ModivCare (MODV) 10-Q 2 Nov 23 2023 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2023	Oct. 27, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
Document Transition Report	false
Entity File Number	001-34221
Entity Registrant Name	ModivCare Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	86-0845127
Entity Address, Address Line One	6900 E Layton Avenue
Entity Address, Address Line Two	12th Floor
Entity Address, City or Town	Denver
Entity Address, State or Province	CO
Entity Address, Postal Zip Code	80237
City Area Code	303
Local Phone Number	728-7012
Title of 12(b) Security	Common Stock, $0.001 par value per share
Trading Symbol	MODV
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		14,186,655
Entity Central Index Key	0001220754
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
Amendment Flag	false

Unaudited Condensed Consolidate

Unaudited Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 8,070	$ 14,451
Accounts receivable, net of allowance of $1,396 and $2,078, respectively	202,701	223,210
Contract receivables	129,275	71,131
Other receivables	8,782	2,506
Prepaid expenses and other current assets	38,569	34,332
Restricted cash	544	524
Total current assets	387,941	346,154
Property and equipment, net	81,419	69,138
Goodwill	785,554	968,654
Payor network, net	346,109	391,980
Other intangible assets, net	34,482	47,429
Equity investment	45,207	41,303
Operating lease right-of-use assets	39,744	39,405
Other assets	42,630	40,209
Total assets	1,763,086	1,944,272
Current liabilities:
Accounts payable	41,834	54,959
Accrued contract payables	133,576	194,287
Accrued transportation costs	102,974	96,851
Accrued expenses and other current liabilities	146,564	135,860
Current portion of operating lease liabilities	8,902	9,640
Short-term borrowings	83,000	0
Total current liabilities	516,850	491,597
Long-term debt, net of deferred financing costs of $17,370 and $20,639, respectively	982,630	979,361
Deferred tax liabilities	42,001	57,236
Operating lease liabilities, less current portion	33,397	32,088
Other long-term liabilities	29,347	29,434
Total liabilities	1,604,225	1,589,716
Commitments and contingencies (Note 13)
Stockholders’ equity
Common stock: Authorized 40,000,000 shares; $0.001 par value; 19,771,636 and 19,729,923, respectively, issued and outstanding (including treasury shares)	20	20
Additional paid-in capital	448,443	444,255
Retained earnings (accumulated deficit)	(19,185)	180,023
Treasury shares, at cost, 5,575,275 and 5,573,529 shares, respectively	(270,417)	(269,742)
Total stockholders’ equity	158,861	354,556
Total liabilities and stockholders’ equity	$ 1,763,086	$ 1,944,272

Unaudited Condensed Consolida_2

Unaudited Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 1,396	$ 2,078
Deferred financing fees	$ 17,370	$ 20,639
Common stock, shares authorized (in shares)	40,000,000	40,000,000
Common stock, par (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares, issued (in shares)	19,771,636	19,729,923
Common stock, shares, outstanding (in shares)	19,771,636	19,729,923
Treasury stock, shares (in shares)	5,575,275	5,573,529

Unaudited Condensed Consolida_3

Unaudited Condensed Consolidated Statements of Operations - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Income Statement [Abstract]
Service revenue, net	$ 686,925,000	$ 647,782,000	$ 2,048,338,000	$ 1,850,472,000
Grant income (Note 2)	551,000	789,000	4,649,000	4,587,000
Operating expenses:
Service expense	579,214,000	534,563,000	1,718,735,000	1,498,108,000
General and administrative expense	70,142,000	75,889,000	229,095,000	232,108,000
Depreciation and amortization	26,077,000	25,672,000	77,679,000	74,376,000
Impairment of goodwill	0	0	183,100,000	0
Total operating expenses	675,433,000	636,124,000	2,208,609,000	1,804,592,000
Operating income (loss)	12,043,000	12,447,000	(155,622,000)	50,467,000
Interest expense, net	17,844,000	15,557,000	50,769,000	46,429,000
Income (loss) before income taxes and equity method investment	(5,801,000)	(3,110,000)	(206,391,000)	4,038,000
Income tax (provision) benefit	1,659,000	1,053,000	4,362,000	(877,000)
Equity in net income (loss) of investee, net of tax	(160,000)	(26,448,000)	2,821,000	(28,020,000)
Net loss	$ (4,302,000)	$ (28,505,000)	$ (199,208,000)	$ (24,859,000)
Loss per common share:
Basic (in dollars per share)	$ (0.30)	$ (2.03)	$ (14.06)	$ (1.77)
Diluted (in dollars per share)	$ (0.30)	$ (2.03)	$ (14.06)	$ (1.77)
Weighted-average number of common shares outstanding:
Basic (in shares)	14,182,839	14,051,794	14,169,537	14,041,224
Diluted (in shares)	14,182,839	14,051,794	14,169,537	14,041,224

Unaudited Condensed Consolida_4

Unaudited Condensed Consolidated Statements of Cash Flows - USD ($)	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Operating activities
Net loss	$ (199,208,000)	$ (24,859,000)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation	18,212,000	14,398,000
Amortization	59,467,000	59,978,000
Stock-based compensation	4,029,000	5,152,000
Deferred income taxes	(15,235,000)	(31,232,000)
Impairment of goodwill	183,100,000	0
Amortization of deferred financing costs and debt discount	3,907,000	3,878,000
Other assets	(2,421,000)	(8,448,000)
Equity in net (income) loss of investee	(3,915,000)	38,883,000
Reduction of right-of-use assets	9,875,000	8,680,000
Changes in operating assets and liabilities:
Accounts receivable and other receivables	14,242,000	4,403,000
Contract receivables	(58,143,000)	(35,580,000)
Prepaid expenses and other current assets	(4,499,000)	4,254,000
Accrued contract payables	(60,710,000)	(37,786,000)
Accounts payable and accrued expenses	(2,422,000)	55,887,000
Accrued transportation costs	6,123,000	(13,180,000)
Other long-term liabilities	(9,729,000)	1,098,000
Net cash provided by (used in) operating activities	(57,327,000)	45,526,000
Investing activities
Purchase of property and equipment	(31,143,000)	(25,518,000)
Acquisitions, net of cash acquired	0	(78,872,000)
Net cash used in investing activities	(31,143,000)	(104,390,000)
Financing activities
Net proceeds from short-term borrowings	83,000,000	0
Payment of debt issuance costs	(376,000)	(2,415,000)
Proceeds from common stock issued pursuant to stock option exercise	31,000	1,237,000
Restricted stock surrendered for employee tax payment	(861,000)	(649,000)
Other financing activities	315,000	0
Net cash provided by (used in) financing activities	82,109,000	(1,827,000)
Net change in cash, cash equivalents and restricted cash	(6,361,000)	(60,691,000)
Cash, cash equivalents and restricted cash at beginning of period	14,975,000	133,422,000
Cash, cash equivalents and restricted cash at end of period	8,614,000	72,731,000
Supplemental cash flow information
Cash paid for interest	32,816,000	31,460,000
Cash paid for income taxes	8,348,000	4,159,000
Assets acquired under operating leases	10,214,000	3,298,000
Acquisitions:
Purchase price	0	79,199,000
Less:
Cash acquired	0	327,000
Acquisitions, net of cash acquired	$ 0	$ 78,872,000

Unaudited Condensed Consolida_5

Unaudited Condensed Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Retained Earnings (Accumulated Deficit)	Treasury Stock
Beginning balance (in shares) at Dec. 31, 2021		19,589,422
Beginning balance at Dec. 31, 2021	$ 373,267	$ 20	$ 430,449	$ 211,829	$ (269,031)
Beginning balance (in shares) at Dec. 31, 2021					5,568,983
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	318			318
Stock-based compensation	1,963		1,963
Exercise of employee stock options (in shares)		20,683
Exercise of employee stock options	1,138		1,138
Restricted stock issued (in shares)		16,306
Restricted stock surrendered for employee tax payment (in shares)					5,179
Restricted stock surrendered for employee tax payment	(572)				$ (572)
Shares issued for bonus settlement and director stipends (in shares)		732
Shares issued for bonus settlement and director stipends	86		86
Ending balance (in shares) at Mar. 31, 2022		19,627,143
Ending balance at Mar. 31, 2022	376,200	$ 20	433,636	212,147	$ (269,603)
Ending balance (in shares) at Mar. 31, 2022					5,574,162
Beginning balance (in shares) at Dec. 31, 2021		19,589,422
Beginning balance at Dec. 31, 2021	373,267	$ 20	430,449	211,829	$ (269,031)
Beginning balance (in shares) at Dec. 31, 2021					5,568,983
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(24,859)
Ending balance (in shares) at Sep. 30, 2022		19,632,749
Ending balance at Sep. 30, 2022	354,148	$ 20	436,839	186,970	$ (269,681)
Ending balance (in shares) at Sep. 30, 2022					5,574,905
Beginning balance (in shares) at Mar. 31, 2022		19,627,143
Beginning balance at Mar. 31, 2022	376,200	$ 20	433,636	212,147	$ (269,603)
Beginning balance (in shares) at Mar. 31, 2022					5,574,162
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	3,328			3,328
Stock-based compensation	2,363		2,363
Exercise of employee stock options (in shares)		16
Restricted stock forfeited (in shares)		(551)
Restricted stock surrendered for employee tax payment (in shares)					322
Restricted stock surrendered for employee tax payment	(36)				$ (36)
Shares issued for bonus settlement and director stipends (in shares)		1,000
Shares issued for bonus settlement and director stipends	85		85
Ending balance (in shares) at Jun. 30, 2022		19,627,608
Ending balance at Jun. 30, 2022	381,940	$ 20	436,084	215,475	$ (269,639)
Ending balance (in shares) at Jun. 30, 2022					5,574,484
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(28,505)			(28,505)
Stock-based compensation	570		570
Exercise of employee stock options (in shares)		3,381
Exercise of employee stock options	100		100
Restricted stock issued (in shares)		914
Restricted stock surrendered for employee tax payment (in shares)					421
Restricted stock surrendered for employee tax payment	(42)				$ (42)
Shares issued for bonus settlement and director stipends (in shares)		846
Shares issued for bonus settlement and director stipends	85		85
Ending balance (in shares) at Sep. 30, 2022		19,632,749
Ending balance at Sep. 30, 2022	$ 354,148	$ 20	436,839	186,970	$ (269,681)
Ending balance (in shares) at Sep. 30, 2022					5,574,905
Beginning balance (in shares) at Dec. 31, 2022	19,729,923	19,729,923
Beginning balance at Dec. 31, 2022	$ 354,556	$ 20	444,255	180,023	$ (269,742)
Beginning balance (in shares) at Dec. 31, 2022	5,573,529				5,573,529
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	$ (3,962)			(3,962)
Stock-based compensation	1,039		1,039
Restricted stock issued (in shares)		24,903
Restricted stock surrendered for employee tax payment (in shares)					6,000
Restricted stock surrendered for employee tax payment	(620)				$ (620)
Shares issued for bonus settlement and director stipends (in shares)		1,006
Shares issued for bonus settlement and director stipends	85		85
Ending balance (in shares) at Mar. 31, 2023		19,755,832
Ending balance at Mar. 31, 2023	$ 351,098	$ 20	445,379	176,061	$ (270,362)
Ending balance (in shares) at Mar. 31, 2023					5,579,529
Beginning balance (in shares) at Dec. 31, 2022	19,729,923	19,729,923
Beginning balance at Dec. 31, 2022	$ 354,556	$ 20	444,255	180,023	$ (269,742)
Beginning balance (in shares) at Dec. 31, 2022	5,573,529				5,573,529
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	$ (199,208)
Ending balance (in shares) at Sep. 30, 2023	19,771,636	19,771,636
Ending balance at Sep. 30, 2023	$ 158,861	$ 20	448,443	(19,185)	$ (270,417)
Ending balance (in shares) at Sep. 30, 2023	5,575,275				5,575,275
Beginning balance (in shares) at Mar. 31, 2023		19,755,832
Beginning balance at Mar. 31, 2023	$ 351,098	$ 20	445,379	176,061	$ (270,362)
Beginning balance (in shares) at Mar. 31, 2023					5,579,529
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(190,944)			(190,944)
Stock-based compensation	1,021		1,021
Exercise of employee stock options (in shares)		549
Exercise of employee stock options	31		31
Restricted stock issued (in shares)		9,116
Restricted stock surrendered for employee tax payment (in shares)					3,138
Restricted stock surrendered for employee tax payment	(221)				$ (221)
Shares issued for bonus settlement and director stipends (in shares)		1,871
Shares issued for bonus settlement and director stipends	85		85
Shares issued for ESPP	371		178		$ 193
Shares issued for ESPP (in shares)					(7,874)
Ending balance (in shares) at Jun. 30, 2023		19,767,368
Ending balance at Jun. 30, 2023	161,441	$ 20	446,694	(14,883)	$ (270,390)
Ending balance (in shares) at Jun. 30, 2023					5,574,793
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net income (loss)	(4,302)			(4,302)
Stock-based compensation	1,664		1,664
Restricted stock issued (in shares)		1,583
Restricted stock surrendered for employee tax payment (in shares)					482
Restricted stock surrendered for employee tax payment	(27)				$ (27)
Shares issued for bonus settlement and director stipends (in shares)		2,685
Shares issued for bonus settlement and director stipends	$ 85		85
Ending balance (in shares) at Sep. 30, 2023	19,771,636	19,771,636
Ending balance at Sep. 30, 2023	$ 158,861	$ 20	$ 448,443	$ (19,185)	$ (270,417)
Ending balance (in shares) at Sep. 30, 2023	5,575,275				5,575,275

