How to Start a NEMT Business in Washington (2027)

Washington runs Medicaid rides through six regional brokers, each covering its own group of counties. You subcontract with the broker for your counties, and it sends your trips and pays you. This page follows chapter 182-546 WAC, sections 5000 to 6200, and the Health Care Authority’s posted sample broker contract (revised May 6, 2019, amended July 1, 2023). That sample’s term ran through June 30, 2025, so confirm current terms in your broker’s subcontract.

How Medicaid rides work in Washington

The Washington State Health Care Authority (HCA) runs Apple Health, the state’s Medicaid program. Washington set up its regional broker model for non-emergency medical transportation in 1989, and today six brokers arrange rides in 13 regions covering all 39 counties. HCA’s December 2024 report to the Legislature says five are nonprofit community organizations and one is an Area Agency on Aging.

HCA pays each broker an administrative rate that only the Legislature can change, most recently raised July 1, 2024. The trip cost passes through to the provider in full, and the broker keeps none of it. Brokers also earn incentives for moving trips to cheaper modes such as transit and gas vouchers.

HCA’s broker directory lists these counties as of September 2026:

Broker	Counties
Hopelink	King, Snohomish
Paratransit Services	Clallam, Grays Harbor, Jefferson, Kitsap, Lewis, Mason, Pacific, Pierce, Thurston
People for People	Benton, Chelan, Columbia, Douglas, Franklin, Kittitas, Okanogan, Walla Walla, Yakima
Special Mobility Services	Adams, Asotin, Ferry, Garfield, Grant, Lincoln, Pend Oreille, Spokane, Stevens, Whitman
Community in Motion	Clark, Cowlitz, Klickitat, Skamania, Wahkiakum
Northwest Regional Council	Island, San Juan, Skagit, Whatcom

Community in Motion was formerly Human Services Council. For other states, see NEMT brokers by state.

Who qualifies and how rides are booked

A member needs a current ProviderOne services card, no other way to get there, and an appointment their Apple Health program covers. Managed care members use the same broker. HCA pays for a trip only when all of these apply:

• The service is covered and medically necessary.
• The provider is local, unless the broker approves an exception, such as a service not offered nearby.
• The mode is the lowest-cost one that fits the member’s condition.
• The broker authorized the trip in advance.
• The trip is at least three-quarters of a mile, unless the member cannot walk that far.

Coverage is one round trip a day, unless one trip cannot reach all of a member’s appointments. Members book at least two business days ahead, except for urgent care and hospital discharges, and cannot choose their provider or mode. Transit carried over a third of trips from 2013 to 2019 but under 15 percent by 2023, and HCA says those trips moved to taxis and commercial vehicles.

Members covered only by a Medicare Savings Program, family planning only, or Alien Emergency Medical get no brokered rides. Brokers also do not cover trips to adult day health or PACE, trips related to a hospice diagnosis, discharges against medical advice, or involuntary treatment transports.

How to join the broker for your region

HCA tells new transportation providers to contact the broker for the counties where they want to work. A broker must hold a subcontract with you before it can pay you, and the sample contract bars subcontractors from billing HCA or riders.

1. Find your broker. Use the table above. If your counties touch two regions, apply to both.
2. Check its minimums. They differ a lot, as the sections below show.
3. Get licensed and insured first. Brokers ask for your business license, tax ID, for-hire license, insurance, and L&I coverage.
4. Apply. Send the broker’s application, qualification packet, or letter of interest.
5. Pass the checks. The broker inspects your vehicles and verifies each driver.
6. Sign the subcontract and your rate sheet. Brokers then assign trips largely by cost.

Brokers must screen you and your employees against the federal OIG exclusion list before contracting and on an ongoing basis. Our credentialing guide covers the paperwork in general.

Hopelink: King and Snohomish counties

As of September 2026, Hopelink requires one year of NEMT experience with all required Washington licensing, five or more vehicles, and an office in Washington. Its partner application, last updated in 2015, asks for your license and tax ID numbers, owners, and fleet, and says the review takes up to 30 days. Send all messages about your application to transportationcontracts@hopelink.org.

Paratransit Services: nine western counties

Paratransit Services contracts with over 50 providers whose fleets run from 1 vehicle to more than 30, assigns rides by cost, and guarantees no work. Its qualification packet, dated September 2021, asks for insurance, license, and L&I proof, driver background check requests, a training plan, drug and alcohol testing, policies, rate sheets, a vehicle inventory, references, and a W-9. As of September 2026, its line for subcontracting opportunities is 800-933-3468, extension 362.

