# How Much Does It Cost to Start a NEMT Business in 2027? A Line-by-Line Budget

Canonical URL: https://nemtguide.com/guides/how-much-does-it-cost-to-start-a-nemt-business/ · Updated 2026-09-28

The cost to start a NEMT business is mostly the vehicle and the cash to run until payers pay you. Fees are small: the EIN and NPI are free, an LLC costs $50 to $125 in Arizona, Ohio, North Carolina, and Florida, and Medicaid's application fee, where charged, is $750 in 2026. Florida's contract for public transit agencies prices a new ramp minivan at $70,771.

- Fees are the smallest line. The EIN and NPI are free, and Medicaid charges $750 to enroll in 2026 where your state collects the fee.
- The vehicle is the biggest line. A ramp minivan cost public agencies $70,771 with its required seating on Florida's contract.
- Insurance must be in force before your first ride, at limits such as $500,000 of auto liability and $500,000 of general liability.
- Payers pay weeks after the ride, so keep cash for payroll, fuel, insurance, and loan payments until payments start.
- Three vans cost close to three times one van, because the vehicle, driver, and insurance lines grow with each van.

Most of the money goes to two things: the vehicle, and the months you pay drivers, fuel, and insurance before the first payments arrive. Fees are the smallest part, and they are the easiest to look up. Start with them, then price everything else with real quotes.

## What goes into the cost to start a NEMT business

The SBA splits startup money into one-time expenses and monthly expenses. One-time expenses are what you pay to open. Monthly expenses keep coming, and the SBA suggests counting at least one year of them in your plan, with five years as the ideal.

| What you pay | When you pay it | What sets the amount |
|---|---|---|
| Company filing, licenses, and Medicaid enrollment | Before you apply | Your state's published fees |
| Vehicles | Before the vehicle inspection | Price, down payment, and loan terms |
| Equipment and options | Before the inspection | State and broker vehicle rules |
| First insurance payment | Before your first ride | The limits your state and brokers require |
| Hiring checks and training | Before each driver's first ride | Broker and state driver rules |
| Monthly running costs | Every month from the day insurance starts | Payroll, fuel, repairs, insurance, and loan payments |
| Cash reserve | In the bank on opening day | How long your payers take to pay |

The cash you need to open is your one-time costs plus that reserve. The [NEMT startup cost calculator](https://nemtguide.com/tools/nemt-startup-cost-calculator/) adds them up once you have your numbers.

## Government fees you pay before the first ride

These are the amounts agencies publish, as of September 2026.

| Fee | Amount | Paid to |
|---|---|---|
| Employer identification number (EIN) | Free | IRS |
| National Provider Identifier (NPI) | Free | CMS, through NPPES |
| LLC articles, Arizona | $50, or $85 expedited | Arizona Corporation Commission |
| LLC articles, Ohio | $99 | Ohio Secretary of State |
| LLC articles, North Carolina | $125 | North Carolina Secretary of State |
| LLC articles with registered agent, Florida | $125 | Florida Division of Corporations |
| Medicaid application fee, 2026 | $750 in Arizona and Ohio, $850 in North Carolina | State Medicaid agency |
| Level 2 background screening for each owner, Florida | $60 plus the fingerprint vendor's fee | The Livescan fingerprint vendor, when you book |
| For-hire registration, North Carolina, 15 or fewer passengers | $128.50 per vehicle each year | NC DMV |
| Ambulette service, Ohio | $100 license each year, plus $50 permit and $50 inspection per van each year | Ohio State Board of Emergency Medical, Fire, and Transportation Services |
| Mobility assistance vehicle license, New Jersey, new provider | $1,500 plus $100 per vehicle | New Jersey Department of Health |

### The Medicaid application fee

CMS set the fee at $750 for applications submitted from January 1 through December 31, 2026. It applies to institutional providers. CMS guidance says a state plan may charge it to non-emergency transportation providers, and each state decides. Arizona's NEMT provider profile (revised September 2026) lists the fee as required. North Carolina charges $850 because state law adds $100 to the federal amount.

