Medi-Cal moves some members to fee-for-service Jan. 1; ride companies must be FFS-enrolled to keep serving them
Starting Jan. 1, 2027, federal rules move Medi-Cal members with unsatisfactory immigration status out of health plans and into fee-for-service. DHCS says NMT and NEMT providers must be enrolled in Medi-Cal FFS to keep serving them, and it has accepted TARs for those members since Nov. 1. If a plan sends you these riders today, check your FFS enrollment in PAVE now.
California DHCS, Medi-Cal Fee-for-Service Provider Toolkit
November 6, 2026
Policy & Medicaid
https://www.dhcs.ca.gov/wp-content/uploads/2026/10/DHCS-FFS-Provider-Toolkit-68872c.pdf
New York charges three ride company owners in alleged $4.7 million Medicaid billing scheme
New York's comptroller and State Police charged three family members who ran USA Medical Transport, NYS Med Transport and EZ Medical Transportation in Schenectady. They allegedly billed rides that never happened, group rides as separate trips and inflated mileage from 2020 to 2024. New York requires prior authorization for group rides and pays mileage once per group.
Office of the New York State Comptroller
November 2, 2026
Policy & Medicaid
https://www.osc.ny.gov/press/releases/2026/11/dinapoli-family-members-charged-theft-47m-state-medicaid-program
Judge voids CMS medical frailty rule tied to Medicaid work requirements
A judge struck down the CMS medical frailty definition used for Medicaid work requirement exemptions, a win for states and providers; CMS may appeal.
Healthcare Dive
October 30, 2026
Policy & Medicaid
https://www.healthcaredive.com/news/judge-strikes-down-cms-medical-frailty-policy-medicaid-work-requirements/873284/
New Windsor man sentenced in $3.4M Medicaid transportation fraud case
Two men who ran Medicaid transportation companies were sentenced after a $3.4 million fraud case brought by the Orange County DA and state comptroller.
My Hudson Valley
October 28, 2026
Policy & Medicaid
https://www.timeshudsonvalley.com/stories/new-windsor-man-sentenced-in-34-million-medicaid-fraud-case,249692
Saratoga NEMT provider arrested for allegedly stealing $700K from Medicaid
A Saratoga County Medicaid transportation company owner was arrested and accused of stealing more than $700,000 from the state Medicaid program.
saratogian.com
October 28, 2026
Policy & Medicaid
https://www.saratogian.com/2026/10/27/saratoga-medicaid-transportation-provider-arrested-for-allegedly-stealing-over-700k/
States scramble to implement H.R. 1 Medicaid changes, directors say
At the NAMD conference, state officials discussed implementing H.R. 1 provisions including work requirements and state-directed payments.
Fierce Healthcare
October 27, 2026
Policy & Medicaid
https://www.fiercehealthcare.com/payers/work-requirements-state-directed-payments-front-and-center-namd-2026
Rhode Island charges two NEMT companies; one allegedly ran 16,000 Medicaid rides without required insurance
Rhode Island's attorney general charged the owners of two NEMT companies with Medicaid fraud on Oct. 14. Moshlaw Transportation allegedly gave 16,000 rides without required insurance and with invalid registrations (about $270,000). Assured Transportation allegedly billed rides while its owners were abroad or hospitalized (about $453,000). States do check your insurance and registrations.
Rhode Island Attorney General
October 14, 2026
Policy & Medicaid
https://riag.ri.gov/press-releases/seven-charged-crimes-related-medicaid-fraud-more-1-million
CMS targets duplicate ACA and Medicaid enrollments
CMS reported progress on rooting out duplicative ACA and Medicaid enrollments as part of a broader fraud, waste and abuse push, which could affect eligibility verification tied to NEMT trips.
Fierce Healthcare
October 14, 2026
Policy & Medicaid
https://www.fiercehealthcare.com/regulatory/cms-takes-aim-duplicative-aca-medicaid-enrollments
Michigan auditor finds the state only partly fixed NEMT provider checks and broker oversight
Michigan's Auditor General released a follow-up on Oct. 13, 2026: MDHHS only partly fixed the 2022 audit's two problems, checking provider and driver eligibility and monitoring its broker, ModivCare. It did not penalize the broker for recurring issues or verify its self-reported call abandonment rates. Michigan operators should keep driver files and CHAMPS enrollment current.
