The operator's publication for non-emergency medical transportation. State licensing guides, broker intel, a 2,000+ provider directory and The Dispatch, our weekly newsletter.
Updated October 2026. Every figure links to its source. Market-research numbers are labeled as estimates.
Non-emergency medical transportation had a hard year. The biggest broker in the country went through bankruptcy. Congress passed Medicaid changes that CBO projects will leave 7.5 million more people uninsured in 2034, with most of them starting in January 2027. Diesel passed its 2022 record. Minnesota stopped enrolling new NEMT companies in the Twin Cities.
This report pulls the numbers that matter for people who run NEMT companies: who pays for trips, who rides, what a trip costs to run, and where regulators are looking. We rebuilt it from primary sources this year. Several figures in the 2025 edition could not be traced to the source they cited, so we removed them. The methodology note at the end has the details.
Key numbers at a glance
| Metric | 2026 figure | Source |
|---|---|---|
| Medicaid and CHIP enrollment | 73.2 million (June 2026). KFF: Medicaid enrollment down 5.1 million (6%) in a year | CMS, KFF |
| Medicaid members who use NEMT | About 3 to 4 million a year, 4% to 5% of beneficiaries (2018 to 2021) | CMS Report to Congress, 2023 |
| Americans 65 and older | 64.6 million (July 2025), up 16.2% since April 2020 | Census Bureau |
| Projected increase in uninsured from Medicaid work requirements | 5.3 million in 2034 | CBO |
| Special needs transportation employers | 3,920 establishments, 65,974 employees (2023) | Census CBP |
| Median shuttle driver and chauffeur pay | $17.93 an hour, $37,290 a year (May 2025) | BLS |
| Diesel, US average | $6.276 a gallon (week of Oct 19, 2026), up $2.66 in a year | EIA |
| Regular gasoline, US average | $4.284 a gallon (week of Oct 19, 2026), up $1.27 in a year | EIA |
| Medicare Advantage enrollees with a ride benefit | 22% in 2026, down from 28% in 2025 | KFF |
| Global NEMT market (estimate) | $11.8 billion (2025) to $12.8 billion (2026) | Mordor Intelligence |
The five biggest changes since last year
- The largest broker went bankrupt, and the broker map is being redrawn. Modivcare filed Chapter 11 in August 2025 and came out in December with $1.1 billion less funded debt. Several states moved their NEMT contracts in 2026 (details below).
- Federal Medicaid changes reach riders in January 2027. Work requirements, six-month renewals and shorter retroactive coverage all start on or around January 1, 2027.
- Fuel spiked. Diesel passed its 2022 record in early September, peaked at $6.529 a gallon in the week of September 21, and was still $6.276 in the week of October 19.
- Fraud enforcement turned into enrollment freezes. Minnesota closed its Twin Cities metro to new NEMT providers, and HHS-OIG opened a new multi-state NEMT audit series.
- Medicare Advantage pulled back on rides. A smaller share of Medicare Advantage enrollees has a ride benefit in 2026, which makes private pay more important.
Who pays for the trip now: the 2026 broker map
How states deliver NEMT
States use three models, and many use more than one. As of April 2025, 30 states contract with brokers, 19 run NEMT in-house, and 12 carve it into managed care (Health Management Associates). Federal law requires every state Medicaid program to assure transportation to covered care. Section 209 of the Consolidated Appropriations Act, 2021 wrote that assurance into the Medicaid statute (CMS).
Modivcare's bankruptcy
Modivcare was the largest NEMT broker in the country. In 2024 it earned $1.96 billion in NEMT revenue, paid for 36.8 million trips and averaged 29.5 million members a month, with contracts in 48 states and DC (Modivcare 10-K, FY2024).
In the third quarter of 2025, its average monthly NEMT membership fell to 23.6 million from 30.0 million a year earlier, down 21.3%, which the company put down to contract losses. It paid for 9.3 million trips that quarter at $52.78 of revenue per trip (10-Q, Q3 2025).
Modivcare filed for Chapter 11 on August 20, 2025. Its restructuring plan was confirmed on December 12 (Business Wire). It emerged on December 29 with $1.1 billion less funded debt, more than 85% of what it owed before (Modivcare 8-K, December 29, 2025). It filed to deregister from the SEC the same day, so no more public financials are expected.
