State-by-State Profiles for the Research and Update: NEMT and Public Transportation project is a document that presents a non-Emergency Medical Transportation (NEMT) profile for each of the 50 states and the District of Columbia. The set of profiles provides information for each state in the following sequence:
Authors: Texas A&M Transportation Institute & RLS and Associates, Inc.
Prepared for Community Transportation Association of America & National Center for Mobility Management
INFORMATION UPDATES
Medicaid non-emergency medical transportation is dynamic. Each state profile includes the date the information was collected—located under the map. Contact the CCAM Technical Assistance Center at info@ccam-tac.org to submit state information updates—subject line “NEMT State Profile Update.”
Medicaid is a joint federal and state program that provides health coverage for individuals and families with limited incomes and resources. The Medicaid program provides critical health coverage for millions of people who might not otherwise be able to afford it. The assurance of transportation to necessary medical care is an important feature that sets Medicaid apart from traditional health insurance. Medicaid non-emergency medical transportation (NEMT) is an important benefit for Medicaid beneficiaries who need to get to and from medical services and have no other means of transportation.
Within broad national guidelines established by federal statutes, regulations, and policies, each state establishes its own eligibility standards; determines the type, amount, duration, and scope of Medicaid services; sets the rate of payment for services; and administers its own Medicaid program, including its own NEMT program. The state role means there are differences in how healthcare is administered, and in differences in state-to-state for how NEMT is provided.
The purpose of the state profiles is to provide a reference for the approach to NEMT in each state. The information in the profiles is developed from national sources of data, state websites, and responses from the state Medicaid and Department of Transportation agencies to a questionnaire developed for this project. The state profile date listed at the top of each profile reflects the date the information was collected or updated.
The following provides an overview of the structure of Medicaid service delivery and the provision of Medicaid Non-Emergency Medical Transportation (NEMT) exploring the differences between fee-for-service and managed care approaches, the concepts of “carved in” versus “carved out” services, and the operational models for NEMT, including directly operated and brokered transportation systems. Understanding these elements is essential for comprehending the complexities of Medicaid NEMT service delivery.
States typically provide Medicaid healthcare services in two ways: directly as a fee-for-service basis and/ or through MCOs. While most state Medicaid agencies provide Medicaid healthcare services through a combination of both models, approximately 74 percent of all Medicaid Beneficiaries were enrolled in Managed Care in 2021 to receive healthcare services according to the Kaiser Family Foundation (KFF, 2024)
Under Managed Care, the state may require MCOs to either 1) integrate NEMT in the health care system as a carved in service, or 2) carve out the provision of NEMT, in which case the state remains responsible for the provision of NEMT.
NEMT services are typically either directly operated on a fee-for-service basis or are contracted through a third-party transportation broker. Transportation broker contracts can vary in size and structure, ranging from state-wide or regional contracts.
States that provide a mixed model (with the exception of three states):
The three states that are the exception are Colorado, Michigan, and Pennsylvania that operate a mixed model where the state contracts with a regional transportation broker to provide NEMT around a major metropolitan area, and the remainder of the state is provided through state as a directly operated service.
There are 7 states (or 14%) that provide NEMT as a directly operated service, 11 states (or 22%) that provide NEMT through regional transportation brokers, 12 states (or 23%) that provide NEMT through statewide transportation brokers, and 21 states (or 41%) that provide NEMT as a mixed model (see Table 1 and Figure 1).
Table 1. NEMT Models by State (as of September 2024)
NEMT Model
State
Number of States
Directly Operated
AL, AK, MD, MT, ND, SD, WY
7
Regional Transportation Brokers (contracted by the State)
AR, GA, KY, ME, MA, SC, VT, WA, WV
9
Regional Transportation Brokers (contracted by MCOs)
KS, OR*
3
Statewide Transportation Broker (contracted by the State)
CT, DE, ID, MO, NV, NJ, NY, OK, RI, UT, WI
11
Statewide Transportation Broker (contracted by MCO)
TN
1
Mixed Models
Directly Operated &
Regional Transportation Brokers (contracted by MCOs)
AZ, CA FL HI, IL, NE, MN**, NM, NC, OH
9
Statewide Transportation Broker &
Regional Transportation Brokers (contracted by MCOs)
DC, IN, IA, LA, MS, NH, TX, VA
8
Directly Operated &
Regional Transportation Brokers*** (contracted by the State)
CO, MI, PA
3
Total
51
*Oregon’s regional transportation brokers are contracted 1) by MCOs for MCO members, and 2) by the state for recipients that opt-out of an MCO.
**Minnesota does not have transportation brokers but rather regional MCOs contract directly with transportation providers.
***Colorado, Michigan, and Pennsylvania provide regional transportation brokers around a major metropolitan area; otherwise operate NEMT as directly operated.
NEMT Model: Directly Operated
Alabama administers Medicaid through the Alabama Medicaid Agency (AMA). AMA provides most healthcare as an in-house fee-for-service (FFS) program. Medicaid long term care and non-Medicaid Home and Community Based (HCBS) healthcare is provided through a managed care system called Integrated Care Network (ICN). NEMT is carved-out of the MCO services. The state relies heavily on mileage reimbursement, volunteers and other drivers of private automobiles. The state’s 67 counties are organized into 10 regional NEMT districts. AMA purchases services from transportation providers on a FFS schedule.
CMS Region 4
September 2024
Medicaid recipients contact the NEMT program coordinator in their region to authorize and schedule a ride. Recipients can choose among a list of approved providers.
AMA approves private transportation. A tiered fee for transportation payment structure is utilized based upon a variety of factors including mileage, region, client needs.
NEMT services may be provided by public transit passes/tickets if deemed most appropriate, and the least costly mode of transportation.
NEMT Model: Directly Operated
Alaska administers Medicaid through the Alaska Department of Health and Social Services (DHSS) providing healthcare as an in-house management fee-for-service (FFS) program. DHSS NEMT program is unique in that it does not provide reimbursement ground transportation program for its Medicaid recipients. The vast majority of the state’s NEMT expenditures are for air and ferry transportation to medical services. are paid directly by the state on a FFS basis. Taxi and public transportation (Anchorage) provide “last mile” transportation.
CMS Region 10
September 2024
Requests for medical transportation assistance are made to a statewide call center, which is operated by an administrative services contractor hired by DHSS. Travel is scheduled with approved air carriers, and providers. At the destination, Medicaid recipients use taxi vouchers with an Alaska Medicaid enrolled taxi provider to travel from the airport or by public transit in Anchorage.
DHSS approves transportation providers. Providers are paid directly by the state on a fee-for-service basis.
Alaska Medicaid loads bus passes (one day, one week, or 30 day) through the Mticket application in the Municipality of Anchorage for Medicaid/ Denali KidCare–eligible children and pregnant women. Also, bus passes are mailed if recipients do not have a smart phone.
NEMT Model: Directly Operated, Regional Transportation Brokers (through MCOs)
Arizona administers Medicaid through the Arizona Health Care Cost Containment System (AHCCCS). AHCCCS provides healthcare through managed care organizations. Recipients enrolled in the American Indian Health Program have the option of either a MCO or the state’s in-house management program. MCOs provide NEMT as a carved in service through regional transportation brokers, and the state directly operated in-house program provides NEMT as a fee-for-service. NEMT is provided if recipients do not have their own means of transportation or means to arrange for transportation to include public transit.
CMS Region 9
September 2024
Recipients in the MCO program choose a health plan that is in their zip code. Recipient health plan Member Services arrange for NEMT. American Indian Health Program (AIHP) members can choose to receive NEMT through the AIHP program that arrange rides.
Providers must be AHCCCS registered providers and are screened to include background and site visit and requires a fee. A Tribal business license is required to pick up on reservations. MCOs negotiate rates with providers. AIHP has a set fee schedule for NEMT trips.
Recipients enrolled in a health plan are provided NEMT if they do not have their own transportation or means to arrange for transportation to include taking public transit. FFS members can claim reimbursement for public transportation up to a one-month pass.
