Delaware - Adult Health Transportation — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-08-16

Adult Health Transportation in Delaware, commonly referred to as Non-Emergency Medical Transportation (NEMT), provides pre-scheduled rides for eligible Medicaid, Diamond State Health Plan (DSHP), and Home and Community-Based Services (HCBS) waiver participants to covered medical appointments and waiver services. This service ensures that beneficiaries without alternate means of transit can access necessary healthcare and community support.

The single biggest structural barrier to entry for this service in Delaware is the state's exclusive transportation broker model. Providers cannot enroll directly with Delaware Medicaid as independent Fee-For-Service (FFS) NEMT providers. Instead, an applicant's absolute prerequisite is securing a subcontract with the state's designated NEMT broker, Modivcare, Inc., which controls network access, trip routing, and credentialing, while also requiring providers to complete an MCO-Only Provider Enrollment through the state's Medicaid portal for federal screening.

1. Service Definition and Scope

In Delaware, NEMT is defined as transportation provided to and from a covered medical or waiver service for active Medicaid members who do not have alternate means of transportation. The service is administered statewide and covers routine, pre-scheduled trips.

The scope of service includes various modes of transit depending on the member's medical and mobility needs, ranging from standard ambulatory passenger vehicles to wheelchair-accessible vans and stretcher transports. Emergency transportation (911) is strictly excluded from this service definition.

• Service Modes: Ambulatory, wheelchair-accessible, and stretcher van transportation.
• Target Population: Fully eligible Delaware Medicaid, Diamond State Health Plan (DSHP), and Delaware Healthy Children Program (CHIP) clients.
• Scheduling Window: Transportation arrangements must typically be made no less than three days in advance of a scheduled appointment.
• Trip Authorization: All trips must be verified and routed by the state's transportation broker to ensure the destination is a covered Medicaid service.
• Excluded Services: Emergency ambulance transport and trips for non-covered personal errands are not reimbursable.

2. Regulatory and Oversight Agencies

Oversight of Adult Health Transportation in Delaware is a bifurcated system. The state Medicaid agency establishes the overarching policies, coverage rules, and federal compliance standards, while the contracted statewide broker manages the day-to-day operational oversight, provider credentialing, and dispatch.

Providers must interact with both the state's enrollment portal for mandatory federal background screening and the broker's network management team for actual service authorization and compliance audits.

• State Department: Delaware Department of Health and Social Services (DHSS) (https://dhss.delaware.gov/dhss/)
• Medicaid Agency: Division of Medicaid and Medical Assistance (DMMA) (https://dhss.delaware.gov/dmma/)
• Statewide Broker: Modivcare, Inc. (https://www.modivcare.com/facilities/de)
• Enrollment Portal: Delaware Medical Assistance Program (DMAP) Provider Portal (https://medicaid.dhss.delaware.gov/provider)

3. Gatekeeping Prerequisites: Who Can Even Apply

Delaware operates a closed-network broker model for NEMT, meaning the primary gatekeeper is the broker, not the state licensing board. The absolute structural precondition blocking an applicant is the requirement to secure a subcontract with Modivcare. If the broker determines their network is saturated in a specific Delaware county, they will not accept new provider applications.

Before approaching the broker or the state portal, a business must be fully formed and possess the standard federal and state identifiers required for healthcare billing.

• Broker Subcontracting: Applicants must secure an active network contract with Modivcare; independent FFS Medicaid enrollment for general NEMT is not permitted.
• Network Need/Saturation: Modivcare may impose closed networks or moratoria in specific geographic zones if existing provider capacity meets state-mandated adequacy standards.
• Business Registration: Must register the business entity with the Delaware Division of Corporations and remain in good standing.
• National Provider Identifier: Must obtain a Type 2 (Organization) NPI from the NPPES registry prior to initiating any enrollment steps.

4. Licensure and Certification Requirements

Delaware does not issue a distinct "NEMT Facility License" through the Department of Health and Social Services. Because there is no specific state health licensure for this provider type, authority to operate is granted entirely through successful credentialing with the state's broker and compliance with standard commercial transportation laws.

However, specific vehicle types, such as stretcher vans, are regulated under Delaware Code. All vehicles must pass rigorous safety and ADA-compliance inspections mandated by the broker before they can be deployed.

• State Licensure Exemption: No distinct DHSS NEMT license exists; providers are approved via broker credentialing and DMAP registration.
• Stretcher Van Regulation: Stretcher vans must comply with Delaware Code Title 2, Section 1823, which governs non-emergency medical transportation services using stretchers.
• Vehicle Inspections: All fleet vehicles must pass Modivcare-mandated safety, mechanical, and ADA-compliance inspections.
• Insurance Minimums: Providers must carry commercial auto liability, general liability, and worker's compensation insurance meeting the broker's contractual thresholds.
• Vehicle Restrictions: Brokers typically prohibit the use of pickup trucks, two-door sports cars, and salvage-title vehicles for member transport.

5. Medicaid Provider Enrollment

Even though NEMT providers contract directly with Modivcare for trips and payment, they are federally required to be screened by the state Medicaid agency. In Delaware, this is accomplished through the Delaware Medical Assistance Program (DMAP) Provider Portal.

Providers must submit an "MCO-Only Provider Enrollment Application." This streamlined application ensures compliance with the 21st Century Cures Act and 42 CFR Part 455, subparts B and E, allowing the state to conduct mandatory federal screening activities.

• Application Type: Must complete the MCO-Only Provider Enrollment Application via the DMAP portal.
• Federal Screening: Required for initial and continual participation to comply with the 21st Century Cures Act.
• Application Tracking Number (ATN): Issued by the DMAP portal upon saving an application, required to check enrollment status.
• Application Fee: Subject to the federal Medicaid institutional application fee (approximately $731 for 2024/2025) unless waived or previously paid to Medicare.
• Portal Helpdesk: DMMA Provider Services assists with portal navigation and ATN recovery.

