How to Start an NEMT Business in Virginia (2027): DMV Authority, Brokers and the MTM Switch

NEMTrepreneur Editorial Team

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November 2, 2026

If you plan to start an NEMT company in Virginia, the first fact to know is that the fee-for-service broker has changed hands. On September 15, 2026, the Department of Medical Assistance Services (DMAS) announced in a provider bulletin that MTM "has been selected through a competitive procurement process" to provide fee-for-service transportation, taking over from ModivCare. DMAS's NEMT transportation site now confirms the date: "Effective October 1, 2026, the Virginia FFS NEMT program operations are now being managed by MTM Health." ModivCare no longer holds fee-for-service. Virginia also has something close to an NEMT license: a DMV certificate that lets you carry Medicaid riders and no one else. This guide covers each gate, who pays, what the brokers expect and the order that keeps you from buying a van you cannot use.

Gate 1: The business basics

File the company with the State Corporation Commission. As of October 2026, articles of organization for an LLC cost $100, and every LLC then owes an annual registration fee of $50. Then:

EIN: free from the IRS.
Local business license: Va. Code 58.1-3703 caps the fee for issuing the license at $30 to $50 depending on the locality's population, but localities can also levy a separate business license tax. Ask what both will be.
The name: DMAS's driver, attendant and vehicle requirements (updated May 26, 2026) say "Medicaid" or "FAMIS" may not appear on the vehicle or in the business name. Leave them out of the LLC name.
Workers' compensation: required once you regularly employ more than two part-time or full-time employees.
NPI: MTM records your company NPI in its provider profile, so apply through NPPES early.

Gate 2: The DMV NEMT carrier certificate

Under Va. Code 46.2-2099.44, a nonemergency medical transportation carrier needs a certificate of fitness from the DMV before it carries passengers within Virginia. As of October 2026, the DMV's NEMT carrier page requires:

Application: Form OA 151, a $50 filing fee and a $3 operating authority registration fee.
Bond: a $25,000 surety bond or letter of credit kept on file for three years from the date the certificate is issued. The premium varies, so quote it.
Plates: registration and license plates specifically designated for NEMT carriers.
Exit rule: if you stop carrying Medicaid riders, notify DMV in writing within 30 days and surrender those plates.

The insurance floor, from Va. Code 46.2-2053, depends on how many people the vehicle is designed to carry, including the driver. As of October 2026:

Vehicle designed to carry (including driver)	Minimum bodily injury and property damage
1 to 6	$350,000
7 to 15	$1,500,000
16 or more	$5,000,000

Seven or more seats, driver included, jumps you to the $1.5 million tier. Brokers may require more coverage than the DMV minimum, and MTM requires that it be listed as certificate holder and additional insured.

Now the catch. By definition in Va. Code 46.2-2000, an NEMT carrier provides transportation only through DMAS, a DMAS broker, or a Medicaid managed care plan or its contractor, and the DMV page adds that you "may only be compensated through Medicaid reimbursement." A private-pay rider or a facility paying you directly is outside that certificate. Ask DMV Motor Carrier Services which other authority fits any non-Medicaid work before you take it. If you will cross state lines, DMAS also requires FMCSA operating authority.

Gate 3: Medicaid enrollment

DMAS's NEMT enrollment guide (July 2025) says you do not enroll with DMAS directly for NEMT. You enroll with the broker, the broker preauthorizes every trip, and while members can ask for a specific provider, the broker is under no obligation to assign one.

The September 2026 bulletin adds a line every operator should act on: "Under federal rules, MCOs and DMAS are prohibited from paying claims to network providers who are not enrolled in PRSS," the DMAS provider portal. The two documents read differently for NEMT subcontractors, so ask MTM and each plan vendor in writing whether they need you enrolled in PRSS. Enrolling costs you time; finding out after your claims stop costs more.