Organization and Basis of Prese

Organization and Basis of Presentation	9 Months Ended
	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Basis of Presentation	Organization and Basis of Presentation Description of Business ModivCare Inc. ("ModivCare" or the "Company") is a technology-enabled healthcare services company that provides a suite of integrated supportive care solutions for public and private payors and their members. Its value-based solutions address the social determinants of health ("SDoH") by connecting members to essential care services. By doing so, ModivCare helps health plans manage risks, reduce costs, and improve overall health outcomes. ModivCare is a provider of non-emergency medical transportation ("NEMT"), personal care services ("PCS"), and remote patient monitoring ("RPM") solutions, which serve similar, highly vulnerable patient populations. The technology-enabled operating model in its NEMT segment includes the coordination of non-emergency medical transportation services supported by an infrastructure of core competencies in risk underwriting, contact center management, network credentialing and claims management. Additionally, its personal care services include placements of non-medical personal care assistants, home health aides and nurses primarily to Medicaid patient populations in need of care monitoring and assistance performing daily living activities in the home setting. ModivCare’s remote patient monitoring services include personal emergency response systems, vitals monitoring, medication management and data-driven patient engagement solutions. ModivCare also holds a 43.6% minority interest in CCHN Group Holdings, Inc. and its subsidiaries, which operates under the Matrix Medical Network brand (“Matrix”). Matrix, which is included in our Corporate and Other segment, maintains a national network of community-based clinicians who deliver in-home and on-site services. Basis of Presentation The Company follows accounting standards established by the Financial Accounting Standards Board (“FASB”). The FASB establishes accounting principles generally accepted in the United States (“GAAP”). Rules and interpretive releases of the Securities and Exchange Commission (“SEC”) under the authority of federal securities laws are also sources of authoritative GAAP for SEC registrants. References to GAAP issued by FASB in these notes are to the FASB Accounting Standards Codification (“ASC”), which serves as the single source of authoritative accounting and applicable reporting standards to be applied for non-governmental entities. All amounts are presented in U.S. dollars unless otherwise noted. The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with GAAP for interim financial information, and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and disclosures required by GAAP for complete financial statements. In the opinion of management, all adjustments considered necessary for the fair presentation of the results of the interim periods have been included. The Company has made estimates relating to the reporting of assets and liabilities, revenues and expenses, and certain disclosures in the preparation of these unaudited condensed consolidated financial statements in conformity with GAAP. Actual results could differ from those estimates. Operating results for the three and nine months ended September 30, 2023 are not necessarily indicative of the results that may be expected for the fiscal year ending December 31, 2023. Management has evaluated events and transactions that occurred after the balance sheet date and through the date these unaudited condensed consolidated financial statements were filed with the SEC and considered the effect of such events in the preparation of these unaudited condensed consolidated financial statements. The unaudited condensed consolidated balance sheet at December 31, 2022 included in this Form 10-Q has been derived from audited financial statements at that date, but does not include all the information and footnotes required by GAAP for complete financial statements. The unaudited condensed consolidated financial statements contained herein should be read in conjunction with the audited financial statements and notes included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022. Reclassifications: Certain prior year amounts have been reclassified to conform to current year presentation. Impact of the COVID-19 Pandemic On May 11, 2023, the Department of Health and Human Services ("HHS") declared the end of the public health emergency ("PHE") for the COVID-19 pandemic. While the Company has continued to experience increased trip volume, service hours, and patient visits each year following the pandemic, structural changes in the industry as a result of the pandemic, as well as ongoing constraints on the labor market, specifically related to the strain on healthcare professionals, could continue to have an adverse impact on the Company's financial statements. The Company continues to actively monitor the structural changes to the industry and the impact these have on our business and results of operations with emphasis on protecting the health and safety of its employees, maximizing the availability of its services and products to support SDoH, and supporting the operational and financial stability of its business. Federal, state, and local authorities have taken several actions designed to assist healthcare providers in providing care to COVID-19 and other patients and to mitigate the adverse economic impact of the COVID-19 pandemic. Legislative actions taken by the federal government include the CARES Act and the American Rescue Plan Act of 2021 ("ARPA"). Through the CARES Act, the federal government has authorized payments to be distributed to healthcare providers through the Public Health and Social Services Emergency Fund ("Provider Relief Fund" or "PRF"). Through ARPA the Coronavirus State and Local Fiscal Recovery Fund ("SLFRF") was established to send relief payments to state and local governments impacted by the pandemic to assist with responding to the PHE including the economic hardships that continue to impact communities and to respond to workers performing essential work during the COVID-19 PHE, including providers. These funds are not subject to repayment, provided we are able to attest to and comply with any terms and conditions of such funding, as applicable. See discussion of grant income at Note 2, Significant Accounting Policies and Recent Accounting Pronouncements .

Significant Accounting Policies

Significant Accounting Policies and Recent Accounting Pronouncements	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Significant Accounting Policies and Recent Accounting Pronouncements	Significant Accounting Policies and Recent Accounting Pronouncements Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, including disclosure of contingencies, at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Fair Value Measurements The Company follows FASB ASC Topic 820, Fair Value Measurement (“ASC 820”) which establishes a three-level valuation hierarchy for disclosure of fair value measurements. The valuation hierarchy categorizes assets and liabilities measured at fair value into one of three different levels depending on the observability of the inputs employed in the measurement. The three levels based on the observability of inputs are defined as follows: – Level 1: Quoted Prices in Active Markets for Identical Assets – inputs to the valuation methodology are quoted prices in active markets as of the measurement date for identical assets or liabilities. – Level 2: Significant Other Observable Inputs – inputs to the valuation methodology are based upon quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets and liabilities in markets that are not active, and inputs other than quoted prices that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the financial instrument. – Level 3: Significant Unobservable Inputs – inputs to the valuation methodology are unobservable and significant to the fair value measurement. A financial instrument’s categorization within the valuation hierarchy is based upon the lowest level of input that is significant to the fair value measurement. The Company’s assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment and considers factors specific to the asset or liability. As of September 30, 2023 and December 31, 2022, the carrying amount for cash and cash equivalents, accounts receivable (net of allowance for credit losses), current assets, and current liabilities was equal to or approximated fair value due to their short-term nature or proximity to current market rates. Fair values for our publicly traded debt securities are based on quoted market prices, when available. See Note 9, Debt , for the fair value of our long-term debt. Goodwill and Intangible Assets In accordance with ASC 350, Intangibles-Goodwill and Other , the Company reviews goodwill for impairment annually, and more frequently if events and circumstances indicate that an asset may be impaired. Such circumstances could include, but are not limited to: (1) the loss or modification of significant contracts, (2) a significant adverse change in legal factors or in business climate, (3) unanticipated competition, (4) an adverse action or assessment by a regulator, or (5) a significant decline in the Company’s stock price. When evaluating goodwill for impairment, the Company first performs qualitative assessments for each reporting unit to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying value. If the qualitative assessment suggests that it is more likely than not that the fair value of a reporting unit is less than its carrying value, then the Company performs a quantitative assessment and compares the fair value of the reporting unit to its carrying value and to the extent the carrying value is greater than the fair value, the difference is recorded as an impairment in the consolidated statements of operations. As a result of the Company's annual goodwill assessment during the second quarter of 2023, the Company recorded a $183.1 million impairment of goodwill within its Personal Care and Remote Patient Monitoring reporting units. The Company determined that based on its qualitative assessment for each reporting unit, factors existed which required the Company to test its goodwill and indefinite-lived intangible assets for impairment. These factors included a decline in the market price of the Company's common stock, industry specific regulatory pressures such as Medicaid redetermination and the Centers for Medicare and Medicaid Services ("CMS") proposed ruling on Ensuring Access to Medicaid Services , and general economic and market volatility. As a result, the Company performed a quantitative assessment and determined that the goodwill at its PCS and RPM reporting units was impaired. See Note 7, Goodwill and Intangible Assets , for additional details. Internal-use Software and Cloud Computing Arrangements The Company develops and implements software for internal use to enhance the performance and capabilities of the technology infrastructure. The costs incurred for the development of the internal-use software are capitalized when they meet the internal-use software capitalization criteria outlined in ASC 350-40. The capitalized costs are amortized using the straight-line method over the estimated useful lives of the software, ranging from 3 to 10 years. In addition to acquired software, the Company capitalizes costs associated with cloud computing arrangements (“CCA”) that are service contracts. The CCA includes services which are used to support certain internal corporate functions as well as technology associated with revenue-generating activities. The capitalized costs are amortized using the straight-line method over the term of the related CCA. As of September 30, 2023 and December 31, 2022, capitalized costs associated with CCA, net of accumulated amortization were $14.6 million and $11.9 million, respectively. The value of accumulated amortization as of September 30, 2023 and December 31, 2022 was $4.1 million and $2.2 million, respectively. Amortization expense during the three months ended September 30, 2023 and 2022, totaled $0.6 million and $0.5 million, respectively, and during the nine months ended September 30, 2023 and 2022, totaled $1.8 million and $0.9 million, respectively. Revenue Recognition Under ASC 606, the Company recognizes revenue as it transfers promised services directly to its customers at the amount that reflects the consideration to which the Company expects to be entitled in exchange for providing these services. The Company's performance obligations are driven by its different segments of business and primarily consist of integrated service offerings to provide non-emergency medical transportation, personal care services, or remote monitoring services directly to its customers. The Company receives payment for providing these services from third-party payors that include federal, state, and local governmental agencies, managed care organizations, and private consumers. In the NEMT segment, the Company's performance obligation is to stand ready to perform transportation-related activities, including the management, fulfillment, and recordkeeping activities associated with such services. In the PCS segment, the Company's performance obligation is to deliver patient care services in accordance with the nature and frequency of services outlined in each contract. In the RPM segment, the Company's performance obligation is to stand ready to perform monitoring services in the form of personal emergency response system monitoring, vitals monitoring, and other monitoring services, as contractually agreed upon. The Company satisfies substantially all of its performance obligations over time and recognizes revenue over time instead of at points in time which aligns the pattern of transfer of promised services with the value received by the customer for the performance completed to date. The Company holds different contract types under its different segments of business. In the NEMT segment, there are both capitated contracts, under which payors pay a fixed amount monthly per eligible member and revenue is recognized over each distinct service period, and fee-for-service ("FFS") contracts, under which the Company bills and collects a specified amount for each service that is provided and revenue is recognized using the right to invoice practical expedient. In the PCS segment, contracts are also FFS, and service revenue is reported at the estimated net realizable amount from patients and third-party payors for services rendered and revenue is recognized using the right to invoice practical expedient. Under RPM contracts, payors pay per-enrolled-member-per-month, based on enrolled membership, and revenue is recognized ratably over the contract term. For each contract type, the Company determines the transaction price based on the gross charges for services provided, reduced by estimates for contractual adjustments due to settlements of audits and payment reviews from third-party payors. The Company determines the estimated revenue adjustments at each segment based on our historical experience with various third-party payors and previous results from the claims and adjudication process. The PCS segment uses the portfolio approach to determine the estimated revenue adjustments. See further information in Note 4, Revenue Recognition . Government Grants The Company has received government grants primarily under the CARES Act PRF and the ARPA SLFRF to provide economic relief and stimulus to combat health and economic impacts of the COVID-19 pandemic. During the third quarter of 2023, the Company also filed amended payroll tax returns for 2020 and 2021 to claim refunds for Employee Retention Credits ("ERC"). ERC is a U.S. federal tax credit introduced to support businesses and organizations during the COVID-19 pandemic that was initially established under the CARES Act in 2020 and was later expanded and extended by subsequent legislation, including the Consolidated Appropriations Act of 2021 and the American Rescue Plan Act of 2021. The Company received distributions from these government grants of approximately $6.5 million and $1.4 million during the three months ended September 30, 2023 and 2022, respectively, of which $0.6 million and $0.8 million were recognized as grant income during the three months ended September 30, 2023 and 2022, respectively, with the remaining balance recorded in accrued expenses and other current liabilities. During the nine months ended September 30, 2023 and 2022, the Company received distributions of approximately $21.0 million and $10.4 million, respectively, of which $4.6 million was recognized as grant income during each of the the nine months ended September 30, 2023 and 2022, respectively, with the remaining balance recorded in accrued expenses and other current liabilities. Distributions received under these acts are targeted to assist with incremental health care related expenses or lost revenue attributable to the COVID-19 pandemic as well as provide stimulus to support long-term growth and recovery. The payments from these acts are subject to certain restrictions and possible recoupment if not used for designated purposes. As a condition to receiving PRF distributions, providers must agree to certain terms and conditions, including, among other things, that the funds are being used for healthcare related expenses and lost revenues attributable to COVID-19, as defined by HHS. All recipients of PRF payments are required to comply with the reporting requirements described in the terms and conditions and as determined by HHS. The Company has submitted the required documents to meet reporting requirements for the applicable reporting periods. The Company received an audit inquiry letter from HHS related to one of the business units that received PRF payments, to which the Company has responded and submitted all requested information and believes that the payments received are substantiated and within the terms and conditions defined by HHS and continues to include these amounts as grant income. At this time, the Company is unaware of any other pending or upcoming audits or inquiries related to amounts received under PRF. As a condition to receiving SLFRF distributions, providers must agree to use the funds to respond to the PHE or its negative economic impacts, to respond to workers performing essential work by providing premium pay to eligible workers and to offset reduction in revenue due to the COVID-19 PHE as stipulated by the states in which the funds were received. All recipients of SLFRF payments are required to comply with the reporting requirements that the state in which the funds originated has requested in order for the states to meet the requirements as described in the terms and conditions as determined by the Department of the Treasury. The Company has complied with all known reporting requirements to date. The Company recognizes distributions from government grants as grant income or accrued expenses and other current liabilities in line with the loss of revenues or expenses for which the grants are intended to compensate when there is reasonable assurance that it has complied with the conditions associated with the grant. Recent Accounting Pronouncements The company did not adopt any material new accounting standards during the nine months ended September 30, 2023.

