Key points
- The contract decides your limits. State Medicaid minimums are often low, and broker and facility contracts commonly ask for $1 million in auto liability.
- Most NEMT contracts ask for commercial auto liability, general liability and workers’ compensation. Some add professional liability or abuse and molestation coverage.
- Brokers check the certificate line by line: additional insured, notice of cancellation, the exact business name and every van’s VIN.
- Driver records and vehicle condition decide whether a carrier will quote you at all, so clean them up before you apply.
- NEMT applications are still mostly paper. A complete file the first time is the fastest way to a quote.
NEMT insurance requirements are set by the contract. The Medicaid broker, health plan, hospital or dialysis center that pays for your rides writes its insurance terms into the agreement, and those terms are usually well above the state minimum. If your policy doesn’t match the contract, you don’t get credentialed, and you don’t get trips.
Below: how NEMT contracting works, the coverage contracts ask for, what brokers check on a certificate, and the paperwork to gather before you apply. Where we cite a dollar figure or a rule, we say which program it comes from.
How NEMT contracting works
Most non-emergency medical transportation is paid by Medicaid. The state rarely contracts with van companies directly. It hands the work to a transportation broker or to the Medicaid managed care organizations (MCOs), and they recruit, credential and pay local providers. Your insurance requirements arrive as an exhibit in that provider agreement.
The structure differs by state, and it changes. Three states we write in show the range:
- Texas. NEMT for Medicaid managed care members is coordinated by each member’s health plan. NEMT for fee-for-service clients is coordinated by the Texas Health and Human Services Commission (HHSC) through the Medical Transportation Program (MTP). So a Texas operator may hold separate agreements with several health plans or their transportation vendors, each with its own insurance exhibit.
- Georgia. The Department of Community Health (DCH) uses one statewide broker. Since April 1, 2026, Verida has covered all five Georgia regions (North, Atlanta, Central, East and Southwest), and DCH lists recruiting and contracting with transportation providers among the broker’s jobs. Your insurance terms come from that provider agreement.
- Louisiana. The Louisiana Department of Health (LDH) publishes its NEMT provider insurance rules in its managed care manual, and the MCOs have to enforce them. That means you can read the floor yourself.
Private contracts work the same way on a smaller scale. A dialysis center, hospital discharge department or nursing home that hires you directly will send a vendor agreement with its own insurance page. Read it before you buy anything.
Coverages NEMT contracts typically require
Here is what shows up on most NEMT insurance exhibits. Your contract may list fewer, or more.
Commercial auto liability
This is the first limit every broker and facility checks. It pays for injuries to your passengers and to other people, and for damage to their property, when your van causes a crash. State Medicaid minimums can be low. Louisiana’s managed care manual, for example, sets the floor at $25,000/$50,000/$25,000 split limits or a $300,000 combined single limit. Broker and facility contracts commonly ask for $1 million combined single limit.
If you take trips across state lines, federal rules also apply. Under 49 CFR 387.33, a for-hire passenger carrier in interstate commerce must carry $1.5 million in liability for vehicles seating 15 or fewer, including the driver. Tell us before you accept a cross-state trip so the policy matches.
Your auto policy also has to say what the vans do. A policy written for general passenger transport, or a personal auto policy on a van you use for paid rides, can leave a claim unpaid. See our commercial auto insurance page for how business auto policies are built.
General liability
General liability covers injuries that aren’t part of the driving: a passenger who trips on the curb between the van and the clinic door, or damage to a facility’s entrance during a pickup. Most broker and facility contracts ask for it. Louisiana’s manual requires it where a local ordinance calls for it, and for any provider offering its higher-acuity (ELOC) wheelchair service. More on how it works on our general liability page.
Professional liability
Your drivers do more than drive. They help passengers out of wheelchairs, secure them on lifts and walk them to the door. Professional liability responds to claims that the assistance itself was done wrong. Some contracts require it by name, and others don’t mention it. Ask, because a general liability policy may exclude it.
Workers’ compensation
NEMT drivers lift and assist passengers all day. The legal rule depends on the state:
| State | Workers’ comp rule |
|---|---|
| Texas | Optional for most private employers. Employers without it must report that to the state. |
| Georgia | Required once you regularly employ three or more people, part-time included. |
| Louisiana | LDH requires NEMT companies to carry it as Louisiana law requires. |
Even in Texas, where you can legally go without it, many broker and facility contracts require it. Our workers’ compensation page covers the state rules in more detail.
Abuse and molestation coverage
Your drivers are often alone in a van with elderly, disabled or underage passengers. Some broker and facility contracts require sexual abuse and molestation coverage for that reason. Many general liability policies exclude it, so it usually has to be added by endorsement or written separately. If your contract asks for it, send us the wording, because the limit and the policy it sits on both matter.
What brokers check on your NEMT certificate of insurance
The certificate of insurance is the document credentialing staff actually look at, and small errors hold up approvals and payments. These are the items most often checked.
- Additional insured. The broker, the health plan or the state agency is often named as additional insured. Louisiana requires LDH to be listed as additional insured on both the auto liability and general liability policies.
- Notice of cancellation. Contracts ask for written notice to the certificate holder if the policy cancels. Louisiana’s manual calls for a 30-day cancellation clause issued to the MCO.
- Description of operations. Louisiana requires the certificate to state that the coverage is for a Non-Emergency Medical Transportation Vehicle. Other contracts ask for similar wording.
- Matching named insured. The business name on the policy has to match your other paperwork. Louisiana requires the name on your IRS EIN notice (Form CP 575) to match all other documents, including the signs on your vans. A policy written to the owner personally, or to an old trade name, gets kicked back.
