National NEMT insurance · A division of Thrive Risk Management CA License #6012320
New York · Medicaid Transportation via MAS

New York NEMT insurance, built for New York Medicaid.

Coverage for New York ambulette and Medicaid transportation providers — built for the statewide MAS carve-out, NYSDOT Article 19A, and, in the city, the full NYC TLC licensing stack.

Structured for MAS (manager) — rideshare integrated for ambulatory trips credentialing
Set by NYSDOT permit + NYC TLC for-hire minimums (no-fault/PIP state — high premiums)
Specialty & E&S markets that write NY livery risk

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New York NEMT, in plain terms

New York runs its Medicaid transportation differently from almost every other state: a single statewide manager arranges every trip on a fee-for-service basis, and operating in New York City adds the most demanding for-hire licensing regime in the country. If you run ambulette service here, your coverage has to line up with state DOT authority and, in the five boroughs, the TLC. Here is how it fits together.

How Medicaid transportation works through MAS

New York administers Medicaid through the Department of Health, and transportation is carved out of managed care and managed statewide on a fee-for-service basis by a single transportation manager, Medical Answering Services (MAS). Trips are arranged and authorized through MAS rather than through the health plans, and New York recently carved the transportation benefit out of Managed Long Term Care as well, consolidating it under MAS. Rideshare is integrated through MAS for ambulatory trips, while ambulette and wheelchair-van work runs through enrolled transportation providers.

The New York licensing stack (the most layered in the country)

Ambulette operators in New York carry multiple licenses that stack — and the requirements are stricter in New York City:

  • NYSDOT authority: ambulette providers must hold either a Common Carrier Certificate or a Contract Carrier Permit from the New York State Department of Transportation.
  • DMV Article 19A: providers must maintain an Article 19A driver-qualification and oversight program and submit a dated Letter of Compliance.
  • NYC TLC (city operations): running in the five boroughs requires Taxi & Limousine Commission licensing — a TLC base (e.g., a paratransit base license), per-vehicle TLC permits, and TLC driver licensing on top of the state requirements.

What your insurance has to satisfy in New York

In New York, the binding insurance requirements flow from your NYSDOT permit conditions and, in the city, from TLC for-hire vehicle minimums — not from a single published Medicaid limit. New York is also a no-fault (PIP) state, which is one reason NEMT auto premiums here run among the highest in the country. We structure commercial auto, general liability, SAM, and workers’ comp to satisfy your DOT authority and, where you operate in the city, the TLC’s for-hire vehicle insurance rules, and we keep the certificate aligned to MAS enrollment.

New York NEMT — Frequently Asked

Questions New York operators ask.

Why is NEMT insurance so expensive in New York?
New York is a no-fault (PIP) state, which raises auto-injury claim costs across the board, and ambulette work concentrates in a dense, high-traffic environment — both of which push NEMT commercial auto premiums here among the highest in the country. On top of that, operating in New York City means satisfying TLC for-hire insurance minimums in addition to state DOT requirements. None of that is a reason to overpay: working the specialty markets that actually write New York livery risk, and keeping continuous coverage and clean loss runs, is how operators here keep premiums as workable as the market allows.
Do I need TLC coverage if I operate outside New York City?
Only if you pick up or operate within the five boroughs. Outside the city, your binding requirements come from your NYSDOT Common Carrier Certificate or Contract Carrier Permit and your Article 19A program. Inside the city, the NYC Taxi & Limousine Commission adds its own base license, per-vehicle permits, driver licensing, and for-hire insurance minimums on top of the state rules. We structure the certificate to match where you actually run — state-only or state-plus-TLC — so you’re not paying for city requirements you don’t trigger.
Why won’t my regular commercial auto policy cover NEMT?
Standard personal and most standard commercial fleet policies specifically exclude “for-hire livery” — carrying passengers for payment. NEMT is a livery operation, so insurers treat it as a separate, higher-risk class that needs a for-hire passenger endorsement on a commercial auto policy. On top of the exclusion, NEMT carries exposures most standard carriers avoid: medically fragile passengers, constant high-mileage use, and loading/unloading assistance. As a result, much of the market is written through specialty and Excess & Surplus (E&S) carriers. Running NEMT on a standard policy risks a denied claim and won’t satisfy Medicaid or broker credentialing requirements.
What insurance do brokers like Modivcare, MTM, and Verida require?
Requirements vary by broker and by state contract, but a typical credentialing stack is commercial auto liability, general liability, sexual abuse & molestation (SAM) coverage, and workers’ compensation if you have employees. Many state Medicaid programs and brokers treat $1M combined single limit (CSL) as the practical floor for auto — some networks require $1.5M — and they often require CSL language rather than split limits, plus continuous (no-lapse) coverage and a certificate naming the broker as additional insured. We confirm the exact limits in your broker’s current provider manual and build the certificate to match.
Other States

NEMT insurance in other states.

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