Segments

Segments	9 Months Ended
	Sep. 30, 2023
Segment Reporting [Abstract]
Segments	Segments The Company’s reportable segments are identified based on a number of factors related to how its chief operating decision maker ("CODM") determines the allocation of resources and assesses the performance of the Company’s operations. The CODM uses service revenue, net and operating income as the measures of profit or loss to assess segment performance and allocate resources, and uses total assets as the measure of assets attributable to each segment. The Company's operating income for the reportable segments includes an allocated portion of corporate expenses to the respective segments and includes revenues and all other costs directly attributable to the specific segment. The Company’s reportable segments are strategic units that offer different services under different financial and operating models to the Company’s customers. The Company's CODM manages the Company under four reportable segments. • NEMT - The Company's NEMT segment is the largest manager of non-emergency medical transportation programs for state governments and managed care organizations, or MCOs, in the U.S. This segment also holds the results of the Company's captive insurance program; • PCS - The Company's PCS segment provides in home personal care services to State and Managed Medicaid, Medicare, and Private Pay patient populations in need of care monitoring and assistance performing activities of daily living; • RPM - The Company's RPM segment is a provider of remote patient monitoring solutions, including personal emergency response systems, vitals monitoring and data-driven patient engagement solutions; • Corporate and Other - The Company's Corporate and Other segment includes the costs associated with the Company's corporate operations as well as the results of an investment in innovation related to our data analytics capabilities that the Company made at the end of the first quarter of 2023, which contributes to service revenue and service expense. The operating results of the Corporate and Other segment include activities related to executive, accounting, finance, internal audit, tax, legal and certain strategic and corporate development functions for each segment, the results of this investment in innovation, as well as the results of the Company's Matrix investment. The following table sets forth certain financial information from operations attributable to the Company’s business segments for the three and nine months ended September 30, 2023 and 2022 (in thousands): Three months ended September 30, 2023 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 485,951 $ 179,979 $ 19,779 $ 1,216 $ 686,925 Grant income (1) — 551 — — 551 Service expense 428,021 143,078 6,934 1,181 579,214 General and administrative expense 25,433 20,252 5,685 18,772 70,142 Depreciation and amortization 6,814 12,850 6,174 239 26,077 Operating income (loss) $ 25,683 $ 4,350 $ 986 $ (18,976) $ 12,043 Equity in net income (loss) of investee, net of tax $ 142 $ — $ — $ (302) $ (160) Equity investment $ 1,552 $ — $ — $ 43,655 $ 45,207 Goodwill $ 135,186 $ 415,444 $ 234,894 $ 30 $ 785,554 Total assets $ 512,032 $ 774,731 $ 346,257 $ 130,066 $ 1,763,086 Nine months ended September 30, 2023 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 1,452,389 $ 534,435 $ 57,702 $ 3,812 $ 2,048,338 Grant income (1) — 4,649 — — 4,649 Service expense 1,277,604 417,636 20,129 3,366 1,718,735 General and administrative expense 87,645 63,480 16,781 61,189 229,095 Depreciation and amortization 20,319 38,590 18,087 683 77,679 Impairment of goodwill — 137,331 45,769 — 183,100 Operating income (loss) $ 66,821 $ (117,953) $ (43,064) $ (61,426) $ (155,622) Equity in net income of investee, net of tax $ 984 $ — $ — $ 1,837 $ 2,821 Equity investment $ 1,552 $ — $ — $ 43,655 $ 45,207 Goodwill $ 135,186 $ 415,444 $ 234,894 $ 30 $ 785,554 Total assets $ 512,032 $ 774,731 $ 346,257 $ 130,066 $ 1,763,086 Three months ended September 30, 2022 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 459,796 $ 169,226 $ 18,760 $ — $ 647,782 Grant income (1) — 789 — — 789 Service expense 394,981 132,746 6,836 — 534,563 General and administrative expense 31,815 22,057 5,816 16,201 75,889 Depreciation and amortization 7,079 12,919 5,467 207 25,672 Operating income (loss) $ 25,921 $ 2,293 $ 641 $ (16,408) $ 12,447 Equity in net income (loss) of investee, net of tax $ 208 $ — $ — $ (26,656) $ (26,448) Equity investment $ 208 $ — $ — $ 43,269 $ 43,477 Goodwill $ 135,186 $ 552,775 $ 280,429 $ 30 $ 968,420 Total assets $ 517,930 $ 962,425 $ 402,929 $ 106,561 $ 1,989,845 Nine months ended September 30, 2022 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 1,309,449 $ 491,661 $ 49,362 $ — $ 1,850,472 Grant income (1) — 4,587 — — 4,587 Service expense 1,100,801 379,423 17,884 — 1,498,108 General and administrative expense 102,736 68,536 17,520 43,316 232,108 Depreciation and amortization 21,576 37,976 14,201 623 74,376 Operating income (loss) $ 84,336 $ 10,313 $ (243) $ (43,939) $ 50,467 Equity in net income (loss) of investee, net of tax $ 143 $ — $ — $ (28,163) $ (28,020) Equity investment $ 208 $ — $ — $ 43,269 $ 43,477 Goodwill $ 135,186 $ 552,775 $ 280,429 $ 30 $ 968,420 Total assets $ 517,930 $ 962,425 $ 402,929 $ 106,561 $ 1,989,845 (1) Grant income for the PCS segment includes funding received on a periodic basis from the PRF in relation to relief under the CARES Act and funding received from the SLFRF under ARPA in relation to economic recovery to combat health and economic impacts of the COVID-19 pandemic. See Note 2, Significant Accounting Policies and Recent Accounting Pronouncements.

Revenue Recognition

Revenue Recognition	9 Months Ended
	Sep. 30, 2023
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue Recognition Under ASC 606, the Company recognizes revenue as it transfers promised services to its customers and generates all of its revenue from contracts with customers. The amount of revenue recognized reflects the consideration to which the Company expects to be entitled in exchange for these services. The Company satisfies substantially all of its performance obligations over time and recognizes revenue over time instead of at points in time. Revenue Contract Structure NEMT Capitated Contracts (per-member-per-month) Under capitated contracts, payors pay a fixed amount per eligible member per month. Capitation rates are generally based on expected costs and volume of services. We assume the responsibility of meeting the covered healthcare related transportation requirements based on per-member, per-month fees for the number of eligible members in the payor’s program. Revenue is recognized based on the population served during the period. Certain capitated contracts have provisions for reconciliations, risk corridors or profit rebates. For contracts with reconciliation provisions, capitation payment is received as a prepayment during the month service is provided. These prepayments are reconciled based on actual cost and/or trip volume and may result in refunds to the payor, or additional payments due from the payor. Contracts with risk corridor or profit rebate provisions allow for profit within a certain corridor and once we reach profit level maximums, we discontinue recognizing revenue and instead record a liability within the accrued contract payable account. This liability may be reduced through future increases in trip volume or periodic settlements with the payor. While a profit rebate provision could only result in a liability from this profit threshold, a risk corridor provision could potentially result in receivables if the Company does not reach certain profit minimums, which would be recorded in the reconciliation contract receivables account. NEMT Fee-for-service Contracts Fee-for-service ("FFS") revenue represents revenue earned under non-capitated contracts in which we bill and collect a specified amount for each service that we provide. FFS revenue is recognized in the period in which the services are rendered and is reduced by the estimated impact of contractual allowances. PCS Fee-for-service Contracts PCS FFS revenue is reported at the estimated net realizable amount from clients, patients and third-party payors for services rendered based on actual personal care hours provided. Payment for services received from third-party payors includes, but is not limited to, insurance companies, hospitals, governmental agencies and other home health care providers who subcontract work to the Company. Certain contracts are subject to retroactive review and possible adjustment by those payors based on the nature of the contract or costs incurred. The Company makes estimates of retroactive adjustments and considers these in the recognition of revenue in the period in which the related services are rendered. The difference between estimated settlement and actual settlement is reported in net service revenues as adjustments become known or as years are no longer subject to such audits, reviews, or investigations. RPM per-member-per-month Contracts RPM per-member-per-month ("PMPM") revenue consists of revenue from monitoring services provided to the customer. Under RPM contracts, payors pay per-enrolled-member-per-month based on enrolled membership. Consideration is generally fixed for each type of monitoring service and revenue is recognized ratably over the contract term based on the monthly fee paid by customers. Disaggregation of Revenue by Contract Type The following table summarizes disaggregated revenue from contracts with customers by contract type for the three and nine months ended September 30, 2023 and September 30, 2022 (in thousands): Three months ended September 30, Nine months ended September 30, 2023 2022 2023 2022 NEMT capitated contracts $ 412,762 $ 399,859 $ 1,239,957 $ 1,145,694 NEMT FFS contracts 73,189 59,937 212,432 163,755 Total NEMT service revenue, net 485,951 459,796 1,452,389 1,309,449 PCS FFS contracts 179,979 169,226 534,435 491,661 RPM PMPM contracts 19,779 18,760 57,702 49,362 Other service revenue 1,216 — 3,812 — Total service revenue, net $ 686,925 $ 647,782 $ 2,048,338 $ 1,850,472 Payor Information Service revenue, net, is derived from state and managed Medicaid contracts, managed Medicare contracts, as well as a small amount from private pay and other contracts. Of the NEMT segment’s revenue, 11.4% and 10.4% were derived from one payor for the three months ended September 30, 2023 and 2022, respectively, and 11.2% and 11.0% were derived from one payor for the nine months ended September 30, 2023 and 2022, respectively. Of the PCS segment's revenue, 11.4% and 12.1% were derived from one payor for the three months ended September 30, 2023 and 2022, respectively, and 11.3% and 12.0% were derived from one payor for the nine months ended September 30, 2023 and 2022, respectively. Of the RPM segment's revenue, 19.3% and 18.4% were derived from one payor for the three months ended September 30, 2023 and 2022, respectively, and 17.4% and 20.4% were derived from one payor for the nine months ended September 30, 2023 and 2022, respectively. Revenue Adjustments During the three months ended September 30, 2023 and 2022, the Company recognized a reduction of $0.8 million and an increase of $1.7 million in service revenue, respectively, from contractual adjustments relating to performance obligations satisfied in previous periods to which the payor agreed. During the nine months ended September 30, 2023 and 2022, the Company recognized a reduction of $3.9 million and an increase of $6.5 million in service revenue, respectively, from contractual adjustments relating to performance obligations satisfied in previous periods to which the payor agreed. Related Balance Sheet Accounts The following table provides information about accounts receivable, net (in thousands): September 30, 2023 December 31, 2022 Accounts receivable $ 204,097 $ 225,288 Allowance for doubtful accounts (1,396) (2,078) Accounts receivable, net $ 202,701 $ 223,210 The following table provides information about other revenue related accounts included on the accompanying unaudited condensed consolidated balance sheets (in thousands): September 30, 2023 December 31, 2022 Accrued contract payables (1) $ 133,576 $ 194,287 Contract receivables (2) $ 129,275 $ 71,131 Long-term contract receivables (3) $ — $ 427 Deferred revenue, current $ 2,008 $ 2,202 (1) Accrued contract payables primarily represent overpayments and liability reserves on certain risk corridor, profit rebate and reconciliation contracts. See the contract payables and receivables activity below. (2) Contract receivables primarily represent underpayments and receivables on certain risk corridor, profit rebate, and reconciliation contracts. See the contract payables and receivables activity below. (3) Long-term contract receivables primarily represent future receivable balances on certain risk corridor, profit rebate and reconciliation contracts that may be received in greater than 12 months. The following table provides the summary activity of total contract payables and receivables as reported within the unaudited condensed consolidated balance sheets (in thousands): December 31, 2022 Additional Amounts Recorded Amounts Paid or Settled March 31, 2023 Reconciliation contract payables $ 25,853 $ 1,811 $ (18,110) $ 9,554 Profit rebate/corridor contract payables 155,161 22,316 (10,873) 166,604 Overpayments and other cash items 13,273 799 (2,610) 11,462 Total contract payables $ 194,287 $ 24,926 $ (31,593) $ 187,620 Reconciliation contract receivables $ 48,153 $ 22,204 $ (5,922) $ 64,435 Corridor contract receivables 23,405 14,508 — 37,913 Total contract receivables $ 71,558 $ 36,712 $ (5,922) $ 102,348 March 31, 2023 Additional Amounts Recorded Amounts Paid or Settled June 30, 2023 Reconciliation contract payables $ 9,554 $ 6,687 $ (2,749) $ 13,492 Profit rebate/corridor contract payables 166,604 17,447 (98,683) 85,368 Overpayments and other cash items 11,462 2,707 (3,935) 10,234 Total contract payables $ 187,620 $ 26,841 $ (105,367) $ 109,094 Reconciliation contract receivables $ 64,435 $ 16,686 $ (15,105) $ 66,016 Corridor contract receivables 37,913 16,290 (456) 53,747 Total contract receivables $ 102,348 $ 32,976 $ (15,561) $ 119,763 June 30, 2023 Additional Amounts Recorded Amounts Paid or Settled September 30, 2023 Reconciliation contract payables $ 13,492 $ 4,763 $ (3,034) $ 15,221 Profit rebate/corridor contract payables 85,368 10,614 (1,840) 94,142 Overpayments and other cash items 10,234 16,313 (2,334) 24,213 Total contract payables $ 109,094 $ 31,690 $ (7,208) $ 133,576 Reconciliation contract receivables $ 66,016 $ 14,180 $ (19,460) $ 60,736 Corridor contract receivables 53,747 14,792 — 68,539 Total contract receivables $ 119,763 $ 28,972 $ (19,460) $ 129,275