Broker transitions in 2026
| State or plan | Change | Effective | Source |
|---|---|---|---|
| Georgia | Verida serves all five regions; Modivcare exits three | April 1, 2026 | Georgia DCH |
| Colorado | MediDrive takes over, Denver metro first; new provider enrollment opens October 1, 2026 | Denver metro July 1, 2026; statewide January 1, 2027 | Colorado HCPF |
| Wisconsin | Notice of intent to award to Verida, replacing MTM | No transition date yet | Wisconsin DHS |
| Inland Empire Health Plan (CA) | Plan manages NEMT trips directly instead of through Call the Car; Call the Car keeps non-medical transportation | May 12, 2026 | IEHP provider notice |
| Iowa | Must cover NEMT for its expansion population after CMS declined to renew the waiver | January 1, 2027 | Iowa HHS |
Rates can move fast when state budgets tighten. North Carolina cut NEMT rates 3% on October 1, 2025, then reversed the cut and restored rates in phases from December 17 (NC Medicaid).
What operators should do: if your state is changing brokers, re-credential early, confirm your rates in writing before the start date, and hold enough operating cash to ride out slower payments while the new broker's billing settles in. Our NEMT Broker Report Card tracks each broker's record on payment and complaints.
Medicaid in 2027: what H.R. 1 does to your rider base
The One Big Beautiful Bill Act (P.L. 119-21, signed July 4, 2025) makes major changes to Medicaid eligibility. Most of them start in January 2027.
| Provision | What it does | Start | Projected coverage impact (CBO) |
|---|---|---|---|
| Work (community engagement) requirement | Expansion adults 19 to 64 must show 80 hours a month of work, school or community service, or earnings of at least 80 times the federal minimum wage ($580 a month in 2026) | By January 1, 2027 | 5.3 million more uninsured in 2034 |
| Six-month renewals | Expansion adults must renew eligibility every six months instead of every 12 | Renewals on or after January 1, 2027 | 700,000 more uninsured in 2034 |
| Retroactive coverage | Cut from three months to one month (expansion adults) or two months (other groups) | Applications on or after January 1, 2027 | Not estimated separately |
| All Medicaid provisions combined | 7.5 million more uninsured in 2034; federal deficits $886.8 billion lower, 2025 to 2034 |
Sources: CMS interim final rule, CMS fact sheet, CMS guidance SMD 26-001, CBO, Missouri DSS timeline.
Some states are moving early. Nebraska started work requirements on May 1, 2026 (Nebraska DHHS), and Montana on July 1 (Montana DPHHS). Iowa starts by December 1, 2026 (Iowa HHS). Arkansas began a soft launch on July 1, with no coverage loss before January 1, 2027 (Arkansas DHS). KFF tracks the early states (KFF). Other dates to note: a cap on provider tax rates takes effect October 1, 2026, and expansion adults above 100% of the poverty line can be charged up to $35 per service from October 1, 2028 (Missouri DSS timeline).
Enrollment is already falling. Medicaid and CHIP covered 73.2 million people in June 2026 (CMS). KFF reports that Medicaid enrollment fell by 5.1 million, or 6%, from June 2025 to June 2026 (KFF).
What operators should do: verify each rider's eligibility before trip day, not after, and track trips denied because coverage lapsed. Riders who lose coverage mid-month are the trips you run and never get paid for. If you operate in Nebraska, Montana, Iowa or Arkansas, you will see the effect first.
Who rides: demand fundamentals
- 3 to 4 million Medicaid members use NEMT each year, about 4% to 5% of beneficiaries (2018 to 2021). Ride days in 2021 were still about 30% below pre-pandemic levels (CMS). Medicaid data recorded between 51.5 million (2020) and 81.3 million (2019) ride days a year, which CMS calls a lower bound because some NEMT spending does not show up in claims data (CMS).
- Heaviest users: people eligible through disability or age 65 and older, and people with end-stage renal disease, opioid use disorder or mental health conditions (CMS). In 2019, 41% of Money Follows the Person participants used NEMT, along with 29% of 1915(c) waiver enrollees and 17% of dual eligibles (CMS, 2022).
- The population is aging. 64.6 million Americans were 65 or older on July 1, 2025, about 9 million more than in April 2020 (Census Bureau).
- Missed care is common. In 2017, 5.8 million people (1.8% of the population) delayed medical care because they had no transportation (American Journal of Public Health). In 2022, 5.7% of US adults lacked reliable transportation for daily living, rising to 15.8% of adults below the poverty line (CDC NCHS).
- Missed rides cost the system. Among adults 18 to 64, transportation barriers are linked to more emergency department use (odds ratio 1.45) and higher all-cause mortality (hazard ratio 1.36) (BMC Public Health, 2025).
Medicare Advantage and private pay
Medicare Advantage plans cut back on ride benefits for 2026. The share of individual plan enrollees in a plan with a transportation benefit fell from 28% in 2025 to 22% in 2026. In Special Needs Plans it fell from 80% to 73% (KFF).
Seniors who lose a plan ride benefit still need to get to appointments, and some will pay for the ride themselves. For operators, a private-pay rate card, a facility contract or two, and a card-payment option are worth more than they were a year ago.
