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

Last reviewed: 2026-08-16

In West Virginia, Adult Health Transportation is formally classified as Non-Emergency Medical Transportation (NEMT). This service provides non-ambulance transport for eligible Medicaid and WVCHIP members to and from covered medical appointments, including Home and Community-Based Services (HCBS) waiver programs.

The single biggest structural barrier to entry in West Virginia is the state's exclusive broker model. You cannot enroll directly with West Virginia Medicaid as an independent fee-for-service NEMT provider. Instead, the Bureau for Medical Services (BMS) mandates that all non-ambulance NEMT providers must secure a subcontract with Modivcare, the state's designated transportation broker, before they can receive trip assignments or reimbursement.

1. Service Definition and Scope

West Virginia Medicaid defines NEMT as transportation provided to Medicaid members who have no other means of reaching covered medical services. This includes routine doctor visits, dialysis, and HCBS waiver services like the Aged and Disabled Waiver (ADW) or Intellectual/Developmental Disabilities (I/DD) Waiver.

The service encompasses multiple modes of transport based on member acuity, including ambulatory (sedan/van), wheelchair-accessible vehicles, and non-emergency stretcher transport. Emergency ambulance services are explicitly excluded from this definition and are managed under a separate authority.

• Service Modes: Ambulatory, wheelchair-accessible, and non-emergency stretcher transportation.
• Target Population: Eligible West Virginia Medicaid and WVCHIP members requiring transport to billable medical or waiver services.
• Broker Mandate: All trips must be pre-arranged, routed, and authorized through Modivcare; providers cannot solicit or self-generate Medicaid trips.
• Mileage Limits: Gas mileage reimbursement for self-drivers is limited to the nearest appropriate provider, not exceeding 125 miles in-state or 30 miles beyond the West Virginia border.
• Exclusions: Emergency transport, non-medical trips (e.g., grocery shopping), and transport to non-Medicaid covered services are not billable.

2. Regulatory and Oversight Agencies

The West Virginia Department of Human Services (DoHS), through its Bureau for Medical Services (BMS), is the single state agency responsible for Medicaid. However, BMS delegates the day-to-day credentialing, routing, and quality assurance of NEMT to its contracted broker.

Providers must also interact with state business and transportation authorities to ensure their vehicles and corporate entities are legally authorized to operate for-hire in the state.

• State Medicaid Agency: West Virginia Bureau for Medical Services (BMS) (https://bms.wv.gov)
• Statewide NEMT Broker: Modivcare (https://www.modivcare.com)
• Business Registration: West Virginia Secretary of State (https://sos.wv.gov)
• Vehicle Regulation: West Virginia Division of Motor Vehicles (DMV) (https://transportation.wv.gov/DMV)
• Ambulance Oversight (if applicable): West Virginia Bureau for Public Health, Office of Emergency Medical Services (OEMS) (https://www.wvoems.org)

3. Gatekeeping Prerequisites: Who Can Even Apply

The absolute structural precondition for operating an NEMT business in West Virginia is the broker subcontracting requirement. According to BMS Provider Manual Chapter 524, non-ambulance transportation providers must have a contract with the State's transportation Broker to be eligible for reimbursement.

Because Modivcare manages network adequacy, they operate a closed network in certain regions. If Modivcare determines that a specific West Virginia county already has sufficient transportation providers, they will refuse to accept new applications for that area, acting as a de facto moratorium.

• Broker Subcontracting Requirement: Applicants must apply directly to Modivcare's network; direct Medicaid fee-for-service enrollment for NEMT is prohibited.
• Network Adequacy Closures: Modivcare may reject applications outright if the requested service counties are already saturated with existing providers.
• Business Entity Registration: Must be registered as a legal business entity in good standing with the West Virginia Secretary of State.
• Operating Authority: Must hold appropriate commercial vehicle registration through the West Virginia DMV before applying to the broker.
• Insurance Pre-Approval: Must secure commercial auto and general liability insurance quotes that meet Modivcare's minimum limits before a contract is offered.

4. Licensure and Certification Requirements

West Virginia does not issue a distinct "Adult Health Transportation" or NEMT facility license through the Office of Health Facility Licensure & Certification (OHFLAC). Instead, providers are "certified" through the broker's credentialing process.

If a provider wishes to offer ambulance-level transport (even non-emergency), they cross into a different regulatory tier and must be formally licensed by the West Virginia Office of Emergency Medical Services (OEMS).

• Facility Licensure: No specific health facility license is required by OHFLAC for standard ambulatory or wheelchair NEMT.
• Ambulance Exception: Non-emergency ambulance providers must be licensed by the West Virginia OEMS.
• Vehicle Inspections: Every vehicle must pass Modivcare's comprehensive 45-point safety inspection (checking HVAC, seatbelts, first aid kits, fire extinguishers, and tire tread).
• ADA Compliance: Wheelchair vans must meet Americans with Disabilities Act (ADA) specifications, including crash-tested tie-downs and hydraulic lifts.
• Insurance Minimums: Providers must maintain commercial auto liability, general liability (typically $1 million per occurrence), and workers' compensation as dictated by the Modivcare contract.

5. Medicaid Provider Enrollment

Enrollment is a dual-track process. While the primary contract is held with Modivcare, providers must also be registered in the West Virginia Medicaid Management Information System (WVMMIS) to receive a Medicaid Provider ID.

Providers enroll as "atypical" or contracted providers through the state's portal, ensuring they are screened against federal exclusion databases.

