How to Start an NEMT Business in Minnesota (2027): The Metro Freeze, STS and the Real Gates



October 5, 2026

If you are planning to start an NEMT company in the Twin Cities, the first fact to know is that you cannot enroll as a new Minnesota Health Care Programs (MHCP) NEMT provider in the seven-county metro right now. The Minnesota Department of Human Services (DHS) stopped enrolling new NEMT providers located in Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington counties effective January 27, 2026, and in July 2026 extended that moratorium to January 27, 2027. Outside the metro, NEMT providers can still enroll, but under heavy scrutiny. This guide covers the gates you still have to clear, who actually pays for trips, what the state pays, and how to use the freeze window instead of losing it.

Gate 1: The business basics and a USDOT number

Register the business with the Minnesota Secretary of State, then get a USDOT number from the Federal Motor Carrier Safety Administration. MnDOT asks for the USDOT number before it will issue the MnDOT number that starts your Special Transportation Service application. You will also need a workers' compensation certificate for the MnDOT packet, so line up coverage before you file.

Gate 2: The MnDOT Special Transportation Service (STS) certificate

Minnesota does not issue an "NEMT license." The credential that matters is the Special Transportation Service Certificate of Compliance from the Minnesota Department of Transportation. MHCP will not enroll an NEMT provider without a current STS certificate and a current vehicle list from MnDOT.

MnDOT runs the application in phases:

MnDOT number packet: business information form, data privacy notice and your workers' compensation certificate.
Certificate of Compliance packet: Form E commercial insurance filing, driver and non-driver information, vehicle registrations, a passed STS vehicle inspection, DHS background studies, MHCP provider training and, on MnDOT's checklist, MHCP enrollment.
Initial STS Provider Education: an online course you must finish within 90 calendar days of receiving the certificate.

The insurance floor is set in Minnesota Rules part 8840.6000: $500,000 combined single limit residual liability per vehicle, plus basic economic loss (no-fault) benefits and uninsured and underinsured motorist coverage under Minnesota Statutes chapter 65B, filed with MnDOT on Form E. Get quotes on that exact limit before you buy a vehicle. Insurance is usually the line that breaks a Minnesota startup budget.

MnDOT inspects each vehicle before it goes into service and at least annually after that, and can run unannounced inspections. It also enforces driver and attendant qualifications, securement and safety equipment, maintenance standards and insurance.

Gate 3: DHS background studies for almost everyone

Background studies run through the DHS NETStudy 2.0 system, and the net is wide. As of September 2026, DHS requires a fingerprint-based study for every owner with a direct or indirect interest of 5% or more, every controlling individual and managerial official, all drivers and staff who assist passengers, and administrative staff who have passenger contact or handle scheduling, dispatch or billing. For owners, DHS looks for an "eligible" or "set-aside" result. Budget the time: nobody drives or dispatches until their study clears.

Gate 4: MHCP enrollment (frozen in the metro)

With the STS certificate in hand, you enroll with MHCP as a medical transportation provider. Expect three things:

A screening fee, or proof you already paid it to Medicare or another state's Medicaid agency.
A site visit before enrollment, unless Medicare or another state Medicaid program already completed one.
Time: DHS says to allow 30 days for processing, plus 60 more days if a site visit is needed.
Driver enrollment: every driver must be individually enrolled with MHCP and listed on the claim as the rendering provider.

Now the freeze. In coordination with the federal Centers for Medicare & Medicaid Services, DHS paused new enrollments for 13 Medicaid services it considers high risk for fraud, NEMT among them, starting January 27, 2026. For NEMT in the seven metro counties, that moratorium now runs to January 27, 2027. NEMT providers located outside the seven metro counties can enroll. Existing high-risk providers also had to complete an off-cycle revalidation by May 31, 2026. The moratorium has already been extended once, so check MHCP provider news for the current status before you file anything.

One more gate arrives with the reopening. Starting January 1, 2027, an agency applying to provide a service DHS designates as high risk, which includes NEMT, must have its owners who are active in day-to-day management and all managerial and supervisory staff complete DHS compliance training before it applies (Minnesota Statutes section 256B.0446, added in 2026).

Gate 5: Who actually pays for the trip

As of September 2026, Minnesota splits NEMT across three payers, and each one decides whether you get trips:

Managed care plans. About 80% of NEMT spending is overseen by managed care organizations, according to DHS figures presented to a Minnesota House committee in March 2026. Each plan runs its own transportation program and vendor network (Blue Cross, for example, runs BlueRide, and PrimeWest administers its own NEMT). Plan credentialing is where most of your volume comes from, and it is a separate application from MHCP enrollment.
County and tribal agencies handle basic fee-for-service NEMT (ambulatory and assisted rides) for people not in managed care. In the Twin Cities area, that work runs through Medical Transportation Management (MTM) under a contract with the Metro County Consortium, in a program called MNET.
State-administered NEMT covers the higher levels of fee-for-service service: Mode 5 (ramp or lift-equipped), Mode 6 (protected transportation) and Mode 7 (stretcher). The state's medical review agent certifies the member's level of service (for protected transport, the county mental health crisis team or qualified facility staff do it), and then the member chooses and schedules directly with an enrolled provider. There is no broker in the middle, so these members have to be able to find you.