You skip the federal fee if you are already enrolled in Medicare or another state's Medicaid, or paid the fee there ([42 CFR 455.460](https://www.ecfr.gov/current/title-42/section-455.460)). Ohio takes the fee by credit card only and does not refund it. CMS sets a new amount every year, and it announced the 2024, 2025, and 2026 fees in November or December of the year before.

### An example: fees for one Ohio wheelchair van

A new Ohio company with one wheelchair van pays $99 to form its LLC, $750 to enroll with Ohio Medicaid, $100 for the ambulette license, and $100 in permit and inspection fees for the van. That comes to $1,049, before vehicle registration and any local permits. With three vans it is $1,249, because only the permit and inspection fees grow with each van.

Every state is different, and some cities and counties add their own for-hire permits. Look up your state's list in our [state guides](https://nemtguide.com/states/) and the guide to [NEMT license requirements](https://nemtguide.com/guides/nemt-license-requirements/).

## What the vehicle costs

The vehicle is the largest single cost. Public contracts show what agencies pay for new accessible vehicles built to their specifications.

| Vehicle | Price | Source and date |
|---|---|---|
| Lowered-floor ramp minivan, 2 wheelchair positions | $69,476 base, $70,771 with the required fold-away seat and seat fabric | Florida DOT transit vehicle contract, order form effective February 20, 2025 |
| Side-entry minivan, 3 seated riders and 2 wheelchairs | $85,477 estimated | Wisconsin DOT grant guide for 2027, based on its 2026 purchase |
| Transit-style van, medium or high roof | $87,004 to $88,560 estimated | Same Wisconsin guide |
| Medium bus, gas | $128,196 to $129,509 estimated | Same Wisconsin guide |

These are prices for public agencies and grant recipients. A private company buys from a dealer, so treat them as benchmarks and get your own quotes. The guide to [wheelchair van cost](https://nemtguide.com/guides/wheelchair-van-cost/) covers used vans, conversions, and upkeep.

### The cash each vehicle takes

If you finance, the cash you need up front is the down payment. At 10 percent down, the $70,771 Florida minivan takes $7,077. At 20 percent down, it takes $14,154. The monthly loan payment then joins your running costs, so the [vehicle loan calculator](https://nemtguide.com/tools/nemt-vehicle-loan-calculator/) and the guide to NEMT business loans belong in the same plan.

For smaller amounts, the SBA's microloan program lends up to $50,000 through nonprofit lenders. As of September 2026, the SBA says the average microloan is about $13,000, terms run up to seven years, and rates are generally between 8% and 13%.

Riders who walk can ride in sedans and minivans, which cost less than a converted van. Check your state's and your broker's vehicle rules before you count on a car you already own. See [NEMT vehicle requirements](https://nemtguide.com/guides/nemt-vehicle-requirements/) and using a personal vehicle for NEMT.

## Equipment and options for each vehicle

The Florida order form also prices common add-ons. They show what these items cost on a new van.

| Option on the Florida minivan contract | Price per van |
|---|---|
| Bumper-to-bumper warranty, 5 years or 100,000 miles | $3,338 |
| Bumper-to-bumper warranty, 7 years or 150,000 miles | $5,802 |
| Two-camera recording system, 1 TB | $1,610 to $3,243 |
| Extra set of wheelchair tie-downs (2 sets are standard) | $264 |
| WC-18 compliant tie-down system | $456 |
| Extra seat belt extension (2 are standard) | $25 |
| GPS antenna | $200 |

Programs add their own equipment rules. Arizona checks for your company logo on every vehicle during its site visit. Ohio's ambulette inspection covers a fire extinguisher, a blanket, disinfectants, oxygen equipment, isolation equipment, and first aid equipment. It also checks four-point wheelchair tie-downs, a ramp or lift, and your company name in letters at least three inches high on both sides. The [vehicle requirements guide](https://nemtguide.com/guides/nemt-vehicle-requirements/) lists what inspections check, so you can price the gear before the inspection.

