How to Start a Non-Emergency Medical Transportation (NEMT) Business in Mississippi

Non-emergency medical transportation (NEMT) businesses drive patients to doctor visits, dialysis, pharmacies, and other appointments that do not involve an ambulance. In Mississippi, the work sits at the intersection of three systems: ordinary business formation through the Secretary of State, local licensing through the city or county, and a state health permit from the Mississippi State Department of Health (MSDH). If you want Medicaid trips, you also have to enroll with the Medicaid NEMT broker. This guide walks through the order that works best.

Disclaimer: This article is informational content, not legal or tax advice. Rules change, and the agencies named below are the final authority. Before you sign a lease, buy vehicles, or sign a payer contract, talk with a qualified attorney and a CPA who works with transportation businesses.

What You Are Actually Building

Before you file anything, decide what kind of NEMT company you will run. The answer determines which permits you need and who pays you.

• Medicaid NEMT trips. Mississippi Medicaid members who need a ride to a covered service are scheduled through the Division of Medicaid's NEMT broker. You do not bill Medicaid directly for these trips. You become a subcontracted provider of the broker, which means meeting the broker's requirements in addition to state rules.
• Private-pay and facility trips. Some riders pay out of pocket, and some hospitals, dialysis centers, assisted living facilities, or employers contract with you directly. Payment terms are set by contract, so get them in writing.
• Mixed operations. Many small operators combine both. That works, but your permit, insurance, and billing must cover every type of trip you run.

Materials and Documents You Need Before You Start

Gather these items first. Missing one of them is the most common reason a first application stalls.

• A business plan with a realistic budget for at least six months of operating costs
• A proposed business name, plus a backup name in case the first is taken
• A Mississippi street address for your registered office, plus a registered agent who meets state requirements
• A federal Employer Identification Number (EIN) from the IRS
• Vehicles that fit your service plan, including any wheelchair lift or securement equipment you intend to use
• Commercial auto insurance quotes, and general liability quotes, from an agent who knows passenger transportation
• A driver screening plan that covers fingerprint checks, criminal and sex-offender checks, motor vehicle record checks, drug screens, and federal exclusion checks
• A bookkeeping system and a business bank account in the company's legal name
• Personal information for every owner and manager, since state forms ask for it

Step-by-Step: Forming and Launching Your NEMT Business in Mississippi

Step 1: Choose your business structure

Most NEMT operators in Mississippi form a limited liability company (LLC). An LLC separates your personal assets from company debts and claims, and it is simple to maintain. A corporation is also possible, but it brings different tax rules.

Tax treatment matters. An LLC taxed as a pass-through entity reports its income on the members' Mississippi returns. An LLC taxed as a corporation pays Mississippi corporate income tax, which is 0% on the first $5,000 of taxable income, 4% on the next $5,000, and 5% on taxable income above $10,000. A corporation also pays the franchise tax, which for tax year 2026 is $0.50 per $1,000 of capital above $100,000, with a $25 minimum. That tax steps down to $0.25 for 2027 and is repealed effective January 1, 2028. The franchise tax applies to corporations, not to an LLC taxed as a partnership. Ask a CPA which structure fits your ownership and expected profit.

Step 2: Choose and reserve your name

An LLC name must contain the words "limited liability company," or the abbreviation "L.L.C." or "LLC," under Miss. Code Ann. 79-29-109. It can include a member's or manager's name. It must also be distinguishable on the Secretary of State's records from every registered domestic or foreign business entity in Mississippi that is not dissolved, and from any name already reserved or registered.

If you need time to finish paperwork, you can reserve the name for 180 days for a $25 fee. Search the name first on the Secretary of State's business search at corp.sos.ms.gov, and check the Secretary of State's business services page at sos.ms.gov/business-services for current forms.

Step 3: File the Certificate of Formation

File the Certificate of Formation (Form F0100) with the Mississippi Secretary of State's Business Services Division. The filing fee is $50. Online filings through the state portal at corp.sos.ms.gov are generally approved immediately when paid online. Filings that need staff review are normally returned filed within 24 hours. There is no paid expedite option for formation filings. Paper filings take significantly longer, so file online.

Mississippi does not issue a general statewide business license. Registering an LLC with the Secretary of State is a registration, not a license.

Step 4: Appoint a registered agent

Every Mississippi LLC must maintain a registered office in the state and a registered agent for service of process, under Miss. Code Ann. 79-29-113. The agent must be a Mississippi resident individual, or an entity authorized to do business in Mississippi, and the agent's business office must match the registered office. You need a physical Mississippi street address. A P.O. box does not qualify.

