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Texas does not issue an "NEMT license." There is no state agency you apply to for one, and no state NEMT registration fee. What you need instead is a stack of business, Medicaid and vehicle credentials, and which ones apply depends on who pays for your trips. If you plan to run Medicaid trips, the order looks like this:
- Form the business with the Texas Secretary of State and get a free EIN from the IRS.
- Get an NPI through NPPES.
- Enroll with TMHP, the state's Medicaid enrollment contractor, as a demand response transportation provider.
- Get credentialed with the transportation vendors that Medicaid managed care organizations (MCOs) use, and contract with the Medical Transportation Program (MTP) if you want fee-for-service trips.
- Equip vehicles and train drivers to the state's NEMT vehicle and driver standards, and buy commercial auto coverage.
- Check your city's vehicle-for-hire ordinance. Dallas and Houston both run permitting programs.
- Register with TxDMV or FMCSA only if you cross a threshold, such as a vehicle designed for more than 15 passengers or interstate trips.
Rules and contracts change. Confirm the details with HHSC, TMHP and the MCOs in your area before you buy vehicles. For the general startup checklist that applies in any state, see our guide to starting a medical transportation business.
How Texas Medicaid NEMT works in 2026
Most of the confusion about Texas NEMT licensing comes from not knowing who actually buys the trip. Texas Medicaid splits nonemergency transportation into two channels, and each one has its own way in.
Managed care members: MCOs and their transportation vendors
Since June 1, 2021, Medicaid MCOs have been responsible for nonemergency medical transportation for their own members. The Texas State Auditor's Office reviewed the switch and reported that HHSC moved the program from regional managed transportation organizations to the MCO model on that date, and ran readiness reviews on 17 MCOs and their 6 transportation subcontractors. The change came from House Bill 1576 (2019), which also opened the program to transportation network companies.
In practice, an MCO member's ride is approved by the member's health plan and dispatched through the transportation vendor that plan contracts with. As a provider, you do not contract with HHSC for these trips. You join the vendor's network.
Fee-for-service members: the Medical Transportation Program
For fee-for-service Medicaid, Children with Special Health Care Needs (CSHCN) and Transportation for Indigent Cancer Patients (TICP) clients, HHSC still runs the Medical Transportation Program. The MTP handbook in the Texas Medicaid Provider Procedures Manual says MTP prior-authorizes all fee-for-service trips, states that the handbook "does not apply to managed care," and lists the services MTP covers: mass transit passes, demand response transportation (taxi, wheelchair van and similar carriers), mileage reimbursement, and meals, lodging and advance funds for clients under 21.
The same handbook names the two MTP provider types that enroll directly with TMHP: Demand Response Transportation Service (DRTS) providers and transportation network companies. A wheelchair or ambulatory van company is a DRTS provider. Clients book MTP rides by calling 1-877-633-8747 at least two business days ahead, or five business days for trips outside their county.
ITP mileage reimbursement is not a business model
The handbook also describes Individual Transportation Participants (ITPs): a family member, friend, neighbor or the client who drives a personal vehicle and gets mileage reimbursement. ITPs register with TMHP but, in the handbook's words, "do not enroll as Medicaid providers." If someone tells you to start as an ITP and grow from there, that is the wrong path. ITP status is tied to a specific client's trips and does not make you a transportation company.
| Trip type | Who approves the trip | How a provider gets in |
|---|---|---|
| Medicaid managed care member | The member's MCO | Credential with the MCO's transportation vendor |
| Fee-for-service Medicaid, CSHCN, TICP | MTP (HHSC) | Enroll with TMHP as a DRTS provider and contract with MTP |
| Family or friend driving one client | MTP | ITP registration with TMHP (not a provider enrollment) |
| Private pay, facility contracts | The payer | Your own contract. No Medicaid enrollment needed, but city, insurance and vehicle rules still apply |
Step by step: Texas NEMT licensing requirements in order
1. Form the entity and get an EIN
Most operators form an LLC. The Secretary of State's Form 205, Certificate of Formation for a limited liability company, lists a $300 filing fee. Once the entity exists, get an EIN from the IRS, which issues it online for free. Open a business bank account in the entity's name before you sign a single vendor agreement. Credentialing packets ask for it.
2. Get an NPI
Apply for an organizational National Provider Identifier through NPPES. The MTP handbook lists taxonomy code 343800000X for DRTS providers billing procedure code T2003, so use that taxonomy unless TMHP or your vendor tells you otherwise. The legal name and address on the NPI must match your Secretary of State filing exactly, or enrollment stalls. For the full walkthrough, see our NPI guide for NEMT companies.
