How Much Does a NEMT Business Make? Revenue, Rates, and Margins

A NEMT business makes money one trip leg at a time, so its income is the rate per trip multiplied by the trips each vehicle completes, minus what it costs to run those vehicles. The industry data below shows what companies actually take in. The worked examples show how to estimate your own number.

What Census data shows about NEMT revenue

The Census Bureau classifies NEMT companies under special needs transportation (NAICS 485991). The 2022 Economic Census, the most recent, counted 3,662 establishments with employees in that industry. Together they took in $5.8 billion in revenue and employed 59,334 people. That averages about $1.59 million in revenue and 16 employees per establishment, but the average blends large paratransit contractors with one-van companies, so it says little about a typical small operator.

The size breakdown is more useful. The Census Bureau’s 2022 Statistics of U.S. Businesses sorts the same industry’s 3,569 firms by annual revenue:

So 53 percent of firms with employees took in under $500,000, and 69 percent under $1 million. Owner-operators with no payroll are not counted in these tables at all, so the real share of small companies is higher.

Revenue per trip: the rate sets the ceiling

In these three states, Medicaid fee-for-service rates are a base amount per trip plus a rate per loaded mile. Here is what the same six-mile trip pays under each published fee schedule:

Three things to know about these numbers:

• Broker rates can differ from the fee schedule. Where brokers and managed care plans run transportation, the broker contract sets your rate. Florida’s Medicaid policy, for example, leaves all non-ambulance transportation to a rate negotiated between the broker and the provider.
• Service level changes everything. New York City pays $230 for a stretcher trip. California’s ambulatory figure is its non-medical transportation rate. California pays $11.30 per half hour of waiting time after the first 15 minutes and $5.52 for an attendant.
• Rates move. Colorado cut its taxi and mobility van base from $36.40 to $12.15 on July 1, 2026. Pennsylvania’s county-run program spent an average of $32.65 per trip in state fiscal year 2025, across every kind of ride it pays for.

Private-pay and facility rates are whatever you set or negotiate. See how to price NEMT trips and how much Medicaid pays for NEMT.

Revenue per van per day

Multiply the rate by trips per day. This table uses the six-mile wheelchair trip above:

At 8 trips a day on 22 working days a month, that is about $13,100 a month in New York City, $8,900 in Colorado, and $5,200 in California. Over 264 working days a year, one van comes to roughly $157,000, $107,000, or $62,000.

Trips per day is the number you control. It depends on trip length, wait times, cancellations, and how well the day’s trips chain together. Recurring riders help most: in-center dialysis usually runs three times a week, so one dialysis rider is six trip legs every week. See trips per hour and vehicle utilization.

Where the money goes

Revenue is only half the answer. Four costs decide what you keep.

• Drivers. The May 2025 median wage for shuttle drivers and chauffeurs was $17.93 an hour, before payroll taxes and benefits. At 9 paid hours a day and 8 trips, that is about $20 of wages per trip.
• Vehicles. The IRS business mileage rate, based on the fixed and variable costs of running a car, is 76 cents a mile for July through December 2026. Replace it with your own costs once you have them.
• Empty miles and no-shows. Medicaid generally does not pay separately for miles driven with nobody aboard, including the drive back after a rider no-shows, although states may build those costs into their rates. See deadhead miles.
• Insurance and overhead. Insurance, dispatch, billing, phones, and software. Insurance is priced on your quote.

A worked monthly example

This hypothetical example is one wheelchair van with a hired driver, 8 six-mile trips a day, 22 days a month, and 100 total miles a day.

The California column is not a verdict on California. Medi-Cal managed care plans must cover rides for their members and may hire brokers, and those brokers negotiate their own rates. What the table shows is how directly the rate drives the result, and why owners check every payer’s rate before they commit a van to it. If you drive the van yourself, add the $3,550 driver line back to each column. Run your own numbers in the profit per vehicle calculator.

How owners raise what each van makes

The levers are the same in every state.

1. More trips per van-hour. Tighter routing and fewer empty miles let the same van and driver finish more trips. See how to reduce deadhead miles and NEMT route optimization.
2. Recurring work. Standing orders for dialysis and therapy fill the same hours every week.
3. A better payer mix. Facility and private-pay trips at rates you set balance lower Medicaid rates. See private pay NEMT.
4. Fewer no-shows. Confirm rides the day before and enforce a written policy. See how to reduce no-shows.
5. Billing everything you earned. Bill wait time, attendants, and mileage where the payer allows them, and track what each payer owes. See NEMT KPIs.

Seeing your real numbers

Estimates only get you started. HealthRide’s reports show trips, on-time performance, driver hours, and revenue by payer, five reports with no report builder required. Ryder Go plans and assigns the whole day in one click. See reports and Ryder Go.