You can serve as your own agent if you live in Mississippi and have a physical address there. If you use a commercial registered agent, that agent must file a listing statement with the Secretary of State for a $100 fee and appear on the state website. A commercial agent has 14 days to accept or decline the appointment. A noncommercial agent does not register with the state, but you must have the agent's permission before you list them. Commercial agents are convenient for out-of-state owners. They are also a recurring cost, so compare renewal pricing before you choose one.

Step 5: Register a DBA if you will use a different name

If your customers will know you by a name other than your LLC's legal name, such as "Delta Med Rides" when your LLC is "Delta Medical Transport, LLC," you need a fictitious business name registration (Form F0070). Mississippi files these with the Secretary of State, not the county. The fee is $25. Do not skip this step, because a trade name used without filing can cause problems when you open accounts or accept payments.

Step 6: Get your EIN and tax registrations

Apply for an EIN from the IRS before you open a bank account or hire anyone. The EIN application is free through the IRS website. Then check whether you need a Mississippi sales tax permit. The Department of Revenue treats the permit as a tax registration for businesses that make retail sales, and there is no fee for it. A bond may be required for applicants with no permanent Mississippi location. Most NEMT companies sell transportation services rather than taxable goods, but confirm the treatment of your services with the Department of Revenue at dor.ms.gov before you assume you are exempt. Register for withholding if you will have employees, and confirm the account setup with your CPA.

Step 7: Obtain local privilege licenses

This is the step most first-time operators miss. Mississippi has no state general business license, so local government fills the gap. Under Miss. Code Ann. 27-17, every city, town, and village issues its own privilege license. Counties license businesses that operate outside municipal limits. If your office is in Jackson, Gulfport, Hattiesburg, Tupelo, Biloxi, or any other incorporated city, the city is your licensing authority. If you operate from a rural address, the county may be the authority. Ask the clerk in each city or county where you base vehicles or keep an office, and ask whether a separate license applies to vehicle-based businesses. License fees and rules differ from one jurisdiction to another, so check with each one's clerk. Do not rely on a fee figure from a website that is not the city or county itself.

Also check the sales tax treatment with the Department of Revenue, since city levies on sales apply only in Jackson and Tupelo on top of the 7% state rate.

Step 8: Apply for your MSDH NEMT permit

This is the license that matters most for your operations. Under Miss. Code Ann. 41-55-71, the Mississippi State Department of Health permits NEMT providers, and the Department sets the rules. Every NEMT company needs an MSDH permit. The grace period for operating without one ran to July 1, 2024 under 2023 SB 2613 as it was sent to the Governor. That date has passed, so plan to hold the permit before your first trip. Confirm the enacted text of that bill and the current permit rules with MSDH.

The MSDH rules address four areas:

• Driver qualifications. These include a fingerprint background check, annual criminal and sex-offender checks, annual motor vehicle records checks, drug screens, and Office of Inspector General (OIG) exclusion checks. Build these into your hiring process from day one, and keep the records, because MSDH will ask for them.
• Vehicle safety and inspection. Your vehicles must meet the MSDH standards for safety and inspection. Ask MSDH for the current checklist before you buy or lease vehicles.
• Minimum insurance. MSDH sets the minimum coverage that a permitted NEMT company must carry. Confirm the amounts with MSDH before you buy a policy.
• Permit fee and application. Check the permit fee directly with MSDH, because this article does not list a settled figure. Start the application through the MSDH website at msdh.ms.gov, and ask whether inspection must happen before or after your application is approved.

There is one exemption to know about. A provider under contract with the Division of Medicaid's NEMT broker may be exempt from the MSDH permit if the broker inspects and certifies your drivers and vehicles to MSDH. Even then, you must still register with MSDH. Do not read the exemption as permission to skip registration, and confirm in writing with the broker and MSDH how the exemption applies to your company.

Step 9: Buy insurance before you carry a single rider

Get quotes for commercial auto insurance that covers passenger transport, not just personal-use vehicles. Ask each insurer whether it writes NEMT or medical transport risk, because many standard carriers decline it. Compare general liability coverage as well. If you will have employees, you need workers' compensation coverage. Confirm your specific insurance requirements with the MSDH rules and your insurance agent, since MSDH sets minimums that your policy must meet. Keep certificates of insurance on file, because MSDH, the Medicaid broker, and facilities will each ask for them.

Step 10: Hire, screen, and train your drivers

Driver screening is where many NEMT companies run into trouble. Do not let anyone drive a rider until the required checks are complete and documented. Keep a file for each driver with the fingerprint check result, the criminal and sex-offender check results, the motor vehicle record, the drug screen results, and the OIG exclusion check. Set calendar reminders for the annual rechecks. Train drivers on passenger assistance, securement, wheelchair lifts, and how to handle a rider with dementia or a medical emergency. Document the training.