Community in Motion: southwest Washington

Community in Motion takes a Letter of Interest through its Our Vendors page and opens qualification rounds only when it needs a vehicle type or county covered. Its May 2025 FAQ asks for state and city business licenses, two years of paid passenger experience, three references, insurance certificates, written policies, and your last financial audit. The review takes about four months.

People for People, Special Mobility Services, and Northwest Regional Council

These three post no provider application, so call them. People for People contracts with transit agencies, volunteer drivers, nonprofits, cabulance, and taxi companies; its home office is 509-248-6726. Special Mobility Services asks providers to call its regional manager at 509-534-9760. Northwest Regional Council, an Area Agency on Aging, answers its main line at 360-676-6749.

Licenses and registrations

Your company

Form an LLC with the Secretary of State’s Corporations and Charities Division. As of September 2026, the online Certificate of Formation costs $180 plus an online processing fee, and expedited review ($100) generally takes three working days. File the initial report with it, since deferring it means a separate filing within 120 days and an extra fee. The $70 annual report is due each year by the last day of the month you formed, or $95 once delinquent.

Your LLC gets its Unified Business Identifier (UBI) when the filing is accepted. Then get a business license from the Department of Revenue’s Business Licensing Service for a $50 processing fee plus any endorsement fees. Online applications take about 10 business days, plus two to three weeks when the license carries city or state endorsements. The IRS issues your EIN free. See forming an LLC for NEMT.

Washington Department of Licensing

The Department of Licensing (DOL) says you must be licensed to carry people for a fee in a for-hire vehicle, naming taxis and cabulances as examples. The Business Licensing Service prints the license on your business license as an endorsement. HCA’s sample contract repeats that for-profit and for-hire businesses need a DOL for-hire license and vehicle certificate.

If you	You need
Carry riders for pay as a for-profit company	A DOL for-hire license and a certificate for each vehicle
Are a private nonprofit serving only people with special transportation needs	A UTC private, nonprofit transportation provider permit instead
Carry patients who must lie on a stretcher	A licensed ambulance, except in the narrow cases under Vehicle rules
Drive a vehicle designed for 16 or more people, driver included	A commercial driver’s license

As of September 2026, the for-hire permit costs $110 and is required only if your city or county does not license for-hire businesses. Each vehicle certificate costs $55. To apply, send:

• The For Hire Addendum, completed and signed by your local jurisdiction.
• The registration for each vehicle, with a use class of “F/H” or “CAB”.
• A certificate of liability insurance showing $325,000 combined single limit or split limits of $100,000 per person, $300,000 per accident, and $25,000 property damage, each vehicle’s year, make, and VIN, and DOL’s Olympia post office box as certificate holder.

Use the same business and trade names on every document. DOL sends your license and certificates within 14 business days of complete documents. Certificates last one year and must be carried in the vehicle. Call the Business Licensing Service at 360-705-6741, or DOL at 360-664-6645 with regulatory questions.

King County runs its own for-hire licensing for drivers, vehicles, and companies. If you plan to run trips there, call its for-hire licensing office at 206-263-1982 and ask whether its rules cover your vehicles and drivers.

Private nonprofits apply to the Utilities and Transportation Commission (UTC) under RCW 81.66. A complete application usually takes about eight days, and permit holders file a yearly report. For licensing in general, see NEMT license requirements.

Vehicle rules

The broker does the inspections. Under HCA’s sample contract, it inspects every vehicle before its first trip, then 10 percent of each provider’s vehicles on site in odd years, half unannounced, and 10 percent on paper in even years. If more than 5 percent fail, it inspects the whole fleet. A failed vehicle leaves service until it passes again.

Every vehicle needs:

• A two-way radio or cell phone linking it to your dispatcher, and working heat and ventilation. A vehicle missing either is out of service.
• A clean, working seat belt for every seat, stored off the floor when not in use. When a rider asks for a seat belt extender, the broker tries to send a vehicle that has one.
• Working door handles, speedometer, odometer, and interior lights, two outside mirrors, and an inside mirror for watching riders.
• A clean body and interior with no torn seats, sharp edges, or major dents.
• Your company name and vehicle number displayed.
• Devices that secure wheelchairs, and a way to secure child safety seats.