NEMT Model: Regional Transportation Brokers (through the State)
Arkansas administers Medicaid through the Arkansas Human Services, Division of Medical Services (DMS). DMS contracts with regional transportation brokers to provide NEMT—called Arkansas Non-Emergency Transportation (NET) Program. The regional transportation broker can contract with subcontractors in the region to serve as a gatekeeper, processing transportation requests and monitoring complaints. There are currently 7 regions and three NET brokers—that are a combination of for-profit and human service brokers—Southeastrans (Verida), Central Arkansas Development Council, and Area Agency on Aging of Southeast Arkansas. In addition, some human service transportation providers provide NEMT directly under contract to DMS.
CMS Region 6
December 2024
Recipients are provided NEMT rides without limit on the number of trips or miles travelled within their region. Recipients schedule a ride through the regional broker through a toll-free line. Travel outside the member region requires a referral from the doctor that is sent to the NET broker.
Brokers can provide transportation directly or subcontract (subject to approval) with transportation providers to provide NEMT in the region. Brokers are required to negotiate service delivery rates with qualified sub-contractors.
If a recipient has public transit available and able to ride, then NEMT is not provided. Broker contracts include a “gatekeeping process” that states that if the answer is yes to “Is there public transit available to the beneficiary?” then the broker shall deny NEMT transportation.
NEMT Model: Directly Operated, Regional Transportation Brokers (through MCOs called MCPs)
California administers Medicaid through the state Department of Health Care Services, Medi-Cal program agency. Recipients receive healthcare services through either a managed care plan (MCP) or directly as a fee-for service. Two types of medical transportation are offered for Medi-Cal recipients—NEMT and “Non-Medical Transportation” (NMT). NEMT service requires a physician completed Physician Certification Statement (PCS). NEMT is designed for recipients who cannot use ordinary transportation due to medical and physical conditions.
CMS Region 9
September 2024
Therefore, public transportation is generally not used—NEMT typically involves wheelchair vans, litter vans, ambulance, and other specialized vehicles. Whereas NMT does not require a PCS. NMT expands the provision of transportation to mental health, substance use disorder, dental and other healthcare services. NMT is designed for recipients that can use ordinary transportation but need assistance to get to healthcare appointments. NMT provides use of additional transportation modes to include TNCs, taxicab, and public transportation. MCPs provide for NEMT and NMT through transportation brokers and directly through transportation providers. Medi-Cal also provides for NEMT and NMT for recipients who are not enrolled in MCPs as a fee-for-service.
Recipients that receive Medi-Cal through a MCP contact the MCP to request NEMT. Recipients that receive Medi-Cal as a FFS email DHCS requesting assistance with coordinating transportation. NEMT services “require a written prescription from a licensed provider and prior authorization on a form known as a Physician Certification Statement (PCS).
MCPs either subcontract with transportation brokers for the provision of NEMT or provide NEMT through their own providers directly. MCP trips are subject to utilization controls and permissible time or distance standards. DCHS approves and contracts with transportation providers to provide fee-for-service trips. FFS trips are not subject to utilization controls and permissible time or distance standards.
Fee-for-service members can be reimbursed for parking, ferry, busses, rail transit, taxis, and toll bridges. Members must submit an original itemized receipt attached to a completed Member Reimbursement Form for Transportation Expenses. Members enrolled in Managed Care can contact their MCO or NEMT broker to request public transit passes.
NEMT Model: Directly Operated, Regional Transportation Brokers (through the State)
Colorado administers Medicaid through the Colorado Department of Health Care Policy and Financing, Colorado Health First program. Colorado Health First provides healthcare as an in-house program. NEMT is provided through 1)a regional broker for nine counties in the Denver metro area (currently Health Solutions by Transdev), and 2)through local transportation providers on a fee-for-service basis if outside of the Denver metro area. Colorado encourages the regional Denver metro area broker to utilize public transit where appropriate. Transdev provides state-wide driver and vehicle credentialing.
CMS Region 8
September 2024
If a recipient lives in the Denver metro area, the member contacts Health Solutions by Transdev to schedule transportation 48 hours before travel. If a recipient lives outside of the Denver metro are, the recipient visits the NEMT provider page to find a local NEMT provider and contact the provider’s office directly to schedule rides for travel at least two business days before the appointment.
Areas outside of the Denver metro area, transportation rates are set on an annual basis by service type. The regional Denver area broker negotiates rates as part of the contract. Transdev manages driver and vehicle credentialing for the entire state.
Denver’s public transit—RTD provides Special Discount Cards and reduced fares for Medicaid NEMT qualified. The Special Discount Card provides a 50 percent fare reduction for bus and rail services, excluding ADA paratransit.
NEMT Model: Statewide Transportation Broker (through the State)
Connecticut administers Medicaid through the Connecticut Department of Social Services, Husky Health program. Husky Health provides healthcare through different contractors to serve the physical, behavioral, and dental health needs. Husky Health contracts for NEMT with a state-wide broker (currently MTM). The NEMT program transitioned from a fee-for-service contract to a capitated broker model as part of the state’s transition to an Administrative Services Only (ASO) model in 2018. The goal of this transition was to allow greater flexibility for the NEMT broker to implement pay-for-performance incentives related to quality and customer satisfaction while controlling costs.
CMS Region 1
April 2024
Recipients can schedule trips by calling MTM or by using the MTM Link Member Portal or mobile app. Rides may be scheduled as shared ride with another recipient, as appropriate.
The state-wide broker contracts with transportation providers to include commercial providers, independent drivers, and home and community-based service providers. Majority are commercial providers that complete an application, interview, credentialing, and if approved a contract is signed with a negotiated rate, training is required.
Nearly two-thirds of NEMT rides are provided on public transportation in Connecticut. The transportation broker determines the most appropriate NEMT travel that includes fixed route bus tickets if the member’s home and destination are within ¾ (0.75) miles of a bus stop and can walk there independently and safely.
NEMT Model: Statewide Transportation Broker (through the State)
Delaware administers Medicaid through the Department of Health and Social Services, Division of Medicaid and Medical Assistance (DMMA). DMMA provides healthcare through managed care organizations. DMMA provides NEMT as a carved-out service and contracts for NEMT with a statewide broker (currently Modivcare, Inc.). The broker is responsible for the administration and provision of NEMT in each of the three counties in Delaware.
CMS Region 3
September 2024
The statewide broker verifies recipient eligibility and arranges for the appropriate transportation. The recipients must use the statewide broker and the transportation provider assigned by the broker for the NEMT trip.
The statewide broker contracts with transportation providers through a request for proposal process. The broker is paid on a capitated rate basis and the transportation providers are paid as a negotiated rate by the broker.
Delaware provides transit passes in some cases to Medicaid recipients per the State Plan.
NEMT Model: Statewide Transportation Broker, Regional Transportation Brokers (through MCOs)
The District or Columbia (Washington D.C.) administers Medicaid through the Washington DC Department of Health Care and Finance (DHCF). DHCF provides Medicaid healthcare as an in-house program called DC Straight Medicaid, or through a managed care program called DC Managed Care Program. The DC Straight Medicaid program provides NEMT through a state-wide transportation broker (currently MTM). The DC Managed Care Program provides NEMT through the recipient’s managed care provider as a carved-in service and contracts to transportation brokers.
CMS Region 3
September 2024
Recipients enrolled as a DC Straight Medicaid schedule trips through the state-wide transportation broker (currently MTM). Recipients enrolled in a DC Medicaid Managed Care Program schedule trips through their managed care provider broker to request transportation.
The DC Straight Medicaid and the DC Medicaid Managed Care Program both contract with brokers to provide transportation service. Transportation providers contract with the broker at negotiated rates. The broker requires transportation providers to complete an application, broker provides credentialing, and then complete contracting phases.
The brokers provide SmarTrip fare cards to recipients to be used for bus and rail service. The brokers also provide funds to the ADA paratransit EZ pay system that flow into the accounts of ADA-eligible NEMT riders. Travel training is provided to recipients to encourage use of bus and rail service by the Washington Metropolitan Area Transit Authority.
NEMT Model: Directly Operated, Regional Transportation Brokers (through MCOs)
Florida administers Medicaid through Florida’s Agency for Health Care Administration (AHCA). AHCA provides Medicaid healthcare through managed care organizations (MCOs) with NEMT as a carved-in service. Some recipients are not required to enroll in an MCO and obtain services directly through the AHCA in-house, fee-for-service program. MCOs and AHCA contracts with NEMT brokers for the provision of transportation. MCOs contract with brokers to provide NEMT for Medicaid recipients. Most recipient are required to enroll in an MCO.
