Starting a stretcher van business: licensing, two-person crews, and facility work
First confirm your state lets stretcher vans carry Medicaid riders. Louisiana does not allow them in NEMT, and New Jersey sends riders who must lie flat by ambulance. Where vans are allowed, expect a state license in some places (Illinois charges $25 per vehicle), a crash-stable cot mount, and two trained crew members per trip. Discharge planners and nursing facilities supply most of the work.
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Stretcher van service is for riders who have to travel lying flat but are stable enough that no one has to treat or monitor them on the way. New York, North Dakota, and California all pay more for a stretcher trip than for a wheelchair trip. The costs run higher too: two trained people on every run, and only one stretcher rider in the van at a time.
Before you price a van, find out whether your state lets stretcher vans do Medicaid work.
Check that your state uses stretcher vans
States take one of three approaches. Some license stretcher vans directly, some pay for them under their general NEMT rules, and others route all stretcher riders to ambulances. A few examples:
| State | How stretcher rides work |
|---|---|
| Illinois | IDPH stretcher van license at $25 per vehicle (up to 100 vehicles), good for four years if the annual inspections pass |
| Virginia | Allowed in Medicaid NEMT, staffed by a driver plus an assistant trained in state-approved courses |
| Pennsylvania | Covered by the PUC paratransit certificate, which lists wheelchair and stretcher vans |
| New York | Billed as T2005 under the ambulette category |
| North Dakota | Paid only with an SFN 1507 authorization issued before the trip |
| California | Called a litter van, with a treatment authorization request for nearly every trip |
| Indiana | Stretcher rides for members outside managed care are booked straight with an enrolled ambulance company, bypassing the broker |
| New Jersey | Mobility assistance vehicles may not carry stretchers, so riders who travel lying flat go by BLS ambulance |
| Louisiana | Stretcher vans are on the Medicaid NEMT manual’s list of vehicles that may not be used |
In the last three, Medicaid stretcher riders go by ambulance rather than stretcher van (in Indiana, for fee-for-service members). Our NEMT license requirements guide covers the approvals every company needs, and NEMT vs ambulance explains where the line sits.
Where stretcher work comes from
Most stretcher trips start with a facility, not a rider calling in.
- Hospital discharges. Patients leaving for home or a nursing facility who can’t sit upright for the ride. See hospital discharge transportation.
- Nursing and rehab facilities. Residents headed to specialist visits, imaging, or therapy. See NEMT facility contracts and nursing home transportation software.
- Hospice and home moves. Illinois counts a move from home to another residential setting as an appropriate stretcher trip. See hospice transportation.
- Medicaid brokers. Where the state pays for stretcher vans, brokers need providers at that level. See NEMT broker credentialing.
Plan for private-pay requests too. Medicare covers ambulances, not stretcher vans, so when a patient covered only by Medicare needs one, the patient, a relative, or the facility pays for it. See private pay NEMT.
Screening riders: stretcher van or ambulance
A stretcher rider is stable, cannot sit for the trip, and needs no treatment on the way. Illinois writes that test into its rule: the passenger needs no medical monitoring or clinical observation and is convalescent or otherwise bed-confined, traveling to or from an appointment or service. Its examples include a move from home to another residence, a medical appointment, and a therapy session.
The same rule lists riders a stretcher van must turn down:
- Anyone headed to an emergency department for treatment
- Anyone having a medical emergency or needing active monitoring
- Riders who need IV fluids, suctioning, isolation precautions, or continuous airway management during the trip
- Riders on oxygen they cannot give themselves
Illinois also flags two groups as a poor fit: riders likely to develop complications on the way, and riders whose mental or physical state keeps them from working with the crew, such as a person with dementia who may try to leave.
California’s Medi-Cal describes litter van riders in similar terms. They must travel lying down because they cannot tolerate sitting for the trip, they need more room or equipment than a car or taxi offers, and their condition is stable enough that an ambulance crew is unnecessary. Its examples: riders in spica casts, bed-bound riders, and stable patients just out of surgery who can’t stay upright for the whole ride.
Medicare draws a different line. Its ground benefit covers ambulances. It pays for a nonemergency ambulance when the patient is bed-confined and no other transport is safe, or when the patient’s condition requires an ambulance for another reason. To count as bed-confined, a patient must need help getting out of bed, be unable to walk at all, and be unable to stay seated in any chair or wheelchair. Because a stretcher van is not an ambulance, Medicare will not cover the ride. See does Medicare cover NEMT.
Two people on every trip
Crew cost is what sets stretcher work apart. Illinois sets a minimum crew of two trained attendants, each holding CPR certification and stretcher training, with one staying beside the passenger. Virginia pairs the driver with an assistant, and both need DMAS-approved training that covers first aid, bloodborne pathogen handling, and stretcher transfers and loading. The assistant rides in the patient compartment and alerts the driver if the rider’s condition suddenly changes.
Price that person into every trip. As an example, if a second crew member costs you $24 an hour with payroll taxes and a typical stretcher run keeps the crew busy for 75 minutes, the second person adds $30 per trip before the van, fuel, or insurance. Time your own runs, because stairs, elevators, and facility check-in all add minutes at pickup.
Stretcher work also changes scheduling:
- One stretcher rider per van. Illinois and Virginia both cap it at a single stretcher passenger, so two stretcher riders cannot share a run.
- Crews, not drivers. Schedule the two-person crew as a unit, with breaks for both.