Brokers add their own lists. Paratransit Services adds a first aid kit, biohazard kit, fire extinguisher, three reflective devices, flashlight, step stool for vans and buses, seat belt cutter, seat belt extenders, GPS device, and 3-inch lettering of your name, phone, and vehicle number on both sides. It limits sedans and vans to 10 years old, and wheelchair vans and buses to 15. Use our vehicle inspection checklist before each visit.

Wheelchair vans must meet ADA rules. Paratransit Services also wants a rider belt at each wheelchair position, separate from the tiedowns. See NEMT vehicle requirements for the basics.

Stretcher work is tightly limited. RCW 18.73.180 bars non-ambulance vehicles from carrying patients who must be carried on a stretcher, except in a disaster or when the rider’s own mobility aid cannot be secured and a physician authorizes the transfer in writing. HCA’s December 2024 report says its non-ambulance stretcher van pilot, running since May 2021, is still very limited.

Driver rules and training

HCA’s sample contract has the broker verify each driver before the first trip. Every driver needs:

• A valid driver’s license, an abstract of driving record, and insurance.
• A Washington State Patrol fingerprint background check before starting and every three years, with a Washington Access to Criminal History (WATCH) name check in the years between. A WATCH check can cover a new driver while fingerprints are pending.
• A record that clears them for unsupervised access to children and vulnerable adults under RCW 43.43.830, checked against the DSHS crimes list in WAC 388-113-0020.
• Child safety seat training. The contract also recommends CPR and first aid, passenger assistance, fire suppression, and defensive driving.

Paratransit Services’ packet sets stricter limits. A driver is out if they:

• Are under 21 or have held a license less than five years.
• Have more than one moving violation or at-fault accident in the last three years.
• Have a felony conviction at any time.
• Have a DUI or DWI conviction in the last 10 years, or more than one ever, even when reduced to negligent driving.
• Have a misdemeanor against persons in the last 10 years, or another misdemeanor in the last 5.

Its drivers also take a defensive driving course of at least four hours, first aid and CPR, passenger assistance, and yearly HIPAA training, and pass a road test and a pre-employment drug test. Community in Motion requires child safety seat training, CPR and first aid, defensive driving, and passenger assistance. See NEMT driver training for course options.

On the job, drivers wear company ID, open doors, help riders to the main door, and check belts and wheelchair securement before moving. Under chapter 182-546 WAC, the broker sets each rider’s level of help, from curb to curb and door to door to hand to hand. Drivers never wear headphones, hold a phone while driving, smoke with riders aboard, or ask riders for money.

The broker keeps a monthly list of your drivers and rechecks at least 10 percent each year. Paratransit Services also wants a yearly driving abstract and a monthly license status check. Track it all with our driver file checklist. Pay for trips by an unapproved driver or vehicle must be returned within 30 days of discovery.

Trip rules and how you get paid

HCA’s sample contract sets these service standards:

• Pickup. The average wait going to an appointment is 15 minutes or less, and no rider waits more than 30. Riders never arrive more than 30 minutes early unless they ask.
• Returns. The average wait for a scheduled return is 30 minutes or less. Will-call trips are exempt; Special Mobility Services gives drivers 60 minutes after the call.
• Shared rides. No rider rides more than 45 minutes longer than a direct trip would take.
• Late arrivals. If the rider arrives too late to be seen, the trip is not paid. The broker may still pay if the delay was not your fault, such as an accident that stopped all traffic, but not for construction delays.

After hours, you may carry an urgent care or hospital discharge rider under the broker’s after-hours instructions, then request retroactive authorization within two business days.

HCA does not set NEMT rates. Its December 2024 report says costs vary too much by region, so each broker negotiates with each provider. Paratransit Services has you propose a base, per-mile, and shared-ride rate for ambulatory and wheelchair trips, plus lift, wait time, and assistant fees. Community in Motion’s pricing form, revised January 28, 2026, sets these limits:

Item	Community in Motion rule
Per-mile rate	$3.50 at most
Shared or group pickup fee	No more than the regular pickup fee
After-hours fee	Only for pickups from 8:30 pm to 4:30 am
Bariatric fee	Wheelchairs over 32 inches wide or over 600 pounds

Before you fill in a rate sheet, read how to negotiate broker rates.

