How to Start a NEMT Business With One Van

Most NEMT companies are small. In the Census Bureau’s 2022 business size data, 649 special needs transportation firms with employees had less than $100,000 in annual revenue, and 1,233 more had between $100,000 and $500,000. Owner-operators with no employees are not in that count at all, because it only includes companies with payroll.

One van works when three things are true: the van is busy on most days, you drive it yourself at first, and you have a plan for the day it breaks down. This guide covers each of those, plus the paperwork, which is the same for one van as for twenty.

Pick the van for the riders you want

Your first van decides which trips you can accept, so choose the riders before the vehicle.

• Ramp minivan. Carries wheelchair riders and walking riders. Florida’s state transit contract lists a Braun ADA lowered-floor Chrysler Voyager with seating for 6 and 2 wheelchair positions at $69,476 before options. See wheelchair-accessible vehicles.
• Standard minivan or sedan. Enough for ambulatory riders only. Cheaper to buy, but ambulatory trips pay the least.
• Stretcher van. Pays the most per trip. New York City Medicaid pays $230 for a stretcher trip against $52.90 for a wheelchair van. Check your state’s crew rules first, because a second attendant may be required.

A ramp minivan is the flexible choice for a single-vehicle company because it can take either kind of rider on the same day. Its size also keeps you under two useful thresholds, as long as it is designed for 8 or fewer people including the driver. Under federal rules, a vehicle below 10,001 pounds with that seating is not a commercial motor vehicle, even on paid interstate trips, and the Florida contract Voyager has a gross vehicle weight rating of 6,055 pounds. California’s CPUC sets its lowest insurance tier, $750,000 combined single limit, for vehicles that carry up to 8 people including the driver.

The paperwork is the same for one van

A one-van company goes through every step a larger fleet does. Our NEMT startup checklist lists them all. The short version:

1. Form the company. An LLC keeps business debts separate from your own. Check which structures your state and brokers accept.
2. Get a free EIN and NPI. A sole proprietor gets a Type 1 NPI. An LLC gets a Type 2 NPI. See how to get an NPI for NEMT.
3. Meet state and city licensing. Some states and cities license NEMT or paratransit operators and others do not. See NEMT license requirements and your state guide.
4. Insure the van. Get quotes that meet the highest requirement among your state and the payers you plan to serve.
5. Build your own driver file. You are the first driver, so you need the same license check, driving record, background check, drug screen, and training that a broker asks for on any driver. Use the driver file checklist.
6. Enroll with at least one payer. That can be your state Medicaid program and its broker, a facility, or private-pay riders. See becoming a Medicaid transportation provider.

Where the first trips come from

Revenue for one van depends on filling the same hours every week. Recurring riders do that better than one-off trips.

Dialysis. In-center hemodialysis usually runs three times a week, Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday, for about four hours. One rider is six trip legs a week. Two riders on opposite schedules can give a van a steady base six days a week. See dialysis transportation contracts and standing orders.

Brokers. In broker states, Medicaid trips come from the broker after you credential with it. Some brokers set performance standards from day one. SafeRide Health, for example, holds providers to 95 percent on-time performance. In New York, you cannot enroll in Medicaid as a transportation provider until MAS issues a letter of support. See NEMT broker credentialing.

Facilities and private pay. Senior living communities, rehab centers, and families pay for rides Medicaid does not cover, and you set or negotiate the rate. See NEMT facility contracts and private pay NEMT.

A day as an owner-driver

Running dispatch from the driver’s seat is the hard part. You cannot safely answer calls, confirm tomorrow’s rides, and book new trips while you drive. Set up the day so most of that work happens before the first pickup and after the last drop-off.

• Set a booking cutoff. Take next-day trips until a fixed time the afternoon before, so the schedule is final before you go to bed.
• Confirm rides the day before. A confirmation call or text catches cancellations while you can still fill the slot. See reducing no-shows.
• Leave room for will-calls. Return trips with no set pickup time need a gap in the schedule. See will-call trips.
• Batch the office work. Billing, credential renewals, and broker portal work go in one block, not between trips.

One-van economics, by example

What one van earns depends mostly on the rate. This hypothetical example uses published Medicaid fee-for-service rates for a wheelchair van trip with 6 loaded miles, 8 trips a day, and 22 days a month. It assumes you drive, so there is no driver wage, and it uses the IRS business mileage rate of 76 cents for 100 total miles a day as the vehicle cost.

Two cautions. California’s figure is its fee-for-service maximum. Medi-Cal managed care plans must cover rides for their members and may hire brokers, and those brokers negotiate their own rates. And 8 trips a day is an assumption, not a promise. Our profit per vehicle calculator lets you test your own trip counts and rates, and how much a NEMT business makes goes deeper.

Plan for the day the van breaks down

With one vehicle, a breakdown or a failed inspection stops all revenue and strands every scheduled rider. Federal matching funds are not available for a ride the provider fails to show up for, and CMS expects states and brokers to line up replacement providers on short notice, so a missed pickup can go to another provider.

NEMTAC’s startup checklist recommends reserve vehicles equal to 10 to 20 percent of a fleet. For one van, that means a written plan: a rental source that allows commercial passenger use, or an agreement with another local provider to cover your standing riders. Keep a cash reserve for repairs, too. The same checklist recommends three to six months of operating expenses.

When to add a second van

Add van two when demand is steady, not when one week is busy. Good signals:

• You turn down recurring trips every week because the schedule is full.
• A facility or broker offers a regular route you cannot fit.
• You spend more time dispatching and billing than the business can afford while you also drive.

The second van usually brings your first hire. The May 2025 median wage for shuttle drivers and chauffeurs was $17.93 an hour, so price a full-time driver into the plan before you commit. Our guide on hiring NEMT drivers covers screening and onboarding.

Running one van in HealthRide

HealthRide works the same for one van as for fifty. You book trips on the dispatch board and assign them in one motion, recurring rides stay on the schedule once you set them up, and the driver app opens turn-by-turn navigation in one tap and captures signatures on screen. It costs $59 per vehicle per month, month-to-month. See software for small fleets.