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PROFITABILITY & FINANCE
Short answer
There is no single Medicaid NEMT rate. Payment is typically built from a base or pickup rate plus a loaded mileage rate, and the actual figures vary by state, by managed-care plan, by broker, by region, by service level and by your individual contract. Any single national or statewide number you find online is a snapshot of somebody else's contract. The only rate that matters for your business is the one in your current fee schedule or signed agreement.
Operators ask what Medicaid pays per trip expecting a number, and the honest answer is that the question is underspecified. Two operators in the same state, carrying the same passenger the same distance, can be paid materially different amounts.
What changes the rate:
Although the figures vary, the shape is remarkably consistent. Understanding the structure is more useful than memorising anyone's numbers.
How a trip payment is typically built:
| Base or pickup rate | Flat amount per completed trip | Sometimes called a load fee |
|---|---|---|
| Loaded mileage rate | Per mile with the passenger aboard | Deadhead miles are usually unpaid |
| Service-level uplift | Higher for wheelchair or stretcher | Reflects equipment and time |
| Modifiers | Wait time, extra passengers, cancellations | Highly contract-specific |
In order of reliability:
What is not reliable: a figure quoted in a forum, a video, or an article — including this one. Rates change, and they were never universal to begin with. Record where your number came from and the date you checked it, because you will need to re-verify.
The rate is only half the equation, and it is the half you do not control. The half you do control is your cost per mile — and operators who know that number can tell instantly whether a contract is worth signing.
Work these out before evaluating any rate:
A high rate with heavy deadhead, slow payment and unpaid no-shows can pay less per month than a lower rate with clean terms and tight trip clustering. Compare contracts on what lands in your account, not on the headline figure.
Free resource
Model revenue and margin with a current published or contracted base rate, mileage rate, trip volume, and operating costs.
Get it freeNo. Medicaid is administered state by state, and within a state, rates differ by managed-care plan, broker, region and service level. There is no national figure, and any single number presented as one is a snapshot of a particular contract.
Usually not. Most contracts pay only for loaded miles — those driven with the passenger aboard. This is why trip density and scheduling have such a large effect on margin, often larger than the rate itself.
Typically yes, reflecting the additional equipment, securement time and training involved. The size of the difference varies by contract, and the higher rate comes with higher vehicle and compliance costs.
Rates can change with fee schedule updates, contract renewals and plan changes. Record the source and date of any rate you rely on, and re-verify before making a decision that depends on it, such as buying a vehicle.
Covered in more depth on the Nemiton channel: How Much Does Medicaid Pay Per NEMT Trip? (Real 2026 Rates).
Educational use only. This article is not legal, tax, insurance, medical, accounting or official payer guidance. Requirements and rates vary by state, payer, broker and contract — confirm what applies to you before making a business decision.
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