Who runs NEMT: the operator count
The Census Bureau counts NEMT companies under NAICS 485991, Special Needs Transportation. In 2023 there were 3,920 employer establishments with 65,974 employees and $2.51 billion in annual payroll, up from 3,825 establishments and 63,864 employees in 2022. 1,854 of them (47%) had fewer than five employees (Census County Business Patterns).
Two cautions. The category includes some special-needs transportation that is not Medicaid NEMT, such as senior center vans. And it counts only businesses with payroll. The Census also counts 131,531 transit businesses with no employees (2023), but that figure mixes NEMT with shuttles and other transit, so it is not a count of NEMT owner-operators (Census Nonemployer Statistics).
We found no reliable market-share figure for NEMT transportation providers. The industry is made up mostly of small, local operators, with a handful of large brokers and managed care plans controlling the trip volume. Browse the operators near you in the NEMTrepreneur provider directory.
What it costs to run a trip in 2026
Fuel
Fuel is the fastest-moving cost this year.
| Week of Oct 19, 2026 | Change vs a year earlier | 2025 average | 2026 forecast (EIA, estimate) | |
|---|---|---|---|---|
| Regular gasoline | $4.284 | +$1.265 | $3.097 | $3.91 |
| On-highway diesel | $6.276 | +$2.656 | $3.660 | $5.19 |
Sources: EIA weekly prices, EIA annual series for gasoline and diesel, EIA Short-Term Energy Outlook, October 2026. Diesel reached $5.967 on September 7, above its 2022 weekly record of $5.810, and peaked at $6.529 in the week of September 21 (EIA weekly diesel series). EIA forecasts prices easing in 2027, to $3.56 for gasoline and $4.49 for diesel.
Unless your broker contract has a fuel adjustment, a price spike comes straight out of margin. Run your own numbers with the NEMT trip cost calculator.
Driver pay
BLS counts NEMT drivers with shuttle drivers and chauffeurs (SOC 53-3053), a category that explicitly includes nonemergency medical transporters (O*NET). The median was $37,290 a year, or $17.93 an hour, in May 2025. The lowest 10% earned under $28,090 and the highest 10% over $55,070 (BLS, O*NET).
Median pay by industry for the same job:
| Industry | Median annual pay |
|---|---|
| Services for the elderly and persons with disabilities | $35,070 |
| Other transit and ground passenger transportation | $37,640 |
| Local government | $39,270 |
| Taxi and limousine service | $43,230 |
BLS projects shuttle driver and chauffeur jobs to grow 7% from 2025 to 2035, from 251,500 to 269,400 (BLS). There is no national data on NEMT driver vacancies or turnover. That is one of the gaps our operator survey will fill (see below).
Vehicles
BraunAbility's own example for a new wheelchair-accessible minivan: a 2026 Chrysler Pacifica at $47,935 MSRP plus a Power XT conversion at $40,750, $88,685 in total before taxes and fees (BraunAbility). Dealer price guides put new converted vans at about $45,000 to $120,000, depending on base vehicle and conversion (Falls Mobility, Southern Bus and Mobility, Access 2 Mobility). For comparison, the average new vehicle sold for $50,089 in August 2026, up 1.9% in a year (Cox Automotive).
Plan your fleet budget with the NEMT startup cost estimator, which covers vehicles, insurance, licensing and working capital by state.
Enforcement and enrollment freezes
Regulators are spending more time on NEMT, and the cost of weak records is going up.
- Minnesota stopped enrolling new NEMT providers in the seven-county Twin Cities metro (Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington) on January 27, 2026, and extended the freeze to January 27, 2027. Providers elsewhere in the state can still enroll (Minnesota DHS). Browse Minnesota NEMT providers.
- HHS-OIG added a new series, "Audits of Medicaid Non-Emergency Medical Transportation Services," to its work plan in May 2026, with completion expected in fiscal 2028. The audits check whether selected states paid only for properly authorized trips by credentialed providers with documentation (HHS-OIG).
- New York (federal): the owner of two Long Island taxi companies that billed Medicaid for medical rides was sentenced to 97 months in prison for stealing more than $19 million through phantom rides and rider kickbacks (US Attorney, EDNY).
- New Mexico: a driver pleaded guilty in a case where an NEMT company received about $4.14 million from Medicaid on fraudulent claims from 2020 to 2026 (DOJ).
- New York (state): the Attorney General recovered $13 million from 25 transportation companies in June 2025, after sending cease-and-desist notices to 54 companies in January (NY AG).
- Massachusetts: the State Auditor found MassHealth overpaid at least $1.67 million for nonemergency transportation where no qualifying medical service took place that day (Mass. State Auditor).