Equity Investment

Equity Investment	9 Months Ended
	Sep. 30, 2023
Equity Method Investment, Summarized Financial Information [Abstract]
Equity Investment	Equity Investment As of September 30, 2023 and December 31, 2022, the Company owned a 43.6% non-controlling interest in Matrix. Pursuant to a Shareholder’s Agreement, affiliates of Frazier Healthcare Partners hold rights necessary to control the fundamental operations of Matrix. The Company accounts for its investment in Matrix under the equity method of accounting and the Company’s share of Matrix’s income or losses are recorded as “Equity in net income (loss) of investee, net of tax” in the accompanying unaudited condensed consolidated statements of operations. During the year ended December 31, 2022, Matrix recorded asset impairment charges of $82.2 million, of which the entire asset impairment charge was recorded during the three and nine months ended September 30, 2022. No asset impairment charges were recorded for the three or nine months ended September 30, 2023. The Company's gross share of its Matrix's operations for the three months ended September 30, 2023 and September 30, 2022 was a loss of $0.4 million and a loss of $36.1 million, respectively, which is presented net of tax on the unaudited condensed consolidated statements of operations for a loss of $0.3 million and a loss of $26.7 million, respectively. The Company's gross share of its Matrix's operations for the nine months ended September 30, 2023 and September 30, 2022 was income of $2.5 million and a loss of $39.0 million, respectively, which is presented net of tax on the unaudited condensed consolidated statements of operations for income of $1.8 million and a loss of $28.2 million, respectively. The carrying amount of the assets included in the Company’s unaudited condensed consolidated balance sheets and the maximum loss exposure related to the Company’s interest in Matrix as of September 30, 2023 and December 31, 2022 totaled $45.2 million and $41.3 million, respectively. Summary financial information for Matrix on a standalone basis is as follows (in thousands): September 30, 2023 December 31, 2022 Current assets $ 112,994 $ 97,750 Long-term assets $ 355,143 $ 373,297 Current liabilities $ 34,955 $ 36,913 Long-term liabilities $ 317,806 $ 325,613 Three months ended September 30, Nine months ended September 30, 2023 2022 2023 2022 Revenue $ 84,395 $ 76,461 $ 252,973 $ 235,582 Operating income (loss) $ 7,593 $ (79,992) $ 32,196 $ (81,604) Net income (loss) $ (239) $ (85,081) $ 6,976 $ (93,211)

Prepaid Expenses and Other Curr

Prepaid Expenses and Other Current Assets	9 Months Ended
	Sep. 30, 2023
Prepaid Expense and Other Assets, Current [Abstract]
Prepaid Expenses and Other Current Assets	Prepaid Expenses and Other Current Assets Prepaid expenses and other current assets were comprised of the following (in thousands): September 30, 2023 December 31, 2022 Prepaid insurance $ 8,251 $ 6,334 Deferred ERP implementation costs 5,070 5,817 Prepaid income taxes 4,075 7,186 Deferred financing costs on credit facility 2,864 3,061 Inventory 2,261 2,041 Prepaid rent 1,152 278 Other prepaid expenses 14,896 9,615 Total prepaid expenses and other current assets $ 38,569 $ 34,332

Goodwill and Intangible Assets

Goodwill and Intangible Assets	9 Months Ended
	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Goodwill and Intangible Assets The Company tests goodwill for impairment for its reporting units annually as of July 1 or more frequently when events or changes in circumstances indicate that impairment may have occurred. The Company reviews its intangible assets for impairment whenever events or changes in circumstances indicate that the carrying value of an asset group may not be recoverable. Goodwill During the second quarter of 2023, the Company recorded a $183.1 million impairment of goodwill within its Personal Care and Remote Patient Monitoring reporting units. This impairment was driven primarily by macroeconomic factors, including a decline in the market value of the Company's common stock. After recording these impairments, the associated reporting units have $650.3 million of goodwill remaining. If, among other factors, (i) the Company's equity values were to decline significantly, (ii) the Company experienced additional adverse impacts associated with macroeconomic factors, including increases in our estimated weighted average cost of capital, or (iii) the adverse impacts stemming from competition, economic, regulatory or other factors were to cause the Company's results of operations or cash flows to be worse than currently anticipated, the Company could conclude in future periods that additional impairment charges of certain reporting units are required in order to reduce the carrying values of goodwill. Any such impairment charges could be significant. The Company performed a quantitative test comparing the carrying value of the Company's reporting units with their respective fair value. The fair value of the Company's reporting units was estimated using both the income approach and the market valuation approach. The income approach produces an estimated fair value of a reporting unit based on the present value of the cash flows the Company expects the reporting unit to generate in the future. Estimates included in the discounted cash flow model are primarily Level 3 inputs and include the discount rate, which the Company determines based on adjusting an industry-wide weighted-average cost of capital for size, geography, and company specific risk factors, long-term rates of growth and profitability of the Company’s business, working capital effects and planned capital expenditures. The market approach produces an estimated fair value of a reporting unit based on a comparison of the reporting unit to comparable publicly traded entities in similar lines of business. The Company’s significant estimates in the market approach include the selected similar companies with comparable business factors such as size, growth, profitability, risk and return on investment and the multiples the Company applies to earnings before interest, taxes, depreciation and amortization (“EBITDA”) to estimate the fair value of the reporting unit. Changes in key assumptions from the prior year annual goodwill assessment and the resulting reduction in projected future cash flows included in the current year goodwill test resulted in a decrease in the fair values of the Company's PCS and RPM reporting units such that the fair value of each respective reporting unit was less than its respective carrying value. As a result, during the second quarter of 2023, the Company recorded a non-cash goodwill impairment charge of $137.3 million in the PCS reporting unit and $45.8 million in the RPM reporting unit, which is recorded in “Impairment of goodwill” on the Company’s unaudited condensed consolidated statement of operations. No further impairment was taken during the three months ended September 30, 2023. There was no such goodwill impairment charge in the three and nine months ended September 30, 2022. Changes in the carrying value of goodwill by reportable segment are presented in the following table (in thousands): NEMT PCS RPM Corporate and Other Total Balance at December 31, 2022 $ 135,186 $ 552,775 $ 280,663 $ 30 $ 968,654 Impairment of goodwill — (137,331) (45,769) — (183,100) Balance at September 30, 2023 $ 135,186 $ 415,444 $ 234,894 $ 30 $ 785,554 The accumulated impairment losses on goodwill totaled $279.1 million as of September 30, 2023 and $96.0 million as of December 31, 2022. Intangible Assets Intangible assets are comprised of acquired payor networks, trademarks and trade names, developed technology, non-compete agreements, licenses, and an assembled workforce. Finite-lived intangible assets are amortized using the straight-line method over the estimated economic lives of the assets. These finite-lived intangible assets are reviewed for impairment whenever events or changes in circumstances indicate that the carrying value of such assets may not be recoverable. Indefinite-lived intangible assets are not amortized, but are tested for impairment annually and more frequently if events occur or circumstances change that indicate an asset may be impaired. Based on the continued value of the definite-lived and indefinite-lived intangible assets acquired, the Company did not identify any circumstances during the three and nine months ended September 30, 2023 that would require an impairment test for our intangible assets.

Accrued Expenses and Other Curr

Accrued Expenses and Other Current Liabilities	9 Months Ended
	Sep. 30, 2023
Payables and Accruals [Abstract]
Accrued Expenses and Other Current Liabilities	Accrued Expenses and Other Current Liabilities Accrued expenses and other current liabilities were comprised of the following (in thousands): September 30, 2023 December 31, 2022 Accrued compensation and related liabilities $ 47,183 $ 47,947 Accrued interest 24,855 10,643 Insurance reserves 19,439 17,836 Accrued operating expenses 13,788 18,432 Accrued legal fees 12,002 15,574 Accrued government grants (1) 10,970 7,367 Union pension obligation 2,970 3,665 Deferred revenue 2,008 2,202 Other 13,349 12,194 Total accrued expenses and other current liabilities $ 146,564 $ 135,860 (1) Accrued government grants include payments received from government entities, primarily in relation to the PRF and SLFRF, to offset lost revenue or increased expenditures for which the related expenditure has not yet been incurred and thus the related payments are deferred as of September 30, 2023 and December 31, 2022.

Debt

Debt	9 Months Ended
	Sep. 30, 2023
Debt Disclosure [Abstract]
Debt	Debt Senior Unsecured Notes Senior unsecured notes as of September 30, 2023 and December 31, 2022 consisted of the following (in thousands): Senior Unsecured Note Date of Issuance September 30, 2023 December 31, 2022 $500.0 million 5.875% due November 15, 2025 (effective interest rate 6.467%) 11/4/2020 $ 493,265 $ 491,098 $500.0 million 5.000% due October 1, 2029 (effective interest rate 5.392%) 8/24/2021 489,365 488,263 Total $ 982,630 $ 979,361 The Company pays interest on the Senior Unsecured Notes semi-annually in arrears. Principal payments are not required until the maturity date. Debt issuance costs of $14.5 million in relation to the issuance of the Senior Notes due 2025 were incurred and these costs were deferred and are amortized to interest cost over the term of the Notes. Debt issuance costs of $13.5 million were incurred in relation to the issuance of the Senior Notes due 2029 and these costs were deferred and are amortized to interest cost over the term of the Notes. As of September 30, 2023, $17.4 million of unamortized deferred issuance costs was netted against the long-term debt balance on the unaudited condensed consolidated balance sheets. The fair value of the Notes as of September 30, 2023 and December 31, 2022 was $836.3 million and $896.6 million, respectively, which was determined based on quoted prices in active markets, and therefore designated as Level 1 within the fair value hierarchy. The Company was in compliance with all covenants as of September 30, 2023. Credit Facility The Company is a party to the amended and restated credit agreement, dated as of February 3, 2022, (as amended, the “Credit Agreement”) with JPMorgan Chase Bank, N.A., as administrative agent, swing line lender and an issuing bank, Wells Fargo Bank, National Association, as an issuing bank, Truist Bank and Wells Fargo Bank, National Association, as co-syndication agents, Deutsche Bank AG New York Branch, Bank of America, N.A., Regions Bank, Bank of Montreal and Capital One, National Association, as co-documentation agents, and JPMorgan Chase Bank, N.A., Truist Securities, Inc. and Wells Fargo Securities, LLC, as joint bookrunners and joint lead arrangers, and the other lenders party thereto. The Credit Agreement provides the Company with a senior secured revolving credit facility (the “Credit Facility”) in an aggregate principal amount of $325.0 million and sublimits for swingline loans, letters of credit and alternative currency loans in amounts of up to $25.0 million, $60.0 million and $75.0 million, respectively. The Credit Facility matures on February 3, 2027 and the proceeds may be used (i) to finance working capital needs of the Company and its subsidiaries and (ii) for general corporate purposes of the Company and its subsidiaries (including to finance capital expenditures, permitted acquisitions and investments). On June 26, 2023, the Company entered into an Amendment No. 1 (the "First Amendment") to the Credit Agreement which amended and restated the maximum permitted Total Net Leverage Ratio under the Credit Agreement as follows: for the fiscal quarters ending June 30, 2023 through September 30, 2023, 5.25:1.00; for the fiscal quarters ending December 31, 2023 through March 31, 2024, 5.00:1.00; for the fiscal quarter ending June 30, 2024, 4.75:1.00; and for the fiscal quarters ending September 30, 2024 and for the fiscal quarters ending thereafter, 4.50:1.00. As of September 30, 2023, the Company had $83.0 million of short-term borrowings outstanding on the Credit Facility and had $39.1 million of outstanding letters of credit under the Credit Facility. The interest rate for borrowings outstanding as of September 30, 2023 was 9.8% per annum. As of December 31, 2022, the Company did not have any borrowings outstanding on the Credit Facility and had $38.1 million of outstanding letters of credit under the Credit Facility. Under the Credit Facility, the Company has an option to request an increase in the amount of the Credit Facility or obtain incremental term loans from time to time (on substantially the same terms as apply to the existing facilities) by an aggregate amount of up to $175.0 million, so long as, after giving effect to the relevant incremental facility, the pro forma secured net leverage ratio does not exceed 3.50:1.00, provided that the lenders agree to increase their existing commitments or to participate in such incremental term loans. The Company may prepay the Credit Facility in whole or in part, at any time without premium or penalty, subject to reimbursement of the lenders’ breakage and redeployment costs in connection with prepayments of Term Benchmark loans or RFR loans, each as defined in the Credit Agreement. The unutilized portion of the commitments under the Credit Facility may be irrevocably reduced or terminated by the Company at any time without penalty. Interest on the outstanding principal amount of the loans accrues at a per annum rate equal to the Alternate Base Rate, the Adjusted Term SOFR Rate, the Adjusted Daily Simple SOFR Rate, the Adjusted EURIBOR Rate or the Adjusted Daily Simple SONIA Rate, as applicable and each as defined in the Credit Agreement, in each case, plus an applicable margin. The applicable margin ranges from 1.75% to 3.50% in the case of Term Benchmark loans or RFR loans, each as defined in the Credit Agreement, and 0.75% to 2.50% in the case of the Alternate Base Rate loans, as defined in the Credit Agreement, in each case, based on the Company’s total net leverage ratio as defined in the Credit Agreement. Interest on the loans is payable quarterly in arrears in the case of Alternate Base Rate loans, on the last day of the relevant interest period in the case of Term Benchmark loans, and monthly in arrears in the case of RFR loans. In addition, the Company is obligated to pay a quarterly commitment fee based on a percentage of the unused portion of the revolving credit facility and quarterly letter of credit fees based on a percentage of the maximum amount available to be drawn under each outstanding letter of credit. The commitment fee and letter of credit fee range from 0.30% to 0.50% and 1.75% to 3.50%, respectively, in each case, based on the Company’s total net leverage ratio. The Credit Agreement contains customary representations and warranties, affirmative and negative covenants and events of default. The negative covenants include restrictions on the Company’s ability to, among other things, incur additional indebtedness, create liens, make investments, give guarantees, pay dividends, sell assets and merge and consolidate. The Company's borrowing capacity under the Credit Facility is currently limited by, among other covenants, compliance with the total net leverage ratio covenant for each fiscal period as amended in the First Amendment to the Credit Agreement. The Company’s obligations under the Credit Facility are guaranteed by all of the Company’s present and future material domestic subsidiaries, excluding certain material domestic subsidiaries that are excluded from being guarantors pursuant to the terms of the Credit Agreement. The Company’s obligations under, and each guarantor’s obligations under its guaranty of, the Credit Facility are secured by a first priority lien on substantially all of the Company’s or such guarantor’s respective assets. If an event of default occurs, the required lenders may cause the administrative agent to declare all unpaid principal and any accrued and unpaid interest and all fees and expenses under the Credit Facility to be immediately due and payable. All amounts outstanding under the Credit Facility will automatically become due and payable upon the commencement of any bankruptcy, insolvency or similar proceedings. The Credit Agreement also contains a cross default to any of the Company’s indebtedness having a principal amount in excess of $40.0 million. The Company was in compliance with all covenants under the Credit Agreement as of September 30, 2023 .

