Most profitable NEMT service: ambulatory, wheelchair, and stretcher compared by revenue and cost per trip

There is no single most profitable NEMT service. On the Medicaid schedules in this guide, stretcher trips earn the most per trip and ambulatory trips earn the least. But a stretcher trip needs two people and a more expensive van, several states do not pay for stretcher vans at all, and a crew that sits idle between calls eats the margin fast. The way to compare is per trip, then per full day, on your own state’s rates.

What a 10-mile trip pays by mode

A Medicaid fee schedule usually pays a base amount for each trip plus so much per loaded mile, and the base climbs with the level of service. The table below prices the same 10-mile one-way trip on three current fee-for-service schedules. Minnesota uses its statutory rates before the quarterly fuel adjustment, so all three modes are on the same footing. Arizona uses the Phoenix and Tucson rates effective October 1, 2026, and Indiana uses the 2026 Professional Fee Schedule.

How each number is built:

• Minnesota. Minn. Stat. 256B.0625, subd. 17 sets unassisted transport at $12.10 plus $1.43 a mile (county and tribal agencies pay this mode), lift or ramp at $19.80 plus $1.70, and stretcher at $60 plus $2.40. The statute moves every mode’s per-mile rate each quarter with Minnesota gas prices, and by July 1, 2026 that had lifted the mileage DHS pays to $1.80 for lift or ramp and $2.54 for stretcher. A 2026 law keeps these rates in force until Minnesota’s new statewide NEMT administrator takes over. See the Minnesota rates guide.
• Arizona. AHCCCS pays $6.64 per trip on the A0120 ambulatory code plus $1.28 a mile, $11.15 plus $1.54 per mile for wheelchair vans, and $49.09 plus $1.54 per mile for stretcher vans. Rural trips pay more, and the rural stretcher base is $86.70. See the Arizona rates guide.
• Indiana. The 2026 fee is $12.71 per trip for commercial ambulatory service and $31.79 for wheelchair van service. Indiana pays nothing for a one-way trip’s first 10 miles and $1.67 for each mile after that, so a 10-mile trip earns the base only.

The order holds wherever a mode is paid, but the gaps differ. In Minnesota a stretcher trip earns more than three times an ambulatory one. In Indiana the wheelchair base is two and a half times the ambulatory base, which makes wheelchair the stronger choice there.

States where a mode pays nothing

Before comparing margins, check that your state pays for the mode at all.

• Indiana. For fee-for-service members, every stretcher trip on or after July 1, 2023 goes straight to an ambulance company enrolled with Indiana Medicaid, and the fee schedule shows T2005, the stretcher van code, as noncovered.
• Ohio. Ohio Adm. Code 5160-15-21 lets four kinds of providers bill Medicaid for transportation: wheelchair van companies, ambulance services, hospitals, and companies under contract with a Medicaid managed care plan. The fee-for-service appendix pays $31.00 per wheelchair van trip plus $1.30 a mile and lists no ambulatory or stretcher van code. Ambulatory work there comes through managed care plans, county job and family services departments that contract livery service under Ohio Adm. Code 5160-15-10, or private payers. Stretcher van work comes through the plans or private payers. See the Ohio rates guide.
• New Jersey. Stretchers and litters may not be carried in any mobility assistance vehicle (N.J.A.C. 8:40-5.6), so stretcher work there means running a licensed ambulance.

Managed care plans and brokers can set their own rates, so get each payer’s rate sheet before you compare modes. The billing codes guide explains each code.

What each mode costs to run

Revenue per trip is only half the comparison. Three costs move with the mode.

Crew

Ambulatory and wheelchair trips usually run with one driver. Stretcher work does not. Illinois stretcher vans must carry two trained crew members, and one rides beside the passenger for the whole trip (77 Ill. Adm. Code 515.845). The rate does not always pay for that second person. Minnesota pays $9 per stretcher trip for an extra attendant, and only when one is medically necessary.

For wages, the May 2025 BLS median was $17.93 an hour for shuttle drivers and chauffeurs. For ambulance drivers and attendants who are not EMTs, it was $17.04. Payroll taxes, workers’ compensation, and paid time off come on top.

Vehicle and equipment

Ambulatory service can run on a sedan or minivan with no conversion. Wheelchair service needs a lift or ramp van, and stretcher service needs room for the cot, its mount, and the second attendant. Federal purchase records give a sense of the gap. In fiscal 2026, GSA ordered full-size two-wheelchair rear-lift vans for $64,974 to $74,495, and in August 2026 it paid $82,995 for a full-size van with three wheelchair positions, one cot, and a curbside lift. The wheelchair van cost guide covers conversion pricing in detail.