CMS Region 4
September 2024
Recipients contact their MCO brokers or AHCA fee-for-service broker to request NEMT rides.
The brokers each contract with a variety of transportation providers including taxicabs, public transit, human services transportation providers, and in some counties, the community transportation coordinator.
Public transit providers may contract with brokers as NEMT providers. Recipients may be provided public transit fares for NEMT.
NEMT Model: Regional Transportation Brokers (through the State)
Georgia administers Medicaid through the Georgia Department of Community Health (DCH). DCH provides Medicaid healthcare as an in-house management and through managed care organizations. NEMT is carved-out of MCO services. NEMT is provided for all recipients through DCH’s regional brokerage system with two brokers, currently Modivcare Solutions and Verida, that coordinate and provide NEMT services for the state’s five regions (North, Atlanta, Central, East and Southwest).
CMS Region 4
September 2024
Recipients must contact the broker for NEMT services. The broker that will use the most appropriate mode of transportation – minibus, wheelchair vans, automobiles, stretcher vans, public or paratransit. The broker may also use gas reimbursement and taxicabs for urgent care and/or back-up services when necessary.
Transportation providers must contract with Modivcare Solutions and/or Verida to provide NEMT services. NEMT brokers are paid a monthly capitated rate based on the number of recipients in the region(s). Providers are paid at the contract negotiated rate.
Brokers have procedures in place to determine whether public transportation is accessible to and appropriate for the member requesting service. Both NEMT brokers review electronic route information to determine if a pickup and drop-off locations are on a public transit route. There are also procedures in place for distribution of transit tokens/passes to the member and or escort (if applicable) using public transit.
NEMT Model: Directly Operated, Regional Transportation Brokers (through MCOs)
Hawaii administers Medicaid through the Hawai’i Department of Human Services, Med-QUEST Division. Medicaid healthcare is provided by a combination of managed care organizations (MCO) or as an in-house, fee-for-service (FFS) delivery system. NEMT is provided by MCOs through transportation brokers, and is provided by Med-QUEST directly through fee-for service taxi providers.
CMS Region 9
September 2024
MCO members receive NEMT through the MCO transportation brokers or transportation coordinators. FFS members receive NEMT directly through Med-QUEST. Med-QUEST uses taxi, curb-to-curb, door-to-door transportation services for NEMT.
Providers contract with MCOs and Med-QUEST Division. MCO’s negotiation rates with providers. Taxi service is provided only when justified by a licensed physician justification that must submit a Request for Individualized Transportation Service form.
NEMT services are authorized when recipients are unable to utilize public transportation, has a car but is unable to drive themselves, or does not have someone to drive them.
NEMT Model: Statewide Transportation Broker (through the State)
Idaho administers Medicaid through the Idaho Department of Health and Welfare (DHW), Division of Medicaid. The Division provides Medicaid medical care for all recipients as FFS. The Department provides some services, such as Behavioral Health, Dental, and Vision, as carved-out services through managed care organizations (MCOs). NEMT is a carved-out service and is provided through a state-wide broker, currently MTM, Inc.
CMS Region 10
April 2025
Recipients contact the statewide broker to request NEMT trips. Medicaid recipients must use the transportation provider assigned by the broker for the NEMT trip. Recipients must schedule a ride with the broker at least 2 working days in advance unless there is urgent need.MTM uses curb-to-curb, door-to-door, and hand-to-hand transportation services for NEMT. Broker may use gas reimbursement.
Transportation providers contact the statewide broker for information on steps to become a NEMT provider, training requirements and other resource materials. Transportation providers negotiate rates with the statewide broker. The broker contracts with transportation providers, handles transportation provider credentialing, and authorizes TNCs such as Uber or Lyft to provide NEMT.
Public transit providers may contract with brokers as NEMT providers. Recipients may be provided public transit fares for NEMT. Recipients can use if their residence and the medical facility is within 1/2 mile of a transit stop.
NEMT Model: Directly Operated, Regional Transportation Brokers (through MCOs)
Illinois administers Medicaid through the Illinois Department of Healthcare and Family Services, Division of Medical Programs. The Division requires most recipients to enroll in a managed care organization (MCO) for healthcare. Recipients enrolled in MCOs receive all transportation services, except emergency and non-emergency ground ambulance services, through transportation brokers or through the MCO itself. For recipients not enrolled in a MCO, the state provides NEMT through a vendor. The state contracts with the Non-Emergency Transportation Services Prior Authorization Program (NETSPAP) that authorizes recipients’ NEMT trips prior to transport. NETSPAP does not arrange transportation but does maintain a list of certified state transportation providers to choose from, including public transit services.
CMS Region 5
December 2024
Recipients enrolled in MCOs contact the MCO broker, or contact the MCO directly to schedule trips. Recipients not enrolled in MCOs choose transportation providers certified by Illinois Medicaid, but must first obtain prior authorization from the state’s prior approval vendor.
MCO brokers or MCOs directly contract with transportation providers. For the fee-for-service program, Illinois Medicaid contracts with transportation providers. In 2023, Illinois authorized TNCs such as Uber or Lyft to provide NEMT.
Public transportation operators may contract with Illinois Medicaid, and possibly brokers and MCOs, to receive trips. Use of public transit services depend on recipients’ medical needs.
NEMT Model: State-Wide Transportation Broker (through the State), Regional Transportation Brokers (through MCOs)
Indiana administers Medicaid through Family and Social services Administration, Indiana Health Coverage Program (IHCP). IHCP provides “Traditional Medicaid” recipients with healthcare as an in-house management program. NEMT is provided through a state-wide broker, Verida, for Traditional Medicaid members. Hoosier Healthwise (CHIP, children up to age 19 and pregnant individuals, and Hoosier Care Connect (individual 65 and older, blind, disabled, or have Medicare), healthcare is provided by managed care organizations. NEMT is provided as a MCO carved-in service and MCOs contract with transportation brokers.
CMS Region 5
September 2024
Medicaid recipients contact their designated NEMT broker to request trips.
Providers may contract with the state’s broker or MCO brokers to perform trips for negotiated rates. Fee-for-service NEMT providers must first enroll as IHCP providers prior to contracting with the state-wide broker.
Public transportation operators may contract with the various brokers.
NEMT Model: State-Wide Transportation Broker (through the State), Regional Transportation Brokers (through MCOs)
Iowa administers Medicaid through the Iowa Department of Human Services, Iowa Medicaid Enterprise (IME) Division. IME provide Medicaid healthcare through the managed care organization program called IA Health Link, or through Iowa Medicaid in-house program. NEMT is a carved-in MCO program. Currently three MCOs in IA Health Link contract with the NEMT broker Access2Care. NEMT is provided through a statewide broker , MTM Inc., for in-house members. The Iowa Health and Wellness Plan (IHAWP) is a part of IA Medicaid demonstration program for recipients in the Affordable Care Act expansion population—recipients in the IHAWP do not receive NEMT.
CMS Region 7
September 2024
Recipients schedule a ride with a broker at least two working days in advance unless urgent need. Recipients must schedule through the broker.
Transportation providers contract with brokers to provide NEMT at negotiated rates.
Public transit providers are eligible to contract with brokers. Transportation brokers may arrange for a bus ticket or bus pass.
NEMT Model: Regional Transportation Brokers (through MCOs)
Kansas administers Medicaid through the KanCare program. Medicaid recipients must enroll in one of the three KanCare managed care organizations (MCOs). Recipients access NEMT through their MCO’s NEMT brokers—Aetna uses Access2Care as their broker, and Sunflower Health Plan and United HealthCare use ModivCare.
CMS Region 7
September 2024
Recipients contact their broker in advance to request a ride. Urgent rides are available but are subject to verification with the member’s medical care provider.
Providers contract with the brokers. The brokers pay the providers for rides. The providers are responsible for collecting applicable Spenddown amounts from Spenddown members, prior to billing the brokers for the balances.
Some public transit operators’ contract with the brokers. Where available and suitable for the physical condition of the member, the brokers will provide mass transit tickets or passes for riders traveling near a bus route.
