The medical transport (NEMT) launch plan
Every step from deciding to opening, in the order it happens, shaped to your situation, with your own numbers beside it. About 43 steps in 8 phases, 19 of them specific to a medical transport (NEMT). Free to read; ticking steps off and putting in your own numbers come with membership.
The plan43 steps
- 01Not started0/6Fold
Decide with the numbersa week or two
Before a dollar is spent. Most expensive mistakes happen here, and this phase costs nothing.
NEMT makes money on contracted trips, and the mix decides your margins.
Typical for one unit is $300,000 to $3,000,000 a year; the owner keeps 15 to 25% of it before paying themselves. If that band does not cover what you need, that is the signal to pause and look again.
~50% survive 5 years. Roughly half of all new U.S. businesses reach five years.
Twelve questions about your money, time, experience and temperament, scored. Then the 5 questions this business asks of its owner, about the hours and the work. Answer both before you spend a dollar.
Rule of thumb: if you can buy an operation with diversified contracts, standing-order routes, and drivers likely to stay, buying skips the slow enrollment grind. Answer it in your situation above and the plan reshapes.
Customers, prices, rent, staff pay, what it costs to open. We filled in typical numbers; change what you know and everything on this page follows.
- 02Not started0/5Open
Plan the moneya week
What it costs to open, where the money comes from, and the cushion that keeps you alive until the business pays for itself.
NEMT needs no , because the van is the operation, but a fleet of converted vans is real money.
The itemized cost to open10 lines
- Wheelchair vans (five, converted): $135,000 to $340,000Used rear-entry minivans to new high-roof vans with a lift
- Securement, safety and first aid gear: $240 to $5,100Extinguishers, triangles, first aid, a second securement position
- Phones, dash cams, laptop and printer: $1,800 to $11,300Driver phones for broker trip apps, dispatch and billing computer
- Door signs, logo and website: $1,100 to $8,700
- Dispatch desk and locked records storage: $500 to $7,000
- Van tax, title, permits and inspections: $7,000 to $25,000Sales tax follows the van price; permits run about $400 to $900 a van
- Insurance down payments (auto, liability, workers comp): $6,000 to $20,000Required before brokers enroll you
- Medicaid enrollment, driver screening and training: $840 to $2,700Background checks, drug tests, CPR and PASS courses
- Business setup, license and driver recruiting: $750 to $5,700
- Initial working capital: $20,000 to $80,000Payroll, fuel, and billing float; broker claims pay in 30 to 90 days
Costs start on day one; customers take months. Map the first twelve months of cash so the business does not run out of money while it is getting going.
The business has to earn your pay like any other bill. Set it in your numbers and watch the month it move.
How deals in this business are financed4 lines
- SBA 7(a) loan (Up to 10 yr (25 with real estate) · 75-85% government-guaranteed)The workhorse for buying an existing NEMT operation or funding a startup’s vans, conversions, and working capital.
- Seller financing (Often 5-25% of price · 3-7 yr)Common when buying a contract book.
- Equipment & fleet financing (Secured by vans & equipment)Finance vans and conversions, secured by the assets themselves.
- Working-capital line of credit (Revolving · sized to receivables)A revolving line to bridge the gap between running trips and getting paid by brokers and plans.
Most new shops pair an with 10 to 20% of your own cash. Know the monthly payment before you look at a single space.
Before you shop. A lender tells you what they would fund, what they need from you (credit, your cash in, a plan with numbers), and a pre-qualification letter makes a landlord or a seller take you seriously.
- 03Not started0/4Open
Set up the companya day or two
A day of paperwork, and it has to come before the space: a lease, a loan application and every permit are in the company’s name.
Your state’s business name search, the trademark register, and the domain, before the name is on a sign, a van, or a lease.
A , an , and the S-corporation election each change what you keep and what you are exposed to. Compare them with the numbers, confirm with a CPA and an attorney, then file with your state.
After:The is free from the IRS in minutes once the company exists. The bank account needs both. Keep business money separate from day one.
After:Pick the accounting software and connect the bank account now, so every cost of opening is captured and the numbers you later are real.
- 04Not started0/4Open
The territory and the vehiclea week or two
NEMT has no storefront; your "location" is the territory you serve and the contracts that feed it.
What decides it for this business: dialysis centers & treatment clinics nearby, sizable medicaid & senior population, active broker networks enrolling providers, adequate density (route efficiency), not oversaturated with operators.
Mobile businesses still answer to city rules: where the vehicle can be kept overnight, whether you can run the business from home, and what the state licenses.
The van or truck is the shop. Price it, outfit it, insure it, and brand it before the first job. The quotes go into the loan application.
Commercial auto for the vehicle, for the work. Customers and any lender will ask for the certificate.
- 05Not started0/2Open
Get the loanfour to eight weeks
Four to eight weeks with an SBA lender, longer if the file is incomplete. Everything else waits on this, so send a complete file.
Your plan with numbers (download it as a PDF from this page), the company’s papers, the vehicle and equipment quotes, your personal financial statement, and proof of the cash you put in.
The lender funds against the quotes and the insurance; the money goes to the vendors and the build.
After:
- 06Not started0/8Open
Permits and the vehicletwo to four weeks
NEMT is a regulated, credentialed field: you move patients on funded contracts, so enrollment, vehicle standards, and driver screening are real barriers, and a moat against unqualified competition.
Bind the policies you had quoted before a contractor, a vehicle or a customer is in play. Keep the certificates; the landlord, the lender and the city will ask.
After:With the money in hand: the vehicle, the , the branding, and the state inspection most cities require before it can work.
After:Register your or corporation and obtain a city or county operating license.
With your state, before the first taxable sale. Usually free and online; check your state.
Enroll with the brokers and managed-care plans that assign trips.
Coverage for every van and for transporting passengers, commonly to enroll and to bid contracts.
- 07Not started0/8Open
Set up to runduring the build
During the build, so the business runs from day one: the systems, the prices, the people and the routine.
The backbone: imports broker trips, sequences routes, tracks pickups and drop-offs, captures signatures, and feeds billing.
Submit clean claims to brokers and Medicaid plans, track authorizations, and work denials.
A dedicated account keeps contract , fuel, and separate from personal money, essential for clean books, billing float, and any future sale.
You transport vulnerable passengers in a fleet.
See the price the the business needs implies, then check it against what the market pays.
Early morning: Dispatch builds the day: sequence standing-order dialysis pickups,... Daytime: Vans run the schedule: appointment trips, treatment runs, and... Dialysis cycles: Standing-order riders go to treatment and come back hours later,...
Opening, closing, the sale, the complaint, the cash. One page each. This is the manual a franchise would have sold you.
Free, and it is how most people will find you. Address, hours, photos and the menu or price list, live before opening day; then the sign, the soft opening and the first regulars.
- 08Not started0/6Open
Open and measurethe first ninety days
You own it. Now run it on the numbers.
Friends, neighbors and a short menu or list. Find the problems while the room is forgiving.
Enter the real numbers and see every cost line against the for this business.
Driver wages & van utilization; Billing denials & slow payment; Vans, fuel & maintenance.
Wages are the start: , insurance, training time and the hours you stop billing. Register as an employer and carry workers’ comp before the first payday.
Growth consumes cash before it produces it. Find the rate your own cash funds before you push.
NEMT operations with diversified contracts and standing-order routes are sellable assets.