Waiver Consulting Group — Start any program. In any state.

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

Last reviewed: 2026-09-10

The Virginia Department of Medical Assistance Services (DMAS) delegates the administration of Non-Emergency Medical Transportation (NEMT) to contracted transportation brokers rather than enrolling independent transportation companies directly. Providers seeking to transport Medicaid members to covered appointments or waiver services must apply to join the network of the state's designated Fee-For-Service (FFS) broker, Modivcare, or the specific brokers contracted by Cardinal Care Managed Care Organizations (MCOs).

Because Virginia utilizes this broker model, independent NEMT businesses cannot obtain a Medicaid provider number to bill the state's Medicaid Enterprise System (MES) directly for routine transport. Approval requires securing a subcontract with the active broker, passing their specific vehicle and driver credentialing inspections, and holding the appropriate passenger carrier authority from the Virginia Department of Motor Vehicles (DMV).

1. Service Definition and Scope

In Virginia, Non-Emergency Medical Transportation (NEMT) provides pre-authorized rides for eligible Medicaid members to and from covered medical services, including waiver services, when the member has no other means of transportation. The service covers multiple modes of transport based on medical necessity, including ambulatory (sedan/van), wheelchair-accessible vehicles, and non-emergency ambulances.

The scope of service is strictly limited to Medicaid-billable appointments and approved waiver activities. Trips for personal errands or non-covered services are excluded, and all trips must be routed and dispatched through the designated regional or MCO broker.

2. Regulatory and Oversight Agencies

While DMAS is the ultimate state Medicaid authority, the day-to-day regulation and oversight of NEMT providers are handled by the contracted brokers and state transportation authorities. The Virginia DMV regulates the commercial operating authority required to transport passengers for hire.

For specialized medical transport, such as non-emergency ambulances, the Virginia Department of Health's Office of Emergency Medical Services (OEMS) provides the necessary agency and vehicle certifications.

3. Gatekeeping Prerequisites: Who Can Even Apply

Virginia operates a closed-network broker model for NEMT, meaning direct enrollment with DMAS as an independent NEMT provider is not permitted. To provide services, an applicant must successfully execute a subcontract with Modivcare or another MCO-contracted transportation broker.

Brokers only accept new transportation providers when there is a demonstrated network adequacy need in a specific geographic area. If the broker's network in a county is saturated, new applications will be rejected or waitlisted regardless of the applicant's qualifications.

4. Licensure and Certification Requirements

Virginia does not issue a specific "Medicaid NEMT License." Instead, providers must obtain standard commercial transportation authority from the Virginia DMV. This requires registering as a passenger carrier and obtaining For-Hire Intrastate Operating Authority.

Providers offering non-emergency ambulance services must hold a separate certification from the Virginia OEMS. All vehicles must pass physical inspections conducted by the broker to ensure compliance with ADA and safety standards.

5. Medicaid Provider Enrollment

Because NEMT is carved out to brokers, transportation companies do not complete the standard DMAS provider enrollment process through the Provider Services Solution (PRSS) portal for routine NEMT. Instead, the enrollment process is entirely managed through the broker's credentialing department.

The broker acts as the enrolled Medicaid entity and pays the subcontracted transportation providers. Providers must submit their W-9, NPI (if applicable), and business credentials directly to the broker's network management team.

6. Staffing, Training and Background Checks

Transportation brokers enforce strict driver credentialing standards to ensure member safety. Providers are responsible for maintaining driver files and submitting proof of compliance to the broker before a driver is authorized to transport Medicaid members.

Drivers must pass comprehensive background checks, drug screenings, and complete specific training modules, including defensive driving and passenger assistance techniques.

7. Documentation, Policies and Records

Providers must maintain meticulous records of every trip to satisfy broker auditing and Medicaid program integrity requirements. Missing or incomplete trip documentation is the primary cause of payment clawbacks.

Brokers require the use of specific routing software or electronic trip logs to track GPS coordinates, timestamps, and member signatures for every completed leg of a journey.

8. Billing, Rates and Claims

NEMT providers do not bill the Virginia Medicaid Enterprise System (MES) directly. All claims are submitted to the contracted broker (e.g., Modivcare) through their proprietary billing portal.

Rates are not published on a standard DMAS fee schedule; instead, they are negotiated directly between the transportation provider and the broker during the contracting phase. Rates typically include a base pickup fee and a per-mile rate.

9. Approval Sequence and Timeline

The timeline to become an active NEMT provider depends heavily on the broker's current network needs and the provider's readiness. The process begins with submitting a letter of interest or initial application to the broker.

If the broker identifies a network need, they will invite the provider to submit full credentialing packets, schedule vehicle inspections, and negotiate rates. The entire process can take several months.

10. Common Denials and Survey Findings

Applications to join the broker network are most frequently denied due to a lack of geographic network need or failure to meet commercial insurance minimums. Brokers strictly enforce network capacity limits.

For active providers, routine audits often result in corrective action plans or payment retractions due to missing trip documentation, expired driver credentials, or failure to maintain vehicles to ADA standards.

11. Key Contacts and Resources

Prospective NEMT providers must coordinate with the state's designated brokers and transportation authorities to establish their business and secure contracts.

The primary point of contact for entering the Virginia Medicaid NEMT space is the Modivcare Provider Network Management team, alongside the Virginia DMV for commercial operating authority.

See all Virginia services · Virginia Medicaid consulting · book a consultation.