3. Enroll with TMHP
Texas Medicaid & Healthcare Partnership (TMHP) handles Medicaid provider enrollment through the Provider Enrollment and Management System (PEMS). For fee-for-service MTP trips, DRTS enrollment with TMHP is required by the MTP handbook. For managed care trips, federal rules require states to screen and enroll all MCO network providers (42 CFR 438.602(b)), so expect the MCO's vendor to ask for proof of your Texas Medicaid enrollment. Ask each vendor up front which enrollment record it needs to see.
4. Get credentialed with MCO transportation vendors
This is where managed care trips come from, and where most of the waiting happens. List the MCOs that serve your service delivery area, call each plan's provider services line, and ask which vendor manages its NEMT and how that vendor recruits transportation providers. Each vendor runs its own application, document review, vehicle inspection and rate schedule. Credential with more than one if you can. A single-vendor company lives or dies by one contract.
Before you sign, run the vendor's per-trip and per-mile rates through our NEMT cost per trip calculator. Ask how each vendor pays for deadhead miles, no-shows and cross-county trips, because those terms decide your margin more than the base rate.
5. Vehicles: what the state standards require
Texas has no NEMT plate and no state NEMT vehicle permit. The vehicle rules come from the program. 1 Tex. Admin. Code § 380.501, written for MTP's contracted brokers and managed transportation organizations, sets the floor. Every vehicle must:
- Show the provider name and vehicle number in letters at least six inches high.
- Have clean, working seat belts for every passenger seat, stored off the floor when not in use.
- Have a working speedometer and odometer, interior lights, heating and cooling, two exterior mirrors and an interior mirror for watching the passenger area.
- Carry a fire extinguisher within the driver's reach and a first aid kit with gloves, waste bags, a scrub brush, disinfectant and deodorizer.
- Post "No Smoking, Eating or Drinking," "All passengers must wear seat belts" and "Concealed Weapons Prohibited" signs.
- Comply with the ADA vehicle guidelines (36 CFR 1192), federal motor vehicle safety standards (49 CFR 571) and Chapter 547 of the Texas Transportation Code.
The State Auditor's report notes that driver and vehicle requirements from the old model were carried into the MCO contracts, so expect vendors to inspect against a similar list and add their own items. For purchase prices and conversion options, see our breakdown of what a medical transport van costs, then test the payback with the NEMT vehicle break-even calculator.
6. Insurance
Texas law requires every driver to carry at least 30/60/25 liability coverage: $30,000 per injured person, $60,000 per accident and $25,000 for property damage, according to the Texas Department of Insurance. That is a personal auto floor, not an NEMT number. You need a commercial auto policy that covers passengers for hire, and the limits that matter are the ones in your vendor agreements and any city permit. Get the vendor's insurance exhibit before you request quotes so you are pricing the right limits. If you ever need a TxDMV number (step 9), TxDMV sets its own minimums, including $500,000 for vehicles designed to carry more than 15 but fewer than 27 people.
7. Drivers
Texas does not issue an NEMT driver certificate. The driver standards in 1 Tex. Admin. Code § 380.502 require the contracted entity to:
- Verify a valid driver's license.
- Check the driver's DPS driving record against the contract's driving history standard.
- Check DPS public criminal records. No DWI or driving-under-the-influence finding within seven years before hire or any time after, and no conviction within seven years before hire or any time after for abuse, neglect or exploitation of children, elderly people or people with disabilities, Penal Code offenses against the person, family, public order, public health or property, or Controlled Substances Act offenses. No Medicaid fraud findings.
- Train drivers in passenger safety, passenger assistance and assistive devices (wheelchair lifts, tie-downs, child safety seats) at least annually, defensive driving at least every two years, plus sensitivity, customer service and prohibited conduct.
Vendors can add their own requirements on top of these, so ask for the driver onboarding checklist during credentialing. A commercial driver's license only comes into play for larger vehicles: Texas DPS requires a CDL for a vehicle under 26,001 pounds designed to transport 16 or more passengers, and heavier vehicles fall into the higher CDL classes. A minivan or a standard wheelchair van does not need one.
8. Check your city's vehicle-for-hire ordinance
This is the local layer that most Texas startup guides get wrong. Some cities regulate any business that carries passengers for pay, and their ordinances do not carve out medical trips by name. Two examples we checked:
- Dallas. Chapter 47A of the Dallas City Code defines transportation-for-hire service as "the business of offering or providing transportation of persons for compensation" and says no one may operate one inside the city without operating authority. The exclusions in Sec. 47A-1.4 cover DART, ambulances regulated under Chapter 15D and several bus and shuttle categories, but do not name NEMT. The city's Transportation Regulation division issues company, vehicle and driver permits.
