 45 minutes longer than the average direct trip.
• Attendants. DMAS requires an attendant within five business days of approval, and for children 12 and under riding without a family member or escort.

MTM offers trips to eligible providers 7 days before the appointment, and 5 days before it opens every trip in your service area to you in its Marketplace. Turn back a trip at least 24 hours before pickup. Every trip runs with vehicle location tracking for the full ride, through MTM’s free driver app or connected software. NEMT is not on Virginia’s electronic visit verification (EVV) list, which covers personal care, respite, companion, and home health services.

Measure	MTM standard
On-time performance	Above 95 percent
Provider no-shows	Below 0.25 percent
Denied claims	Below 0.29 percent
Trips tracked by GPS	Above 90.01 percent
Trips turned back	Below 0.5 percent

Missing them can bring an improvement plan, liquidated damages, or removal. Providers at 95 percent on time or better for a quarter share a pool funded by liquidated damages.

DMAS does not set NEMT provider rates. Each broker negotiates them, and MTM sets rates with each provider individually, then prices each claim from its Virginia Schedule A rate sheet by mileage, mode, and shared rides.

A clean claim at MTM is an electronic trip log with the trip ID, scheduled and actual pickup times, departure and arrival times, and the member’s signature, on a completed trip. You have six months from the date of service to submit it, and 365 days to appeal a denial. MTM does not pay for no-shows, so confirm each trip with the member the day before. Record every time and signature on your trip log.

MediDrive pays invoiced trips every two weeks. For fee-for-service trips scheduled before October 1, 2026, which stay with Modivcare, the 2026 payment schedule pays invoices due each Wednesday in a check run on Thursday of the following week, with dates into March 2027.

Insurance requirements

DMV sets the floor. Every NEMT carrier keeps bodily injury and property damage coverage on file with DMV, sized by how many people the vehicle is built to carry, driver included:

Seats, with driver	Minimum coverage
1 to 6	$350,000
7 to 15	$1,500,000
16 or more	$5,000,000

If the coverage or bond lapses, DMV suspends and then revokes the certificate, and you must apply again from the start. DMAS keeps wheelchair and stretcher vans at the DMV amount. Brokers add their own terms:

Broker	What it asks for
MTM Health	Full coverage as Virginia requires, MTM named certificate holder and additional insured, and workers’ compensation
Modivcare	General liability, sexual abuse and molestation coverage, auto liability, and workers’ compensation, with limits by state
MediDrive	General liability, auto liability, and workers’ compensation

Ask each broker for its limits in writing before you buy. See NEMT insurance requirements and additional insured.

Virginia requires workers’ compensation once a business regularly employs more than two people in the state, counting part-time, seasonal, and temporary workers and working family members. There is no waiver form for a sole proprietor, and an executive officer may reject coverage only with notice to the employer and the Workers’ Compensation Commission. See workers’ comp for NEMT.

What it costs and how long it takes

These are the fees Virginia sets as of September 2026. Vehicles, insurance, the bond premium, and equipment depend on your quotes. See what it costs to start a NEMT business.

Item	Cost	Paid to
EIN	Free	IRS
LLC articles of organization	$100	SCC
LLC annual registration	$50 a year, $25 more if late	SCC
Fictitious name, if you use one	$10	SCC
NEMT carrier certificate	$50 filing fee	DMV
Bond or letter of credit	$25,000 of coverage for 3 years	Your surety or bank
Operating authority registration	$3 per vehicle a year	DMV
NEMT for-hire plates	No fee beyond registration	DMV
Certificate renewal	No fee	DMV

A workable order, from first call to first trip:

1. Call the brokers. Ask MTM’s provider hotline and the plan brokers which counties and service levels need providers.
2. Form your LLC with the SCC and get your EIN.
3. Get your local business license and an NPI.
4. Buy insurance that meets the DMV minimums and each broker’s terms, and get the $25,000 bond.
5. Apply to DMV for the NEMT carrier certificate with forms OA 151 and OA 210 and your bond form.
6. Title and register each vehicle in Virginia with NEMT for-hire plates once the certificate issues.
7. Equip your vehicles to the DMAS list and pass the broker’s inspection.
8. Hire and screen drivers with background checks and driving records.
9. Apply to each broker, finish credentialing, and put every driver through the broker’s training.

Three steps set the pace: DMV’s review of your application, the broker’s training calendar, and credentialing, since brokers send trips only once every driver and vehicle clears. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

Your NEMT carrier certificate covers only Medicaid trips, and DMV says you may be paid only through Medicaid reimbursement. Since the NEMT application makes you certify that you will provide no other for-hire passenger service, private-pay and facility rides need a different DMV authority instead. A common carrier irregular route certificate (form OA 141) lets you carry the public for individual fares in the areas on the certificate, in vehicles built for 15 or fewer people, driver included, and DMAS accepts it for Medicaid rides too. It needs a filed rate tariff, notice in a local newspaper and to carriers already serving your area, and the same $25,000 bond, and DMV issues only as many of these certificates as public need requires.

With that authority in place, three more sources of rides are worth a call:

• Human services transportation. The Department of Rail and Public Transportation (DRPT) awards FTA Section 5310 grants for seniors and people with disabilities to nonprofits, qualifying local governments, and transit operators, and the grants can pay for contracted rides. Ask the grantees near you when they bid out service.
• Veterans. VA pays for special mode transportation, such as a specially equipped vehicle, when the veteran’s local VA health facility approves it in advance. Ask that facility’s beneficiary travel office how it buys these rides. See VA special mode transportation.
• Facilities and private pay. Dialysis centers, hospitals, and senior living communities pay for rides Medicaid does not cover, though Medicaid hospital discharges still go through the member’s broker. See how to get NEMT facility contracts and private pay NEMT.