Gate 4: Background checks and driving records

DMAS's May 26, 2026 requirements set the floor for drivers and attendants, and brokers can add to it:

Criminal history: no conviction for a "barrier crime" under Virginia law, with criminal background checks from Virginia State Police and/or national databases, including the Sex Offender Registry, before anyone transports a member.
Driving record: at least 18, licensed for two years, no more than two chargeable accidents or moving violations in three years, DMV points no lower than minus 2, and no suspension or revocation for moving violations in five years. MTM's handbook raises the minimum age to 21 for its network.
Drugs and alcohol: drivers who use alcohol or drugs on duty are barred, and volunteer drivers need a drug screen. Neither DMAS nor MTM publishes a testing schedule for a provider's own drivers, so ask each broker what it requires.
Ongoing checks: the broker reviews driver credentials before service and at least annually, and uses the DMV's Driver Alert program to monitor driving records.

Keep every result in a driver qualification file, since the broker rechecks credentials at least once a year.

Gate 5: Broker credentialing

No agency can make a broker add you. For fee-for-service, MTM's Virginia provider page describes application, credentialing and contracting phases with an assigned representative. Its Virginia provider handbook (approved August 10, 2026) adds:

Tracking on every trip. Automated vehicle location must run for the full ride, through MTM's free driver app or a third-party system integrated with MTM Link.
Credentials kept current. Company, driver and vehicle documents live in MTM Link. Expired credentials mean fewer trips, a performance plan, unpaid trips or removal.
Inspection. The broker inspects every vehicle before it carries members and again every six months.

For managed care members, apply separately to each plan's vendor. DMAS says the plan brokers' requirements are "similar, if not the same" as fee-for-service, but each one enrolls, trains, inspects, negotiates and pays on its own terms. The NEMT Broker Report Card covers what the public record shows about each broker.

Who actually pays for the trip

Cardinal Care, Virginia's Medicaid program, runs NEMT two ways. MTM's handbook says about 94% of members received NEMT through managed care as of July 2024, and about 6% through fee-for-service: people newly eligible and not yet in a plan, certain waiver members and FAMIS members not in a plan. Many fee-for-service trips are recurring, such as dialysis or day support. The September 15, 2026 bulletin says managed care transportation is not changing and pairs each plan with its vendor:

Members in	Transportation vendor (as of Sept. 15, 2026)
Fee-for-service	MTM (took over from ModivCare on October 1, 2026)
Humana and Sentara	ModivCare
Anthem	MTM
Aetna	Medidrive
UnitedHealthcare	SafeRide

Trust the bulletin over the older plan pairings in DMAS's July 2025 enrollment guide.

What Virginia pays: negotiated, not published

There is no public NEMT rate table. MTM says rates "are discussed and determined with transportation providers on an individual basis," and its handbook pays from a Schedule A rate sheet that reflects mileage, mode and multi-loading. What MTM does publish, as of the August 10, 2026 handbook, are the terms your price has to cover:

Term	MTM fee-for-service standard (Aug. 10, 2026)
Trip offers	Standing orders go to their designated provider; other trips go to eligible providers 7 days out and to an open marketplace 5 days out
Turning trips back	At least 24 hours before pickup
On-time pickup	Within 15 minutes before or after the scheduled time
Will-call return	Within 45 minutes of notice
Hospital discharge	Within 3 hours, or liquidated damages apply
Claims	Clean claim within 6 months, with an electronic trip log and the member's signature
No-shows	Not reimbursed

Run your numbers with the cost per trip calculator before the rate conversation.

Driver training and vehicle standards Virginia requires

DMAS requires every driver and attendant to complete the broker's driver training before transporting a member. MTM's list, as of August 2026, covers PASS, HIPAA, defensive driving, first aid and wheelchair securement where they apply, plus modules on fraud, waste and abuse, mandatory reporting and MTM Link. Its training page schedules a six-hour in-person driver training in the vehicle the driver will use, adds stretcher training for stretcher drivers, and says no fee-for-service trips until all of it is done. The handbook says the mandated training is at no cost to the provider.

