How to Start a NEMT Business in South Carolina: ORS Class C Certificate and the Medicaid Broker

Non-emergency medical transportation (NEMT) in South Carolina is a regulated passenger service, not just a van and a phone number. If you plan to drive patients to dialysis, physical therapy, or routine appointments, you will work through three layers: a business entity filed with the Secretary of State, a passenger carrier certificate from the Public Service Commission of South Carolina (PSC) backed by vehicle and driver inspection through the Office of Regulatory Staff (ORS), and, if you want Medicaid trips, a subcontract with the transportation broker that the SC Department of Health and Human Services (SCDHHS) works with. This guide puts those steps in the order you should tackle them, so you do not buy vehicles or sign leases before you can legally carry a passenger.

This article is informational only. It is not legal, tax, or insurance advice. Passenger carrier rules, fees, and Medicaid broker requirements change, so confirm every step with the agency named before you spend money. Talk with a South Carolina attorney and a CPA before you choose an entity type or sign a broker contract.

What You Need Before You Start

Gather these items first. The insurance and vehicle paperwork in particular comes up at more than one step.

• A business name that meets South Carolina LLC naming rules, plus a registered agent with a South Carolina street address
• The $110 filing fee for Articles of Organization, paid through Business Entities Online
• An IRS employer identification number (EIN)
• A Business Tax Application account on MyDORWAY from the South Carolina Department of Revenue (SCDOR)
• A local business license application for the city or county where you will operate
• Commercial auto insurance for each vehicle, and an insurer that will file Form E for you
• Titles and registrations for each van or car you plan to use
• A driver roster with the information ORS will need to review each driver
• A budget line for the $50 per vehicle, per year fee paid to ORS
• Contact information for SCDHHS and for the transportation broker it currently contracts with

Step 1: Choose Your Service Type Before Your Entity

South Carolina does not treat every passenger service the same way. The service you pick determines which permit route you follow, so settle this first.

Service you plan to run	Regulatory route	What to know
Medicaid NEMT trips	PSC Class C certificate, then a subcontract with the SCDHHS transportation broker	Trips are assigned through the broker, not directly by SCDHHS
Private pay medical transport	PSC Class C certificate, Non-Emergency or Stretcher Van	Choose the certificate type that matches your vehicles and the patients you serve
Limo or charter service	Same Class C route, with LS plates	Use this route for passengers hired outside medical trips
App-dispatched rideshare style service	ORS TNC permit	This is a separate permit, not a Class C certificate

A business can run more than one of these, but confirm with the PSC whether one certificate covers both medical and private pay work or whether you need a separate filing for each category.

Step 2: Form the LLC With the Secretary of State

Most NEMT operators use a limited liability company (LLC). You file Articles of Organization for a Domestic Limited Liability Company under S.C. Code Section 33-44-203 through Business Entities Online at businessfilings.sc.gov. The filing fee is $110. Documents filed online are returned within 24 to 48 business hours. The Secretary of State does not publish a separate expedite fee, so online filing is the fastest path.

Your name must include the words limited liability company or limited company, or the abbreviation LLC, L.L.C., LC, or L.C. Search the Secretary of State's entity database at the business search page before you file, because the name must be distinguishable from names already on record. If you need to hold a name while you gather paperwork, a name reservation costs $25 and lasts 120 days. It cannot be renewed.

Every LLC must keep a registered agent under S.C. Code Section 33-44-108. The agent must be a South Carolina resident individual, a domestic corporation, another LLC, or a foreign entity authorized to do business in the state. The agent's name and address appear on your formation document. If you change agents later, you file a statement of change with the Secretary of State.

A standard LLC does not file an annual report with the Secretary of State, and the SCDOR states that an LLC not taxed as a corporation does not pay the corporate License Fee. If your LLC elects corporate tax treatment, it files Form CL-1 with a one-time $25 initial License Fee within 60 days of commencing business, and recurring annual reports go with your corporate income tax return. A corporation instead files Articles of Incorporation ($110 plus the $25 CL-1 License Fee, signed by a South Carolina attorney). Discuss that choice with your CPA before you file.