What operators should do: keep GPS-stamped pickup and drop-off records, rider or facility signatures, and a trip log that ties every trip to an appointment. HHS-OIG's new audits check authorization, provider credentials and documentation, so those are the records to have ready. Honest operators pay for other people's fraud through tighter rules. Clean records are how you stay out of the freeze.
Global and US market size (estimates)
Market-research firms put the global NEMT market at $11.8 billion in 2025 and $12.8 billion in 2026, growing about 8.2% a year to $18.9 billion by 2031 (Mordor Intelligence). Another firm puts 2025 at $10.8 billion, growing to $19.9 billion by 2034 (The Research Insights). North America is the largest region: more than 35% of the total by one estimate and 40.8% by the other.
For the US alone, ResearchAndMarkets estimates $6.58 billion in 2023, growing to $13.43 billion by 2031, about 9.3% a year (GlobeNewswire).
Treat all of these as estimates. They come from paid reports with undisclosed methods, and the publishers disagree by about $1 billion on the same year. We found no federal source that publishes national NEMT spending after 2021.
What we are measuring next: the 2026 NEMT Operator Benchmark
The biggest gaps in public NEMT data are the ones operators care about most: how fast brokers pay, driver turnover, what fuel does to cost per trip, and how many trips are lost when riders lose coverage. No one publishes them.
We are running a short survey of NEMT operators to fill them, open through November 10, 2026. It has 14 questions, takes about five minutes, and asks about driver pay and turnover, broker payment times, rates, fuel and coverage losses. There are no questions about riders. Results are aggregated, no company is named, and nothing is reported for a broker, state or fleet size with fewer than 20 responses. Everyone who leaves an email gets the full benchmark before it is published here.
Take the 2026 NEMT Operator Benchmark survey
Frequently asked questions
How big is the NEMT industry in 2026?
Market-research estimates put the global market at about $12.8 billion in 2026 (Mordor Intelligence). For the US, ResearchAndMarkets estimated $6.58 billion in 2023 and projects $13.43 billion by 2031. These are estimates from paid reports. The most reliable federal data counts 3,920 special-needs transportation employers with 65,974 employees in 2023.
How many people use Medicaid NEMT?
About 3 to 4 million Medicaid members use NEMT each year, 4% to 5% of beneficiaries, according to CMS's most recent report (2018 to 2021 data).
What happened to Modivcare?
Modivcare filed for Chapter 11 in August 2025 and emerged on December 29, 2025 with $1.1 billion less funded debt. It lost several state contracts in 2025 and 2026, and it is no longer a public company.
When do Medicaid work requirements start?
States must start them for expansion adults by January 1, 2027. Nebraska started on May 1, 2026 and Montana on July 1, 2026. Iowa starts by December 1, 2026. Arkansas began a soft launch on July 1, 2026, with no coverage loss before January 1, 2027.
How much do NEMT drivers make?
The BLS median for shuttle drivers and chauffeurs, the federal job category that includes nonemergency medical transporters, was $17.93 an hour ($37,290 a year) in May 2025.
How much does a wheelchair van cost?
BraunAbility's own example for a 2026 Chrysler Pacifica with a Power XT conversion comes to $88,685 before taxes and fees. Dealer price guides put new converted vans at about $45,000 to $120,000.
Methodology
Sources. Every figure links to the source we opened. We used federal primary sources first (CMS, CBO, Census, BLS, EIA, HHS-OIG, DOJ, the Federal Register), then state Medicaid agencies, then company filings and peer-reviewed research, then reputable reporting of primary sources. Market-research numbers are labeled as estimates and name their publisher. Dealer prices are named but not linked.
Dates. Each figure carries the period it describes. Fuel prices are EIA's weekly US averages for the week of October 19, 2026. Federal NEMT utilization data stops at 2021 because that is the newest CMS has published.
Arithmetic. No number was extrapolated or modeled. Where we show a share or a difference (for example, 1,854 of 3,920 establishments), both inputs come from the same cited source.
What we left out. We dropped figures we could not open at a primary source or whose scope was unclear, including state NEMT billing totals that conflicted between news reports, third-party counts of excluded providers, and broker contract dates that the state or district had not yet published.
Changes from the 2025 edition: - We removed the $13.87 billion market figure, the 7.13% growth rate, and the technology-impact figures (45%, 30%, 25% and 40%). None of them appear in the source the 2025 edition cited. - We replaced "no provider holds more than 5%," which had no underlying source, with Census establishment counts. - We replaced sections on driver shortages and EV adoption, which had no data behind them, with BLS pay data and the operator survey.
This report is for information only. It is not legal, tax or investment advice. Confirm program rules with your state Medicaid agency.
Spot an error or have a newer source? Email contact@nemtrepreneur.com. We check every correction and log the change here.
Sources checked October 1, 2026; fuel prices updated October 21, 2026. Next update: after the Operator Benchmark closes.