Stock-Based Compensation and Si

Stock-Based Compensation and Similar Arrangements	9 Months Ended
	Sep. 30, 2023
Share-Based Payment Arrangement, Noncash Expense [Abstract]
Stock-Based Compensation and Similar Arrangements	Stock-Based Compensation and Similar Arrangements The Company provides stock-based compensation to employees, non-employee directors, consultants and advisors under the Company’s 2006 Long-Term Incentive Plan (“2006 Plan”). The 2006 Plan allows the flexibility to grant or award stock options, stock appreciation rights, restricted stock, unrestricted stock, stock units including restricted stock units and performance awards to eligible persons. Stock options. The Company recognized stock-based compensation expense for non-qualified stock options (“NQs”) of $0.2 million for the three months ended September 30, 2023, and recognized a reversal of previously recognized stock-based compensation expense for NQs of $0.3 million during the three months ended September 30, 2022 due to forfeitures that occurred during the period. For the nine months ended September 30, 2023 and 2022, the Company recognized stock-based compensation expense for NQs of $0.6 million and $1.0 million, respectively, in general and administrative expense. At September 30, 2023, the Company had 87,388 stock options outstanding with a weighted-average exercise price of $106.51. Restricted stock awards and restricted stock units. The Company recognized stock-based compensation expense for restricted stock awards ("RSAs") and restricted stock units ("RSUs") of $1.1 million and $0.7 million for the three months ended September 30, 2023 and 2022, respectively, and $2.9 million and $3.5 million for the nine months ended September 30, 2023 and 2022, respectively, in general and administrative expense. The Company had 16,074 unvested RSAs and 285,472 unvested RSUs outstanding at September 30, 2023 with a weighted-average grant date fair value of $80.47 and $43.86, respectively. Performance-based share awards. The Company grants performance-based restricted stock units ("PRSUs") to align management’s compensation with the Company's financial performance and other operational objectives and to retain key employees. Awards granted under this category are based on the achievement of various targeted metrics as approved by the Compensation Committee and defined in the related PRSU Agreement. Stock-based compensation expense for PRSUs is recognized over the 3-year vesting period under the straight-line attribution method. The Company recorded stock-based compensation expense of $0.4 million for the three months ended September 30, 2023 and recorded a reversal of $0.2 million for the three months ended September 30, 2022 due to forfeitures that occurred during the period. For the nine months ended September 30, 2023 and 2022, the Company recognized stock-based compensation expense for PRSUs of $0.5 million and $0.6 million, respectively, in general and administrative expense. The remaining expense is expected to be recognized over the remainder of the 3-year requisite service period. The Company had 213,428 unvested PRSUs outstanding at September 30, 2023 with a weighted-average grant date fair value of $43.74

Loss Per Share

Loss Per Share	9 Months Ended
	Sep. 30, 2023
Earnings Per Share [Abstract]
Loss Per Share	Loss Per Share The following table details the computation of basic and diluted loss per share (in thousands, except share and per share data): Three months ended September 30, Nine months ended September 30, 2023 2022 2023 2022 Numerator: Net loss $ (4,302) $ (28,505) $ (199,208) $ (24,859) Denominator: Denominator for basic earnings per share -- weighted-average shares 14,182,839 14,051,794 14,169,537 14,041,224 Effect of dilutive securities: Common stock options — — — — Restricted stock — — — — Denominator for diluted earnings per share -- adjusted weighted-average shares assumed conversion 14,182,839 14,051,794 14,169,537 14,041,224 Loss per share: Basic loss per share $ (0.30) $ (2.03) $ (14.06) $ (1.77) Diluted loss per share $ (0.30) $ (2.03) $ (14.06) $ (1.77) The following weighted-average shares were not included in the computation of diluted earnings per share as the effect of their inclusion would have been anti-dilutive: Three months ended September 30, Nine months ended September 30, 2023 2022 2023 2022 Stock options to purchase common stock 90,579 115,686 96,725 123,534 Restricted stock awards and restricted stock units 141,712 80,332 97,719 82,944

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2023
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The Company’s effective tax rate for the three months ended September 30, 2023 and 2022 was a tax benefit of 28.6% and 33.9%, respectively, and for the nine months ended September 30, 2023 and 2022 was a tax benefit of 2.1% and a tax provision of 21.7%, respectively. For the three months ended September 30, 2023 and 2022, the effective tax rates for the benefits were significantly higher than the U.S. federal statutory rate of 21.0% primarily due to state income taxes and nondeductible expenses. For the nine months ended September 30, 2023, the effective tax rate for the benefit was significantly lower than the U.S. federal statutory rate of 21.0% primarily due to the nondeductible goodwill impairment. For the nine months ended September 30,

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Surveys, audits and governmental investigations In the ordinary course of business, the Company may from time to time be or become subject to surveys, audits and governmental investigations under or with respect to various governmental programs and state and federal laws. Agencies associated with the programs and other third-party commercial payors periodically conduct extensive pre-payment or post-payment medical reviews or other audits of claims data to identify possible payments made or authorized other than in compliance with the requirements of Medicare or Medicaid. In order to conduct these reviews, documentation is requested from us and then that documentation is reviewed to determine compliance with applicable rules and regulations, including the eligibility of clients to receive benefits, the appropriateness of the care provided to those clients, and the documentation of that care. Similarly, other state and federal governmental agencies conduct reviews and investigations to confirm our compliance with applicable laws where we operate, including regarding employment and wage related regulations and matters. We cannot predict the ultimate outcome of any regulatory reviews or other governmental surveys, audits or investigations, but management does not expect any ongoing surveys, audits or investigations involving the Company to have a material adverse effect on the business, liquidity, financial condition, or results of operations of the Company. Regardless of our expectations, however, surveys, audits or investigations are subject to inherent uncertainties and can have a material adverse impact on our Company due to, among other reasons, potential regulatory orders that inhibit our ability to operate our business, amounts paid as reimbursement or in settlement of any such matter, diversion of management resources and investigative costs. Legal proceedings In the ordinary course of business, the Company may from time to time be or become involved in various lawsuits, some of which may seek monetary damages, including claims for punitive damages. Management does not expect any ongoing lawsuits involving the Company to have a material impact on the business, liquidity, financial condition, or results of operations of the Company. Legal proceedings are subject to inherent uncertainties, however, and unfavorable rulings or other events could occur. Unfavorable resolutions could involve substantial monetary damages. In addition, in matters for which conduct remedies are sought, unfavorable resolutions could include an injunction or other order precluding particular business practices or requiring other remedies. An unfavorable outcome might result in a material adverse impact on our business, liquidity, financial position, or results of operations. The Company records accruals for loss contingencies related to legal matters when it is probable that a liability will be incurred and the amount of the loss can be reasonably estimated. If the Company determines that a range of reasonably possible losses can be estimated, the Company records an accrual for the most probable amount in the range. Due to the inherent difficulty in predicting the outcome of any legal proceeding, it may not be reasonably possible to estimate a range of potential liability until the matter is close to resolution. Legal fees related to all legal matters are expensed as incurred. On September 27, 2022, Daniel Greenleaf, the Company’s former Chief Executive Officer, asserted claims in an arbitration against the Company. His claims allege that the Company breached Mr. Greenleaf’s employment agreement and included a tort claim against the Company. Mr. Greenleaf’s arbitration complaint sought contractual, extra-contractual, and statutory damages. In May 2023, Mr. Greenleaf and the Company executed a settlement agreement related to both sides' claims in arbitration and a general release of all claims and the Company agreed to pay Mr. Greenleaf $9.6 million. The Company paid the settlement amount in full in May of 2023. On August 6, 2020, the Company’s subsidiary, ModivCare Solutions, LLC (“ModivCare Solutions”), was served with a putative class action lawsuit filed against it by Mohamed Farah, the owner of transportation provider Dalmar Transportation, in the Western District of Missouri, seeking to represent all non-employee transportation providers contracted with ModivCare Solutions. The lawsuit alleges claims under the Fair Labor Standards Act of 1938, as amended (the “FLSA”), and the Missouri Minimum Wage Act, and asserts that all transportation providers to ModivCare Solutions in the putative class should be considered ModivCare Solutions’ employees rather than independent contractors. On June 6, 2021, the Court conditionally certified as the putative class all current and former In Network Transportation Providers who, individually or through their companies, were issued 1099 payments from ModivCare Solutions for providing non-emergency medical transportation services for ModivCare Solutions for the previous three years. Notice of the proposed collective class was issued on October 5, 2021, and potential members of the class had until January 3, 2022 to opt-in. Plaintiff moved for class certification on August 15, 2022, and ModivCare Solutions filed an opposition to class certification on September 6, 2022. On January 13, 2023, the matter was transferred with the consent of the parties and the court to binding arbitration. As of September 30, 2023, the parties have agreed on a settlement and are awaiting the arbitrator's approval. ModivCare Solutions believes that it is and has been in compliance in all material respects with the laws and regulations regarding the characterization of the transportation providers

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022
Pay vs Performance Disclosure
Net loss	$ (4,302)	$ (190,944)	$ (3,962)	$ (28,505)	$ 3,328	$ 318	$ (199,208)	$ (24,859)

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Sep. 30, 2023
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Significant Accounting Polici_2