NEMT Model: Regional Transportation Brokers (through the State)
Kentucky administers Medicaid through the Kentucky Transportation Cabinet, Department of Medicaid Services. Kentucky Transportation Cabinet also is the state public transit oversight agency. The Department provides Medicaid healthcare as an in-house program and through managed care organizations (MCOs). NEMT is provided as a carved-out MCO service. The Department provides NEMT for all Medicaid recipients through a regional brokerage model known as Human Service Transportation Delivery (HSTD). The HSTD program that relies on local community-based brokers, many of which operate as the rural public transit providers.
CMS Region 4
September 2024
Recipients contact their regional brokerage to request rides. HSTD provides a brokerage listing on the HSTD website.
Brokers are required to serve as regional coordinators and “can act as transportation providers themselves, contract with other transportation subcontractors … or act solely as brokers by contracting out all transportation provision.” An NEMT provider must: be licensed; be enrolled as a Kentucky Medicaid Provider; and, be enrolled with the recipient’s MCO.
Some public transit systems serve as the regional brokers. Public transit operators may contract with the brokers to provide NEMT trips. Or the broker may provide fixed route transit passes to members. Depending on a member’s medical needs, transportation may be provided by public transit.
NEMT Model: Statewide Transportation Broker (through the State), Regional Transportation Brokers (through MCOs)
Louisiana administers Medicaid through the Louisiana Department of Health (LDH). LDH uses a statewide NEMT broker, Verida, for in-house program members. Managed care organization (MCO) members receive NEMT as a carved-in service through the MCO transportation brokers. The brokers currently in use are MTM, Verida, Meditrans, and ModivCare.
CMS Region 6
September 2024
Medicaid recipients who receive transportation services from a MCO should contact the call centers. Fee-for-service recipients call the state-wide broker.
Providers are allowed to individually negotiate reimbursement rates. Louisiana publishes a NEMT fee schedule. The MCOs’ brokers may pay more than the minimum fee schedule rates; however, they may not pay less.
Transit providers may contract with the brokers.
NEMT Model: Regional Transportation Brokers (through the State)
Maine administers Medicaid through the Maine’s Department of Health and Human Services, Office of MaineCare Services (OMS). OMS provides Medicaid healthcare through an in-house program and a managed care organization (MCO) program. NEMT is a carved-out MCO program. OMS provides NEMT for all recipients through a regional broker model that divides the state into eight Medicaid districts. The current brokers for these districts are Modivcare, Penquis Community Action Program, and Waldo Community Action Partners. In 2024, Modivcare was awarded all eight regions in Maine via competitive procurement, however, that decision has been appealed and is currently before the Maine Business and Consumer court. A decision by the court will not likely happen until early 2025.
CMS Region 2
December 2024
Recipients contact their local broker in advance to request rides. Urgent trips are provided; the brokers will verify that the trip is urgent.
Providers contract with a broker. The providers include taxis, human service agencies, public transit operators, and other provider types. The brokers contract with individual volunteers to provide some rides.
Public transit providers may contract with the brokers. Brokers may provide transit fare passes to members.
NEMT Model: Directly Operated
Maryland’s Medicaid program is administered by the Department of Health and Mental Hygiene (DHMH). DHMH provides Medicaid healthcare as an in-house program and through managed care organizations (MCOs)—NEMT is a “carved-out” service. NEMT is provided for all Medicaid recipients as FFS. Each year, DHMH allocates medical transportation funds to each county in the form of human service contracts. Most counties provide NEMT through the county Department of Health. In Montgomery County, the county’s Department of Transportation provides NEMT. Some counties become directly involved in overseeing NEMT services, including operating as brokers by arranging trips and monitoring use. Others contract out those functions.
CMS Region 3
September 2024
Transportation services may be arranged through the local health department. Recipients can call the local health department to schedule transportation.
Transportation providers include taxicab, or van transportation. Transportation providers can contact each local health department transportation grant manager for information on becoming a provider.
Medicaid recipient living within a three-quarter mile of a bus or rail stop are expected to use public transportation in accessing medical services. MCOs may offer bus tokens to cover the transit trips.
NEMT Model: Regional Transportation Brokers (through the State)
Massachusetts administers Medicaid through the Executive Office of Health and Human Services, MassHealth Medicaid program. MassHealth provides healthcare through managed care organizations (MCOs)—NEMT is a carved-out MCO service. EOHHS established a Human Service Transportation (HST) Office to coordinate transportation for six state agencies, including MassHealth. HST provides NEMT through a regional brokerage system with Regional Transit Authorities (RTAs) currently brokering and managing trips throughout the state. Two RTAs serve as MassHealth Brokers covering the entire state–Montachusett Regional Transit Authority (MART), and Greater Attleboro and Taunton Regional Transit Authority (GATRA).
CMS Region 1
December 2024
Recipients who are not able to access public transportation and/or private means of transportation are eligible for NEMT. MassHealth assigns a transportation broker to each member based on city or town of residence–brokers arrange rides. To receive NEMT, recipients contact their primary care provider that completes a Provider Request for Transportation form that serves as the authorization to a specific location. Separate forms are needed for each location. A Customer Web Portal is provided.
Brokers arrange transportation services by subcontracting with local qualified transportation providers. Transportation providers are primarily private for-profit, not-for-profit, and public transit agencies. Broker contracts include share-cost incentives. Transportation providers contact the broker in area of service: MART – Western Mass, Central Mass, Metro Boston, Northeastern Mass; and GATRA – Southeastern Mass, Cape Cod, Islands.
Brokers can subcontract to public transit providers for demand response NEMT services. Recipients who are not able to access public transportation and/or private means of transportation are eligible for NEMT.
NEMT Model: Directly Operated, Regional Transportation Brokers (through the State)
Michigan administers Medicaid through the Michigan Department of Community Health, Michigan Department of Human Services (MDHHS). MDHHS provides Medicaid healthcare through the in-house program, and through managed care organizations (MCOs). Medicaid beneficiaries receive dental, substance abuse, and community mental health services through MCOs. NEMT is a carved-out service from the MCOs. MDHHS provides NEMT for all recipients as a fee-for-service program in all Michigan counties except Wayne, Oakland, and Macomb, where NEMT is provided through a regional broker. A proposed policy change to be effective October 1, 2024, would require MCOs to cover NEMT as a “carved-in” service where NEMT is provided through the health plan or health plan’s transportation vendor.
CMS Region 5
September 2024
Transportation is requested through the county MDHHS office that reviews the request for appropriateness and approves accordingly, or through the regional brokerage contractor for Wayne, Oakland, and Macomb counties.
Outside of the regional broker, MDHHS administers provider registration and approval of recipient transportation requests, and payment to providers. Currently MDHHS establishes an annual rate schedule by transportation mode.
Recipients can be reimbursed for public transportation fares.
NEMT Model: Directly Operated, Regional Transportation Brokers (through MCOs)
Minnesota administers Medicaid through the Minnesota Department of Human Services, Minnesota Health Care Program (MHCP). MHCP provides Medicaid healthcare through a county/tribal-run fee-for service (FFS) model, and through managed care organizations (about two-thirds of MHCP members). FFS members who need wheelchair accessible vehicles service level or higher are required to be certified through a contract with Kepro to conduct assessments to receive NEMT. MCOs contract with transportation providers directly at negotiated rates to provide NEMT. MHCP contracts with transportation providers on a fee-for-service basis.
CMS Region 5
April 2025
FFS recipients contact MHCP to be certified and to schedule transportation. Members enrolled in a managed care organization (MCO) must contact the appropriate MCO for the process and procedures for obtaining transportation services. Recipients who are able to travel by public transport must use public transport.
Both MCHP and MCO transportation providers negotiate agreements to provide NEMT services. Potential transportation providers can find enrollment information at Enrollment with Minnesota Health Care or through the respective MCOs.
FFS recipients whose needs are met by public transit may receive public transit tickets or a monthly public transit pass. Counties or tribes cannot require members to select a monthly transit pass if public transit does not meet the member’s needs. MCOs, the county or tribe will negotiate agreements with public transportation systems.
