ADA paratransit vs NEMT

• Who runs it: paratransit is run by the transit agency, often through a contractor. NEMT is paid by Medicaid through a health plan or broker and driven by transportation providers.
• Who qualifies: paratransit is for people the transit agency finds eligible because of a disability. Medi-Cal NEMT needs a provider’s certification that ordinary transport is medically ruled out.
• Where and when: federal rules require paratransit within three-quarters of a mile of each fixed route, during the same hours and days as that route. NEMT goes wherever the covered care is.
• What the rider pays: a paratransit fare can be up to twice the full fixed-route fare. NEMT is a covered Medi-Cal benefit, billed to the plan or to Medi-Cal.
• Trip purpose: paratransit can’t limit trips by purpose. NEMT is for covered medical services, prescriptions and supplies.
• Booking: paratransit must take requests made the day before, and may take them up to 14 days ahead. Medi-Cal plans publish their own notice periods for NEMT.

The vehicles and drivers can look the same, and some companies do both under separate contracts. The rules, the paperwork and the billing are different, so each contract is set up as its own payer.