DMAS vehicle minimums include the ADA specifications in 49 CFR Part 38, heat to 74 and air conditioning to 68 degrees measured at the rear, seat belt extensions, a belt cutter, a first aid kit, a fire extinguisher, a spill kit, and your business name and phone number on both sides in letters at least three inches high. Stretcher vans carry two trained crew, one stretcher passenger at a time, and no one who needs medical monitoring or has an IV, saline lock or airway device. DMAS sets no vehicle age or mileage limit.

The enforcement climate you are entering

Virginia's controls run through the broker's data. MTM's handbook (August 10, 2026) scores every provider and can impose a performance plan, liquidated damages or termination for missing these standards:

On-time performance above 95%.
Provider no-shows (refusing or failing to complete assigned trips) below 0.25%.
Substantiated complaints below 0.1% of completed trips.
A fraud screen comparing trip miles against trip minutes, and a count of overlapping claims (one driver in two vehicles, or two drivers in one), each below 0.99%.

Federal scrutiny is rising too. HHS-OIG announced a multistate NEMT audit series on May 28, 2026, covering prior authorization, provider qualifications and record-keeping. Full-trip GPS tracking, clean trip logs and signatures are the price of staying in the network.

What changes in 2027

A new fee-for-service broker. An operator that ran fee-for-service work under ModivCare still has to credential, train and pass inspection with MTM. The bulletin says MTM will contact members and facilities with standing orders to review them and discuss transportation providers. If you want recurring fee-for-service riders, be credentialed while that happens.
Online-only DMV filings. DMV has taken operating authority applications online since January 1, 2026. From February 1, 2027, applications and renewals must be filed online.
Work requirements and six-month renewals. Virginia's Medicaid expansion covers about 550,000 adults, and according to DMAS both changes apply to applicants from January 1, 2027 and to members with renewals due March 31, 2027 or later. Members who lose coverage stop generating trips, so check eligibility at trip intake.

The full sequence

Step	Agency	Timing
Call the brokers in your area	MTM, ModivCare, Medidrive, SafeRide	First: ask who is adding providers, at which levels of service and insurance limits
Form the LLC; EIN; local license	SCC; IRS; your locality	Before the DMV application; no "Medicaid" or "FAMIS" in the name
Insurance and bond quotes	Your agent and surety	At the broker's limit and your van's seat count
NEMT carrier certificate and plates	Virginia DMV	Before your first Medicaid trip; online only from Feb. 1, 2027
Ask about PRSS enrollment	DMAS, MTM, plan vendors	Before you bill
Driver background checks and records	You, Virginia State Police, DMV	Before any driver transports a member
Broker application, training and contract	Each broker	The longest step; varies by broker
Vehicle inspection	Each broker	Before the first trip, then every six months

Do these five things next

Start MTM credentialing if you want fee-for-service trips. MTM has run Virginia fee-for-service since October 1, 2026, so apply through its Virginia provider page. Send DMAS questions to transportation@dmas.virginia.gov, the contact in its requirements document.
Call each broker's provider line and ask whether it is adding providers where you are, for which levels of service, at what insurance limits and with what drug-testing rules.
Decide on seat count before you buy. Seven or more, driver included, moves your DMV minimum from $350,000 to $1.5 million. Quote both.
Ask in writing whether you need PRSS enrollment to be paid by MTM and each plan vendor.
Call DMV Motor Carrier Services about which authority covers any private-pay or facility work, since the NEMT carrier certificate does not.

Rules, vendors and dates here come from DMAS, the Virginia DMV, the Code of Virginia and MTM as of October 13, 2026. This is not legal, tax or insurance advice; confirm with DMAS, DMV, each broker and your own counsel before you file. Once you are running, claim your listing in the NEMTrepreneur Directory and see who else serves Virginia.

For one operator's view of building a business in this market, read how MC MedRide built an NEMT business in Richmond.

Sources

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