Significant Accounting Policies and Recent Accounting Pronouncements (Policies)	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The Company follows accounting standards established by the Financial Accounting Standards Board (“FASB”). The FASB establishes accounting principles generally accepted in the United States (“GAAP”). Rules and interpretive releases of the Securities and Exchange Commission (“SEC”) under the authority of federal securities laws are also sources of authoritative GAAP for SEC registrants. References to GAAP issued by FASB in these notes are to the FASB Accounting Standards Codification (“ASC”), which serves as the single source of authoritative accounting and applicable reporting standards to be applied for non-governmental entities. All amounts are presented in U.S. dollars unless otherwise noted. The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with GAAP for interim financial information, and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and disclosures required by GAAP for complete financial statements. In the opinion of management, all adjustments considered necessary for the fair presentation of the results of the interim periods have been included. The Company has made estimates relating to the reporting of assets and liabilities, revenues and expenses, and certain disclosures in the preparation of these unaudited condensed consolidated financial statements in conformity with GAAP. Actual results could differ from those estimates. Operating results for the three and nine months ended September 30, 2023 are not necessarily indicative of the results that may be expected for the fiscal year ending December 31, 2023. Management has evaluated events and transactions that occurred after the balance sheet date and through the date these unaudited condensed consolidated financial statements were filed with the SEC and considered the effect of such events in the preparation of these unaudited condensed consolidated financial statements. The unaudited condensed consolidated balance sheet at December 31, 2022 included in this Form 10-Q has been derived from audited financial statements at that date, but does not include all the information and footnotes required by GAAP for complete financial statements. The unaudited condensed consolidated financial statements contained herein should be read in conjunction with the audited financial statements and notes included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022.
Reclassifications	Reclassifications: Certain prior year amounts have been reclassified to conform to current year presentation.
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, including disclosure of contingencies, at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.
Fair Value Measurements	Fair Value Measurements The Company follows FASB ASC Topic 820, Fair Value Measurement (“ASC 820”) which establishes a three-level valuation hierarchy for disclosure of fair value measurements. The valuation hierarchy categorizes assets and liabilities measured at fair value into one of three different levels depending on the observability of the inputs employed in the measurement. The three levels based on the observability of inputs are defined as follows: – Level 1: Quoted Prices in Active Markets for Identical Assets – inputs to the valuation methodology are quoted prices in active markets as of the measurement date for identical assets or liabilities. – Level 2: Significant Other Observable Inputs – inputs to the valuation methodology are based upon quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets and liabilities in markets that are not active, and inputs other than quoted prices that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the financial instrument. – Level 3: Significant Unobservable Inputs – inputs to the valuation methodology are unobservable and significant to the fair value measurement. A financial instrument’s categorization within the valuation hierarchy is based upon the lowest level of input that is significant to the fair value measurement. The Company’s assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment and considers factors specific to the asset or liability. As of September 30, 2023 and December 31, 2022, the carrying amount for cash and cash equivalents, accounts receivable (net of allowance for credit losses), current assets, and current liabilities was equal to or approximated fair value due to their short-term nature or proximity to current market rates. Fair values for our publicly traded debt securities are based on quoted market prices, when available. See Note 9, Debt , for the fair value of our long-term debt.
Goodwill and Intangible Assets	Goodwill and Intangible Assets In accordance with ASC 350, Intangibles-Goodwill and Other , the Company reviews goodwill for impairment annually, and more frequently if events and circumstances indicate that an asset may be impaired. Such circumstances could include, but are not limited to: (1) the loss or modification of significant contracts, (2) a significant adverse change in legal factors or in business climate, (3) unanticipated competition, (4) an adverse action or assessment by a regulator, or (5) a significant decline in the Company’s stock price. When evaluating goodwill for impairment, the Company first performs qualitative assessments for each reporting unit to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying value. If the qualitative assessment suggests that it is more likely than not that the fair value of a reporting unit is less than its carrying value, then the Company performs a quantitative assessment and compares the fair value of the reporting unit to its carrying value and to the extent the carrying value is greater than the fair value, the difference is recorded as an impairment in the consolidated statements of operations. As a result of the Company's annual goodwill assessment during the second quarter of 2023, the Company recorded a $183.1 million impairment of goodwill within its Personal Care and Remote Patient Monitoring reporting units. The Company determined that based on its qualitative assessment for each reporting unit, factors existed which required the Company to test its goodwill and indefinite-lived intangible assets for impairment. These factors included a decline in the market price of the Company's common stock, industry specific regulatory pressures such as Medicaid redetermination and the Centers for Medicare and Medicaid Services ("CMS") proposed ruling on Ensuring Access to Medicaid Services , and general economic and market volatility. As a result, the Company performed a quantitative assessment and determined that the goodwill at its PCS and RPM reporting units was impaired. See Note 7, Goodwill and Intangible Assets , for additional details.
Internal-use Software and Cloud Computing Arrangements	Internal-use Software and Cloud Computing Arrangements The Company develops and implements software for internal use to enhance the performance and capabilities of the technology infrastructure. The costs incurred for the development of the internal-use software are capitalized when they meet the internal-use software capitalization criteria outlined in ASC 350-40. The capitalized costs are amortized using the straight-line method over the estimated useful lives of the software, ranging from 3 to 10 years.
Revenue Recognition	Revenue Recognition Under ASC 606, the Company recognizes revenue as it transfers promised services directly to its customers at the amount that reflects the consideration to which the Company expects to be entitled in exchange for providing these services. The Company's performance obligations are driven by its different segments of business and primarily consist of integrated service offerings to provide non-emergency medical transportation, personal care services, or remote monitoring services directly to its customers. The Company receives payment for providing these services from third-party payors that include federal, state, and local governmental agencies, managed care organizations, and private consumers. In the NEMT segment, the Company's performance obligation is to stand ready to perform transportation-related activities, including the management, fulfillment, and recordkeeping activities associated with such services. In the PCS segment, the Company's performance obligation is to deliver patient care services in accordance with the nature and frequency of services outlined in each contract. In the RPM segment, the Company's performance obligation is to stand ready to perform monitoring services in the form of personal emergency response system monitoring, vitals monitoring, and other monitoring services, as contractually agreed upon. The Company satisfies substantially all of its performance obligations over time and recognizes revenue over time instead of at points in time which aligns the pattern of transfer of promised services with the value received by the customer for the performance completed to date. The Company holds different contract types under its different segments of business. In the NEMT segment, there are both capitated contracts, under which payors pay a fixed amount monthly per eligible member and revenue is recognized over each distinct service period, and fee-for-service ("FFS") contracts, under which the Company bills and collects a specified amount for each service that is provided and revenue is recognized using the right to invoice practical expedient. In the PCS segment, contracts are also FFS, and service revenue is reported at the estimated net realizable amount from patients and third-party payors for services rendered and revenue is recognized using the right to invoice practical expedient. Under RPM contracts, payors pay per-enrolled-member-per-month, based on enrolled membership, and revenue is recognized ratably over the contract term. For each contract type, the Company determines the transaction price based on the gross charges for services provided, reduced by estimates for contractual adjustments due to settlements of audits and payment reviews from third-party payors. The Company determines the estimated revenue adjustments at each segment based on our historical experience with various third-party payors and previous results from the claims and adjudication process. The PCS segment uses the portfolio approach to determine the estimated revenue adjustments. See further information in Note 4, Revenue Recognition . Government Grants The Company has received government grants primarily under the CARES Act PRF and the ARPA SLFRF to provide economic relief and stimulus to combat health and economic impacts of the COVID-19 pandemic. During the third quarter of 2023, the Company also filed amended payroll tax returns for 2020 and 2021 to claim refunds for Employee Retention Credits ("ERC"). ERC is a U.S. federal tax credit introduced to support businesses and organizations during the COVID-19 pandemic that was initially established under the CARES Act in 2020 and was later expanded and extended by subsequent legislation, including the Consolidated Appropriations Act of 2021 and the American Rescue Plan Act of 2021. The Company received distributions from these government grants of approximately $6.5 million and $1.4 million during the three months ended September 30, 2023 and 2022, respectively, of which $0.6 million and $0.8 million were recognized as grant income during the three months ended September 30, 2023 and 2022, respectively, with the remaining balance recorded in accrued expenses and other current liabilities. During the nine months ended September 30, 2023 and 2022, the Company received distributions of approximately $21.0 million and $10.4 million, respectively, of which $4.6 million was recognized as grant income during each of the the nine months ended September 30, 2023 and 2022, respectively, with the remaining balance recorded in accrued expenses and other current liabilities. Distributions received under these acts are targeted to assist with incremental health care related expenses or lost revenue attributable to the COVID-19 pandemic as well as provide stimulus to support long-term growth and recovery. The payments from these acts are subject to certain restrictions and possible recoupment if not used for designated purposes. As a condition to receiving PRF distributions, providers must agree to certain terms and conditions, including, among other things, that the funds are being used for healthcare related expenses and lost revenues attributable to COVID-19, as defined by HHS. All recipients of PRF payments are required to comply with the reporting requirements described in the terms and conditions and as determined by HHS. The Company has submitted the required documents to meet reporting requirements for the applicable reporting periods. The Company received an audit inquiry letter from HHS related to one of the business units that received PRF payments, to which the Company has responded and submitted all requested information and believes that the payments received are substantiated and within the terms and conditions defined by HHS and continues to include these amounts as grant income. At this time, the Company is unaware of any other pending or upcoming audits or inquiries related to amounts received under PRF. As a condition to receiving SLFRF distributions, providers must agree to use the funds to respond to the PHE or its negative economic impacts, to respond to workers performing essential work by providing premium pay to eligible workers and to offset reduction in revenue due to the COVID-19 PHE as stipulated by the states in which the funds were received. All recipients of SLFRF payments are required to comply with the reporting requirements that the state in which the funds originated has requested in order for the states to meet the requirements as described in the terms and conditions as determined by the Department of the Treasury. The Company has complied with all known reporting requirements to date. The Company recognizes distributions from government grants as grant income or accrued expenses and other current liabilities in line with the loss of revenues or expenses for which the grants are intended to compensate when there is reasonable assurance that it has complied with the conditions associated with the grant.
Recent Accounting Pronouncements	Recent Accounting Pronouncements The company did not adopt any material new accounting standards during the nine months ended September 30, 2023.

Segments (Tables)

Segments (Tables)	9 Months Ended
	Sep. 30, 2023
Segment Reporting [Abstract]
Schedule of Financial Information Attributable to the Company's Business Segments	The following table sets forth certain financial information from operations attributable to the Company’s business segments for the three and nine months ended September 30, 2023 and 2022 (in thousands): Three months ended September 30, 2023 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 485,951 $ 179,979 $ 19,779 $ 1,216 $ 686,925 Grant income (1) — 551 — — 551 Service expense 428,021 143,078 6,934 1,181 579,214 General and administrative expense 25,433 20,252 5,685 18,772 70,142 Depreciation and amortization 6,814 12,850 6,174 239 26,077 Operating income (loss) $ 25,683 $ 4,350 $ 986 $ (18,976) $ 12,043 Equity in net income (loss) of investee, net of tax $ 142 $ — $ — $ (302) $ (160) Equity investment $ 1,552 $ — $ — $ 43,655 $ 45,207 Goodwill $ 135,186 $ 415,444 $ 234,894 $ 30 $ 785,554 Total assets $ 512,032 $ 774,731 $ 346,257 $ 130,066 $ 1,763,086 Nine months ended September 30, 2023 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 1,452,389 $ 534,435 $ 57,702 $ 3,812 $ 2,048,338 Grant income (1) — 4,649 — — 4,649 Service expense 1,277,604 417,636 20,129 3,366 1,718,735 General and administrative expense 87,645 63,480 16,781 61,189 229,095 Depreciation and amortization 20,319 38,590 18,087 683 77,679 Impairment of goodwill — 137,331 45,769 — 183,100 Operating income (loss) $ 66,821 $ (117,953) $ (43,064) $ (61,426) $ (155,622) Equity in net income of investee, net of tax $ 984 $ — $ — $ 1,837 $ 2,821 Equity investment $ 1,552 $ — $ — $ 43,655 $ 45,207 Goodwill $ 135,186 $ 415,444 $ 234,894 $ 30 $ 785,554 Total assets $ 512,032 $ 774,731 $ 346,257 $ 130,066 $ 1,763,086 Three months ended September 30, 2022 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 459,796 $ 169,226 $ 18,760 $ — $ 647,782 Grant income (1) — 789 — — 789 Service expense 394,981 132,746 6,836 — 534,563 General and administrative expense 31,815 22,057 5,816 16,201 75,889 Depreciation and amortization 7,079 12,919 5,467 207 25,672 Operating income (loss) $ 25,921 $ 2,293 $ 641 $ (16,408) $ 12,447 Equity in net income (loss) of investee, net of tax $ 208 $ — $ — $ (26,656) $ (26,448) Equity investment $ 208 $ — $ — $ 43,269 $ 43,477 Goodwill $ 135,186 $ 552,775 $ 280,429 $ 30 $ 968,420 Total assets $ 517,930 $ 962,425 $ 402,929 $ 106,561 $ 1,989,845 Nine months ended September 30, 2022 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 1,309,449 $ 491,661 $ 49,362 $ — $ 1,850,472 Grant income (1) — 4,587 — — 4,587 Service expense 1,100,801 379,423 17,884 — 1,498,108 General and administrative expense 102,736 68,536 17,520 43,316 232,108 Depreciation and amortization 21,576 37,976 14,201 623 74,376 Operating income (loss) $ 84,336 $ 10,313 $ (243) $ (43,939) $ 50,467 Equity in net income (loss) of investee, net of tax $ 143 $ — $ — $ (28,163) $ (28,020) Equity investment $ 208 $ — $ — $ 43,269 $ 43,477 Goodwill $ 135,186 $ 552,775 $ 280,429 $ 30 $ 968,420 Total assets $ 517,930 $ 962,425 $ 402,929 $ 106,561 $ 1,989,845 (1) Grant income for the PCS segment includes funding received on a periodic basis from the PRF in relation to relief under the CARES Act and funding received from the SLFRF under ARPA in relation to economic recovery to combat health and economic impacts of the COVID-19 pandemic. See Note 2, Significant Accounting Policies and Recent Accounting Pronouncements.

Revenue Recognition (Tables)

Revenue Recognition (Tables)	9 Months Ended
	Sep. 30, 2023
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	The following table summarizes disaggregated revenue from contracts with customers by contract type for the three and nine months ended September 30, 2023 and September 30, 2022 (in thousands): Three months ended September 30, Nine months ended September 30, 2023 2022 2023 2022 NEMT capitated contracts $ 412,762 $ 399,859 $ 1,239,957 $ 1,145,694 NEMT FFS contracts 73,189 59,937 212,432 163,755 Total NEMT service revenue, net 485,951 459,796 1,452,389 1,309,449 PCS FFS contracts 179,979 169,226 534,435 491,661 RPM PMPM contracts 19,779 18,760 57,702 49,362 Other service revenue 1,216 — 3,812 — Total service revenue, net $ 686,925 $ 647,782 $ 2,048,338 $ 1,850,472
Schedule of Accounts Receivable	The following table provides information about accounts receivable, net (in thousands): September 30, 2023 December 31, 2022 Accounts receivable $ 204,097 $ 225,288 Allowance for doubtful accounts (1,396) (2,078) Accounts receivable, net $ 202,701 $ 223,210
Schedule of Other Account Liabilities	The following table provides information about other revenue related accounts included on the accompanying unaudited condensed consolidated balance sheets (in thousands): September 30, 2023 December 31, 2022 Accrued contract payables (1) $ 133,576 $ 194,287 Contract receivables (2) $ 129,275 $ 71,131 Long-term contract receivables (3) $ — $ 427 Deferred revenue, current $ 2,008 $ 2,202 (1) Accrued contract payables primarily represent overpayments and liability reserves on certain risk corridor, profit rebate and reconciliation contracts. See the contract payables and receivables activity below. (2) Contract receivables primarily represent underpayments and receivables on certain risk corridor, profit rebate, and reconciliation contracts. See the contract payables and receivables activity below. (3) Long-term contract receivables primarily represent future receivable balances on certain risk corridor, profit rebate and reconciliation contracts that may be received in greater than 12 months. The following table provides the summary activity of total contract payables and receivables as reported within the unaudited condensed consolidated balance sheets (in thousands): December 31, 2022 Additional Amounts Recorded Amounts Paid or Settled March 31, 2023 Reconciliation contract payables $ 25,853 $ 1,811 $ (18,110) $ 9,554 Profit rebate/corridor contract payables 155,161 22,316 (10,873) 166,604 Overpayments and other cash items 13,273 799 (2,610) 11,462 Total contract payables $ 194,287 $ 24,926 $ (31,593) $ 187,620 Reconciliation contract receivables $ 48,153 $ 22,204 $ (5,922) $ 64,435 Corridor contract receivables 23,405 14,508 — 37,913 Total contract receivables $ 71,558 $ 36,712 $ (5,922) $ 102,348 March 31, 2023 Additional Amounts Recorded Amounts Paid or Settled June 30, 2023 Reconciliation contract payables $ 9,554 $ 6,687 $ (2,749) $ 13,492 Profit rebate/corridor contract payables 166,604 17,447 (98,683) 85,368 Overpayments and other cash items 11,462 2,707 (3,935) 10,234 Total contract payables $ 187,620 $ 26,841 $ (105,367) $ 109,094 Reconciliation contract receivables $ 64,435 $ 16,686 $ (15,105) $ 66,016 Corridor contract receivables 37,913 16,290 (456) 53,747 Total contract receivables $ 102,348 $ 32,976 $ (15,561) $ 119,763 June 30, 2023 Additional Amounts Recorded Amounts Paid or Settled September 30, 2023 Reconciliation contract payables $ 13,492 $ 4,763 $ (3,034) $ 15,221 Profit rebate/corridor contract payables 85,368 10,614 (1,840) 94,142 Overpayments and other cash items 10,234 16,313 (2,334) 24,213 Total contract payables $ 109,094 $ 31,690 $ (7,208) $ 133,576 Reconciliation contract receivables $ 66,016 $ 14,180 $ (19,460) $ 60,736 Corridor contract receivables 53,747 14,792 — 68,539 Total contract receivables $ 119,763 $ 28,972 $ (19,460) $ 129,275

Equity Investment (Tables)

Equity Investment (Tables)	9 Months Ended
	Sep. 30, 2023
Equity Method Investment, Summarized Financial Information [Abstract]
Schedule of Income Statement and Balance Sheet Disclosure	Summary financial information for Matrix on a standalone basis is as follows (in thousands): September 30, 2023 December 31, 2022 Current assets $ 112,994 $ 97,750 Long-term assets $ 355,143 $ 373,297 Current liabilities $ 34,955 $ 36,913 Long-term liabilities $ 317,806 $ 325,613 Three months ended September 30, Nine months ended September 30, 2023 2022 2023 2022 Revenue $ 84,395 $ 76,461 $ 252,973 $ 235,582 Operating income (loss) $ 7,593 $ (79,992) $ 32,196 $ (81,604) Net income (loss) $ (239) $ (85,081) $ 6,976 $ (93,211)