Michigan Office of the Auditor General, report 391-0715-20F
October 13, 2026
Policy & Medicaid
https://audgen.michigan.gov/complete-projects/medicaid-non-emergency-medical-transportation-services-2/
Ohio law now in effect will make GPS trip data a condition of Medicaid NEMT payment
Ohio SB 315 took effect Oct. 6, 2026. It directs Ohio Medicaid to verify NEMT trips by GPS: pickup arrival, trip start, drop-off and completion, plus route and miles. Standards are due in 6 months, a pilot in 12, and all NEMT providers must use the system within 18 months. Claims missing the data will not be paid. Ohio operators should confirm their dispatch software can capture and transmit it.
Ohio General Assembly, Sub. S.B. 315 (as enrolled)
October 6, 2026
Policy & Medicaid
https://search-prod.lis.state.oh.us/api/v2/general_assembly_136/legislation/sb315/05_EN/pdf/
Montana Medicaid NEMT is now run by Modivcare, and providers enroll and bill through it
Montana DPHHS moved Medicaid NEMT to Modivcare, with phone lines opening Sept. 1 and the new program starting Oct. 1, 2026. Modivcare replaced Conduent for provider enrollment and now administers all NEMT billing. Members get a Modivcare trip ID for each ride. Montana operators who want Medicaid trips now enroll and submit claims through Modivcare instead of the state's claims contractor.
Montana DPHHS provider notice, Changes to NEMT
October 1, 2026
Brokers
https://medicaidprovider.mt.gov/docs/providernotices/2026/ChangestoNEMT.pdf
Virginia fee-for-service Medicaid rides moved from Modivcare to MTM Health on Oct. 1
Virginia DMAS says MTM Health began managing the state's fee-for-service NEMT program on Oct. 1, 2026, replacing Modivcare after a competitive procurement. DMAS says phone numbers, policies, standing order trips and reservation processes did not change. Managed care rides are not affected. FFS transportation providers should confirm trip assignment and claims contacts with MTM.
Virginia DMAS, Medicaid Transportation (FFS NEMT) site
October 1, 2026
Brokers
https://transportation.dmas.virginia.gov/
Arizona raises its rural fee-for-service NEMT mileage rate to $1.63 a mile
AHCCCS raised the rural NEMT mileage rate (S0215 with TN modifier) from $1.53 to $1.63 per mile for fee-for-service dates of service on or after Oct. 1, 2026. The urban rate stays at $1.28. AHCCCS cited unmaintained or dirt roads, long distances to members and a lack of rural providers. Rural operators billing FFS see it directly; those paid under plan contracts should ask if their rate follows.
AHCCCS, Final Rates Notice of Public Information FFY27
October 1, 2026
Policy & Medicaid
https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/FinalRatesNoticeofPublicInformation-FFY27.pdf
Colorado reopens NEMT provider enrollment; every trip runs through MediDrive from Jan. 1
Colorado's NEMT enrollment moratorium ended Sept. 30, so new providers can enroll again from Oct. 1. Starting Jan. 1, 2027, all NEMT trips statewide are scheduled, approved and paid through MediDrive. Contract with MediDrive under the exact business name and NPI you used to enroll with Health First Colorado.
Colorado HCPF
October 1, 2026
Policy & Medicaid
https://hcpf.colorado.gov/sites/hcpf/files/Bulletin%201026_B2600543_0.pdf
Blue Cross Medicaid plans in Illinois and Texas move NEMT from Modivcare to MTM; New Mexico follows Nov. 1
Blue Cross and Blue Shield of Illinois and of Texas (STAR, CHIP, STAR Kids) switched Medicaid NEMT from Modivcare to MTM Health on Oct. 1. Blue Cross of New Mexico makes the same switch Nov. 1. If you ran those members' trips through Modivcare, that volume now runs through MTM's network.
Blue Cross and Blue Shield of Texas
October 1, 2026
Brokers
https://www.bcbstx.com/provider/medicaid/education-and-reference/news/2026/6-29-2026-mtm-health-to-provide-medical-transportation-for-medicaid-members
House bill would require electronic verification of Medicaid NEMT trips nationwide
Rep. Gabe Evans (R-CO) introduced H.R. 10618, the STOP Medicaid Fraud Act, on Sept. 28, 2026. It would expand electronic visit verification to Medicaid NEMT and ABA services. It is part of a 14-bill House Energy and Commerce fraud package released Sept. 29 with a staff report naming NEMT a high-fraud service. It is a bill, not law. Operators already logging GPS trip data would have less to change.
