Broker States vs Non-Broker States: Complete Guide to Medicaid NEMT Models Across All 50 States

What Are NEMT Broker States and Non-Broker States?

The distinction centers on who manages Medicaid transportation benefits. In a broker state, the state Medicaid agency or its managed care organizations contract with a third-party transportation broker — companies like ModivCare, MTM (Medical Transportation Management), or First Transit — to receive ride requests, verify eligibility, authorize trips, assign providers, and process payments. The broker acts as an intermediary between the patient, the state, and the transportation company.

In a non-broker state (also called directly operated), the state Medicaid agency manages NEMT internally. Providers enroll directly with the state, patients request rides through the state agency, and claims are submitted to the state without a broker intermediary. These states may still contract out specific functions like call center operations, but the management authority stays with the state.

This matters because the model determines three things for every NEMT stakeholder:

• For providers: Who you must credential with, who assigns you trips, and who pays your claims
• For patients: Who you call to schedule rides, how far in advance you must book, and who handles complaints
• For facilities: Which entity coordinates discharge transport, how billing documentation flows, and which providers are in-network

Most states do not fit neatly into "broker" or "non-broker." The majority use hybrid approaches where fee-for-service Medicaid operates under one model and managed care operates under another. The CCAM Transportation Assistance Committee developed a seven-category classification system to capture this complexity.

The Seven NEMT Management Models — CCAM-TAC Classification

The CCAM (Community of Care Alliance for Mobility) Transportation Assistance Committee classifies state Medicaid NEMT programs into seven models based on how each state structures broker relationships and direct operations. Understanding these categories is the foundation for navigating NEMT enrollment and billing in any state.

Complete State-by-State NEMT Model Table

The following table classifies all 50 states and Washington, D.C. by their NEMT management model according to the CCAM-TAC framework. States are grouped by model type for quick reference. Scroll horizontally on mobile devices.

Source: CCAM Transportation Assistance Committee classifications. Models may shift as states rebid contracts or restructure managed care programs. Last verified March 2026.

Directly Operated States — How They Work

Seven states — Alabama, Alaska, Maryland, Montana, North Dakota, South Dakota, and Wyoming — manage Medicaid NEMT without any broker intermediary. In these states, the state Medicaid agency handles everything: provider enrollment, ride scheduling, prior authorization, and claims payment.

How providers operate in directly operated states:

• Enroll directly with the state Medicaid agency as an NEMT provider
• Meet state-specific vehicle inspection, insurance, and driver training requirements
• Receive trip assignments from the state scheduling system or accept ride requests from patients
• Submit claims directly to the state Medicaid program
• Receive payment from the state at state-set reimbursement rates

Advantages for providers: Higher per-trip reimbursement rates (no broker margin), simpler enrollment with one entity, direct relationship with the payer, and fewer administrative intermediaries.

Disadvantages for providers: Lower trip volume (state scheduling systems may be less efficient at matching riders with providers), less technology for real-time dispatching, and the provider may bear more administrative burden for documentation and compliance.

Statewide Broker States — The Dominant Model

Eleven states use a statewide broker contracted directly by the state (Connecticut, Delaware, Idaho, Missouri, Nevada, New Jersey, New York, Oklahoma, Rhode Island, Utah, and Wisconsin), plus Tennessee uses an MCO-contracted statewide broker model. In these states, one organization manages all Medicaid NEMT for the entire state or for each MCO's full membership.

How the statewide broker model works:

1. The state awards a contract (often through a competitive RFP) to a single transportation broker
2. The broker builds a network of local NEMT providers by credentialing companies willing to accept the broker's contracted rates
3. Patients call the broker's centralized phone line or use an online portal to request rides
4. The broker verifies Medicaid eligibility, authorizes the trip, and assigns a local provider
5. The provider completes the trip and submits documentation to the broker
6. The broker processes the claim and pays the provider at the contracted rate

The major statewide NEMT brokers nationally include ModivCare (formerly LogistiCare / Providence Service Corporation), MTM (Medical Transportation Management), and First Transit. ModivCare historically held the largest market share before filing Chapter 11 bankruptcy in August 2025.

For providers: Statewide broker states offer consistent trip volume because the broker aggregates all Medicaid rides into one dispatch system. The trade-off is lower per-trip rates — the broker retains a management fee from the state's per-member allocation before paying providers. Providers must meet the broker's credentialing requirements, which may differ from the state Medicaid enrollment requirements.

