NEMT market research: finding the riders, payers, and gaps in your area

Good NEMT market research answers three questions with numbers: how many people in your area are likely to need rides, who pays for those rides, and who already drives them. Almost all of the data is free and public. The work is pulling it together for your own service area and turning it into a trip estimate you can hold up against the cost of a van.

Draw the service area first

Decide which counties or ZIP codes you will actually serve, because every number below depends on it. Think in drive time, not map distance. A van that spends 40 minutes reaching its first pickup burns empty miles, and Medicaid rarely pays for those. See deadhead miles.

Payer rules shape the map too. Minnesota’s Medicaid law, for example, sets a distance limit on trips (30 miles for primary care, 60 for specialty care) that only an authorization can lift. Read your state’s rules and your broker’s service regions before you draw lines. Your state guide lists who runs rides where.

Count the Medicaid riders

Medicaid members make up the bulk of NEMT demand, because each state Medicaid program must get members to covered care when they lack a ride of their own. Start with enrollment:

• State totals. CMS posts monthly Medicaid and CHIP enrollment for each state on data.Medicaid.gov. The September 25, 2026 update runs through June 2026, with that month’s figures still preliminary.
• County totals. Check whether your state Medicaid agency publishes enrollment by county or region. Search its site for enrollment reports or dashboards.
• A fallback estimate. The Census Bureau’s American Community Survey table S2704 estimates how many people in each county have Medicaid or other means-tested coverage. It is a survey estimate, so it will not match the state’s official count, but it works for comparing counties.

Enrollment alone overstates demand, because most members never ride. In 2021, fewer than 4 in 100 members used NEMT even once, CMS reported to Congress in 2023. How often members ride depends heavily on the state. Table B1.1a of that report lists annual NEMT ride days per 10,000 members for every state:

These gaps partly reflect how each state delivers and reports rides, not only real need, and CMS calls its figures a lower bound. Use your own state’s row, not the national figure, and compare it with what brokers tell you.

The same report shows how rides split by mode nationally in 2021: taxis on 32.5 percent of ride days, vans on 28.0 percent, private vehicles on 8.5 percent, ambulances on 7.2 percent, and public transit on 3.8 percent. The mix shifts with geography. Vans served 29.0 percent of ride days in large central metro areas and 41.3 percent in frontier and remote areas, while the taxi share fell from 42.6 percent to 17.6 percent. Your state’s split is in Table B5.4b.

Find the repeat riders

Repeat trips make a schedule predictable, so research them separately.

• Dialysis centers. CMS’s dialysis facility file, updated June 2026, lists 7,490 centers with each one’s county, number of dialysis stations, whether it offers in-center hemodialysis, and whether it runs a late shift. You can search the same facilities on Medicare’s Care Compare. NIDDK describes the center schedule as three sessions a week of about four hours, which means a rider who needs transport both ways uses six trip legs weekly. Nationally, NIDDK reports that 68 percent of the more than 808,000 people with kidney failure are on dialysis, and at the end of 2021 just 14.1 percent of people on dialysis did it at home.
• Nursing homes. CMS’s nursing home provider file, updated August 2026, lists 14,690 facilities, each with its county, bed count, and daily resident census. Residents still travel to outside appointments, and facilities are direct buyers of trips. See nursing home transportation software.
• PACE programs. Medicare’s plan finder includes a PACE plan search. A PACE organization near you either runs its own vans or contracts them out. See PACE transportation.
• Aging programs. The federal Eldercare Locator finds the area agency on aging that covers your county, and these agencies can fund rides for older adults. Our guide to working with area agencies on aging explains how.

Then call. Dialysis social workers and nursing home schedulers can tell you how many patients struggle with rides, which times are hardest to cover, and who drives for them now. That conversation is worth more than any table. See dialysis transportation contracts.

Count the people who find it hard to get around

The American Community Survey’s 2020 to 2024 five-year tables give county and census tract counts for three groups that drive NEMT demand beyond Medicaid:

Map these by tract if you can. A cluster of older, car-free households near a hospital can be a sharper target for private-pay marketing than any county average. See private pay NEMT.

Size up the competition

Three quick checks show who already serves your area.

1. The NPI Registry. Search by city or ZIP code for taxonomy 343900000X, Non-emergency Medical Transport (VAN), plus 343800000X, Secured Medical Transport (VAN), and 344600000X, Taxi. Having an NPI does not prove a company is active, so treat the list as a starting point. See taxonomy codes.
2. Facility answers. The dialysis and nursing home calls above tell you which companies actually run trips and where they fall short.
3. Broker network status. Call each broker’s provider relations team, tell them the county and service level you plan to cover, and ask whether they are adding providers. A network can be open for wheelchair or stretcher work while closed for sedans, so ask about each. Also check your state Medicaid agency for enrollment moratoria, which federal rules allow for provider types judged high risk (42 CFR 455.470). See NEMT broker network full.

Check which payers buy rides where you are

A market is only real if someone will pay. List every payer active in your service area: the state’s delivery model, the Medicaid health plans and their brokers, Medicare Advantage plans that offer rides, PACE organizations, VA facilities, workers’ compensation vendors, and facilities that buy trips. On the Medicare side, look first at special needs plans, which are far likelier to include rides. KFF’s 2026 figures put the share of special needs plan enrollees with a ride benefit at 73 percent, compared with 22 percent in individual plans. Our payer map explains how each one buys, and how states run NEMT covers the Medicaid side.

Build a one-page demand estimate

Put the numbers on one page. This hypothetical example uses round figures for an imaginary county, so replace each line with your own data.

Dialysis riders on Medicaid already sit inside the Medicaid lines, so do not add the two; the dialysis line shows how much of the work repeats every week. In this example, the Medicaid van work alone equals about nine vans’ worth of trips, before private-pay and facility work. A new company does not need the whole market. Winning one in ten van trips would fill one van. The estimate is a floor, since CMS’s ride counts miss some rides, and a ceiling on what you can win, since existing providers already hold most of it. Test your cost side in the startup cost calculator, and see the per-hour math in our guide on whether NEMT is a good business.

Mistakes that skew the numbers

• Treating population as demand. Most Medicaid members never ride in a given year. Start from riders, not residents.
• Using the national rate. State ride rates differ by a factor of more than 100. Use your state’s figure.
• Skipping the broker call. A market full of riders is worthless to you if every network is closed.
• Counting facilities without calling them. A dialysis center with 30 stations may already have a provider it likes.
• Ignoring service level. Wheelchair and stretcher demand is a fraction of the total, and it may be where the openings are.

When the page is done, fold it into your NEMT business plan.

Checking your estimate against real trips

An estimate is a starting point, and your first months of trips are the real test. HealthRide’s payer summary breaks out completed trips and revenue by payer, so you can check which payers and facilities bring the volume you planned for. Facilities can request rides and follow vehicles live, and riders and families can book online and follow their driver from a text link. See reports and the live map.