If you plan to operate under a name other than your LLC name, South Carolina has no state DBA filing. Record the trade name with your county or municipality, usually on your local business license, and list it on your EIN and SCDOR applications. Sole proprietors and general partnerships do not file organizing documents with the Secretary of State, but the PSC certificate still applies to the carrier, so ask the PSC how it treats your entity type.

Step 3: Get the Local Business License

South Carolina has no general statewide business license. Secretary of State registration is not a business license. Most cities levy a business license tax, and nine counties do too: Beaufort, Charleston, Dorchester, Horry, Jasper, Marion, Orangeburg, Richland, and Sumter. Check both your city and your county, because a business located inside city limits may owe the city rather than the county, and the reverse can also be true.

Local licenses run on a May 1 to April 30 license year, and renewals are due April 30. Renewals are handled at localblrenewal.com, according to the SC Revenue and Fiscal Affairs Office. Put the April 30 date on your calendar the day you receive the license. Ask the local office whether your garage or lot address has any zoning limits on overnight vehicle parking, since that question is easier to settle before you sign a lease.

Step 4: Set Up Your EIN and SCDOR Tax Account

Apply for your EIN with the IRS, then register your business with the SCDOR through the Business Tax Application on MyDORWAY. Use the same legal name on both. If you have a trade name, list it on both applications.

You may also see a retail license requirement on SCDOR guidance. That license is a one-time $50 fee per location for sellers of tangible goods. A transportation service generally sells a service rather than goods, so ask the SCDOR whether you need one rather than assuming either way.

Tax treatment depends on your entity. A single-member LLC is usually taxed through the owner's personal return, while a corporation files its own return and pays the corporate income tax, which is 5 percent of South Carolina taxable income for C corporations. Ask a CPA which structure fits your plan before you choose.

Step 5: Apply for the PSC Class C Certificate

This is the gate for paid passenger service. The PSC issues a directive and order for your carrier certificate, and that order starts a clock. Do not carry paying passengers until the certificate and the inspection requirements are complete.

Before you file, contact the PSC and ask for the current application package, the filing fee, and which certificate designation fits your service: Non-Emergency or Stretcher Van. The PSC's current fees are not settled in this guide, so confirm them directly with the PSC. Be ready to describe your entity, your vehicles, your proposed insurance, your drivers, and the areas and patients you plan to serve.

Expect the PSC to review your application before a directive and order issues. Keep copies of everything you submit, and note the date each document was sent. Those records are useful if a question comes up during inspection or broker credentialing.

Step 6: Pass ORS Vehicle and Driver Inspection Within 90 Days

After the PSC directive and order, you have 90 days to pass the ORS vehicle and driver inspection. In the same window, your insurer must file Form E. Both pieces have to be in place for the certificate to be usable, so treat the 90 days as a hard deadline.

Work backward from the deadline. Have vehicles ready for inspection early, not on day 85. Ask your insurer when it will file Form E, and confirm the filing with ORS after it goes in. Make sure every driver's documents are complete before inspection day. If something will not be ready in time, contact the PSC and ORS before the window closes rather than assuming an extension exists.

Step 7: Register Each Vehicle and Pay the Annual ORS Fee

Each vehicle carries a fee of $50 per year, paid to ORS under S.C. Code Section 58-23-560. Vehicles are registered on a yearly cycle, so the fee and the registration both come due every year, not once. Build the cost into your monthly budget for each vehicle, including backup vehicles, and calendar the renewal date with a reminder two weeks ahead.

Confirm the current payment method and renewal process with ORS. A lapsed registration on one van can stop that vehicle from carrying passengers, so track each vehicle separately.