Prepaid Expenses and Other Cu_2

Prepaid Expenses and Other Current Assets (Tables)	9 Months Ended
	Sep. 30, 2023
Prepaid Expense and Other Assets, Current [Abstract]
Schedule of Prepaid Expenses and Other Current Assets	Prepaid expenses and other current assets were comprised of the following (in thousands): September 30, 2023 December 31, 2022 Prepaid insurance $ 8,251 $ 6,334 Deferred ERP implementation costs 5,070 5,817 Prepaid income taxes 4,075 7,186 Deferred financing costs on credit facility 2,864 3,061 Inventory 2,261 2,041 Prepaid rent 1,152 278 Other prepaid expenses 14,896 9,615 Total prepaid expenses and other current assets $ 38,569 $ 34,332

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2023
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	Changes in the carrying value of goodwill by reportable segment are presented in the following table (in thousands): NEMT PCS RPM Corporate and Other Total Balance at December 31, 2022 $ 135,186 $ 552,775 $ 280,663 $ 30 $ 968,654 Impairment of goodwill — (137,331) (45,769) — (183,100) Balance at September 30, 2023 $ 135,186 $ 415,444 $ 234,894 $ 30 $ 785,554

Accrued Expenses and Other Cu_2

Accrued Expenses and Other Current Liabilities (Tables)	9 Months Ended
	Sep. 30, 2023
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses and other current liabilities were comprised of the following (in thousands): September 30, 2023 December 31, 2022 Accrued compensation and related liabilities $ 47,183 $ 47,947 Accrued interest 24,855 10,643 Insurance reserves 19,439 17,836 Accrued operating expenses 13,788 18,432 Accrued legal fees 12,002 15,574 Accrued government grants (1) 10,970 7,367 Union pension obligation 2,970 3,665 Deferred revenue 2,008 2,202 Other 13,349 12,194 Total accrued expenses and other current liabilities $ 146,564 $ 135,860 (1) Accrued government grants include payments received from government entities, primarily in relation to the PRF and SLFRF, to offset lost revenue or increased expenditures for which the related expenditure has not yet been incurred and thus the related payments are deferred as of September 30, 2023 and December 31, 2022.

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2023
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	Senior unsecured notes as of September 30, 2023 and December 31, 2022 consisted of the following (in thousands): Senior Unsecured Note Date of Issuance September 30, 2023 December 31, 2022 $500.0 million 5.875% due November 15, 2025 (effective interest rate 6.467%) 11/4/2020 $ 493,265 $ 491,098 $500.0 million 5.000% due October 1, 2029 (effective interest rate 5.392%) 8/24/2021 489,365 488,263 Total $ 982,630 $ 979,361

Loss Per Share (Tables)

Loss Per Share (Tables)	9 Months Ended
	Sep. 30, 2023
Earnings Per Share [Abstract]
Schedule of Basic and Diluted Loss Per Share	The following table details the computation of basic and diluted loss per share (in thousands, except share and per share data): Three months ended September 30, Nine months ended September 30, 2023 2022 2023 2022 Numerator: Net loss $ (4,302) $ (28,505) $ (199,208) $ (24,859) Denominator: Denominator for basic earnings per share -- weighted-average shares 14,182,839 14,051,794 14,169,537 14,041,224 Effect of dilutive securities: Common stock options — — — — Restricted stock — — — — Denominator for diluted earnings per share -- adjusted weighted-average shares assumed conversion 14,182,839 14,051,794 14,169,537 14,041,224 Loss per share: Basic loss per share $ (0.30) $ (2.03) $ (14.06) $ (1.77) Diluted loss per share $ (0.30) $ (2.03) $ (14.06) $ (1.77)
Schedule of Antidilutive Securities	The following weighted-average shares were not included in the computation of diluted earnings per share as the effect of their inclusion would have been anti-dilutive: Three months ended September 30, Nine months ended September 30, 2023 2022 2023 2022 Stock options to purchase common stock 90,579 115,686 96,725 123,534 Restricted stock awards and restricted stock units 141,712 80,332 97,719 82,944

Organization and Basis of Pre_2

Organization and Basis of Presentation (Details)	Sep. 30, 2023
Matrix Investment
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]
Equity method investment, ownership percentage	43.60%

Significant Accounting Polici_3

Significant Accounting Policies and Recent Accounting Pronouncements (Details) - USD ($)	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Disaggregation of Revenue [Line Items]
Impairment of goodwill	$ 0	$ 183,100,000	$ 0	$ 183,100,000	$ 0
Capitalized costs, net of accumulated amortization	14,600,000			14,600,000		$ 11,900,000
Capitalized costs, accumulated amortization	4,100,000			4,100,000		$ 2,200,000
Capitalized costs, amortization expense	600,000		500,000	1,800,000	900,000
Grant income	551,000		789,000	4,649,000	4,587,000
Grant Income
Disaggregation of Revenue [Line Items]
Grant income	$ 6,500,000		$ 1,400,000	$ 21,000,000	$ 10,400,000
Software Development | Minimum
Disaggregation of Revenue [Line Items]
Finite-lived intangible asset, useful life	3 years			3 years
Software Development | Maximum
Disaggregation of Revenue [Line Items]
Finite-lived intangible asset, useful life	10 years			10 years

Segments - Narrative (Details)

Segments - Narrative (Details)	9 Months Ended
	Sep. 30, 2023 segment
Segment Reporting [Abstract]
Number of reportable segments	4

Segments - Schedule of Financia

Segments - Schedule of Financial Information Attributable to the Company's Business Segments (Details) - USD ($)	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Segment Reporting Information [Line Items]
Service revenue, net	$ 686,925,000		$ 647,782,000	$ 2,048,338,000	$ 1,850,472,000
Grant income	551,000		789,000	4,649,000	4,587,000
Service expense	579,214,000		534,563,000	1,718,735,000	1,498,108,000
General and administrative expense	70,142,000		75,889,000	229,095,000	232,108,000
Depreciation and amortization	26,077,000		25,672,000	77,679,000	74,376,000
Impairment of goodwill	0	$ 183,100,000	0	183,100,000	0
Operating income (loss)	12,043,000		12,447,000	(155,622,000)	50,467,000
Equity in net income (loss) of investee, net of tax	(160,000)		(26,448,000)	2,821,000	(28,020,000)
Equity investment	45,207,000		43,477,000	45,207,000	43,477,000	$ 41,303,000
Goodwill	785,554,000		968,420,000	785,554,000	968,420,000	968,654,000
Total assets	1,763,086,000		1,989,845,000	1,763,086,000	1,989,845,000	1,944,272,000
NEMT
Segment Reporting Information [Line Items]
Service revenue, net	485,951,000		459,796,000	1,452,389,000	1,309,449,000
Grant income	0		0	0	0
Service expense	428,021,000		394,981,000	1,277,604,000	1,100,801,000
General and administrative expense	25,433,000		31,815,000	87,645,000	102,736,000
Depreciation and amortization	6,814,000		7,079,000	20,319,000	21,576,000
Impairment of goodwill				0
Operating income (loss)	25,683,000		25,921,000	66,821,000	84,336,000
Equity in net income (loss) of investee, net of tax	142,000		208,000	984,000	143,000
Equity investment	1,552,000		208,000	1,552,000	208,000
Goodwill	135,186,000		135,186,000	135,186,000	135,186,000	135,186,000
Total assets	512,032,000		517,930,000	512,032,000	517,930,000
PCS
Segment Reporting Information [Line Items]
Service revenue, net	179,979,000		169,226,000	534,435,000	491,661,000
Grant income	551,000		789,000	4,649,000	4,587,000
Service expense	143,078,000		132,746,000	417,636,000	379,423,000
General and administrative expense	20,252,000		22,057,000	63,480,000	68,536,000
Depreciation and amortization	12,850,000		12,919,000	38,590,000	37,976,000
Impairment of goodwill		137,300,000		137,331,000
Operating income (loss)	4,350,000		2,293,000	(117,953,000)	10,313,000
Equity in net income (loss) of investee, net of tax	0		0	0	0
Equity investment	0		0	0	0
Goodwill	415,444,000		552,775,000	415,444,000	552,775,000	552,775,000
Total assets	774,731,000		962,425,000	774,731,000	962,425,000
RPM
Segment Reporting Information [Line Items]
Service revenue, net	19,779,000		18,760,000	57,702,000	49,362,000
Grant income	0		0	0	0
Service expense	6,934,000		6,836,000	20,129,000	17,884,000
General and administrative expense	5,685,000		5,816,000	16,781,000	17,520,000
Depreciation and amortization	6,174,000		5,467,000	18,087,000	14,201,000
Impairment of goodwill		$ 45,800,000		45,769,000
Operating income (loss)	986,000		641,000	(43,064,000)	(243,000)
Equity in net income (loss) of investee, net of tax	0		0	0	0
Equity investment	0		0	0	0
Goodwill	234,894,000		280,429,000	234,894,000	280,429,000	280,663,000
Total assets	346,257,000		402,929,000	346,257,000	402,929,000
Corporate and Other
Segment Reporting Information [Line Items]
Service revenue, net	1,216,000		0	3,812,000	0
Grant income	0		0	0	0
Service expense	1,181,000		0	3,366,000	0
General and administrative expense	18,772,000		16,201,000	61,189,000	43,316,000
Depreciation and amortization	239,000		207,000	683,000	623,000
Impairment of goodwill				0
Operating income (loss)	(18,976,000)		(16,408,000)	(61,426,000)	(43,939,000)
Equity in net income (loss) of investee, net of tax	(302,000)		(26,656,000)	1,837,000	(28,163,000)
Equity investment	43,655,000		43,269,000	43,655,000	43,269,000
Goodwill	30,000		30,000	30,000	30,000	$ 30,000
Total assets	$ 130,066,000		$ 106,561,000	$ 130,066,000	$ 106,561,000

Revenue Recognition - Schedule

Revenue Recognition - Schedule of Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disaggregation of Revenue [Line Items]
Total service revenue, net	$ 686,925	$ 647,782	$ 2,048,338	$ 1,850,472
Other service revenue
Disaggregation of Revenue [Line Items]
Total service revenue, net	1,216	0	3,812	0
NEMT
Disaggregation of Revenue [Line Items]
Total service revenue, net	485,951	459,796	1,452,389	1,309,449
NEMT | Capitated Contracts
Disaggregation of Revenue [Line Items]
Total service revenue, net	412,762	399,859	1,239,957	1,145,694
NEMT | FFS Contracts
Disaggregation of Revenue [Line Items]
Total service revenue, net	73,189	59,937	212,432	163,755
PCS
Disaggregation of Revenue [Line Items]
Total service revenue, net	179,979	169,226	534,435	491,661
PCS | FFS Contracts
Disaggregation of Revenue [Line Items]
Total service revenue, net	179,979	169,226	534,435	491,661
RPM
Disaggregation of Revenue [Line Items]
Total service revenue, net	19,779	18,760	57,702	49,362
RPM | RPM PMPM contracts
Disaggregation of Revenue [Line Items]
Total service revenue, net	$ 19,779	$ 18,760	$ 57,702	$ 49,362

Revenue Recognition - Narrative

Revenue Recognition - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
NEMT
Disaggregation of Revenue [Line Items]
Performance obligation satisfied in previous period, increase (decrease)	$ (0.8)	$ 1.7	$ (3.9)	$ 6.5
NEMT | One US State | Sales Revenue, Net | Government Contracts Concentration Risk | Continuing Operations
Disaggregation of Revenue [Line Items]
Concentration risk, percentage	11.40%	10.40%	11.20%	11%
PCS | One US State | Sales Revenue, Net | Government Contracts Concentration Risk | Continuing Operations
Disaggregation of Revenue [Line Items]
Concentration risk, percentage	11.40%	12.10%	11.30%	12%
RPM | One US State | Sales Revenue, Net | Government Contracts Concentration Risk | Continuing Operations
Disaggregation of Revenue [Line Items]
Concentration risk, percentage	19.30%	18.40%	17.40%	20.40%

Revenue Recognition - Schedul_2

Revenue Recognition - Schedule of Accounts Receivable (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Revenue from Contract with Customer [Abstract]
Accounts receivable	$ 204,097	$ 225,288
Allowance for doubtful accounts	(1,396)	(2,078)
Accounts receivable, net	$ 202,701	$ 223,210

Revenue Recognition - Schedul_3

Revenue Recognition - Schedule of Other Accounts (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Revenue from Contract with Customer [Abstract]
Accrued contract payables	$ 133,576	$ 194,287
Contracts receivables	129,275	71,131
Long-term contract receivables	0	427
Deferred revenue, current	$ 2,008	$ 2,202