Regional Broker States — Divided Territories

Nine states use state-contracted regional brokers (Arkansas, Georgia, Kentucky, Maine, Massachusetts, South Carolina, Vermont, Washington, and West Virginia). Two states use MCO-contracted regional brokers (Kansas and Oregon). In this model, the state or its MCOs divide the geography into zones and contract a separate broker for each.

What regional brokering means for providers:

• A provider operating in multiple regions must credential with each region's broker separately
• Each broker may have different credentialing timelines, documentation requirements, and payment terms
• Trip rates and volume may vary significantly between regions
• Crossing regional boundaries on a single trip may involve coordination between two brokers

Advantages: Regional brokers often have better local knowledge, faster response times, and more accountability to the communities they serve. A broker failing in one region does not affect the entire state.

Disadvantages: More administrative overhead for multi-region providers. Patients who live near regional borders may face scheduling friction if their medical providers are in a different broker's territory.

Mixed Model States — Including Illinois

The majority of states — 21 states plus D.C. — use some form of mixed model. Mixed models combine two or more of the approaches above, usually splitting along the line between fee-for-service (FFS) Medicaid and managed care (MCO) Medicaid. The three mixed model variants are:

• Direct + Regional Broker MCO (10 states including Illinois): The state operates NEMT directly for FFS enrollees. MCOs contract with regional brokers for managed care enrollees.
• Statewide + Regional Broker MCO (8 states + D.C.): A statewide broker handles FFS or a base population. MCOs layer regional brokers for managed care members.
• Direct + Regional Broker State (3 states): The state runs NEMT directly in some geographic regions and contracts with brokers in others.

Mixed models create the most complexity for providers. A single transportation company may need to maintain enrollment at the state level, credentialing with one or more MCO brokers, and awareness of which patients fall under which pathway. Billing procedures, prior authorization requirements, and payment timelines differ between the FFS and MCO tracks within the same state.

For a detailed breakdown of billing codes and claims procedures across these pathways, see our NEMT billing ICD-10 codes guide, which covers HCPCS codes, origin/destination modifiers, and Illinois-specific claims submission.

Illinois Deep-Dive — How the Mixed FFS + MCO Broker Model Works

Illinois is classified as Mixed: Direct + Regional Broker MCO. This means two parallel systems run simultaneously for Medicaid NEMT, depending on whether the patient is enrolled in traditional fee-for-service Medicaid or a managed care organization.

Fee-for-Service (FFS) Pathway

Patients on traditional Medicaid (not enrolled in an MCO) have their NEMT managed directly by the Illinois Department of Healthcare and Family Services (HFS). The process works as follows:

• Providers enroll with Illinois HFS through the IMPACT (Illinois Medicaid Program Advanced Cloud Technology) portal
• Prior authorization is handled by Transdev/NETSPAP — this entity is the prior authorization manager, not a broker. Transdev/NETSPAP authorizes trips but does not assign providers or process payment
• Providers submit claims directly to Illinois HFS
• HFS pays providers at state-set fee-for-service rates
• Since January 1, 2022, non-emergency ground ambulance transport for MCO enrollees is also billed directly to HFS, not the MCO

Managed Care (MCO) Pathway

The majority of Illinois Medicaid enrollees are in managed care. Each MCO contracts with a transportation broker to manage NEMT for its members:

• Major Illinois MCOs include Meridian Health Plan, Molina Healthcare, CountyCare, and Blue Cross Community Health Plan
• MCO-contracted brokers include ModivCare, MTM, and First Transit (assignments vary by MCO and region)
• Patients call their MCO's broker to request rides
• The broker verifies eligibility, authorizes the trip, and assigns a credentialed NEMT provider
• Providers submit trip documentation to the broker
• The broker processes payment at the broker's contracted rates

What This Means for Illinois NEMT Providers

To serve the full spectrum of Illinois Medicaid patients, an NEMT provider must:

1. Enroll with Illinois HFS through the IMPACT portal (for FFS patients and ground ambulance)
2. Credential with each MCO broker that operates in the provider's service area
3. Maintain separate billing workflows — HFS claims for FFS patients, broker claims for MCO patients
4. Track prior authorization through Transdev/NETSPAP for FFS trips and through the MCO broker for managed care trips

Dream Care Rides operates from Olympia Fields, IL within this mixed model. The company maintains active enrollment at the HFS level and credentialing with MCO brokers, allowing it to serve both FFS and managed care patients. For Illinois-specific rates: ambulatory transport costs $35 to $65 base plus $2 to $4 per mile, wheelchair transportation costs $65 to $115 base plus $3 to $6 per mile, and stretcher transportation costs $300 to $525 base plus $5 to $16 per mile.

