A non-emergency medical transportation (NEMT) business can generate anywhere from around $50,000 to well over $300,000 in annual revenue per vehicle, depending on the type of service, the number of daily trips, and which state you operate in. The wide range reflects the reality that a sedan doing basic ambulatory trips in Mississippi earns a fraction of what a stretcher van pulling premium rates in New York brings in. Here’s how the numbers break down.
Revenue Per Trip by Service Type
NEMT earnings start with what you charge per trip, and that varies dramatically based on the level of care your vehicle provides.
Ambulatory transport (standard sedans or minivans for patients who can walk) pays the least at $25 to $60 per trip. The tradeoff is speed: drivers can complete 6 to 10 trips per day because pickups and drop-offs are quick. At the low end, that’s $150 a day. At the high end, $600.
Wheelchair-accessible vans earn $45 to $150 per trip through Medicaid, with weekend rates sometimes reaching $75 to $90. Loading and securing wheelchair passengers takes longer, so most operators complete 3 to 5 trips per day. Daily revenue typically lands between $135 and $750, though the upper range requires a high-paying market.
Stretcher van services sit at the top, earning $100 to $400 or more per trip for transporting bedridden patients on gurneys. Volume is lower, but fewer operators compete in this space because of the higher vehicle and equipment costs.
How Your State Changes Everything
Medicaid is the single largest payer in the NEMT industry, and reimbursement rates are set at the state level. The gap between the highest and lowest-paying states is enormous. The best-paying state reimburses at rates roughly 454% higher than the worst.
For wheelchair transport specifically, New York pays $45 to $120 per trip, California pays $40 to $110, and New Jersey pays $40 to $100. Move to the Southeast and the picture changes sharply: Tennessee pays $18 to $45, Georgia pays $20 to $50, Alabama pays $18 to $40, and Mississippi bottoms out at $16 to $38 per trip for the same service.
Ambulatory rates follow the same pattern. Southern states typically pay $18 to $35 per trip, while Northeastern and West Coast markets pay $35 to $60. If you’re evaluating whether to start an NEMT business, your state’s Medicaid rate is probably the single most important number to research first.
Private Pay and Facility Contracts
Medicaid doesn’t have to be your only revenue stream. Private-pay clients, who are often families arranging rides for elderly relatives, pay significantly more. Private dialysis transportation runs $75 to $150 per trip compared to Medicaid’s $40 to $60 for the same ride. Specialized services for private-pay clients can range from $50 to $250 per trip.
Direct contracts with hospitals, dialysis centers, and senior living communities offer another layer of income. These facilities pay $60 to $100 or more per trip in exchange for guaranteed vehicle availability. Contract work typically makes up 5% to 15% of a company’s revenue, but it provides predictable, recurring income that smooths out the volatility of Medicaid scheduling.
What Drivers and Owners Earn
The median salary for NEMT drivers was $95,888 in 2023, according to labor data, though this figure likely reflects owner-operators and experienced drivers rather than entry-level employees. Job postings told a different story: the median advertised salary was $67,456. The lowest earners made about $59,010, while the highest earners reached $158,163.
These numbers blend together employed drivers and owner-operators who keep the profit from their own vehicles. An owner-operator running a single wheelchair van and completing 4 trips a day at $80 per trip would gross roughly $83,000 a year before expenses (assuming 260 working days). With a stretcher van averaging $200 per trip and 3 trips daily, gross revenue jumps to $156,000. Your actual take-home depends heavily on what you spend to keep that vehicle running.
Operating Costs That Cut Into Profit
Insurance is the biggest recurring expense. Commercial auto liability runs $5,000 to $12,000 per vehicle per year for standard coverage limits. General liability insurance adds another $400 to $900 annually for incidents that don’t involve vehicles, like a patient slipping during a transfer.
Fuel, vehicle maintenance, and dispatch software stack up quickly. Routing and dispatch platforms cost $100 to $500 per month per vehicle. GPS and communication equipment runs $200 to $500 per unit. Then there’s fuel, tires, oil changes, and the inevitable repairs that come with putting high mileage on a commercial vehicle.
If you hire drivers instead of driving yourself, labor becomes your largest single cost. Even at $15 to $18 an hour, a full-time driver costs $31,000 to $37,000 a year before payroll taxes and benefits.
Startup Investment
Getting into the NEMT business requires meaningful upfront capital. A small fleet of 2 to 3 vehicles typically costs $80,000 to $120,000 or more, depending on the service type. A used ambulatory sedan starts around $15,000, while a new wheelchair-accessible van can run $35,000 to $75,000. Stretcher vehicles cost $50,000 to $80,000 or more. On top of that, wheelchair lifts, securement systems, and safety modifications add $5,000 to $15,000 per vehicle.
Licensing and permits total $1,000 to $5,000 in most states, covering business registration, state NEMT provider certification, and vehicle inspections. Technology setup (dispatch software, a booking website, CRM tools) adds another $2,000 to $8,000. All in, a small operation with two or three vehicles should expect to invest roughly $85,000 to $135,000 before completing the first trip.
The Bigger Market Picture
The NEMT industry as a whole was valued at $17.45 billion in 2025 and is projected to reach $18.19 billion in 2026, growing at about 5.5% per year. At that pace, the market could hit $25.4 billion by 2032. The growth is driven by an aging population, increasing chronic disease rates (particularly diabetes and kidney disease requiring regular dialysis), and Medicaid expansion in more states.
For someone evaluating this as a business opportunity, steady 5.5% annual growth means demand is rising faster than many small-business sectors. The aging of the baby boomer generation virtually guarantees that the need for medical transportation will increase for at least the next decade. The question isn’t whether the market is growing. It’s whether you can operate efficiently enough in your specific state and service type to keep margins healthy after insurance, fuel, and labor take their share.