How to Start a NEMT Business? Full Guide

Disclaimer: Please note that this article is published for informational purposes and does not provide legal advice. 

This article has been updated on 04/17/2024. 

The medical industry presents many opportunities for business owners wanting to help people. Sure, doctors and nurses provide hands-on care, but other less visible workers are equally important to the big picture. 

For example, ambulances and non-emergency medical transport providers carry patients to and from appointments, meeting the critical demand for medical transportation in the US. 

A growing elderly demographic, increased prevalence of lifestyle-related diseases and chronic conditions, and uneven distribution of hospitals across the country mean many citizens depend on specialized transport for healthcare access.  

Research estimates that by 2028 the global NEMT market will reach $15.57 billion globally. The report also predicted “robust growth” in the medical transportation industry, predicting its value will hit $ 23 billion by 2031 with an impressive compound annual growth rate (CAGR) of 12%. 

If you want to enter this expanding market, now is the time to create an NEMT business plan for your company.

What Exactly is a Non-Emergency Medical Transportation Business?

Before you learn how to start a medical transportation business, you must make an important decision: Ambulance or NEMT? Most people picture an ambulance when thinking about medical transport, but non-emergency medical transportation is an entirely different service. 

NEMT services help patients get to and from medical visits. These services meet patients’ special needs, like if they need extra room for a wheelchair or walker. For the most part, passengers schedule NEMT ahead of time and get picked up and dropped off at set locations. The dispatcher, driver, and any assistants know what each patient requires and make sure everything goes smoothly during the trip.

Ambulances are much more specialized vehicles equipped with a stretcher and medical gear to monitor patients. There are also EMTs on board who can assess patients in an emergency and get them stable en route to the hospital. These vehicles are equipped for dire medical situations where someone needs urgent care.

Operating an ambulance costs a lot more than NEMT. However, since medical transportation is covered by some private insurance providers and Medicaid, it can be a good business opportunity for a healthcare entrepreneur. It’s also much more flexible and diverse, coming in a range of forms. 

Types of NEMT Services

If you want to open an NEMT business, you must decide whether to offer a specialized medical transport service or a variety of them. 

The most common types of NEMT services are:

  • Ambulatory transportation: Meant for passengers who are mostly mobile without any assistance. These vehicles are customized to provide spacious, comfortable seating with room for patients to keep canes or walkers.

  • Wheelchair transportation: To help patients in wheelchairs, NEMT companies need a customized van with ramps and lifts to get wheelchairs inside. These bigger rides are usually manned by drivers trained to provide basic medical assistance.

  • Stretcher medical transportation: Bedridden individuals need medical attention more regularly than most. NEMT providers should have vehicles that can fit a stretcher, plus an additional orderly to assist the driver in loading and unloading the patient.

  • Courier service: Some patients might need specialized equipment like oxygen tanks delivered to their homes. Medical transportation courier services can also bring medical supplies while maintaining standards set by the Health Insurance Portability and Accountability Act (HIPAA). 


6 Simple Steps to Start an NEMT Business

Once you know what kind of NEMT services to offer, you are ready to learn how to start a medical transportation business. 

We’ve outlined six simple steps for opening an NEMT company:

1. Establish a business entity

Talk to a lawyer and accountant to decide how to set up your NEMT company legally. Each business structure impacts taxes and liability differently.

You can choose one of the following:

  • Sole proprietorship: While easy to start and maintain, you are personally liable for debts and legal issues as the sole proprietor.
  • Limited Liability Company (LLC): This structure protects personal assets from business setbacks while offering flexibility on tax structure.
  • Partnership: Similar to sole proprietorship, except liability is shared between all the partners.
  • Corporation: Offers tax advantages and liability protection because profits are being distributed among shareholders.


2. Acquire necessary license

Before anything else, you need the proper licenses to run a medical transportation service in your state. Before investing further resources into your new NEMT company, you must apply for, at minimum, a business license, a motor carrier permit, commercial auto insurance, and a hazardous materials permit. 

3. Set up a fleet

As for vehicles, most medical transportation companies start small with a van or two, either bought or even rented. The goal over time is to build up a full fleet of vehicles that can provide services to as many patients as possible.

Make sure that all vehicles meet the standards of the Americans with Disabilities Act (ADA) with the following features:

  • 56-inch door opening height 
  • Minimum 30-inch width for wheelchair lifts
  • Gearshift interlock 
  • Four tie-downs with lap and shoulder belt 

In summary, get your legal/financial structure set, obtain the right permits, and gradually build an ADA-compliant fleet. Do all that, and you’ll be on your way to running an NEMT business.

4. Find and hire qualified personnel

For your NEMT business to thrive, you need a team of skilled professionals. Here’s what you should look for when hiring employees for your NEMT company:

  • Drivers: NEMT drivers need the right licenses and training to help passengers and treat them professionally and with courtesy. Perform thorough criminal background checks and look through driving records before hiring.
  • Dispatchers: Hiring a dispatcher might work if you have a small fleet, but you should equip them with efficient NEMT software as you scale up your business. These tools have automated dispatching features that reduce human error and overhead costs.
  • Manager: office managers should be able to switch between tasks easily, handle logistics of pick-up and drop-off, oversee billing activities, schedule appointments, and deal with customers. Once again, NEMT software is a multi-faceted tool that can be used to great effect in all these areas by office managers.

5. Insurance

Providing NEMT services means interacting with vulnerable, disadvantaged populations. In the event of an accident, you will need insurance to cover damages and protect your business. 

The cost of medical transport business insurance will depend on number of workers, how big your fleet is, and what kinds of services you offer.

6. Get the Clients

At this stage, you are ready to launch an NEMT business. But a critical step remains if you want to succeed: you need to attract the clientele who will use your NEMT services.

There are several ways to promote your business and get patients to use your services.


Launch a website with a simple user interface for clients to request NEMT services. 

Building a website will incur the following expenses:

  • Web hosting
  • Website builder or web development
  • Paid ads
  • Search engine optimization

Costs will vary significantly depending on your needs. There are free and DIY options for all of the above, but you must manage your expectations regarding results. Freelancers and agencies offer their services at varying price points depending on their experience and the scope of your project.

Social Media

Be active on all the big platforms like Facebook, Instagram, and X/Twitter, and talk with your target audience.


One really effective way medical transport companies can spread the word in their community is through local referrals. Partner with clinics, hospitals, and patient centers to put brochures and flyers to promote your business to those who need you the most.

Enter the NEMT Industry

With this primer, you have what you need to take on starting your own NEMT business.  There’s definitely room for growth in the industry, but it takes time to build up a customer base, and you need some significant resources to get up and running. 

Always do a cost/benefit check before jumping into any new business, NEMT included. Once established, make sure you get the medical transportation software to optimize your operations and prepare for growth. 


Are NEMT businesses profitable?

Yes. When run efficiently, NEMT businesses can be reliable profit generators. Several factors decide how much profit your NEMT business will make, including operational costs, labor expenses, insurance premiums, and patient payment plans. Despite this, a healthy NEMT business can expect to see between $40,000 and $60,000 in profits on an annual basis.

How much does an NEMT business make?

The revenue your NEMT business will generate depends on the scale and scope of your operations. Factors like local regulations, regional pricing differences, brand image, and overhead costs all play a role in determining how much money an NEMT business makes. Studies have shown that a single NEMT vehicle can generate $30,000 to $56,000 a year.