Step 8: Meet Wheelchair Van Specifications

If you run wheelchair vans, the vehicle must follow ADA specifications. In practice that means a lift or ramp, a securement system that holds wheelchairs in place, and floor anchors, along with door and headroom dimensions that accommodate a wheelchair passenger. Do not rely on a dealer or upfitter to tell you the vehicle is compliant. Ask for the compliance details in writing, and compare them against the current federal ADA vehicle requirements before you buy.

Plan for the inspection as well. ORS will check the vehicle against its requirements, so bring the upfitter's documentation and the securement equipment manuals to the inspection.

Step 9: Subcontract With the Medicaid Transportation Broker

Medicaid NEMT in South Carolina runs through the transportation broker that SCDHHS contracts with. You generally do not bill SCDHHS directly. You subcontract with the broker, and the broker assigns trips to its network. Check the SCDHHS website for the current broker's name and its credentialing process, because brokers and their requirements can change.

Expect credentialing to ask for your PSC certificate, your ORS inspection records, your insurance certificates, your driver records, and your vehicle information. Ask the broker for these requirements in writing, including the timeline and any site or vehicle inspections it runs on its own. Ask about rates, trip volume, and payment terms before you sign. Do not assume a minimum number of trips, because a broker controls how many it assigns.

What Results to Expect

Once the LLC, local license, SCDOR account, PSC certificate, ORS inspection, and broker credentialing are finished, you may be able to accept Medicaid trips and private pay work. The timeline depends on agency processing and on the broker's credentialing queue, so no single schedule applies to every operator. Confirm each agency's current timeframe before you plan around it.

Revenue depends on the trips you are assigned and the services you can deliver. Nothing in this process guarantees a specific volume of trips or income. Build your budget around a conservative trip count, and keep enough cash to cover insurance, fees, and vehicle costs during the slow months.

Common Mistakes to Avoid

• Forming the LLC and assuming you can start carrying passengers. The PSC certificate and ORS inspection come first.
• Buying vehicles before you confirm the wheelchair van specifications and the ORS inspection requirements.
• Letting the 90-day inspection window run out while waiting on the insurer's Form E.
• Forgetting the $50 per vehicle, per year ORS fee and the yearly vehicle registration.
• Choosing a name without one of the required LLC endings, or using a trade name without recording it locally.
• Assuming Medicaid trips come directly from SCDHHS. They come through the broker, so the broker subcontract is a separate step.
• Confusing the rideshare style TNC permit with the Class C certificate. They are different permits.
• Missing the April 30 local license renewal.

Tips That Save Time

• Call the PSC and ORS before you buy any vehicle. Ask what they will inspect and what paperwork they expect.
• Keep one compliance calendar with the Form E filing date, the inspection deadline, each vehicle's registration renewal, and the April 30 local renewal.
• Ask your insurer for written confirmation of when Form E will be filed.
• Get the broker's credentialing checklist early, so you can gather documents while the PSC application is pending.
• Use free help when you need it. The South Carolina Small Business Development Centers (SC SBDC) at scsbdc.com can review your plan, and the SBA's South Carolina page at sba.gov lists district resources.

Next Steps and Professional Help

Start with the LLC, because every later step relies on a legal entity and a registered agent. Then move through the local license and SCDOR account, and file the PSC application once your entity and service type are settled. The inspection clock and the broker credentialing process are where most schedule problems start, so plan both before you commit to vehicles or a lease.

This is complex enough that a South Carolina business attorney and a CPA are worth the cost. An attorney can review your entity choice, your insurance terms, and any broker contract. A CPA can advise on how your entity will be taxed and whether a corporate election makes sense for your plan.

Disclaimer: This article is for general information only. It is not legal, tax, or insurance advice, and it does not create an attorney-client or accountant-client relationship. Fees, deadlines, and program requirements change. Confirm every item with the PSC, ORS, SCDHHS, the transportation broker, the Secretary of State, the SCDOR, and your local government before you act.