Non-emergency medical transportation, NEMT, is the ride to dialysis, to physical therapy, to the oncology clinic, for people who can't drive themselves and don't need an ambulance. Two kinds of customers book those rides. In many states, Medicaid-covered rides are arranged through a broker that assigns trips to approved providers. Separately, dialysis centers, rehab units, clinics and assisted living communities book rides for their own patients and residents. A new NEMT firm usually needs both.

The numbers below follow a made-up six-vehicle firm through its first six months. Rates, trip counts and costs vary a great deal by state and program, so treat them as arithmetic to copy with your own figures. Licensing and program rules differ everywhere; check yours.

What NEMT is, and who pays

The payer depends on the rider. For Medicaid members, the state runs the benefit, usually through a contracted broker who takes ride requests from members and dispatches them to enrolled providers. Some health plans and Medicare Advantage plans include rides as a benefit. Facilities sometimes pay directly, or the patient does. The difference matters because the broker pays a set rate per trip or mile and you cannot negotiate it, while a facility contract can be priced by agreement.

Broker contracts versus facility contracts

Broker work is faster to start and lower in price. After you are credentialed with the broker, trips are offered to you based on your area and your record. Facility work takes longer to win and pays more per trip, and it is stable, since a dialysis patient rides three times a week for months. The risk with brokers is that a few lost trips or late pickups reduce what you're offered; the risk with a facility contract is that one clinic can be a quarter of your revenue.

A six-vehicle firm, month one to six

Harbor Route Transit (fictional) has four ambulatory vans and two wheelchair-lift vans, and a rough capacity of 1,188 trips a month, assuming about nine trips per vehicle per working day over 22 days. Assume broker trips average $28 and negotiated facility trips average $36.

  • Month 1: broker only, 220 trips, $6,160.
  • Month 2: broker only, 300 trips, $8,400.
  • Month 3: broker 340 trips ($9,520) plus a first facility route, 200 trips ($7,200). Total $16,720.
  • Month 4: broker 360 ($10,080) plus facilities 310 ($11,160). Total $21,240.
  • Month 5: broker 380 ($10,640) plus facilities 450 ($16,200). Total $26,840.
  • Month 6: broker 400 ($11,200) plus facilities 600 ($21,600). Total $32,800.

Six-month revenue is $112,160. That is revenue, not profit: driver pay, fuel, insurance, vehicle costs and dispatch software come out of it. The point is the mix. By month six, facilities are 60 percent of trips and 66 percent of revenue, on 1,000 trips, or about 84 percent of capacity. The facility routes also fill the gaps in the day that broker trips leave.

Who books rides at a facility

At a dialysis center it is usually the social worker or the clinic manager, often with a patient care technician who sees which patients arrive late. At a rehab unit or skilled nursing facility, it is the discharge coordinator or the admissions director. At an assisted living community, the administrator or the activities director. Each one hears about late rides from patients and families and has to explain them. Names are findable on facility websites and through local health directories. See how to find office managers and facility managers and how to get meetings with decision makers.

The weekly-route first offer

Don't offer rides in general. Offer a dedicated weekly route for one facility: the same driver and vehicle, the same pickup windows, a stated on-time standard. For example: "We will run a three-day-a-week route for your morning shift of dialysis patients. Pickups within a 15-minute window, a driver who knows your patients, and a weekly on-time report." Start with 8 to 12 patients. That is about 70 trips a week at 12 patients riding three days, in both directions.

A cold email to a dialysis social worker might be: "I run Harbor Route Transit, a licensed NEMT company with wheelchair-lift vans. I'd like to run a trial route for 8 to 12 of your morning-shift patients for 30 days. Same driver, 15-minute pickup windows, and a weekly on-time report with timestamps. If it's not better than what you have now, we stop. May I stop by for ten minutes?" Include an address and an opt-out, per CAN-SPAM. If you call, use the approach in a cold call script for B2B.

Credentialing steps that vary by state

  1. Business registration and any state or local transportation licensing.
  2. Vehicle inspections, accessibility equipment checks and commercial insurance at the limits the broker or state requires.
  3. Driver requirements: license checks, background screening, drug testing where required, and training in passenger assistance, wheelchair securement, and emergency procedures (many programs also require CPR and first aid).
  4. Enrollment as a Medicaid provider, if your state requires it, and an application to each broker in your region.
  5. Software for dispatch and trip records, since brokers and facilities will ask for pickup and drop-off times.

Start with a call to your state Medicaid agency or the broker's provider line and ask for the current checklist in writing. Requirements change. This is general information, not legal advice.

Keeping on-time numbers you can show

Facilities hire the provider whose numbers they can show their manager. Log every pickup: scheduled time, actual time, driver, and the reason for any delay. After 60 days you have an on-time figure and a list of causes. Share the figure monthly with each facility contact, along with what you changed. When you lose a trip or a ride is late, call the facility before they call you. A related approach to a facility customer with a standing need is in how to get clients for a courier business, and how to follow up on a referral helps once a social worker sends a patient your way. The communities that book rides for residents are the same ones covered in getting clients for an assisted living facility.

Rocketship can find the social workers, clinic managers and discharge coordinators by name, email them from your own Gmail, and follow up, and it can answer your existing number so a dispatch or booking call isn't missed; see how the AI workers run it.

Rocketship finds the buyers, emails them from your own Gmail, follows up, and books the meeting on its own. Plans that get you customers start at $24.99 a month (Launch), and both Launch and Frontier start with a 7-day free trial, card required. Answering your existing number works on Launch, with call minutes bought as you go ($15 for 50), and a dedicated line is $5 a month.