• Broker Application: Submit the Transportation Provider Application directly to Modivcare's West Virginia Network Management team.
• Medicaid Portal Registration: Register in the WVMMIS Provider Enrollment Portal (https://www.wvmmis.com).
• NPI Requirement: Obtain a National Provider Identifier (NPI) via the federal NPPES system, required for the WVMMIS application.
• Tax Documentation: Submit a completed IRS W-9 form and proof of Employer Identification Number (EIN).
• Application Fee: A Medicaid enrollment application fee (approximately $709) may apply during WVMMIS registration, though waivers sometimes apply for broker-exclusive subcontractors.

6. Staffing, Training and Background Checks

Drivers are the core of an NEMT business. West Virginia BMS and Modivcare enforce strict credentialing standards to ensure the safety of vulnerable Medicaid members.

Providers are responsible for covering the costs of all background checks, drug screens, and training certifications before a driver is permitted to transport a member.

• Background Checks: Mandatory state and federal criminal background checks, plus clearance through the West Virginia CARES registry for all drivers.
• Driving Records: Annual Motor Vehicle Record (MVR) checks; drivers with major violations (e.g., DUI, reckless driving) in the past 5-7 years are disqualified.
• Drug Testing: Mandatory pre-employment and random 10-panel drug and alcohol screening.
• Basic Certifications: Valid CPR and First Aid certification required for all active drivers.
• Specialized Training: Defensive driving course completion and Passenger Assistance Safety and Sensitivity (PASS) certification required for wheelchair transport drivers.

7. Documentation, Policies and Records

Rigorous documentation is required to survive broker audits and prevent fraud, waste, and abuse (FWA). Modivcare utilizes digital routing, but providers must maintain flawless internal records.

Failure to produce required documentation during a routine audit will result in immediate payment clawbacks or network termination.

• Trip Logs: Must capture member signature, driver signature, exact pickup/drop-off times, and odometer readings for every leg of the trip.
• GPS Tracking: Providers must use Modivcare's proprietary routing software or an approved API-integrated GPS tracking system in all vehicles.
• Maintenance Records: Daily pre-trip vehicle inspection logs and routine preventative maintenance records must be kept on file.
• Incident Reporting: Documented policies for reporting accidents, member no-shows, or behavioral incidents to Modivcare within 24 hours.
• Record Retention: All trip logs, billing records, and driver credentialing files must be retained for a minimum of five years per West Virginia Medicaid policy.

8. Billing, Rates and Claims

Because of the broker model, NEMT providers do not bill West Virginia Medicaid (WVMMIS) directly. All claims are submitted to Modivcare, which reimburses providers based on negotiated contracted rates.

Providers cannot bill for unauthorized trips, member no-shows, or "unloaded" miles (miles driven without a Medicaid member in the vehicle).

• Reimbursement Structure: Payment is typically structured as a base rate per trip plus a per-mile rate for loaded miles only.
• Claims Submission: Claims are billed electronically through the Modivcare Provider Portal.
• Prior Authorization: All trips must be pre-authorized and assigned by Modivcare; providers cannot self-generate billable trips.
• Gas Mileage Reimbursement: Members driving themselves use a specific Modivcare Gas Mileage Reimbursement Trip Log, and reimbursement is paid directly to the member, not a provider.
• Payment Schedule: Modivcare typically processes clean claims and issues electronic funds transfer (EFT) payments on a bi-weekly schedule.

9. Approval Sequence and Timeline

The timeline to become an active NEMT provider in West Virginia depends heavily on Modivcare's current network needs and the speed of driver background checks.

Providers should expect a multi-month process from the initial letter of interest to receiving their first trip assignment.

• Step 1: Submit a Letter of Interest/Application to Modivcare (1-2 weeks for initial response and network need assessment).
• Step 2: Complete Business Registration and WVMMIS portal registration (2-4 weeks).
• Step 3: Procure vehicles, secure commercial insurance, and complete Modivcare vehicle inspections (3-6 weeks).
• Step 4: Complete driver background checks, drug screens, and training certifications (2-4 weeks).
• Step 5: Contract execution and Modivcare portal training (1-2 weeks).
• Total Estimated Timeline: 60 to 120 days from initial application to active status.

10. Common Denials and Survey Findings

Audits are conducted regularly by Modivcare's Quality Assurance team and occasionally by the West Virginia Medicaid Fraud Control Unit (MFCU).

Most penalties and contract terminations stem from administrative negligence rather than intentional fraud, highlighting the need for strict daily oversight.

• Network Saturation Denials: Initial applications rejected because Modivcare has sufficient providers in the requested West Virginia county.
• Missing Signatures: Trip logs lacking the member's or driver's physical or electronic signature, resulting in total claim clawbacks.
• Unqualified Drivers: Dispatching a driver whose CPR certification, MVR check, or background check has expired.
• Vehicle Deficiencies: Failing unannounced broker inspections due to broken air conditioning, missing fire extinguishers, or malfunctioning wheelchair lifts.
• GPS Discrepancies: Billed mileage that does not match the GPS-tracked route or documented odometer readings.

11. Key Contacts and Resources

Navigating the NEMT landscape in West Virginia requires coordinating with the state Medicaid agency, the exclusive broker, and state business authorities.

Use these official portals to begin the registration and credentialing process.

• West Virginia Bureau for Medical Services (BMS): https://bms.wv.gov
• Modivcare (West Virginia NEMT Broker): https://www.modivcare.com
• West Virginia Medicaid Provider Enrollment Portal (WVMMIS): https://www.wvmmis.com
• West Virginia Secretary of State (Business Registration): https://sos.wv.gov
• West Virginia Division of Motor Vehicles: https://transportation.wv.gov/DMV

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