NEMT Model: State-Wide Transportation Broker (through the State), Regional Transportation Brokers (through MCOs)
Mississippi administers Medicaid through the Mississippi Division of Medicaid (DOM). DOM provides Medicaid healthcare through in-house program, and managed care organization program called Mississippi Coordinated Access Network (MississippiCAN). DOM uses a statewide NEMT broker for in-house members—currently ModivCare. The MCO program MississippiCAN is divided into three MCO regions and members are provided NEMT through MCO transportation brokers. There are currently three brokers for the three designated regions—Modivcare Region 1, Waldo CAP Region 2, Penquis CAP Region 3.
CMS Region 4
September 2024
FFS recipients contact Modivcare to request rides. A Transportation Broker List is maintained. MCO recipients are instructed to contact their regional broker to schedule NEMT trips.
Providers can contract with the various transportation brokers.
Public transit operators may contract with the brokers. Public transportation passes and fares may be provided to recipients as an NEMT service.
NEMT Model: Statewide Transportation Broker (through the State)
Missouri administers Medicaid through the Missouri Department of Social Services, MO HealthNet Division. MO HealthNet Division (MHD). MHD provides Medicaid healthcare through managed care organizations (MCOs) and as in-house program. NEMT is “carved out” of the MCO program. NEMT is provided through a statewide broker for both the MCOs and in-house program members—current broker is MTM, Inc.
CMS Region 7
September 2024
The broker determines the level-of-service, and which transportation provider will be assigned to provide NEMT. Recipients request NEMT through the broker. Travel standards are defined and based on the recipient’s county of residence. Counties are classified as urban, basic, and rural.
The broker may provide NEMT services either through direct service and/or through subcontracts between the broker and subcontractor(s).
Transportation broker determines the client level-of-service, and arranges the least expensive and most appropriate mode of transportation to include public transit/bus tokens.
NEMT Model: Directly Operated
Montana’s Medicaid program is administered by the Department of Public Health and Human Services (DPHHS). DPHSS provides Medicaid healthcare in-house as a fee-for-service. DPHSS contracts with Mountain-Pacific Quality Health (MPQH) to manage transportation to include NEMT. MPQH is a non-profit organization that provides utilization review and other services to state government. MPQH verifies Montana Medicaid NEMT trip eligibility, confirms appointments and that services are kept. DPHHS enrolls transportation providers that are paid on established fee schedules.
CMS Region 8
September 2024
Recipients call MPQH Medicaid Transportation Center to schedule a NEMT trip. NEMT includes commercial transportation (taxicabs and busses), specialized transportation (wheelchair accessible vans and non-emergency ambulances), and personal transportation.
DPHHS enrolls transportation providers for NEMT. Medicaid travel assistance is limited to the closest site of service, based on provider licensure and certification. Recipients may choose to travel to a farther location and accept the reduced reimbursement to the closer site.
NEMT assistance covers bus fares.
NEMT Model: Directly Operated, Regional Transportation Brokers (through MCOs)
Nebraska administers Medicaid through the Nebraska Department of Health and Human Services (DHHS). DHHS provides Medicaid healthcare through managed care organizations MCOs) or recipients can opt-out and receive services through an in-house fee-for-service (FFS) program. MCOs contract with transportation brokers for the provision of NEMT—currently MTM, Inc, and Modivcare. In-house members are provided NEMT through the DHHS Medicaid Transportation FFS program.
CMS Region 7
September 2024
FFS members contact the assigned Nebraska Medicaid transportation staff to make an appointment for pick-up. The assigned transportation staff then contacts the appropriate provider to schedule the trip. MCO members contact the MCO broker that is responsible for covering and arranging NEMT for their members enrolled in Medicaid.
Nebraska Medicaid FFS transportation providers receive direct vendor payment as a fee-for-service. Nebraska Medicaid pays for NEMT at the lower of: 1. The provider’s submitted charge; or 2. The allowable amount in the Nebraska Medicaid Transportation Fee Schedule. Except as noted, state-developed fee schedule rates are the same for both governmental and private providers. MCO transportation providers negotiate rates with the MCO.
NEMT can include public transportation as providers and provides reimbursement for fares.
NEMT Model: Statewide Broker (through the State)
Nevada administers Medicaid through the Nevada Department of Health and Human Services (DHHS), Division of Health Care Financing and Policy (DHCFP). DHCFP provides Medicaid healthcare through managed care organizations (MCOs) for areas covered by the MCO, and through in-house program. NEMT is carved-out of MCO services with NEMT provided to all Medicaid recipients through a statewide broker. The statewide NEMT broker is currently MTM, Inc. In Nevada the public transit providers can enter into an agreement with DHCFP that allows the statewide broker to enter and schedule dually-eligible (ADA/NEMT) trips directly into the paratransit scheduling/dispatching system—Las Vegas Regional Transportation Commission (RTC) is a current example. DHCFP has a cost-based reimbursement—or an intergovernmental transfer method of payment. The counties pay the state share, and the state obtains a federal match. DHCFP reimburses RTC for NEMT directly.
CMS Region 9
September 2024
The broker conducts a public transportation assessment process to determine if recipients have access to free transportation and if can use public transportation either fixed-route or ADA paratransit. Recipients considered high-risk pregnancy or past eighth month bypass the assessment. All NEMT services require prior broker authorization with the exception of NEMT services provided by Indian Health Programs.
The broker contracts with various transportation providers and transportation modes throughout Nevada. Local NEMT trip providers include private paratransit providers, Transportation Network Company, and Taxi.
Recipients must ride fixed route or ADA paratransit public transportation services if qualified. Recipients with frequent travel on fixed route transit are provided with passes when cost effective. Public transit agencies may enter into an agreement that allows the broker to schedule NEMT directly into the public transit paratransit scheduling system.
NEMT Model: Statewide Broker (through the State), Regional Transportation Brokers (through MCOs)
New Hampshire administers Medicaid through the New Hampshire Department of Health and Human Services (NH DHHS), Division of Medicaid Services. The Division provides Medicaid healthcare through managed care organizations (MCOs) and as an in-house program. Three MCOs contract with transportation brokers for the provision of NEMT—currently MTM, Inc. and CTS. NH DHSS contracts with a state-wide broker for in-house members for the provision of NEMT—currently CTS.
CMS Region 1
September 2024
Medicaid members contact their designated NEMT broker obtain mileage reimbursement, a bus pass, or to request trips. If members have a car, or when a family member or friend can drive them to an appointment, they are required to use the car and may obtain mileage reimbursement. If no car is available, they must use transit if their residence and their provider’s office are located one half mile or less from a bus route. The transit requirement does not apply when the member is traveling with two children under age 6, with one child over age 6 with limited mobility, or has certain medical conditions.
Providers may contract with the state’s broker or MCO brokers to perform trips at for negotiated rates.
Members can obtain free bus passes from the brokers if their residence and their provider’s office are located one half mile or less from a bus route. Public transportation operators may contract with the various brokers to provide NEMT trips.
NEMT Model: Statewide Transportation Broker (through the State)
New Jersey administers Medicaid (known as NJ FamilyCare) through the New Jersey Department of Human Services (DHS), Division of Medical Assistance and Health Services (DMAHS). DHS provides Medicaid healthcare through managed care organizations (MCOs). NEMT is carved out of the MCO program and is provided by a state-wide broker—currently Modivcare. New Jersey code states that transportation costs for Medicaid beneficiaries who are required to make regular visits to medical facilities outside of their immediate community are reimbursable only if the required services are not available within their community. As a result, a 20-mile limit is placed on NEMT trips when an equivalent provider or service is available unless the member is seeing a unique specialist or in the middle of a treatment course (i.e. chemotherapy or surgical evaluation and treatment), then NEMT is provided without limit.
CMS Region 2
September 2024
Passengers should call Modivcare in advance to request rides. Urgent/same day trips can be booked through Modivcare. Such trips should be for true urgent conditions where a physician is requiring the client be seen the same day or next day. All urgent/same day trips will be verified with physician’s office for medical necessity.
Providers may contract with the Modivcare to perform trips for negotiated rates.
NEMT includes mass transit as a mode of service to include bus and rail passes.
