California NEMT insurance, built for Medi-Cal.

California runs the largest Medicaid transportation market in the country, and one of the most distinctive. The Medi-Cal benefit is split into two named services and delivered through managed-care plans rather than a single statewide broker — and since 2025 it carries a vehicle-inspection requirement no other state has. Here is what that means for your insurance.

How NEMT works under Medi-Cal

California’s Medicaid program, Medi-Cal, is administered by the Department of Health Care Services (DHCS), and it splits medical transportation into two benefits. NEMT (Non-Emergency Medical Transportation) covers ambulance, litter van, and wheelchair-van trips and requires a physician-signed Physician Certification Statement (PCS). NMT (Non-Medical Transportation) covers car, taxi, rideshare, public transit, and mileage reimbursement, and does not require a PCS.

The benefit is carved into managed care: each Medi-Cal Managed Care Plan is responsible for transportation and most delegate it to brokers rather than run it themselves. There is no single statewide broker — it is plan-by-plan and county-by-county, with Modivcare and MTM among the active networks. To reach the full Medi-Cal population in a region, a provider usually has to credential with more than one broker, each with its own insurance and additional-insured requirements.

California-specific permitting and the 2025 inspection rule

California layers state permitting on top of Medicaid enrollment, and this is where most operators get tripped up:

• CPUC / TCP permit: vehicles generally must hold a California Public Utilities Commission charter-party carrier (TCP) permit, or equivalent local operating authority, before carrying passengers for hire.
• BAR / VSSI inspection (new in 2025): effective March 27, 2025, NEMT providers must submit a valid Vehicle Safety Systems Inspection certificate from the Bureau of Automotive Repair with their enrollment — a California-only requirement. Litter and wheelchair vans also need a brake-and-light certificate.
• Driver vetting: the appropriate license class, a DOT medical card, DOJ/FBI LiveScan fingerprinting, and commercial DMV vehicle registration.

What your insurance has to satisfy in California

Because the operative requirements come from the CPUC and your broker — not the low state liability floor — the binding number is almost always a $1M combined single limit on commercial auto, frequently paired with $1M/$2M general liability, a sexual abuse & molestation (SAM) rider, and workers’ compensation, with the broker named as additional insured. We build a Medi-Cal-ready program around those requirements and the CPUC permit your vehicles operate under.