House Energy and Commerce Committee
September 29, 2026
Policy & Medicaid
https://energycommerce.house.gov/posts/e-and-c-republicans-introduce-critical-fraud-fighting-package-to-protect-vulnerable-americans-and-safeguard-taxpayer-dollars
New York ride company owners plead guilty to billing group rides as individual Medicaid trips
Brothers Jawad and Junaid Choudhary, owners of NY Jet Transport and A1 Rides, pleaded guilty to grand larceny in Albany County over more than $1.6 million in alleged false Medicaid claims from 2021 to 2025. Prosecutors say they billed unauthorized group rides as individual trips. Sentencing is Dec. 14. New York group rides need prior authorization; billing them as separate trips is a fraud flag.
Office of the New York State Comptroller
September 28, 2026
Policy & Medicaid
https://www.osc.ny.gov/press/releases/2026/09/dinapoli-brothers-plead-guilty-defrauding-medicaid-out-16-million
Fuel costs squeeze Ohio NEMT operators on fixed Medicaid rates
Toledo-area provider Golden Care Transportation told WTOL that rising fuel prices are eating into trips paid at fixed reimbursement rates. On a fixed per-trip rate, every fuel increase comes straight out of your margin.
WTOL 11
September 19, 2026
Operations
https://www.wtol.com/article/money/rising-fuel-costs-put-pressure-on-non-emergency-medical-transportation/512-0fdfbba1-4e47-4472-9cd0-26bc7003e0b9
Oregon NEMT owner sentenced for billing rides for a patient who had died
The owner of Portland's Pride Transit pleaded guilty to two felony false-claim counts for billing transportation for a person who had died. Sentence: 36 months probation, $6,420 restitution, a $5,000 fine and a permanent bar from Medicaid-funded businesses.
Oregon DOJ
September 17, 2026
Policy & Medicaid
https://www.doj.state.or.us/media-home/news-media-releases/ag-rayfield-announces-multiple-medicaid-fraud-enforcement-actions/
Colorado cuts NEMT ambulatory base rate from $36.40 to $12.15; providers shed staff ahead of statewide broker
Colorado's July 1 change took ambulatory trips from $36.40 to $12.15 and per-mile pay from $3.00 to $2.74. One Colorado Springs provider laid off 15 people and dropped from about 115 families to 80. A single statewide broker takes over by January 2027, with rideshare as the provider of last resort.
KOAA News 5
September 17, 2026
Policy & Medicaid
https://www.koaa.com/news/local-news/colorado-medicaid-transportation-cuts-force-local-provider-to-reduce-services-for-children-in-aba-therapy
SafeRide Health marks ten years in NEMT
The tech-first broker put out a ten-year recap this week. Worth reading for the plan-partner list if you are deciding which broker portals to credential with next.
Business Wire
September 15, 2026
Brokers
https://www.businesswire.com/news/home/20260915836921/en/SafeRide-Health-Marks-10-Years-of-Transforming-Non-Emergency-Medical-Transportation-NEMT
Modivcare names Marshalina Ramos CEO of Personal Care Services
Leadership shuffle at the largest NEMT broker's personal-care arm. No change announced on the transportation side yet.
Home Health Care News
September 11, 2026
People
https://homehealthcarenews.com/2026/09/modivcare-names-new-ceo-of-personal-care-services-lifecare-appoints-new-coo/
Provide A Ride sold to 1585 Healthcare Capital
The Cleveland NEMT and paratransit operator, 100-plus vehicles and 500-plus employees since 1989, was acquired by healthcare investor 1585 Healthcare Capital in a deal advised by Kroll. Another sign that mid-size regional fleets are drawing PE money.
Kroll
September 11, 2026
M&A
https://www.kroll.com/en/transactions/sell-side-advisor-provide-a-ride
Crown Care NEMT launches nationwide private-pay booking with two-hour confirmation
A national private-pay play with a two-hour booking promise. If it holds, it sets a service bar local operators will get compared against by discharge planners.
GlobeNewswire
September 10, 2026
Operations
https://www.globenewswire.com/news-release/2026/09/10/3360011/0/en/crown-care-nemt-launches-nationwide-private-pay-medical-transportation-with-two-hour-booking-confirmation.html