NEMT Model: Directly Operated, Regional Transportation Brokers (through MCOs)
New Mexico administers Medicaid through the Health Care Authority’s Medical Assistance Division (MAD), Centennial Care program. Centennial Care provides Medicaid healthcare through managed care organizations (MCOs) and provides an option for Native American members to receive healthcare as an in-house, fee-for-service. NEMT is provided as a carved-in service, and MCO’s contract to brokers for the provision of NEMT. Recipients can choose an MCO during open enrollment and if the recipient does not select an MCO, then Centennial Care assigns an MCO to the recipient. The exception to the MCO mandatory model, is that Native American members have the choice between enrolling with an MCO or using Fee for Service health care providers.
CMS Region 6
September 2024
Recipients contact the MCO transportation broker call center to schedule a ride. Native American FFS members contact the stat’s broker to schedule NEMT rides.
Transportation providers contract with the MCO or state broker to become a transportation provider.
Public transit passes may be issued as appropriate.
NEMT Model: Statewide Transportation Broker (through the State)
New York administers Medicaid through the New York State Department of Health (NYSDOH. NYSDOH provides Medicaid healthcare through managed care organizations (MCOs). NEMT is a carved-out of the MCO program and is provided through a statewide transportation broker—currently Medical Answering Services (MAS). For many years, MAS has scheduled recipient trips, manage contact centers, conduct utilization review, and perform other administrative functions. In 2023, New York contracted with MAS as the NEMT comprehensive state-wide broker with MAS contracting with transportation providers for the provision of NEMT.
CMS Region 2
September 2024
Enrollees call the MAS contact center for their region (Downstate or Upstate) in advance to schedule appointments. MAS offers a website for trip scheduling. Same day and urgent trips are available.
Providers apply on MAS’ website to receive a letter of support. Then, providers enroll with Medicaid. After receiving Medicaid approval, providers and MAS enter into contracts. Policy Guidelines and Transportation Fee Schedules by county, service category and procedure are developed for providers.
Enrollees capable of using public transit submit requests for bus or train fares five or more days before their appointment. MAS mails fare media to the enrollees. In the New York City area, as the enrollee’s current medical condition permits, the Medicaid program expects that enrollees will use public transit if their residence and medical appointment are within ½ mile of a bus or subway stop. Enrollees who use public transit for normal activities of daily living and live no more than ½ mile from their medical destination are not eligible to receive reimbursement for subway or bus travel with Medicaid-funded MetroCards.
NEMT Model: Directly Operated, Regional Transportation Brokers (through MCOs)
North Carolina administers Medicaid through the North Carolina Department of Health and Human Services (NCDHHS) Division of Health Benefits. NCDHHS provides Medicaid healthcare through managed care organizations (MCOs) and as an in-house fee-for-service program. Starting in July 2021, NEMT services were carved into MCOs, meaning MCOs now contract with transportation brokers—such as ModivCare and MTM—to provide transportation for their beneficiaries. This transition marked a significant change from the prior system, where local county Departments of Social Services (DSS) played a central role in coordinating NEMT services.
CMS Region 4
September 2024
NC Medicaid Direct and Eastern Band of Cherokee Indian (EBCI) Tribal Option members continue to receive NEMT services “in-house” from their county DSS offices on a fee-for-service basis. Local transit agencies were heavily involved in providing NEMT before this shift to managed care, and while their role has evolved, they can still contract with transportation brokers or local DSS offices to provide rides for Medicaid beneficiaries.
Managed care members call the NEMT contact numbers provided by their health plans. These numbers connect them to the assigned broker. NC Medicaid Direct or EBCI Tribal Option members contact their local DSS offices.
The two brokers providing NEMT to managed care members contract with transportation providers. DSS offices contract with providers on a fee-for-service basis for NC Medicaid Direct members.
Following the shift to managed care transit agencies still contract with transportation brokers to deliver NEMT services. The North Carolina Public Transportation Association (NCPTA) has been crucial in helping local agencies navigate this transition, ensuring they remain part of the transportation network, particularly in rural areas. Public transit continues to provide bus passes and services under both managed care and NC Medicaid Direct.
NEMT Model: Directly Operated
North Dakota administers Medicaid through North Dakota Health and Human Services (NDHHS), Medical Services Division. NDHHS provides Medicaid healthcare as an in-house, fee-for-service program that is structured by regional human service zones and tribes. Human services zones and tribal offices approve and provide NEMT. Except for transportation from a hospital, NEMT must be approved in advance using the state-prescribed NEMT Authorization or Taxi Voucher forms, which must be given to the transportation provider prior to transportation of the member.
CMS Region 8
September 2024
Members contact human service zones for their county or their tribal office. The human service zone or tribe approves the ride and schedules it with a provider.
Providers enroll in the Medicaid program to receive trip assignments from human service zones and are reimbursed. The rate offers a flat rate per trip to mini-bus and wheelchair van operators.
Medicaid covers the cost of bus passes. Public transit operators providing mini-bus and wheelchair van transportation can become NEMT providers and receive trip assignments from human service zones.
NEMT Model: Directly Operated, Regional Transportation Brokers (through MCOs)
Ohio administers Medicaid through the Department of Medicaid (ODM). ODM provides Medicaid healthcare through managed care entities (MCEs) and through a fee-for-service program. Both the MCEs and the fee-for-service program provide NEMT. Currently, using an FTA Innovative Coordinated Access and Mobility (ICAM) grant, Ohio DOT is working with transit operators in southeast Ohio to pilot a regional transportation resource center that will coordinate NEMT trips in a four-county region.
CMS Region 5
December 2024
Fee-for-service members and MCE members needing transportation assistance to a location that is less than 30 miles each way can contact their local county JFS office. Members of the MCEs – Managed Care Organizations (MCOs) and MyCare Ohio Plans (MCOPs, which are for members with both Medicaid and Medicare) – must contact their managed care provider for any additional transportation services. Many MCEs offer members a certain number of supplementary “value-added rides” that may be used for certain trips.
County JFS offices typically release Requests for Proposals for NEMT every 2 years, although some operate transportation in-house. The MCEs contract with brokers. Brokers contract with providers directly.
Many public transit operators in Ohio contract with their county JFS department to provide NEMT. It is less common for transit operators to contract with the brokers for the MCEs. In counties that directly operate public transit, sometimes no RFP is involved since the county has access to in-house transportation.
NEMT Model: Statewide Broker (through the State)
Oklahoma administers Medicaid, known as SoonerCare, through the Oklahoma Health Care Authority (OHCA OHCA). Beginning April 2024, more than half of SoonerCare recipients are provided healthcare through managed care organization program called SoonerSelect. Federally recognized tribal members or individuals that qualify for services through Indian Health Service (IHS), may receive healthcare through the in-house SoonerCare plan or may opt-in to managed care. All in-house SoonerCare Medicaid recipients are provided NEMT (known as SoonerRide) through a statewide transportation broker—currently Modivcare. All SoonerSelect members are provided NEMT via their managed care plan’s contracted NEMT vendor.
CMS Region 6
December 2024
Members contact Modivcare in advance to request rides. Urgent/same day trips can be booked through Modivcare when the medical provider provides confirmation of the urgent nature. Members whose residence and destination are within 1/4 of a mile of a bus stop may be required to use public transit. If a letter of medical necessity is provided by the member’s medical provider as to the need of curb-to-curb services, when the exceptions listed in Oklahoma Administrative Code are applicable, the approval must be confirmed by the Oklahoma Health Care Authority (OHCA).
Providers contract with Modivcare.
Sooner Select members receive curb-to-curb transportation to members within the first 30 days of the member’s NEMT eligibility. Following the 30 day-period, members may be required to use public transportation if their residence and their medical appointment destination are located near a public transportation route. SoonerRide members are required to use the appropriate level of service upon becoming eligible for NEMT. Public transit operators may contract with Modivcare. Modivcare issues bus passes to members who use fixed routes to get to their appointments.