Under the sample contract, the broker must pay you within 10 calendar days of receiving HCA’s monthly payment. Your subcontract must allow rate adjustments at least quarterly, give you an appeals process, and set a fair rate for an authorized trip whose appointment falls through at no fault of yours. The broker can review your records for six years after the subcontract ends.

No-shows are different. HCA’s December 2024 report says that when a facility or rider changes plans without telling the broker, the provider gets a no-show and cannot be paid. See billing for no-shows.

Insurance requirements

HCA’s sample contract sets the broker’s own insurance and applies the same types and limits to providers that hold no for-hire or UTC license:

Coverage	Minimum
Commercial general liability	$1 million per occurrence, $2 million aggregate
Business auto liability	$1 million combined single limit
Professional liability	$1 million per claim, $2 million aggregate
Privacy breach response	Forensics, notification, and regulatory defense

HCA wants the broker’s insurers authorized in Washington and rated B++, Class VII or better. Providers licensed as for-hire operators or by the UTC need at least the legal minimums, but brokers can ask for more. Paratransit Services’ 2021 packet asks its providers for the full list above, naming Paratransit Services and HCA as additional insureds. See NEMT insurance requirements for other states.

These are the state minimums for bodily injury and property damage liability as of September 2026. UTC counts the driver as a passenger.

License	Minimum
DOL for-hire	$325,000 combined single limit, or $100,000 per person, $300,000 per accident, and $25,000 property damage
UTC nonprofit, fewer than 16 passengers	$500,000 combined single limit
UTC nonprofit, 16 or more passengers	$1 million combined single limit

Workers’ compensation in Washington comes only from the Department of Labor and Industries (L&I), unless you qualify to self-insure. Premiums follow your workers’ hours, reported quarterly. Business owners are generally excluded from mandatory coverage, and so are for-hire operators who own or lease their vehicles. Brokers ask for proof of L&I coverage. Before paying drivers as contractors, read 1099 or W-2 drivers.

What it costs and how long it takes

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

Item	Cost	Paid to
LLC Certificate of Formation	$180 plus an online processing fee	Secretary of State
LLC annual report	$70 a year, $95 if delinquent	Secretary of State
Business license, new business	$50 processing fee	Department of Revenue
For-hire permit, where no local license	$110	Department of Licensing
For-hire vehicle certificate	$55 per vehicle, yearly	Department of Licensing
WATCH name check	$11 online	Washington State Patrol
Fingerprint background check	$58	Washington State Patrol
EIN	Free	IRS

A workable order, from first call to first trip:

1. Call the broker for your counties. Ask whether it needs providers and what its minimums are.
2. Form your company and get your EIN.
3. Get your business license with the for-hire endorsement, and open an L&I account if you will have workers.
4. Buy insurance that meets the broker’s list, with DOL as certificate holder.
5. Register each vehicle with the F/H or CAB use class and get its for-hire certificate.
6. Equip your vehicles to the broker’s list.
7. Hire drivers and run driving abstracts, WATCH and fingerprint checks, and drug tests.
8. Apply to the broker, pass its checks, and sign your subcontract and rate sheet.

The state steps take a few weeks. The business license takes about 10 business days online, plus two to three weeks for endorsements, and DOL issues the for-hire license within 14 business days of complete documents. The broker sets the real pace: up to 30 days at Hopelink once you meet its experience minimum, and about four months at Community in Motion after a round closes. See how to start a NEMT business for the general steps and starting with one van for a small start.

Work beyond Medicaid

Three other sources of rides are worth a call.

• Broker programs beyond Medicaid. Community in Motion’s vendor pricing form also covers employment rides, Reserve-A-Ride, Sponsor-A-Ride senior trips, and a shuttle. The same form says you cannot charge any other contract or private payer less than you charge Community in Motion.
• Special needs transportation grants. WSDOT’s Consolidated Grant Program funds rural and tribal public transportation and rides for older adults and people with disabilities. Nonprofits, tribes, transit agencies, and local agencies can apply, and projects must appear in the regional coordinated human services transportation plan. Ask your regional transportation planning organization which agencies run that service near you.
• Veterans. The VA pays for special mode transportation, such as a specially equipped vehicle, when the veteran qualifies for travel pay, a VA provider decides their condition requires it, and VA approves the trip in advance. Ask the beneficiary travel office at your nearest VA facility how it books these rides.

Dialysis centers, hospitals, senior living communities, and riders who pay for themselves add work that does not depend on one broker. See how to get NEMT facility contracts and private pay NEMT.