Getting Started in NEMT

August 2, 2021


I am asked many times about getting started in NEMT. How do I get started, how much will it cost, what about training, what about insurance, where do I get the passengers from? All good questions and topics that need to be thought about very carefully. The difference in a successful company and one that is struggling is in the planning!

What do I need to know?

I think that the first thing that you need to know and understand is the obligation to get into this business and take it very seriously. This type of business is one that demands your attention all of the time. Remember that the product you put on the street is a reflection of your company. This includes the way the vehicles look, the driver’s professionalism, the driver /company’s appearance, and the performance of the driver/company.  In addition, and most important to remember is once you start transporting passengers, you are putting their safety into your hands!

What’s First?

What do I get done first? Well, that is a loaded question. The first thing is proper planning regarding your operation. This planning needs to include the following topics:

  1. The name of your company.
  2. The type of company you want regarding an LLC, S Corporation, Partnership, Sole Proprietor, etc. You may want to consult with a lawyer or tax attorney.
  3. The structure of your organization – What will it include?
  4. Where will you be located? – What will be the physical address?
  5. Develop a financial plan to understand your overheads, expenses, and bottom lines. Having a accountant that understands transportation on board early will help determine expenses, and guide you through the tax situations that you may encounter.
  6. What will be your days and hours of service, 12-hour days, 24 hours availability, 5 days per week, 6 days per week, or 7 days a week. Do you want to operate on holidays?
  7. The amount of time your company is in service will lead you to determine the number of drivers, staff, and vehicles that you will need.
  8. Determine the way your company will communicate through social media, web site design, a company logo. Need to work on developing a marketing plan or determine who your target passengers will be.
  9. Understand what your state laws are regarding Non-Emergency Medical Transportation.
  10. What type of service will you deliver, Wheelchair /Mobility Device access, Ambulatory, Stretcher Transportation, or a combination of these? What kind of vehicles will you require?
  11. Obtain the services of an Insurance Broker who works in the public transportation field. This is not your typical family insurance guy, but someone who has the commercial aspect of the public transportation experience. You will need insurance for auto liability, general liability, worker compensation, errors and omissions, abuse, property insurance, garage insurance, etc. You will need to discuss these needs at length and understand their costs. Auto liability insurance will be one of the biggest expenses besides labor. As a new company, not having experience in the NEMT business will dictate your exposure and insurance premiums.
  12. Development of an employee policy & procedure manual, or handbook is important to help guide you and the employee through the policies, procedures, and programs of your company. This manual can contain items such as attendance policies, mission statements, collision policies, how to report abuse, etc. There are many avenues to help develop this type of program from a HR viewpoint through the services of a HR professional. 

Once You’re Ready!

Once your initial plans are in place, and you’re comfortable with the direction you are headed, have an understanding of the business, then it will be time to hire employees. It is important to remember that hiring the right employee is critical to all aspects of the NEMT business. As I stated earlier, the driver becomes the face of the company. How they appear, how they act towards the passengers, and how they perform will be a reflection on your company. Some first steps, or what I call the safety checks that need to be implemented are listed below. These will help you to determine how you are going to hire and train employees:

  1. Application process – Is your application complete and asks the right questions?
    1. Hiring /Interview process.- Do you know how to interview, how to probe the applicant for past history, what are the right and wrong questions to ask during an interview.
    1. Substance Abuse & Prevention Program– You must have a substance abuse prevention program in place that will help keep your company and passengers safe. I recommend a DOT program to be implemented for all types of NEMT companies.
    1. Criminal Background Checks – Understand who you are hiring. Do they meet the requirements? What will you, as a company, allow a person to have in their background? Felonies, Misdemeanors, DUI, Any Abuse, etc. should be reviewed and determined, based on your hiring polices, what will be allowed.
    1. Motor Vehicle Record Checks.- Determining patterns of unsafe behavior needs to be recognized. In addition, what will be your company’s allowance for moving violations? Will it be based on points, or a count? For example, we will allow only 2 pts in the last 36 months, or no more than 2 moving violations during a 36-month period.
    1. Fingerprint Checks (if required)- Who conducts fingerprint process in your area? Is it the local police, sheriff, or an outside agency? What will be the written process to follow?
    1. Physical Examination– This is a critical component of hiring a driver. Again, I recommend obtaining a DOT examination from a MD. Some states allow for a physician assistant to conduct examinations, but make sure that a doctor signs the physical form. Best practice would dictate that you have a MD complete the physical. Applicants that have medical conditions such as diabetes, heart conditions, vision problems,  heart conditions, etc. fall into a risk category. You will need to be careful on understanding these folks and determine if they can be employed. You might be putting your passengers and the motoring public at risk.
    1. Training – Training of drivers is critical to the operation of the company and the safety of the passengers. Training must be provided that is structured, is a pass /fail program, and contains a classroom element, a behind the wheel element, and a cadet element. The classroom element must contain information that will train the driver about the job. The behind the wheel element will give them the skills that they need, and the cadet element will give them exposure to the passengers and the conditions that they will face.

Once these steps are completed, and you have satisfied your company’s requirement to hire and train, then the new employee, pending any contract approvals, will be ready for revenue service.

Interaction with the Industry

It is important to get connected with the industry. Research the industry trade associations that you might want to join and attend their conferences. Being able to network with other owners of NEMT companies opens the door to a better understanding of the business and possibly more business that can come your way.

In Summary

Starting an NEMT company is exciting and certainly challenging. Don’t be afraid to ask for help when working in the planning stages. Poor planning leads to poor performance… Understanding of the NEMT business is critical and will help you make wise decisions regarding the direction of your company.

Thanks, and See You Next Time!

Frank J. Ciccarella

For more information, contact me at or visit my website at

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