NEMT Model: Regional Transportation Brokers (through the State and MCOs)
Oregon administers Medicaid through the Oregon Health Authority (OHA). OHA provides Medicaid healthcare through a system of Coordinated Care Organizations (CCOs) which function as managed care organizations, and as an in-house program for those that are not CCO members. NEMT is a carved-in service where CCOs each contract with a regional transportation broker. The CCOs brokerages consist of a mix of public transit agencies, non-profit organizations, and private companies. Medicaid recipients who are not CCO members receive NEMT through OHA contracted regional transportation brokers. Currently, OHA is piloting the use of Transportation Network Companies (TNCs) for NEMT trips. OHP also has a NEMT Technical Advisory Committee to generate recommendations and provide feedback to OHA on improvements to Oregon’s NEMT system.
CMS Region 10
December 2024
Members contact their designated regional brokerage to request rides. Different brokerages have different policies on advance notification requirements.
Transportation providers may contract with the regional brokerages. Oregon is one of a small number of states in which some transit systems serve as brokers.
Some public transit systems serve as the regional brokers for the CCOs. Public transit operators may contract with the brokers to provide NEMT trips. Some brokers provide fixed route transit passes to members.
NEMT Model: Directly Operated, Regional Transportation Brokers (through the State)
Pennsylvania administers Medicaid through the Pennsylvania Department of Human Service’s (PDHS). PDHS provides Medicaid healthcare through managed care organizations (MCOs). NEMT is provided as a carved-out service from the MCO program. NEMT is provided through the Medical Assistance Transportation Program (MATP) with NEMT as a county-based fee-for-service program for all counties except Philadelphia County. Philadelphia County NEMT is provided through a regional broker—currently Modivcare. In some counties, the public transit systems operate MATP. In other counties, non-profit organizations (for example, community action programs) operate MATP.
CMS Region 3
September 2024
Individuals outside of Philadelphia County contact their local MATP program for rides. In Philadelphia County, individuals contact Modivcare.
Providers contract with the MATP program, or, in Philadelphia County, with Modivcare.
In some counties, the public transit systems operate MATP. Where fixed router public transit is available, county MATPs may provide tokens or passes.
NEMT Model: Statewide Broker (through the State)
Rhode Island administers Medicaid through the Executive Office of Health and Human Services (EOHHS). EOHHS provides Medicaid healthcare through managed care organizations (MCOs). NEMT is carved-out of the MCO service. EOHHS contracts for NEMT with a statewide broker—currently MTM. Prior to 2014, the statewide public transit agency, Rhode Island Public Transit Authority (RIPTA), acted as the NEMT broker for all managed care organizations (MCOs)—NEMT was a “carved in” service. CMS challenged RIPTA’s widespread use and distribution of bus passes to Medicaid recipients with over 70% of Medicaid trips on the fixed-route bus. EOHHS shifted to its current statewide broker model—as a “carved out” model. The statewide broker also provides trips for Rhode Island’s senior transportation program (for adults aged 60+ who do not have access to Medicaid NEMT).
CMS Region 1
September 2024
Recipients contact the statewide broker—MTM, Inc. in advance to request trips.
Providers contract with MTM for rates that are published on MTM’s Rhode Island web page. This web page also contains a listing of participating providers, the number of trips each have completed in the previous quarter, and the frequency of no shows, late arrivals, substantiated complains and accidents/ incidents.
Recipients use public transit if their residence and medical facility is within ½ mile of a bus stop. Car or van service is provided to those that meet the criteria but are unable to walk to a bus stop. It is unclear whether any public transit operators’ contract with MTM to provide this pickup service.
NEMT Model: Regional Transportation Brokers (through the State)
South Carolina administers Medicaid through the South Carolina Department of Health and Human Services (SCDHHS). SCDHHS provides Medicaid healthcare through managed care organizations (MCOs). NEMT is provided with regional transportation brokers as a “carved out” service. There are three regions in South Carolina that previously used different regional brokers. However, Modivcare is listed as the broker for all three regions. SCDHHS conducted a significant stakeholder input process in 2013 on the subject of its NEMT administrative model. However, it has maintained its three-region brokerage model.
CMS Region 4
September 2024
Individuals contact the regional call center in advance to request trips.
Providers contract with the regional broker–Modivcare.
Modivcare requires members with a pick-up and drop-off within ¼ mile of a public bus stops to use transit if they are medically able to do so. A healthcare provider must submit a form to Modivcare to exempt a member from this requirement. Public transit operators may contract with Modivcare to provide NEMT rides.
NEMT Model: Directly Operated
South Dakota administers Medicaid through the South Dakota Department of Social Services (DSS). DSS provides Medicaid healthcare as an in-house, fee-for-service program. Recipients are referred to transportation providers in their community that are enrolled as Medicaid providers.
CMS Region 8
September 2024
Recipients arrange for rides directly with community transportation providers.
Providers are paid by South Dakota Medicaid at rates advertised on their website. Currently, the rate listed for in-city “mini-bus or other transportation system” is $3.97 for a one-way trip ($5.96 for outside city). The “loaded community transportation mileage” rate for trips outside of the city 21 miles or more one way is $0.87.
Recipients arrange rides directly with community transportation providers, including transit systems. The state maintains a map/listing of providers on its website.
NEMT Model: Statewide Transportation Brokers (through MCOs)
Tennessee has adopted a mandatory managed care organization model known as TennCare that serves its Medicaid population, with NEMT responsibility carved in to state contracts with participating health plans. TennCare has three MCOs that use two statewide brokerages (currently, Verida and Tennessee Carriers). Starting with the creation of the Office of Mobility and Accessible Transportation (OMAT) in 2020, the Tennessee Department of Transportation (TDOT) and its partner state agencies, including TennCare, have initiated a planning effort to provide resources and expertise that result in improved accessible transportation and mobility across the state.
CMS Region 4
February 2025
Members contact the brokerage for their MCO in advance to request rides.
Providers may contract with the MCO brokers.
Public transit operators may contract with the brokers to provide rides. Members living in urban areas have access to bus passes on fixed route transit. OMAT is conducting the NEMT Policy project to identify policy changes to support more efficient use of NEMT funds and better service to beneficiaries, including more effective collaboration between TennCare and public transit.
NEMT Model: State-wide Broker (through the State), Regional Transportation Brokers (through MCOs)
Texas administers Medicaid through the Texas Health and Human Services Commission (HHSC). HHSC provides Medicaid healthcare through managed care organizations (MCOs), and as an in-house program during the 30-45 day period before a recipient becomes a member of an MCO. NEMT services are provided as a “carved-in” component of the overall individual’s health care. MCOs contract with transportation brokers for the provision of NEMT. HHSC’s contracts directly with a statewide broker to provide NEMT during the interim period.
CMS Region 6
September 2024
Recipients choose an MCO available in the designated region. Once the recipient becomes a member of an MCO the NEMT requirements transfer to the MCO broker. For NEMT rides, recipients contact the HHSC broker (prior to becoming a MCO member) or the MCO broker after becoming a member.
Providers contact the individual MCOs for information on how to join their transportation networks. Transportation brokers typically negotiate rates with transportation providers on a cost per unit basis. In general, Texas brokers primary sources for the provision of transportation for members are transit and paratransit passes/ tickets, private transportation companies, public transit providers (typically rural).
Public transportation agencies can contract with brokers of the MCO to provide demand response service—contracts with public transit providers are used particularly in rural areas and for wheelchair accessible vehicles. Brokers purchase tickets and passes for Medicaid members that are determine appropriate for public transit fixed-route or ADA paratransit by the MCO and according to state guidelines.
NEMT Model: Statewide Transportation Broker (through the State)
Utah administers Medicaid through the Utah Department of Health and Human Services (DHHS). DHHS provides Medicaid healthcare through managed care organizations (MCOs) and as an in-house program. NEMT is a carved-out service from the MCO program. DHHS contracts with one broker to provide NEMT statewide for all Medicaid recipients—currently Modivcare. NEMT services are available only to recipients who do not have access to personal transportation. If there is a vehicle in the household, the state requires a Medicaid recipient to drive himself or have someone else drive to the medical appointment. Salt Lake and Cedar City residents can receive bus passes for use on either the fixed-route or paratransit public transportation services. Medicaid recipients who do not have access to public transportation may be eligible to call the broker.
CMS Region 8
December 2024
Individuals must contact Modivcare in advance to schedule a ride before a medical appointment unless deemed urgent. Trips are provided on Saturdays and holidays only for members needing dialysis or have a condition that requires recurring care; trips are not provided on Sundays. If a recipient does not live in an area served by bus, ADA paratransit services (if eligible), or needs door-to-door service, then may be eligible for ModivCare services.