Step 11: Enroll with the Medicaid NEMT broker

If you want Medicaid trips, you must enroll as a provider with the Medicaid NEMT broker. Modivcare was the broker named in its 2024 provider manual, but brokers can change. Check with the Mississippi Division of Medicaid for the current broker and the current enrollment requirements before you send an application. Enrollment usually requires your MSDH permit or your exemption documentation, your insurance certificates, your driver records, and your vehicle records. Ask whether the broker has a minimum volume expectation, and whether it pays on a per-trip or per-mile basis.

Step 12: Set up your compliance calendar

Your LLC must file its annual report every year. The MS LLC Annual Report (Form F0108) is due April 15 each year and may be filed on or after January 1. It must be filed online, and there is no fee for it. Failure to file can lead to administrative dissolution, which would leave your company unable to operate legally. Put April 15 on your calendar on the day you form the company. Also calendar your MSDH permit renewal, insurance renewals, driver rechecks, vehicle inspections, and each city or county license renewal.

Costs at a Glance

The table below lists the state fees confirmed in this guide. Costs marked "check with" are not settled figures, so confirm them with the named agency before you budget.

Item	Cost	Where to confirm
LLC Certificate of Formation (Form F0100)	$50	Secretary of State, sos.ms.gov
Name reservation (180 days)	$25	Secretary of State
Fictitious business name (Form F0070)	$25	Secretary of State
LLC annual report (Form F0108)	$0 fee, due April 15	Secretary of State
Commercial registered agent listing statement	$100	Secretary of State
Sales tax permit (if applicable)	No fee, bond may be required	Department of Revenue
City or county privilege license	Check with each city or county clerk	Local clerk
MSDH NEMT permit	Check with MSDH	Mississippi State Department of Health
Commercial auto and liability insurance	Varies by vehicle, driver record, and coverage; get quotes	Your insurance agent

Tips for a Smoother Launch

• Call the city or county clerk before you sign a lease. Zoning and privilege licensing questions are easier to answer before you commit to a location.
• Get MSDH's written checklist early. Ask for the current requirements in writing and file them with your launch documents.
• Talk to the Mississippi Small Business Development Center network. The lead center is hosted by the University of Mississippi, with 19 locations statewide, at mississippisbdc.org. Its advisors can review your plan before you spend money.
• Use the SBA's Mississippi district page for loan and training resources. Start at sba.gov/district/mississippi.
• Price your trips with a mileage floor and a wait-time rule. Medicaid and facility rates differ, and waiting time is often where small companies lose money.
• Keep every driver file complete. A clean file is your strongest defense in an audit or a payer dispute.

Common Mistakes to Avoid

• Operating before the MSDH permit is issued. The grace period has passed. Driving riders without a permit puts your company, your contracts, and your insurance at risk.
• Assuming the Secretary of State registration is a business license. It is a registration. You still need local licensing and your MSDH permit.
• Filing a DBA with the county. Mississippi files fictitious business names with the Secretary of State.
• Skipping the local privilege license. Under Miss. Code Ann. 27-17, cities and towns issue their own licenses, and counties cover businesses outside municipal limits.
• Buying the cheapest insurance policy. A policy that does not cover passenger transport or does not meet MSDH minimums may leave you exposed after a crash.
• Treating the MSDH exemption as automatic. Even a contracted provider must register with MSDH.
• Assuming Mississippi sets a state minimum wage. Mississippi has no state minimum wage law, but federal wage and hour rules still apply to your drivers. Confirm your pay practices with an employment attorney.
• Missing the April 15 annual report. The report is free and online, but missing it can lead to administrative dissolution.

What Results to Expect

Results vary widely, and no article can promise a specific income. Many NEMT operators in Mississippi report that the first few months are slow while they build relationships with facilities, brokers, and case managers. Companies that complete their permit, insurance, and driver screening before launch may be better positioned to win contracts, since payers often ask for proof of compliance before they route trips to a provider. Operators who track cost per trip, wait time, and no-show rates early tend to set prices more accurately. If you pursue Medicaid trips, expect the enrollment and credentialing process to take longer than a standard state filing, and plan your cash flow for that gap.

Next Steps

1. File your LLC with the Secretary of State and appoint a registered agent.
2. Obtain your EIN and confirm your sales tax position with the Department of Revenue.
3. Contact the clerk in every city or county where you will base vehicles to confirm the privilege license.
4. Request the current MSDH NEMT permit requirements, fee, and inspection process in writing.
5. Bind insurance that meets MSDH minimums, then start driver screening.
6. Enroll with the Medicaid NEMT broker if you plan to serve Medicaid members.
7. Calendar the April 15 annual report and every renewal.

Reminder: This article is informational content, not legal or tax advice. Confirm every fee, deadline, and requirement with the agency named, and consult a qualified attorney and CPA before you form the company or sign a payer contract.