Before You Start an NEMT Company, Read This

Provider. Broker. Software. Morgan has seen the NEMT industry from every angle. This series is your inside scoop into Non-Emergency Medical Transportation: honest answers and actionable advice to help you navigate the chaos and scale your business.

NEMT gets talked about like it's a side hustle. Pick up a vehicle, run a few trips, grow when you're ready. That advice sounds harmless, but it's why most people don't make it.

NEMT can be started small. Yes, it can be done on the side. But treating it like a side hustle limits growth and makes everything harder. Companies that survive long-term see it as a profession. For a lot of them, it's a calling.

If you're thinking about getting into NEMT, there are a few things you need to seriously think through before you ever take your first trip.

The Myth of “No Boss"

A lot of people come into NEMT because they don't want a boss. They're tired of someone else controlling their schedule or their pay. Or they're driving for a rideshare company and sick of giving up a big chunk of every trip to a platform that doesn't care if the math works for them.

That frustration makes sense. Wanting control over your time and income is a valid reason to start a business.

But you need to know that NEMT is always a grind, especially in the first few years.

When you leave a rideshare company, you're not escaping a boss. You're replacing one boss with several:

• Insurance companies
• Vehicle lenders
• Payroll & Staff
• Regulators
• Brokers & Facilities

Unlike an app, these "bosses" don't care how many trips you ran last week or whether volume is slow. Just like Paulie in Goodfellas: insurance, the bank, and payroll all say, "F* you, pay me," whether you have trips or not.

Your overhead doesn't scale down just because things are quiet. Vehicles still have notes. Insurance still renews. Employees still expect checks. That's the reality whether you have one vehicle or ten.

Cash Flow Will Make or Break You

Most people underestimate this part. You need to plan for a period where you're operating with little to no income. Not because you're failing, but because this industry moves slowly.

• Credentialing takes time.
• Contracts take time.
• Payments take time.

If you're counting on immediate revenue to cover fixed costs, you're starting behind. Too many new operators run the math like this: "If I do X trips a day, I'll be fine." That's not how this works.

You need reserves. You need a runway.

You need the ability to keep the lights on while things get set up the right way. If you don't have that, you'll end up making desperate decisions: taking bad trips, underpricing, burning out drivers, or doing everything yourself just to survive.

You Can't Do Everything Forever

Doing everything yourself feels smart at first. Driving, dispatching, billing, answering the phone at night. But if the business only works when you're exhausted and involved in every detail, you don't have a company. You just have a job with more risk.

Professional NEMT operators think about systems early. How trips are scheduled. How drivers are managed. How billing works.

They ask: "How do problems get handled when I'm gone?" That mindset is what allows a company to grow without breaking the owner.

Know Why You're Really Doing This

If the answer is "easy money," this industry will humble you fast. If the answer is "no boss," you're just trading one kind of pressure for another.

But if you want to build something real, serve your community, and run a professional operation? NEMT can be incredibly rewarding.

This industry serves people who depend on you. Missed rides matter. Late pickups matter. The operators who succeed treat that responsibility seriously. They show up. They're reliable. They communicate well.

NEMT isn't a shortcut. It's a commitment. But if you start with the right expectations from day one, your chances of making it long-term go way up.

Meet Morgan: The Guy Who’s Sat in Every Chair

• The Provider: Started in the trenches. Started by managing and growing a fleet to become the largest private fleet in the state. 
• The Broker: He took a 13-van fleet and scaled it into the state's #1 operator for Medicaid brokers. Managed operations for a nationwide NEMT broker, gaining a behind-the-scenes understanding of how trip placement and performance work.
• The Software: Now at MediRoutes, he helps owners improve dispatch and operations using the exact strategies that scaled his own career.

Have a question or want to talk more with Morgan?