Use our NEMT cost calculator for trip-specific private pay estimates, or review the full breakdown on our Illinois NEMT rates page.

How Broker Models Affect NEMT Providers

The NEMT model in your state directly shapes your business operations. Here is a practical comparison of how different models affect providers:

Key takeaway for multi-state providers: If you operate across state lines, you need separate enrollment and credentialing strategies for each state. A provider serving Illinois (mixed model) and Indiana (statewide + regional broker MCO) faces different broker relationships, billing systems, and compliance requirements in each state.

Regardless of model, building direct relationships with facilities — hospitals, dialysis centers, skilled nursing facilities — generates trip volume independent of broker assignments. Dream Care Rides maintains hospital discharge partnerships and dialysis transportation contracts that supplement broker-assigned trips.

How Broker Models Affect Patients

The NEMT model in your state determines your experience as a Medicaid transportation user. Here is what differs across models:

If your Medicaid transportation is unreliable — late pickups, no-shows, long wait times — private pay is an alternative with no broker intermediary. Call Dream Care Rides at (708) 505-6994 to schedule directly.

ModivCare Bankruptcy (2025) — Industry Impact on NEMT Brokers

ModivCare, Inc. — formerly known as Providence Service Corporation and later LogistiCare — filed for Chapter 11 bankruptcy protection in August 2025. As the largest NEMT broker in the United States, ModivCare managed Medicaid transportation contracts in dozens of states, handling over 45 million trips annually prior to the filing.

What caused the bankruptcy: ModivCare accumulated significant debt through a series of acquisitions, including its 2021 purchase of Simplura Health Group (home health services) for $575 million. Rising operating costs, driver shortages, and reduced Medicaid reimbursement rates in several states compressed margins. The company's debt load became unsustainable against its operating cash flow.

Impact on states and providers:

• Operations continued during bankruptcy proceedings under court protection
• Multiple states activated contingency plans and accelerated contract rebids
• Some states transitioned contracts to MTM, First Transit, or regional providers
• Providers in ModivCare-served states experienced payment delays during the transition
• States that relied on a single statewide ModivCare contract faced the highest disruption

Industry implications for 2026 and beyond:

• Concentration risk is real: States dependent on one statewide broker are reconsidering the model
• Regional broker and direct models may gain favor: Spreading risk across multiple entities or returning to state operation
• Provider diversification is critical: Companies that relied solely on ModivCare for trip volume were disproportionately affected
• The NEMT market continues growing: Industry analysts project the U.S. NEMT market to grow from approximately $17.45 billion in 2025 to $25.43 billion by 2032, driven by aging demographics and Medicaid expansion

The bankruptcy reinforced that NEMT providers should maintain multiple revenue streams: state enrollment for FFS, credentialing with multiple brokers, direct facility partnerships, and private pay services. Dependence on a single broker creates a single point of failure.

What NEMT Providers Should Do in 2026

Based on the current state landscape and the post-ModivCare environment, NEMT providers should take the following actions to protect and grow their operations:

1. Maintain direct state enrollment even in broker states. If your state shifts models or a broker exits, you need active state-level credentials to continue operating. Do not let your state enrollment lapse just because all your current trips come through a broker.
2. Credential with every broker in your service area. In mixed models, this means both FFS enrollment and MCO broker credentialing. In regional broker states, enroll with all regions you can serve. More broker relationships equal more trip sources.
3. Build facility relationships independent of brokers. Hospitals, dialysis centers, skilled nursing facilities, and physician offices generate trip referrals regardless of which broker is in play. When a broker changes, your facility relationships persist.
4. Monitor state RFPs and contract rebids. States are rebidding NEMT contracts more frequently in the wake of the ModivCare bankruptcy. New RFPs create opportunities to become a preferred provider under a new broker or to bid directly as a regional operator.
5. Develop a private pay revenue stream. Private pay trips — patients paying directly without Medicaid, Medicare, or broker involvement — provide higher margins and are not subject to broker assignment or rate negotiations. Many patients who experience poor Medicaid transportation service are willing to pay privately for reliability.
6. Invest in compliance documentation. As states tighten oversight following the ModivCare disruption, expect more frequent audits, stricter credentialing reviews, and increased documentation requirements. Providers with organized records will survive audits; those without will lose contracts.

Dream Care Rides operates this exact multi-track strategy from Olympia Fields, IL: enrolled with Illinois HFS, credentialed with MCO brokers, partnered with hospitals and dialysis centers, and serving private pay patients directly. To discuss partnerships or schedule transport, call (708) 505-6994.

Frequently Asked Questions: NEMT Broker States vs Non-Broker States