- Mixed use. Virginia allows wheelchair riders in a stretcher van equipped with the right anchorages and securements, which helps fill the gaps between stretcher runs.
The van and cot equipment
Buy the van to your state’s stretcher standard. Illinois publishes a detailed list that doubles as a shopping checklist in other states:
- Not a passenger sedan, limousine, or RV.
- Space for two attendants and their equipment, with a clear line of sight to the stretcher rider.
- A main wheeled cot measuring 75 inches or more in length and 22 inches or more in width, locked down with a three-point, quick-release fastener that is crash-stable (a Ferno Type 175 or equivalent).
- Three restraint straps across the rider, plus shoulder straps.
- A flat, non-skid floor, and surfaces in the patient area that are non-porous and easy to sanitize.
- A loading light, quick-release crash-stable mounting for every oxygen cylinder, and working heat, air conditioning, and ventilation.
- Voice contact with dispatch and receiving facilities, and a way for the driver to see and talk to the rider.
- A working 5-pound ABC extinguisher, a battery flashlight, seat belts for every passenger, and no emergency lights, red or blue.
- Two pillows, two sheets, two blankets, a CPR mask with a safety valve, red biohazard isolation bags, and a box of disposable gloves.
- Either a written 24-hour road service agreement or a spare wheel and tire, a jack, and a lug wrench.
Virginia adds a detailed cot specification and requires the provider to bring a stair chair, scoop, or Reeves stretcher for any rider who needs one. Our stretcher vs gurney guide walks through Virginia’s cot and mount standards, and the stair chair entry explains when you need one.
For a price reference, the GSA paid $82,995 in August 2026 for a curbside-lift van set up for three wheelchairs and one cot.
Pricing stretcher trips
Use Medicaid rates as an anchor, then price private work from your own costs. The spread is wide: New York City’s Medicaid schedule lists $230 for a stretcher trip, while California’s fee-for-service maximum base is $26.29.
| Program | Stretcher base rate | Per mile | 10 loaded miles (example) |
|---|---|---|---|
| Westchester County, NY (April 2026) | $200.00 | $2.323 | $223.23 |
| Erie County, NY (April 2026) | $101.00 | $3.00 | $131.00 |
| North Dakota (July 2026) | $97.37 | $2.57 | $123.07 |
| California Medi-Cal fee-for-service maximum | $26.29 | $1.50 | $41.29 |
A private-pay rate has to cover two wages, longer time on scene, and a van that cannot take a second stretcher rider. Build it from your cost per hour rather than copying a Medicaid number. The NEMT pricing guide, the rate sheet template, and the trip price calculator walk through the math.
Steps to launch stretcher service
- Read the rules. Confirm your state allows stretcher vans in NEMT, and find any license, inspection, and crew rule.
- Size the demand. Ask discharge planners and facility schedulers how many stretcher rides they book each week and who runs them now.
- Buy and equip the van. Match the cot, mount, straps, and oxygen brackets to your state’s standard, and buy the stair chair your riders’ homes will need.
- Hire and train crews. Document CPR, first aid, bloodborne pathogen, and stretcher transfer training for every crew member.
- License and inspect. Apply for any state license and pass the vehicle inspection before the first trip.
- Enroll and contract. Add the stretcher level to your Medicaid and broker enrollment, and sign facility agreements for private work.
- Screen at booking. Ask the screening questions above on every request, so no ambulance-level rider is ever sent a stretcher van.
Dispatching stretcher work in HealthRide
HealthRide matches each stretcher leg to a vehicle set up with a stretcher space. Facilities can request rides through their own portal, and HealthRide connects with your brokers, like MTM, Alivi and Sentry, so new trips show up on your dispatch board on their own. Facilities and riders get a text link showing when the crew will arrive. See the stretcher transportation software page for the full picture.
Frequently asked questions
- Does every stretcher trip need two crew members?
- Where states spell it out, yes. Illinois bars running a stretcher van with fewer than two trained attendants and keeps one of them beside the passenger. Virginia staffs every stretcher trip with a driver plus a second crew member seated in back with the rider. Read your state rules and each broker agreement, and build the second wage into every stretcher rate.
- Will Medicare cover a stretcher van ride?
- No. The Medicare ground benefit in 42 CFR 410.40 is an ambulance benefit, and a stretcher van does not qualify. Medicare covers a nonemergency ambulance for a patient who is bed-confined and documented as unable to travel safely any other way, or when the condition otherwise requires an ambulance. A stretcher van ride needs another payer: the patient or family, a facility, or Medicaid where it covers stretcher vans.
- Are riders on oxygen allowed in a stretcher van?
- Yes, if they manage it themselves. Illinois refuses stretcher riders whose oxygen has to be given by someone else and wants every cylinder locked in a crash-stable mount. Virginia allows oxygen the rider handles alone, provided the tank is held per AMD Standard 003. A rider whose oxygen needs monitoring belongs in an ambulance.
- Can two stretcher riders share one van?
- Not in Illinois or Virginia. Both cap a stretcher van at one stretcher passenger per trip. Virginia does let the same van carry wheelchair riders when the right wheelchair anchorages and tiedowns are installed.
- What billing codes do stretcher van trips use?
- HCPCS T2005 covers the stretcher van trip itself. North Dakota and New York counties such as Westchester and Erie add T2049 for stretcher mileage, while Medi-Cal pays litter van mileage under A0380, its mileage code for both wheelchair and litter vans. The codes and modifiers you bill come from your state's fee schedule or your broker contract.
