Non-Emergency Medical Transport (NEMT)
55 million Americans need rides to dialysis, chemo, and doctor's appointments — and Medicaid pays
Non-emergency medical transportation (NEMT) companies provide scheduled rides to medical appointments for elderly, disabled, and Medicaid-eligible patients. The federal government mandates Medicaid covers transportation to medical care — meaning the state pays per trip, creating a reliable government-backed revenue stream. A 5-vehicle operation can generate $500K–$800K annually. The aging U.S. population (10,000 Boomers turning 65 every day) is a permanent demand tailwind.
Avg Revenue
$400K
Profit Margin
20%
Acquisition Multiple
1.5x - 2.5x
Startup Cost
$30K - $120K
Difficulty
3/5
How It Works
NEMT companies contract with state Medicaid brokers (or directly with Medicaid) to provide rides. Drivers transport patients to dialysis centers, cancer treatments, and specialist appointments. Revenue is $30–$56 per vehicle per day on the low end, scaling to $2,500–$4,700/month per vehicle. Adding vehicles is the primary growth lever.
Revenue Range
Real Acquisitions in This Category
SBA 7(a) change-of-ownership loans · NAICS 485991 · Special Needs Transportation
Deal Size Distribution
Deal Flow Over Time
Financing Profile
Recent Comparable Deals
| Closed | State | Loan | Implied deal | Jobs | Franchise |
|---|---|---|---|---|---|
| Sep 2025 | SC | $1.3M | $1.5M | 21 | — |
| Sep 2025 | SC | $100K | $118K | 21 | — |
| Sep 2025 | MO | $510K | $600K | 11 | — |
| Jul 2025 | MA | $1.1M | $1.3M | 2 | — |
| Mar 2025 | KS | $918K | $1.1M | — | — |
| Mar 2025 | OH | $458K | $539K | 13 | — |
| Feb 2025 | IL | $1.9M | $2.2M | 16 | — |
| Dec 2024 | IL | $459K | $540K | 12 | — |
| Jun 2024 | IL | $2.9M | $3.4M | 54 | — |
| Apr 2024 | FL | $1.2M | $1.4M | 11 | — |
Source: SBA 7(a) FOIA dataset, filtered to acquisitions (loans where business age is "Change of Ownership"). Implied deal size assumes an 85% loan-to-purchase ratio, a common SBA change-of-ownership structure. Charge-off rate shown only when 10+ loans have resolved (paid in full or charged off). Interest rates reflect last 24 months only. Actual deal values vary with equity injections, seller financing, and working capital terms.
Pros
- +Government (Medicaid) is the primary payer — low collection risk
- +Aging population creates permanent, growing demand
- +Low startup cost — used wheelchair vans start at $15K–$40K
- +Essential service with minimal competition in underserved areas
Cons
- -Medicaid reimbursement rates are low and vary by state
- -Driver turnover is high — difficult to retain reliable staff
- -Significant compliance and state licensing requirements
Best For
Community-oriented operators with patience for government contracting and compliance
Operating Costs
Driver wages and fuel are 60–70% of revenue. Other costs: vehicle insurance (high for medical transport), maintenance, dispatch software, and state licensing fees.
SBA Financing Estimator
Adjust the deal — see if it cash flows after debt service
Estimates only. Excludes owner compensation, capex, working capital draws, and taxes. Margin assumes average occupancy and volume. Actual SBA terms vary by lender and borrower profile.
Where to Buy
Find NEMT and medical transport businesses for sale
Browse transportation business acquisition opportunities
Acquisition Score
Scores margin (30), entry multiple (25), SBA market depth (20), category risk (15), and deal momentum (10). Higher = better acquisition candidate.
Quick Facts
- Category
- route
- Difficulty
- 3/5
- Buy price
- $600K–$1.0M
Buyer's Toolkit
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