That structure is set to change. A 2025 law directs DHS to contract, statewide or by region, with a single administrator for NEMT, including rides for managed care members. In 2026 the Legislature dropped the fixed July 2026 and January 2027 start dates; DHS must now give counties and plans six months' notice before the switch. Watch for that notice, because it will change who credentials you.

What the state pays for higher-level trips

DHS publishes state-administered rates. The rates below are current as of September 2026; mileage rates took effect July 1, 2026, carry a quarterly fuel adjustment and are paid only for miles with the member on board. Rural and super-rural add-ons apply based on the member's home ZIP code.

Service	Base (pickup)	Mileage	10-mile trip
Mode 5: ramp or lift-equipped (A0130 / S0209)	$19.80	$1.80 per loaded mile	$37.80
Mode 6: protected transport (T2003 UA / S0215 UA)	$75.00, attendant required	$2.54 per loaded mile	$100.40
Mode 7: stretcher (T2005 / T2049)	$60.00	$2.54 per loaded mile	$85.40

A stretcher extra attendant bills T2001 at $9.00. Managed care and county rates differ from these and are set by each plan or agency, so price your model on the payer mix you can actually get, not on the state table. Run your own numbers with the cost per trip calculator.

Driver and attendant training Minnesota requires

Minnesota Rules part 8840.5910 sets training for STS drivers and attendants:

Before first service: orientation on transporting passengers, communication equipment, ramp, lift and wheelchair securement if the vehicle has them, medical emergency and accident procedures, cleaning and sanitizing, and for drivers, daily vehicle inspection and a behind-the-wheel evaluation.
Within 45 days: four hours of first aid, four classroom hours of defensive driving for drivers, abuse-prevention training and passenger assistance training (at least 8 hours for wheelchair and transfer assistance, 2 more for stretcher, 4 for ambulatory-only service, 3 for child restraint systems).
Every three years: refreshers in first aid, abuse prevention, securement, defensive driving and passenger assistance, plus continuing education.

Keep every certificate in the driver qualification file. MnDOT inspections and DHS audits both ask for it.

The enforcement climate you are entering

Minnesota Medicaid paid about $151 million in NEMT claims in 2024 across fee-for-service and managed care, according to DHS figures presented to the House Fraud Prevention Committee in March 2026. At that hearing the DHS Inspector General reported 71 open investigations into NEMT providers and 14 payment suspensions, and described trips billed with no matching appointment, inflated mileage and kickbacks. DHS has been running unannounced site visits, and the 2026 Legislature added NEMT to the state's electronic visit verification requirements, effective January 1, 2027 or on federal approval, whichever is later.

For a new operator, that cuts both ways. It is harder to get in, and every trip will be checked. But clean operators with GPS trip verification, signature capture and tight trip logs are exactly what plans and counties want to add as weaker providers are removed.

The full sequence

Step	Agency	Timing
Register the business; workers' compensation	MN Secretary of State; your carrier	Days
USDOT number	FMCSA	Days
MnDOT number packet	MnDOT STS	Weeks
Form E insurance ($500,000 CSL per vehicle)	Your carrier, filed with MnDOT	1 to 3 weeks for quotes
Background studies	DHS NETStudy 2.0	Varies; fingerprint-based for everyone studied
MHCP provider training	DHS	Before the certificate
Vehicle inspection and Certificate of Compliance	MnDOT STS	Weeks
MHCP enrollment, screening fee and site visit	DHS	30 days, plus 60 for a site visit; metro frozen to Jan 27, 2027
Initial STS Provider Education	MnDOT	Within 90 days of the certificate
Managed care and county credentialing	Each plan, MTM or the county	Varies by payer

Do these five things next

Decide where you will operate. If it is the metro, plan for no MHCP billing before January 27, 2027 at the earliest, since the moratorium can be extended again, and build the company to be ready the day it lifts. If it is Greater Minnesota, call the county or tribal agency and the plans that cover your area first and ask whether they are adding providers.
Get insurance quotes at the $500,000 limit for the exact vehicles and drivers you plan to run, before you buy anything.
Start the MnDOT STS process now. The certificate, inspections and training take weeks. The DHS moratorium does not cover MnDOT, but MnDOT's checklist lists MHCP enrollment as a step, so ask MnDOT STS how a metro application moves during the freeze.
Use the wait for private pay. Facility contracts, private-pay riders and non-Medicaid work need no MHCP enrollment and build the trip history plans ask about.
Build your documentation before your first Medicaid trip: GPS logs, signatures, driver files and appointment matching. In Minnesota's current climate, that is what keeps you paid.

Rules and dates here come from MnDOT, DHS and the Minnesota Revisor as of September 2026. Moratorium and rate dates change, so confirm with MHCP provider news and MnDOT STS before you file. Once you are running, claim your listing in the NEMTrepreneur Directory so facilities and plans can find you.

Sources

Follow us on social media:

Find NEMT providers near you

The NEMT Entrepreneur directory lists 2,000+ non-emergency medical transportation providers by state, city and service type.

Browse the provider directory Run an NEMT company? Claim your listing NEMT Glossary