How much cash does it take to launch an NEMT company in your state? Pick your state, your service type and how you get your vehicles. The estimate covers formation, licensing, vehicles, insurance, drivers and the working capital to carry you until the first payments land. Replace the sample numbers with your quotes. Nothing you type leaves your browser.
Sample numbers are placeholders, not quotes, and sit inside the ranges in our startup guide. State formation and annual report fees are 2026 Secretary of State filing fees for an LLC (check your state before filing). The federal Medicaid and Medicare enrollment application fee is $750 for 2026 (CMS). Vehicle prices vary widely by year, mileage and conversion.
LLC filing, permits, the Medicaid enrollment fee, professional fees, vehicles (or the down payment or lease signing), equipment, the insurance down payment, driver onboarding and marketing.
Driver payroll plus about 10% payroll taxes, fuel and maintenance, software and overhead, insurance spread over the year, and any vehicle payment. Financed vehicles assume a 60-month loan.
The monthly cost times the months you carry before broker and Medicaid payments arrive. Early claims get rejected more often, so err long, not short.
With the sample numbers here, one wheelchair van runs about $25,000 if you lease it and about $50,000 if you buy a used van outright, including two months of payroll and running costs before the first payments arrive. Buying new pushes it past $80,000. Your insurance quote, your vehicle choice and how long payers take to pay move the number most.
On filing fees alone, Massachusetts and Nevada sit at the top, with Tennessee and Texas next; California adds an $800 yearly franchise tax, and New York adds a newspaper publication requirement. Filing fees are small next to vehicles and insurance, though, and insurance varies more by county and carrier than by state line.
The federal application fee applies to institutional providers, and states decide how it applies to NEMT. Some charge it, some do not, and some fold NEMT into broker credentialing instead. Ask your state Medicaid agency and set the field to zero if it does not apply.
Rarely. Leasing and financing cut the vehicle cost, but insurance down payments, permits and payroll before the first payment still need cash. SBA microloans and equipment financing are the usual routes. Run the lease option here to see your floor.
Get written insurance quotes, confirm a broker or facility is adding providers in your area, then price your trips with the cost per trip calculator. The startup guide walks the full order.