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.
If you’ve been in NEMT for any amount of time, you’ve probably noticed something interesting.
A lot of companies make it to one vehicle, some make it to two, a few get to three, and then… they stop. They have plenty of trips available to them, but everything that worked at one or two vehicles starts breaking at three.
When I was recruiting and overseeing NEMT companies at the brokers I worked with, I saw this pattern repeatedly. Providers don’t stall because they’re lazy or bad operators. They stall because the business quietly changes, and they don’t change with it.
Three vehicles is usually the point where the owner is doing too much: driving some days, dispatching most days, and handling billing at night. They answer the phone at all hours because “no one else will do it right.”
It feels like growth, but it’s a weakness. One missed call, one sick driver, or one vehicle down for maintenance, and the whole operation falls apart like a paper plate at a crawfish boil.
That’s not a people problem; that’s a planning problem.
Most owners at this stage are working plenty hard, but they lack clarity.
Decisions are made off gut feel because there’s no clean way to see what’s happening. Another vehicle doesn’t feel like an opportunity; it feels like stress.
This is usually where owners start saying things like:
“I just need one more good driver.” “I just need a little more volume.” “I’ll hire help once things calm down.”
Bad news: things don’t calm down. They get wilder.
The companies that get past three vehicles do one thing differently: they stop relying on memory and start relying on structure.
Dispatch becomes a role, not a favor. Schedules become predictable. Drivers know what’s expected, and rules are applied the same way every time. Successful NEMT operators stop solving the same problems over and over again.
This doesn’t mean hiring a big team or buying fancy tools right away. It means:
Most importantly, it means the owner starts stepping back from some things. That’s the hardest part. Driving feels productive and dispatching feels urgent; both feel safer than building systems because systems don’t give immediate feedback. But if you stay in the weeds too long, the business never grows beyond you.
I’ve seen providers with three vehicles who were busier than companies with ten—and making less money. This isn’t about working harder; it’s about working differently.
If you don’t change how decisions are made, how information flows, and how people are held accountable, adding vehicles just adds pressure. That’s why so many companies stall right there.
Letting go of control in the right places and tightening it in others requires structure, not more hustle. Structure makes it repeatable by anyone on your team, not just by you.
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 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.