## Insurance: what you must carry before the first ride

Insurance comes before revenue. Brokers and states publish the limits, and those limits drive your premium.

| Who sets it | Coverage | Minimum |
|---|---|---|
| MTM Health standard agreement, January 1, 2023 version that Pennsylvania posts | Commercial general liability | $500,000 per occurrence and $500,000 aggregate |
| Same agreement | Commercial auto liability | $500,000 combined single limit |
| Same agreement | Workers' compensation | Your state's statutory amounts |
| New Jersey, licensed mobility assistance vehicle services (N.J.A.C. 8:40-3.3) | Auto, for each vehicle | $500,000 per occurrence, bodily injury and property damage combined |
| Same rule | General liability | $300,000 |
| Modivcare provider page, September 2026 | General liability, sexual abuse and molestation, auto, and workers' compensation where required | Limits vary by state |

MTM's agreement also requires MTM to be named as an additional insured, and a scheduled auto policy must list every vehicle. New Jersey's rule says a licensed service must stop running rides the moment any required coverage lapses.

Your insurer sets the premium from your vehicles, drivers, claims history, and limits, so there is no standard price. Get quotes at the highest limit any of your payers requires, and get them before you buy the van. The guides to NEMT insurance cost and [NEMT insurance requirements](https://nemtguide.com/guides/nemt-insurance-requirements/) go deeper.

## Driver pay and hiring costs

The Bureau of Labor Statistics counts NEMT drivers in its shuttle drivers and chauffeurs group, which includes nonemergency medical transporters. In May 2025, that group's median wage was $17.93 an hour. On top of wages, you pay the employer share of Social Security (6.2 percent) and Medicare (1.45 percent), plus unemployment taxes, and workers' compensation where your state requires it.

Each driver also needs checks and training before the first ride:

- **Modivcare's list:** a hands-on wheelchair training certificate (PASS), first aid and CPR, defensive driving, a drug screen, a motor vehicle report, and a background check.
- **MTM Health:** fraud, waste, and abuse training and HIPAA training for every employee, every year.
- **Arizona:** the owner provides CPR, first aid, and HIPAA training for every driver, under the September 2026 provider profile.
- **Florida:** each driver passes a Level 1 background screening or an equivalent the statute allows, and each owner a Level 2 screening at $60 plus the fingerprint vendor's fee.

Vendors set most of these prices, so get quotes in your area. See [NEMT driver requirements](https://nemtguide.com/guides/nemt-driver-requirements/), [NEMT driver pay](https://nemtguide.com/guides/nemt-driver-pay/), and [1099 or W-2 drivers](https://nemtguide.com/guides/nemt-drivers-1099-or-w2/). If you drive yourself at first, the pay line becomes your own living costs, and you still need to cover them.

## Monthly running costs and the cash reserve

The reserve carries you through three gaps. Size it from the longest one you expect.

1. **Before your first paid ride.** Insurance and loan payments start while you wait for approvals. Arizona's Medicaid agency generally processes enrollments within 60 days. California law gives its agency 180 days, and from July 1, 2026 to June 30, 2027, a missed deadline no longer makes you a provisional provider by default. Broker credentialing comes on top: MTM Health moves each new provider through an application, an interview, contracting, credentialing, and training before the first trip.
2. **Between a ride and its payment.** MTM's standard agreement pays uncontested invoices within 30 days after electronic submission, and it does not pay claims submitted more than 90 days after the date of service. Georgia's NEMT manual (July 1, 2026) has brokers pay undisputed invoices within 15 business days, unless the service agreement sets other terms.
3. **While your trips build.** Until you run enough trips to cover your fixed costs, the reserve pays the difference.