Time per trip

Each step up in service level adds time at the curb: lift cycles and four-point securement for wheelchairs, and for stretchers, the transfer, stairs, elevators, and facility check-in. Most payers pay by the trip and the loaded mile, not by minutes at the door, so slower loading lowers what each crew hour earns. Time your own pickups by mode for a few weeks before you trust any estimate.

A worked day: why volume decides

Per-trip margins point to stretcher. A full day can point somewhere else. This hypothetical example uses Minnesota’s statutory rates, 10-mile trips, an 8-hour paid shift, and wages at the BLS medians above ($143.44 for one driver, $279.76 for a two-person stretcher crew). It assumes 45 minutes of crew time per ambulatory trip, 55 per wheelchair trip, and 75 per stretcher trip, counting loading and the drive to the next pickup.

A full stretcher day leaves the most. With four calls, the same crew leaves far less than a full wheelchair van, and in this example it takes six stretcher calls in a shift to beat a full wheelchair day. So the real question is not which mode pays best per trip but whether you can book six stretcher calls a day, every day. Vehicle payments, fuel, and insurance still come out of every row. Plug your own figures into the profit per vehicle calculator.

How much of each kind of work there is

National data gives a rough picture of where the trips are. MACPAC’s analysis of fiscal 2018 Medicaid claims found vans, a group that includes shared vans and wheelchair or stretcher vans, on 46 percent of NEMT ride-days and taxis on 36.7 percent. Public transportation showed up on 5 percent and air travel on 0.2 percent. MACPAC heard from states that Uber and Lyft rides are probably coded as taxi trips, so much of the ambulatory market sits alongside taxis and rideshare. Arizona’s capped rate for transportation network companies on the A0120 code, $4.00 in urban areas, shows how low that competition can price.

Recurring riders are what fill a wheelchair or ambulatory day. MACPAC found that in fiscal 2018, Medicaid members with end-stage kidney disease who used NEMT averaged 70.1 ride-days, against 12.8 for users with none of the conditions it studied. NIDDK says most hemodialysis patients go to a dialysis center, typically on a fixed schedule of three sessions a week that each last around four hours. A handful of dialysis standing orders can anchor a van’s week.

Scarcity cuts the other way. People MACPAC interviewed said the supply of wheelchair vans and stretcher vans is sometimes limited, and blamed high vehicle insurance costs, low Medicaid payment rates, and competition for drivers. Where that shortage exists, a provider with the equipment has fewer competitors for those trips.

Where long trips, facilities, and private pay change the ranking

Three kinds of work can reorder the list.

• Long-distance trips. On long trips the per-mile rate matters more than the base. At 50 loaded miles, Minnesota’s statutory rates pay $180.00 for stretcher, $104.80 for wheelchair, and $83.60 for ambulatory. Indiana’s 10-mile deduction matters less on long trips: a 40-mile wheelchair trip pays $81.89 for 30 paid miles. Ohio stops paying mileage at 50 miles from the pickup point unless your records support the extra distance (Ohio Adm. Code 5160-15-26). See out-of-county transportation.
• Facility work. Hospitals and nursing facilities pay contract rates you negotiate, and Medicare pays nothing for wheelchair or stretcher vans. CMS’s claims manual says neither Part A nor Part B covers any transportation other than ambulance. Those rides are paid by the facility, the resident, or another payer. For a stretcher van, facility discharge and appointment work can supply volume that Medicaid alone may not. See facility contracts.
• Private pay. Families pay what you charge. The cost side does not change, so price each mode from its own crew time and equipment cost, using the worked day above as a floor. See pricing NEMT trips and stretcher transport cost.

One way to manage the risk is to start where demand is steady and the crew is one person, then add a higher service level once a facility or broker commits volume to it. The wheelchair business guide and the stretcher business guide cover each launch.

Seeing profit by mode in HealthRide

The only rates that matter are the ones on your own trips. In HealthRide, the payer summary lists each payer’s completed trips, cancellations, revenue billed, and balance still owed for whatever period you pick, and driver activity shows hours from real clock-ins. Put the two side by side to see what a wheelchair day or a stretcher day really leaves. Wheelchair, stretcher, and oxygen needs are matched when trips are assigned. See reports and the dispatch board.