Starting an NEMT business in California: licences, insurance and getting on Medi-Cal plans

Medi-Cal has two transportation benefits, and they come with different rules.

• NEMT, non-emergency medical transportation: for members whose medical and physical condition rules out ordinary public or private transport. The modes are wheelchair van, litter (stretcher) van, ambulance and air. NEMT needs a Physician Certification Statement (PCS) form from the member's provider.
• NMT, non-medical transportation: for members who can travel by ordinary means but need a ride, such as by passenger car or taxicab. No PCS form is needed; the plan approves it.

Your vehicles decide which you can offer. A wheelchair van needs a lift or ramp and securements; a stretcher van needs to carry a gurney. Our post on space types covers what each mode needs.

Before any agency, you need the basics: a legal entity, a business address, a federal tax ID and, for billing, a National Provider Identifier (NPI). You will also need commercial vehicle registration with the DMV for each vehicle, and commercial insurance, because Medi-Cal asks for both when you add vehicles.

Most companies that carry passengers for hire in California need operating authority from the California Public Utilities Commission (CPUC), usually a charter-party carrier (TCP) permit. The CPUC lists exceptions in Public Utilities Code sections 226 and 5353 and names medical transportation vehicles among them, without spelling out the conditions on its FAQ page. Ask the CPUC, and the plans you want to work with, whether your service needs a permit before you assume either way.

If you do apply, the CPUC's published requirements include:

• Liability insurance on file, with minimums by seating capacity: $750,000 for 7 passengers or fewer, $1,500,000 for 8 to 15, $5,000,000 for 16 or more.
• Workers' compensation insurance on file if you have employees.
• A CHP safety inspection for any vehicle seating more than 10, including the driver.
• Enrollment in the DMV Employer Pull Notice program, which reports your drivers' records to you.
• A controlled substance and alcohol testing program for drivers.
• Renewal every three years.

Medi-Cal transportation providers enroll with DHCS through PAVE, the Provider Application and Validation for Enrollment portal. Medical transportation applicants pay an application fee when they submit. To add vehicles, DHCS asks for copies of each vehicle's DMV commercial registration and proof of commercial vehicle insurance.

Since March 27, 2025, NEMT applications must include a valid Vehicle Safety Systems Inspection (VSSI) certificate, issued through the Bureau of Automotive Repair (BAR). Book the inspections early, since an application without them is incomplete.

Enrollment matters even if all your trips will come from managed care plans. Under DHCS All Plan Letter 22-008, plans must use Medi-Cal-enrolled transportation providers. A plan may let a provider with a pending application work in its network for up to 120 days, but must end the contract if DHCS denies enrollment or the 120 days run out.

Members in a Medi-Cal managed care plan get NEMT through their plan. A plan may arrange rides itself or contract a transportation broker to schedule them and pay providers. To get trips, you join the plan's or the broker's network in each county you serve, and most providers work with several.

Each one sets its own requirements in its contract, and these are often stricter than the state's. Expect to be asked for:

• Insurance limits and certificates of insurance that name the plan or broker.
• Driver checks and training: background checks, driving records, drug testing, CPR and first aid, passenger assistance, HIPAA.
• Vehicle inspections and equipment lists.
• How you will report trips, signatures, times and miles, and how fast you must arrive.

Read the provider manual of each plan or broker before you sign. It tells you how you will be paid, how claims are filed and what counts as on time. Our guides to Medi-Cal NEMT billing codes and pickup windows cover the two things contracts measure most.

Getting enrolled is a one-time job; staying enrolled is not. Driver licences, background clearances, CPR cards, drug tests, inspections, insurance and permits all expire on their own dates. A driver with an expired credential on a payer's trip can become an audit finding and put that trip's payment at risk. Keep every document with its expiry date in one place, and get reminded well before each runs out.

Set up your trip records the same way from day one. A new provider's first audit is easier when every leg already has its times, miles and signatures. See NEMT trip sheets.

MileCall keeps vehicles with their space-type capacity and documents, and drivers with their credentials, such as licence, LiveScan, CPR and drug tests, flagged 60, 30 and 7 days before they expire. An expired hard-required credential blocks the driver's assignment. Payer contract rules, such as service zones and allowed space types, are set once and checked when a trip is assigned. See MileCall dispatch and the driver app.

1. Medical transportation provider and non-emergency transportation provider application information (DHCS)
2. Updated Medi-Cal non-emergency medical transportation provider requirements (VSSI certificate) (DHCS)
3. Vehicle Safety Systems Inspection manual (Bureau of Automotive Repair)
4. Passenger carrier FAQs (California Public Utilities Commission)
5. Licensing requirements: charter-party carriers (California Public Utilities Commission)
6. All Plan Letter 22-008: Non-Emergency Medical and Non-Medical Transportation Services and Related Travel Expenses (DHCS)
7. Provider Update 22-972: Action required for NEMT requests (APL 22-008 summary and PCS form) (CalViva Health and Health Net, Medi-Cal plans)

This post explains how things work in general; it is not legal, medical or billing advice. Rules change and differ by payer, so check your payer’s current manual and your contract before you rely on any detail here.