- Houston. The city's Vehicles for Hire Permitting and Enforcement section (Administration and Regulatory Affairs) licenses taxicabs, limousines, scheduled ground transportation, charter vehicles and others under Chapter 46, and also issues wheelchair accessible vehicle company and vehicle permits.
Neither city publishes an NEMT-specific rule, so call before you launch, describe your service (prearranged medical trips, Medicaid vendor work, private pay), and get the answer in writing. If you operate elsewhere, search your city's code for "vehicle for hire" or "transportation for hire" and ask the same question.
9. TxDMV and USDOT only if you cross a threshold
A TxDMV number is required for intrastate carriers that operate a vehicle designed to transport more than 15 passengers including the driver, a commercial vehicle over 26,000 pounds, placarded hazmat, a commercial school bus or household goods. A typical NEMT fleet of minivans and wheelchair vans does not trigger it. If you do, TxDMV requires a USDOT number first, and the annual registration costs a $100 one-time application fee, $10 per vehicle and a $100 insurance filing fee. If you plan to carry passengers across state lines, check FMCSA's registration requirements before your first interstate trip.
What it costs to get licensed
The government fees in the Texas stack are small. Vehicles, insurance and the months between enrollment and your first paid trip are not.
| Item | Cost | Source |
|---|---|---|
| LLC Certificate of Formation (Form 205) | $300 | Texas SOS |
| EIN | Free | IRS |
| TxDMV number (only if a threshold applies) | $100 one-time application, $10 per vehicle per year, $100 insurance filing | TxDMV |
| City vehicle-for-hire permits | Set by each city's fee schedule | Your city |
| Vehicles, conversions, commercial auto | Varies by fleet and limits | Use the calculators below |
To model the rest, start with the cost per trip calculator and the vehicle break-even calculator. Budget working capital for the gap between enrollment and steady vendor volume, which is driven by vendor credentialing timelines rather than any state fee.
Common mistakes
- Looking for a state NEMT license. There isn't one. Time spent searching TxDOT or TxDMV for an "NEMT application" is time not spent on vendor credentialing.
- Getting a TxDMV number you do not need. Under the 16-passenger and 26,000-pound thresholds, it adds fees and insurance filings without opening any Medicaid door.
- Enrolling with TMHP and waiting for trips. TMHP enrollment does not send you managed care volume. The MCO vendors do, and each has its own application.
- Mismatched names. Your SOS filing, EIN letter, NPI, bank account and insurance declarations must show the same legal name and address.
- Skipping the city call. A Dallas or Houston permit problem can sideline vehicles that are otherwise fully credentialed.
- Buying the fleet first. Get vendor rate sheets and insurance requirements before you sign a van lease.
Frequently asked questions
Do I need a license to start an NEMT business in Texas?
Texas has no NEMT-specific license. You need a registered business, an NPI, Texas Medicaid enrollment through TMHP if you want Medicaid trips, credentialing with MCO transportation vendors, compliant vehicles and drivers, and any city vehicle-for-hire permit your city requires. A TxDMV number applies only above the passenger or weight thresholds.
Does TxDOT or TxDMV license NEMT providers?
No. TxDOT does not license NEMT companies. TxDMV registers motor carriers, but only when a vehicle is designed for more than 15 passengers including the driver, exceeds 26,000 pounds, or meets one of its other triggers, so most minivan and wheelchair van fleets never need a TxDMV number.
Who pays for Medicaid NEMT trips in Texas?
For Medicaid managed care members, the member's MCO approves and pays for the trip through its transportation vendor, a model in place since June 1, 2021. For fee-for-service Medicaid, CSHCN and TICP clients, HHSC's Medical Transportation Program authorizes the trip and pays enrolled demand response providers.
What are the driver requirements for NEMT in Texas?
State rules call for a valid driver's license, a DPS driving record check, a DPS criminal history check with seven-year lookbacks for DWI and listed offenses, and recurring training in passenger safety, assistance, assistive devices and defensive driving. Vendors add their own requirements on top. A CDL is needed only for vehicles designed for 16 or more passengers or over 26,000 pounds.
Can I run private pay NEMT in Texas without Medicaid enrollment?
Yes. Private pay and facility contract trips do not require TMHP enrollment or vendor credentialing. You still need the business registration, adequate commercial insurance, compliant vehicles, and any city vehicle-for-hire permit where you pick up passengers.
Get found by Texas facilities and riders
Once you are operating, list your company in the Texas NEMT provider directory so discharge planners and families can find you by city and service type. The Houston, Dallas and other metro pages show who already runs trips in each market. Add your listing here. For state rule changes, rate updates and vendor news as they happen, subscribe to The NEMTrepreneur Dispatch.
