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.
Most NEMT operators think their biggest problems are drivers, vehicles, or not having enough trips. Those things matter, but they're rarely what quietly kills profitability.
The real damage usually comes from a handful of operational leaks that feel small in the moment but add up every single day.
The problem isn't that owners don't care. The problem is that these leaks are hard to see when you're busy, tired, and reacting instead of reviewing.
A single no-show doesn't feel catastrophic, especially when you're trying to be flexible or keep a good relationship. But when no-shows aren't tracked, enforced, or billed consistently, they quietly train riders and facilities that your time doesn't matter.
Drivers sit. Schedules get pushed back. And suddenly, your "full day" produces far less revenue than expected.
The worst part is that many operators don't even realize how often this is happening because it just feels like part of the job.
Everyone wants to be accommodating, and in healthcare, that instinct makes sense. But there's a difference between being professional and subsidizing inefficiency.
If drivers are routinely waiting twenty, thirty, or forty minutes without clear rules or compensation, you're paying for someone else's poor planning. Over time, that turns into overtime, frustration, and drivers feeling like their day is out of control.
If wait time isn't defined, communicated, and either minimized or billed for, it becomes an invisible cost that never shows up on paper but always shows up in your bank account.
Deadhead miles are where a lot of newer operators lose money without realizing it. Running empty feels harmless when you're focused on just keeping the wheels moving, but miles without passengers still cost:
When routes aren't planned with intention, drivers spend large portions of the day driving to the next trip instead of earning on the current one. Over time, that turns a busy schedule into an unprofitable one, and owners are left wondering how they worked all week and still came up short.
Multi-loading is the flip side of that problem, and it's one of the biggest differences between struggling operators and sustainable ones.
The ability to safely and reliably carry more than one rider at a time, when appropriate, changes the entire economics of a day. But multi-loading only works when scheduling, timing, and communication are tight. Without that, it turns into late pickups, angry facilities, and drivers who feel set up to fail.
Doing it well requires more than good intentions and experience. It requires consistency.
What ties all of these together is visibility. Most operators feel these issues, but they can't quantify them.
It's a little like running a business with the check engine light on and just turning the radio up so you don't have to hear it.
This is where many owners default to working harder instead of working clearer. They drive more, stay later, answer every call, and try to personally plug every hole.
That approach works for a while, but eventually, it looks like that scene in Titanic where people are rearranging deck chairs while the water is already coming in.
Busy doesn't mean profitable. Effort doesn't fix structural problems.
The operators who stabilize and grow aren't necessarily smarter or more motivated. They're simply able to see what's happening and make decisions based on reality instead of stress.
They define no-show policies and enforce them. They set expectations around wait time and stick to them. They plan routes to limit deadhead miles and look for safe opportunities to multi-load when it makes sense.
Most importantly, they don't rely on memory or gut feel to manage these things day after day.
NEMT margins are too thin to run on vibes. The money is made or lost in the gaps between trips, the minutes spent waiting, and the miles driven without a rider.
If you're serious about building a professional operation, these aren't details. They're the business.
The sooner you can see these leaks clearly and address them consistently, the sooner the operation starts working for you instead of against you. And that's usually the moment when NEMT stops feeling like controlled chaos and starts feeling like a real company.
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?