- Every VIN listed. Each van that carries a passenger has to be on the policy before its first trip. Louisiana requires an updated policy showing the added vehicle before it’s used, and the broker’s inspection records each VIN.
When you add a van, call us before it goes into service. We’ll add it, reissue certificates to each broker and facility, and you can send the update with the vehicle paperwork.
Driver and vehicle requirements that affect insurability
State NEMT rules set minimum standards for drivers and vans. Insurance carriers read the same records, and a file that fails the state rule rarely gets a good quote.
Drivers
Texas HHSC rules for the Medical Transportation Program (1 TAC 380.502) bar drivers with a finding of driving while intoxicated within seven years before hire, along with certain criminal convictions in the same window. Drivers need annual training in passenger safety, passenger assistance and assistive devices such as wheelchair lifts and tie-downs, plus defensive driving every two years.
Louisiana’s current managed care manual requires NEMT drivers to be at least 21, with no more than two moving violations in the past three years. Any conviction for driving under the influence makes a driver permanently ineligible. Drivers also need an annual criminal history check, an annual five-panel drug screen, CPR certification, wheelchair securement training and HIPAA training.
Carriers price every driver on the policy. One driver with a recent DUI or a string of speeding tickets can raise the premium for the whole fleet or get the account declined. Pull MVRs before you hire, keep the training certificates in each driver’s file, and tell us about new drivers before they take a trip.
Vehicles
Louisiana requires vans to be owned or leased and registered in the company’s name, and NEMT providers can’t share vehicles with each other. Stretcher vans, two-door vehicles, pickups and salvage-title vehicles aren’t allowed in Louisiana’s Medicaid NEMT program. Wheelchair vans have to meet Americans with Disabilities Act requirements for restraints, tie-downs, lifts and ramps. Texas rules (1 TAC 380.501) set similar equipment standards, including seat belts, a fire extinguisher, a first aid kit and working heat and air.
Carriers ask for the same details. Lift and ramp equipment, securement systems and vehicle values all go on the application, because they affect what physical damage coverage costs. Titles in an owner’s personal name are a common snag. Move them to the business before you apply.
Why NEMT applications are paper-heavy, and what to have ready
Most standard commercial auto carriers won’t write NEMT, so the business goes to a smaller group of specialty carriers and programs. Their applications are still mostly paper, with a supplemental NEMT questionnaire on top of the regular auto form. The broker credentialing packet is a separate stack. A missing page on either one stalls the quote.
Gather these before you ask for a quote:
- Business formation documents and your IRS EIN notice, with the exact legal name
- A vehicle list with year, make, model, VIN and value, plus lift, ramp and stretcher equipment
- A driver list with license numbers, dates of birth and current MVRs
- Training records: defensive driving, CPR, wheelchair securement and passenger assistance
- Trip types and monthly volumes (dialysis, discharges, therapy, doctor visits) and your service area
- Your current declarations page and three to five years of loss runs, if you’ve been insured before
- The insurance exhibit from every broker, health plan or facility contract you hold or are bidding on
New companies can get coverage, but fewer carriers will quote and the down payment is often higher. With no loss history to go on, underwriters lean harder on driver records and training files.
How Tree Insurance Agency handles NEMT files
Tree Insurance Agency is an independent agency, which means we place business with many carriers instead of selling for one company. We have 150+ carrier partnerships, including carriers that write NEMT, and corporate offices in Katy, TX and Fayetteville, GA. We’ll send you one checklist, complete the carrier forms from what you give us, quote the NEMT carriers that fit your contracts, and issue certificates with the wording each broker or facility asks for.
Read more on our NEMT insurance page, or send us your contract’s insurance page through the NEMT quote form.
Common questions
You need commercial auto liability on every van, general liability on the business, and usually workers’ compensation. The exact limits come from the broker or health plan you contract with, and many ask for $1 million in auto liability. Some also require professional liability or abuse and molestation coverage. Read the insurance exhibit in your provider agreement before you buy a policy.
Louisiana’s Medicaid managed care manual sets the floor at $25,000/$50,000/$25,000 split limits or a $300,000 combined single limit. That’s the state minimum the MCOs must enforce. Individual broker and facility contracts can ask for more, and federal rules require $1.5 million for for-hire passenger vans that cross state lines.
Texas law doesn’t require most private employers to carry workers’ compensation, but employers without it must report that to the state. Many NEMT contracts require it anyway, and without it a lifting injury to a driver falls on your business. Check the insurance exhibit in each contract you sign.
The usual causes are a business name that doesn’t match your other documents, a missing additional insured, no notice of cancellation wording, or a van that isn’t listed on the policy. Some programs also want the certificate to say the coverage is for non-emergency medical transportation. Send us the rejection notice and we’ll correct and reissue the certificate.
The Georgia Department of Community Health uses Verida as its statewide Medicaid transportation broker. Since April 1, 2026, Verida has covered all five regions: North, Atlanta, Central, East and Southwest. Transportation companies contract with the broker, and the insurance requirements come from that provider agreement.
Related coverage
Sources
- Louisiana Department of Health: MCO Manual, Medical Transportation (March 2026)
- Georgia Medicaid: Non-Emergency Medical Transportation
- Texas HHS: Texas Medicaid and CHIP Reference Guide, 14th edition
- 1 Tex. Admin. Code 380.501 and 380.502: MTP vehicle and driver standards
- 49 CFR 387.33: Financial responsibility, motor carriers of passengers
- Texas Department of Insurance: Workers’ compensation for employers
- Georgia State Board of Workers’ Compensation: Insurance FAQs