6. Staffing, Training and Background Checks

Driver qualifications are strictly enforced to ensure member safety and comply with the Consolidated Appropriations Act, 2021. Providers are responsible for vetting all personnel before they interact with Medicaid beneficiaries.

Training requirements are dictated by the broker's credentialing standards and include both medical emergency preparedness and specialized driving techniques.

• Federal Exclusions: All drivers and owners must be screened against the HHS-OIG List of Excluded Individuals/Entities (LEIE); excluded individuals cannot participate.
• Criminal Background Checks: Mandatory state and federal criminal background checks for all drivers and attendants.
• Driving Records: Must obtain and maintain clean Motor Vehicle Records (MVR) for all drivers, with disqualifications for severe or recent infractions.
• Safety Training: Drivers must hold current CPR and First Aid certifications.
• Operational Training: Mandatory completion of Defensive Driving, HIPAA compliance, and ADA wheelchair securement training as required by the broker.

7. Documentation, Policies and Records

NEMT providers must maintain rigorous, audit-ready documentation for every trip performed. Because fraud and abuse are high-risk areas in NEMT, the state and the broker heavily utilize electronic tracking and strict record retention policies.

Failure to maintain proper documentation results in immediate claim denials, recoupments during post-payment audits, and potential contract termination.

• Trip Logs: Must capture exact pickup and drop-off times, GPS coordinates, driver identification, and member signatures.
• Vehicle Rosters: Providers must maintain an updated, broker-approved list of all active vehicles, including VINs and license plates.
• Driver Files: Must keep current copies of driver licenses, training certificates, MVRs, and background check results on file.
• Electronic Routing: Providers are typically required to use the broker's proprietary dispatch software or an approved API-integrated routing system.
• Record Retention: All Medicaid-related transport and personnel records must be retained for a minimum of 5 years.

8. Billing, Rates and Claims

NEMT providers do not bill the Delaware MMIS (Medicaid system) directly for their services. Instead, all claims are submitted to Modivcare, which acts as the clearinghouse and payer for the transportation network.

Reimbursement rates are not published on a public state fee schedule; they are negotiated directly between the provider and the broker during the contracting phase, typically structured around a base rate and mileage.

• Billing Entity: Claims are submitted directly to Modivcare via their provider portal, not to DMMA.
• Rate Structure: Reimbursement is generally based on a negotiated per-trip base rate plus a per-mile rate, varying by vehicle type (ambulatory vs. wheelchair).
• Prior Authorization: Every single trip must be pre-authorized and assigned a specific trip number by Modivcare; unauthorized trips will not be paid.
• Clean Claims: Modivcare processes clean claims according to the schedule outlined in the provider's subcontract (often bi-weekly).
• No-Shows: Broker contracts dictate specific, usually limited, reimbursement policies for member no-shows at the pickup location.

9. Approval Sequence and Timeline

Becoming a fully active NEMT provider in Delaware requires navigating parallel tracks: state Medicaid screening and broker credentialing. Because these processes rely on third-party inspections and state processing times, applicants should expect the sequence to take several months.

Providers cannot begin transporting members until both the DMAP portal enrollment is approved and the Modivcare contract is fully executed.

• Step 1: Register the business with the Delaware Division of Corporations and obtain an NPI (1-2 weeks).
• Step 2: Submit a Letter of Intent or Request for Qualifications to Modivcare to verify network need (2-4 weeks).
• Step 3: Complete the MCO-Only Provider Enrollment Application on the DMAP portal for federal screening (30-60 days).
• Step 4: Submit driver rosters, insurance certificates, and vehicle lists to Modivcare for credentialing (30-45 days).
• Step 5: Pass Modivcare fleet inspections and complete mandatory compliance training (1-2 weeks).
• Step 6: Execute the final subcontract with Modivcare and receive dispatch credentials.

10. Common Denials and Survey Findings

Initial applications and active provider contracts are most frequently jeopardized by vehicle compliance failures and driver background issues. Modivcare conducts routine network audits to ensure ongoing compliance with state and federal standards.

Providers must be proactive in maintaining their fleet and auditing their own driver files to avoid suspension from the broker's network.

• Network Saturation Denials: Initial Letters of Intent rejected because Modivcare has sufficient capacity in the requested Delaware county.
• Vehicle Inspection Failures: Vehicles failing ADA compliance checks, such as broken wheelchair lifts or missing Q-Straint securements.
• Driver Disqualifications: Drivers found on the OIG LEIE exclusion list or having disqualifying marks on their recent MVR.
• Documentation Recoupments: Post-payment audits resulting in clawbacks due to missing member signatures or lack of GPS validation on trip logs.
• Insurance Lapses: Immediate suspension from the dispatch network if commercial auto or liability insurance certificates expire.

11. Key Contacts and Resources

Prospective Adult Health Transportation providers must utilize specific state and broker resources to navigate the enrollment and credentialing process. The DMAP portal is used for state registration, while Modivcare handles all operational inquiries.

Providers should bookmark these official portals and contact numbers to ensure they are accessing the most current applications and network requirements.

• Delaware DMMA Homepage: https://dhss.delaware.gov/dmma/
• DMAP Provider Enrollment Portal: https://medicaid.dhss.delaware.gov/provider
• DMMA Provider Services (Portal Help): 1-800-999-3371 (Option 0, then Option 4)
• Modivcare Delaware Facility Page: https://www.modivcare.com/facilities/de
• Modivcare Delaware Reservations/Inquiries: 1-866-412-3778

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