Providers contract with Modivcare to provide NEMT trips at negotiated rates.
Members are provided with a Utah Transit Authority (UTA) Transit Card for up to 30 monthly rides on rail, bus or paratransit for medical appointments. Bus passes may be provided for Cedar Area Transportation (CATS) also. Recipients are expected to use public transit if available in area live and are not eligible for mileage reimbursement program. Other public transit operators in Utah may contract with DHHS.
NEMT Model: Regional Transportation Brokers (through the State)
Vermont administers Medicaid through the Department of Vermont Health Access (DVHA). DVHA provides Medicaid healthcare as an in-house fee-for-service program. DVHA contracts with Vermont Public Transit Association (VPTA) to provide the state’s NEMT brokerage. VPTA is a statewide network of public transportation providers. VTPA manages member eligibility. Members schedule rides directly with their local public transit operator. VPTA is paid a per-member, per-week methodology. Members are eligible if they do not have a registered vehicle or active driver’s license.
CMS Region 1
December 2024
Members contact their local public transit provider to schedule a ride. If a vehicle is present in a member’s household, the member must prove that is it unavailable to them. If a provider is located more than 100 miles away from the member’s home address, the referring provider will need to submit a transportation Physician Referral Form directly to DVHA for prior approval for the ride. Members who have an active driver’s license and registered vehicle are eligible for a hardship mileage reimbursement if they travel more than 50 miles per week or 215 in a month.
Public transit operators provide trips directly or use volunteer drivers whenever possible. The volunteer drivers receive mileage reimbursement. Taxis are also used. VPTA may set up any methodology to reimburse subcontractors as long as that process complies with all current tax and employment laws.
Members who live within three quarters of a mile of a bus route are required to utilize that mode of transportation, unless they can obtain documentation from their physician confirming they cannot walk that distance or have a medical condition that doesn’t coincide with utilizing public transportation. Vouchers are available to members for fares on fixed and deviated route transit, after confirming scheduled appointments.
NEMT Model: Statewide Transportation Broker (through the State), Regional Transportation Brokers (through MCOs)
Virginia administers Medicaid through Virginia Department of Medical Assistance Services (DMAS). DMAS provides Medicaid healthcare through managed care organizations (MCOs) and as an in-house program. NEMT is an MCO carved-in service. DMAS contracts with a statewide broker—currently Modivcare for individuals in the in-house program. MCOs contract with transportation brokers—currently the five MCOs contract with Modivcare, Access2Care, MTM and Verida transportation brokers.
CMS Region 3
September 2024
Fee-for-service members make reservations in advance with Modivcare; urgent trips are available, subject to treatment facility verification. MCO members contact their MCO’s broker to schedule trips.
Providers contract with Modivcare or the MCOs’ brokers at negotiated rates.
Fee-for-service members that live near a bus line can request bus tickets/tokens to go to their appointments. Public transit operators may contract with the brokers.
NEMT Model: Regional Transportation Brokers (through the State)
Washington administers Medicaid through the Washington State Health Care Authority (HCA). Washington provides Medicaid healthcare through managed care organizations (MCOs), with NEMT as a carve-out. HCA has utilized a system of regional transportation brokers since 1984 for providing in-house NEMT. Local non-profit organizations serve as the regional brokers. This system is well integrated with public transit agencies in rural and urban areas. Transportation brokers include local planning agencies, councils on aging and other human service agencies, and several community transportation providers (Paratransit Services, Hopelink, Northwest Regional Council, Community in Motion, People for People, Special Mobility Services).
CMS Region 10
December 2024
Recipients contract the broker for their county to request rides. A transportation broker directory is available on the HCA website.
Providers contract with the regional brokers.
Public transit providers may contract with the brokers. In some cases, the brokerage organization also operates public transit in the community. Bus passes are provided by some brokers for fixed route services. In the Puget Sound area, the brokers will load ORCA fare cards for beneficiaries.
NEMT Model: Regional Transportation Brokers (through the State)
West Virginia administers Medicaid through the West Virginia Bureau for Medical Services and is provided as a fee-for-service. Since 2014, West Virginia has used a statewide broker for NEMT – currently, Modivcare. Until 2014, the state operated a traditional, decentralized fee-for-service NEMT model.
CMS Region 3
September 2024
Recipients contact Modivcare to arrange travel in advance of appointments. Verifiable urgent trips such as hospital discharges or doctor’s appointments deemed urgent by the physician or facility may be accepted.
Providers contract with Modivcare. During the 2023 regional Coordinated Public Transit-Human Service Transportation Plan Update public engagement meetings, Modivcare reported difficulty with recruiting enough transportation providers to meet demand in multiple regions, especially in rural areas.
Most rural public transit operators in West Virginia contract with Modivcare. Recipients who live near a bus line can request bus tickets/passes for themselves and one escort if medically necessary. NEMT revenue makes up a substantial portion of the local match for rural transit systems’ FTA Section 5311 operating grants.
NEMT Model: Statewide Transportation Broker (through the State)
Wisconsin administers Medicaid through the Division of Medicaid Services (DMS). DMS provides Medicaid healthcare as an in-house program. DMS contracts with statewide broker for the provision of NEMT—currently MTM, Inc. The most recent contract added improvements such as a dedicated NEMT management unit to support rides related to critical appointments, a mobile-friendly member portal, additional call center standards including faster call responses during busy hours, the ability to speak to an independent reviewer if a beneficiary is denied a ride while trying to schedule on over the phone, and the ability to file complaints online.
CMS Region 5
September 2024
Recipients contact MTM to request rides in advance. MTM will coordinate urgent rides with health care provider verification.
Providers contract with MTM at negotiated rates. MTM’s Wisconsin provider webpage states that details regarding rates are discussed and determined with transportation providers on an individual basis.
Transit providers may contract with MTM. MTM requires recipients to use transit if their trip’s starting and ending points are within 1/2 mile of a bus stop. To be exempt from this requirement, the beneficiary’s health care provider fills out a Level of Need (LON) assessment to provide a medically based justification. MTM provides bus passes.
NEMT Model: Directly Operated
Wyoming administers Medicaid through the Wyoming Department of Health Division of Healthcare Financing. Medicaid healthcare is provided as an in-house program Wyoming uses an in-house FFS system for NEMT. According to the Wyoming Medicaid Annual Report for State Fiscal Year 2022, administrative transportation expenses for the cost of transportation to and from medical appointments was $156,368 in 2022, covering expenses for 190 recipients. The vast majority of NEMT trips are provided through the personal mileage reimbursement program.
CMS Region 8
September 2024
Wyoming Medicaid’s operates a call center that recipients contact to obtain travel authorization, request assistance with travel, and learn about available modes of transportation.
The Medicaid State Plan states that “the Travel Call Center has created informal partnerships with external agencies: volunteer organizations, special interest associations, rehabilitation agencies and participants in the WYDOT 49 CFR 5311 programs. The external agencies are contacted to assist in providing transportation services.”
The Wyoming Medicaid Travel Assistance Member Reference Guide lists public transportation, including subsidized public transportation and the Wyoming Rural Transit program (when available in that county) (City Transit Bus) as one of the types of transportation members can use. Medicaid provides punch cards for use on public transit.
ACKNOWLEDGMENT OF SPONSORSHIP
This work was sponsored and funded by the Federal Transit Administration Master Agreement—funding source 5314: Technical Assist, Standard HR and Training to operate the National Center for Mobility Management (NCMM)—associated with the Community Transportation Center of America (CTAA).
AUTHOR ACKNOWLEDGMENTS
Texas A&M Transportation Institute (TTI) in partnership with RLS and Associates, Inc. developed these state-by-state profiles as part of the CTAA/NCMM project. The principal authors are Suzie Edrington of TTI, Christy Campoll of RLS and Associates, Inc., and Ross Peterson of TTI with review and consult of Will Rodman TTI, and Richard Garrity RLS and Associates, Inc. The researchers want to thank the state Medicaid agency, state Department of Transportation, Medicaid transportation broker, and public transportation staff who shared information and responded to information requests.
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