Revenue Recognition - Schedul_4

Revenue Recognition - Schedule of Contract Payables and Receivables (Details) - USD ($) $ in Thousands	3 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023
Summary of Contract Payables [Roll Forward]
Contract with customer, liability beginning of period	$ 109,094	$ 187,620	$ 194,287
Contract with customer, liability, additional amounts recorded	31,690	26,841	24,926
Contract with customer, liability, amounts paid or settled	(7,208)	(105,367)	(31,593)
Contract with customer, liability end of period	133,576	109,094	187,620
Summary of Receivables [Roll Forward]
Contract with customer, asset, beginning of period	119,763	102,348	71,558
Contract with customer, asset, additional amounts recorded	28,972	32,976	36,712
Contract with customer, asset, amounts paid or settled	(19,460)	(15,561)	(5,922)
Contract with customer, asset, end of period	129,275	119,763	102,348
Reconciliation Contract
Summary of Contract Payables [Roll Forward]
Contract with customer, liability beginning of period	13,492	9,554	25,853
Contract with customer, liability, additional amounts recorded	4,763	6,687	1,811
Contract with customer, liability, amounts paid or settled	(3,034)	(2,749)	(18,110)
Contract with customer, liability end of period	15,221	13,492	9,554
Summary of Receivables [Roll Forward]
Contract with customer, asset, beginning of period	66,016	64,435	48,153
Contract with customer, asset, additional amounts recorded	14,180	16,686	22,204
Contract with customer, asset, amounts paid or settled	(19,460)	(15,105)	(5,922)
Contract with customer, asset, end of period	60,736	66,016	64,435
Profit Rebate Contract Payable
Summary of Contract Payables [Roll Forward]
Contract with customer, liability beginning of period	85,368	166,604	155,161
Contract with customer, liability, additional amounts recorded	10,614	17,447	22,316
Contract with customer, liability, amounts paid or settled	(1,840)	(98,683)	(10,873)
Contract with customer, liability end of period	94,142	85,368	166,604
Summary of Receivables [Roll Forward]
Contract with customer, asset, beginning of period	53,747	37,913	23,405
Contract with customer, asset, additional amounts recorded	14,792	16,290	14,508
Contract with customer, asset, amounts paid or settled	0	(456)	0
Contract with customer, asset, end of period	68,539	53,747	37,913
Overpayments and Other Cash Items
Summary of Contract Payables [Roll Forward]
Contract with customer, liability beginning of period	10,234	11,462	13,273
Contract with customer, liability, additional amounts recorded	16,313	2,707	799
Contract with customer, liability, amounts paid or settled	(2,334)	(3,935)	(2,610)
Contract with customer, liability end of period	$ 24,213	$ 10,234	$ 11,462

Equity Investment - Narrative (

Equity Investment - Narrative (Details) - USD ($)	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Schedule of Equity Method Investments [Line Items]
Operating income (loss)	$ 12,043,000	$ 12,447,000	$ (155,622,000)	$ 50,467,000
Equity investments	45,207,000	43,477,000	45,207,000	43,477,000	$ 41,303,000
Matrix
Schedule of Equity Method Investments [Line Items]
Operating income (loss)	7,593,000	(79,992,000)	32,196,000	(81,604,000)
Net income (loss)	$ (300,000)	(26,700,000)	$ 1,800,000	(28,200,000)
Matrix
Schedule of Equity Method Investments [Line Items]
Equity method investment, ownership percentage	43.60%		43.60%		43.60%
Impairment	$ 0	0	$ 0	0	$ 82,200,000
Operating income (loss)	(400,000)	$ (36,100,000)	2,500,000	$ (39,000,000)
Equity investments	$ 45,200,000		$ 45,200,000		$ 41,300,000

Equity Investment - Schedule of

Equity Investment - Schedule of Income Statement and Balance Sheet Disclosure (Details) - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Schedule of Investments [Line Items]
Current assets	$ 387,941						$ 387,941		$ 346,154
Current liabilities	516,850						516,850		491,597
Operating income (loss)	12,043			$ 12,447			(155,622)	$ 50,467
Net income (loss)	(4,302)	$ (190,944)	$ (3,962)	(28,505)	$ 3,328	$ 318	(199,208)	(24,859)
Matrix
Schedule of Investments [Line Items]
Current assets	112,994						112,994		97,750
Long-term assets	355,143						355,143		373,297
Current liabilities	34,955						34,955		36,913
Long-term liabilities	317,806						317,806		$ 325,613
Revenue	84,395			76,461			252,973	235,582
Operating income (loss)	7,593			(79,992)			32,196	(81,604)
Net income (loss)	$ (239)			$ (85,081)			$ 6,976	$ (93,211)

Prepaid Expenses and Other Cu_3

Prepaid Expenses and Other Current Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Prepaid Expense and Other Assets, Current [Abstract]
Prepaid insurance	$ 8,251	$ 6,334
Deferred ERP implementation costs	5,070	5,817
Prepaid income taxes	4,075	7,186
Deferred financing costs on credit facility	2,864	3,061
Inventory	2,261	2,041
Prepaid rent	1,152	278
Other prepaid expenses	14,896	9,615
Total prepaid expenses and other current assets	$ 38,569	$ 34,332

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Narrative (Details) - USD ($)	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
GoodwillLineItems
Impairment of goodwill	$ 0	$ 183,100,000	$ 0	$ 183,100,000	$ 0
Goodwill	785,554,000		968,420,000	785,554,000	968,420,000	$ 968,654,000
Accumulated impairment losses	279,100,000			279,100,000		96,000,000
Personal Care and Remote Patient Monitoring
GoodwillLineItems
Goodwill	650,300,000			650,300,000
PCS
GoodwillLineItems
Impairment of goodwill		137,300,000		137,331,000
Goodwill	415,444,000		552,775,000	415,444,000	552,775,000	552,775,000
RPM
GoodwillLineItems
Impairment of goodwill		$ 45,800,000		45,769,000
Goodwill	$ 234,894,000		$ 280,429,000	$ 234,894,000	$ 280,429,000	$ 280,663,000

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Schedule of Goodwill (Details) - USD ($)	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Goodwill [Roll Forward]
Goodwill - beginning balance				$ 968,654,000
Impairment of goodwill	$ 0	$ (183,100,000)	$ 0	(183,100,000)	$ 0
Goodwill - ending balance	785,554,000		968,420,000	785,554,000	968,420,000
NEMT
Goodwill [Roll Forward]
Goodwill - beginning balance				135,186,000
Impairment of goodwill				0
Goodwill - ending balance	135,186,000		135,186,000	135,186,000	135,186,000
PCS
Goodwill [Roll Forward]
Goodwill - beginning balance				552,775,000
Impairment of goodwill		(137,300,000)		(137,331,000)
Goodwill - ending balance	415,444,000		552,775,000	415,444,000	552,775,000
RPM
Goodwill [Roll Forward]
Goodwill - beginning balance				280,663,000
Impairment of goodwill		$ (45,800,000)		(45,769,000)
Goodwill - ending balance	234,894,000		280,429,000	234,894,000	280,429,000
Corporate and Other
Goodwill [Roll Forward]
Goodwill - beginning balance				30,000
Impairment of goodwill				0
Goodwill - ending balance	$ 30,000		$ 30,000	$ 30,000	$ 30,000

Accrued Expenses and Other Cu_3

Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Payables and Accruals [Abstract]
Accrued compensation and related liabilities	$ 47,183	$ 47,947
Accrued interest	24,855	10,643
Insurance reserves	19,439	17,836
Accrued operating expenses	13,788	18,432
Accrued legal fees	12,002	15,574
Accrued government grants	10,970	7,367
Union pension obligation	2,970	3,665
Deferred revenue	2,008	2,202
Other	13,349	12,194
Total accrued expenses and other current liabilities	$ 146,564	$ 135,860

Debt - Schedule of Long Term De

Debt - Schedule of Long Term Debt Instruments (Details) - Senior Notes - USD ($) $ in Thousands	Sep. 30, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Total long-term debt	$ 982,630	$ 979,361
2025 Senior Notes
Debt Instrument [Line Items]
Face amount	$ 500,000
Stated interest rate	5.875%
Effective interest rate	6.467%
Total long-term debt	$ 493,265	491,098
2029 Senior Notes
Debt Instrument [Line Items]
Face amount	$ 500,000
Stated interest rate	5%
Effective interest rate	5.392%
Total long-term debt	$ 489,365	$ 488,263

Debt - Narrative (Details)

Debt - Narrative (Details)		9 Months Ended
	Jun. 26, 2023	Sep. 30, 2023 USD ($)	Dec. 31, 2022 USD ($)	Feb. 03, 2022 USD ($)
Line of Credit Facility [Line Items]
Deferred financing fees		$ 17,370,000	$ 20,639,000
Senior Notes
Line of Credit Facility [Line Items]
Unamortized debt issuance expense		17,400,000
Fair value		836,300,000	896,600,000
Credit Agreement
Line of Credit Facility [Line Items]
Letters of credit outstanding		$ 83,000,000
Interest rate for borrowings outstanding		9.80%
Additional maximum borrowing capacity		$ 175,000,000
Debt instrument, covenant, maximum indebtedness principal amount				$ 40,000,000
Credit Agreement | Maximum
Line of Credit Facility [Line Items]
Unused capacity, commitment fee percentage		0.50%
Credit Agreement | Maximum | Term Benchmark loans
Line of Credit Facility [Line Items]
Basis spread on variable rate		3.50%
Credit Agreement | Maximum | Alternate Base Rate
Line of Credit Facility [Line Items]
Basis spread on variable rate		2.50%
Credit Agreement | Minimum
Line of Credit Facility [Line Items]
Unused capacity, commitment fee percentage		0.30%
Credit Agreement | Minimum | Term Benchmark loans
Line of Credit Facility [Line Items]
Basis spread on variable rate		1.75%
Credit Agreement | Minimum | Alternate Base Rate
Line of Credit Facility [Line Items]
Basis spread on variable rate		0.75%
Credit Agreement | June 30, 2023 through September 30, 2023
Line of Credit Facility [Line Items]
Debt instrument, maximum permitted total net leverage ratio	5.25
Credit Agreement | December 31, 2023 through March 31, 2024
Line of Credit Facility [Line Items]
Debt instrument, maximum permitted total net leverage ratio	5
Credit Agreement | June 30, 2024
Line of Credit Facility [Line Items]
Debt instrument, maximum permitted total net leverage ratio	4.75
Credit Agreement | September 30, 2024
Line of Credit Facility [Line Items]
Debt instrument, maximum permitted total net leverage ratio	4.50
Credit Agreement | Thereafter
Line of Credit Facility [Line Items]
Debt instrument, maximum permitted total net leverage ratio	4.50
Credit Agreement | Revolving Credit Facility
Line of Credit Facility [Line Items]
Maximum borrowing capacity				325,000,000
Credit Agreement | Revolving Credit Facility | Maximum
Line of Credit Facility [Line Items]
Unused capacity, commitment fee percentage		3.50%
Credit Agreement | Revolving Credit Facility | Minimum
Line of Credit Facility [Line Items]
Unused capacity, commitment fee percentage		1.75%
Credit Agreement | Bridge Loan
Line of Credit Facility [Line Items]
Maximum borrowing capacity				25,000,000
Credit Agreement | Letter of Credit
Line of Credit Facility [Line Items]
Maximum borrowing capacity				60,000,000
Letters of credit outstanding		$ 39,100,000	$ 38,100,000
Credit Agreement | Letter of Credit | Maximum
Line of Credit Facility [Line Items]
Debt instrument, pro forma net leverage ratio		3.50
Credit Agreement | Alternative Currency Loan
Line of Credit Facility [Line Items]
Maximum borrowing capacity				$ 75,000,000
2025 Senior Notes | Senior Notes
Line of Credit Facility [Line Items]
Deferred financing fees		$ 14,500,000
2029 Senior Notes | Senior Notes
Line of Credit Facility [Line Items]
Deferred financing fees		$ 13,500,000

Stock-Based Compensation and _2

Stock-Based Compensation and Similar Arrangements - Narrative (Details) - USD ($)	3 Months Ended			9 Months Ended
	Sep. 30, 2023	Dec. 31, 2022	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation	$ 0			$ 0
Period for recognition				3 years
Employee Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for purchase (in shares)		1,000,000
Annual maximum payroll deduction amount		$ 25,000
Purchase price of common stock, percent		85%
Total shares of common stock reserved for future issuance (in shares)	989,186			989,186
Common stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation	$ 200,000		$ 300,000	$ 600,000	$ 1,000,000
Stock options outstanding (in shares)	87,388			87,388
Weighted-average exercise price (in dollars per share)	$ 106.51			$ 106.51
Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation	$ 1,100,000			$ 2,900,000
Shares of unvested RSAs outstanding (in shares)	16,074			16,074
Weighted-average grant date fair value (in dollars per share)	$ 80.47			$ 80.47
Restricted stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation			700,000		3,500,000
Shares of unvested RSAs outstanding (in shares)	285,472			285,472
Weighted-average grant date fair value (in dollars per share)	$ 43.86			$ 43.86
Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation	$ 400,000		$ (200,000)	$ 500,000	$ 600,000
Shares of unvested RSAs outstanding (in shares)	213,428			213,428
Weighted-average grant date fair value (in dollars per share)	$ 43.74			$ 43.74
Award vesting period				3 years

Loss Per Share - Schedule of Lo

Loss Per Share - Schedule of Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2022	Jun. 30, 2022	Mar. 31, 2022	Sep. 30, 2023	Sep. 30, 2022
Numerator:
Net loss	$ (4,302)	$ (190,944)	$ (3,962)	$ (28,505)	$ 3,328	$ 318	$ (199,208)	$ (24,859)
Denominator:
Denominator for basic earnings per share -- weighted-average shares (in shares)	14,182,839			14,051,794			14,169,537	14,041,224
Effect of dilutive securities:
Denominator for diluted earnings per share -- adjusted weighted-average shares assumed conversion (in shares)	14,182,839			14,051,794			14,169,537	14,041,224
Loss per share:
Basic loss per share (in dollars per share)	$ (0.30)			$ (2.03)			$ (14.06)	$ (1.77)
Diluted loss per share (in dollars per share)	$ (0.30)			$ (2.03)			$ (14.06)	$ (1.77)
Common stock options
Effect of dilutive securities:
Common stock options (in shares)	0			0			0	0
Restricted stock
Effect of dilutive securities:
Restricted stock (in shares)	0			0			0	0

Loss Per Share - Schedule of An

Loss Per Share - Schedule of Antidilutive Securities (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Stock options to purchase common stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)	90,579	115,686	96,725	123,534
Restricted stock awards and restricted stock units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)	141,712	80,332	97,719	82,944

Income Taxes (Details)

Income Taxes (Details)	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Income Tax Disclosure [Abstract]
Effective income tax rate	28.60%	33.90%	2.10%	(21.70%)

Commitments and Contingencies (

Commitments and Contingencies (Details) $ in Millions	1 Months Ended
	May 31, 2023 USD ($)
Commitments and Contingencies Disclosure [Abstract]
Litigation settlement amount	$ 9.6