### A monthly example for one van

The driver pay, tax, and mileage rates below come from BLS and the IRS. The hours and miles are example numbers, so replace them with yours.

| Monthly line, one van | Example | Basis |
|---|---|---|
| Driver pay, one full-time driver, 40 hours a week (about 173 hours a month) | $3,108 | BLS median of $17.93 an hour, May 2025 |
| Employer Social Security and Medicare | $238 | 7.65 percent of pay |
| Fuel and upkeep, 2,000 miles | $470 | IRS medical rate of 23.5 cents a mile from July 1, 2026 |
| Vehicle loan payment | Your lender's quote | Price, down payment, rate, and term |
| Commercial auto, general liability, and workers' compensation | Your insurance quotes | The limits in the insurance table |
| Phone, dispatch, and office | Your quotes | Your own setup |
| **Lines with published rates** | **$3,816** | |

The IRS sets its medical mileage rate from only the variable costs in its yearly study of what it costs to run a car. Treat it as a low starting point for fuel and upkeep, and replace it with your own van's costs once you have them. For comparison, the IRS business rate, which adds the fixed costs of owning a car, is 76 cents a mile from July 1, 2026.

Then work out the reserve:

**Cash reserve = monthly running costs × months until payments cover them**

Say approvals take two months after your insurance and van payments start, and your first payment arrives a month after your first rides. You carry two months of fixed costs, then at least one month of full running costs, before any money comes in. The SBA's break-even guidance also suggests adding about 10 percent for costs you cannot predict. The cash reserve calculator and the [break-even calculator](https://nemtguide.com/tools/nemt-break-even-calculator/) run these numbers for you.

## A budget for one van and for three

This budget uses the Ohio fees, the Florida minivan at 20 percent down, and the monthly lines above. The options are ones you may choose, not requirements. Lines marked "your quote" have no published price.

| Line | One van | Three vans |
|---|---|---|
| Government fees (Ohio example) | $1,049 | $1,249 |
| Down payment, 20 percent of $70,771 per van | $14,154 | $42,462 |
| 5-year warranty and two-camera system, if you add them | $4,948 | $14,844 |
| First insurance payment | Your quote | Your quote |
| Hiring checks and driver training | Your quotes | Your quotes |
| One month of the published-rate running lines | $3,816 | $11,448 |
| **Total of the priced lines** | **$23,967** | **$70,003** |

Add your insurance, hiring, loan payment, and office quotes to that total. Then add one more month of full running costs for each month in your reserve plan.

Three vans take nearly three times the cash of one. The vehicle, driver, and fuel lines grow with each van, and a scheduled auto policy lists every vehicle. Only a few fees stay flat. With three vans, someone also has to take calls and dispatch while the drivers drive, so add that person's pay if it is not you. The guide to starting with one van shows when a second van pays for itself.

## Ways to lower the cost to start

- **Cut the wait between buying and your first ride.** Arizona asks for vehicle registration and insurance with the application, so the van often comes first. Have everything else ready before you buy: the company, the EIN, driver files, and a broker or plan that needs your service level. Every month a financed, insured van waits is a month of fixed costs with no income.
- **Finance instead of paying cash.** A down payment instead of a full price lowers the cash you need to open, though it adds a monthly payment.
- **Start with the riders your contract needs.** Riders who walk can ride in a sedan or minivan, which costs less than a converted van.
- **Claim your startup deductions.** IRS Publication 583 lets you elect to deduct up to $5,000 of start-up costs and $5,000 of organizational costs, reduced by the amount your costs go over $50,000. Vehicles are usually depreciated instead.
- **Plan the reserve from your slowest payer.** Read each broker's and plan's payment terms before you set the months.

Put the final numbers in the [NEMT business plan template](https://nemtguide.com/templates/nemt-business-plan-template/). The SBA notes that investors and lenders compare expected costs with projected revenue to judge whether a business can profit. For the order of every step from forming the company to the first paid trip, see [how to start a NEMT business](https://nemtguide.com/guides/how-to-start-a-nemt-business/).

## Frequently asked questions

### How much does it cost to start a NEMT business with one van?

Most of it is the van and the months before you are paid. In the Ohio example on this page, state fees for one wheelchair van come to $1,049, a 20 percent down payment on a $70,771 ramp minivan is $14,154, and one full-time driver at the May 2025 median wage, with payroll taxes, fuel, and upkeep, costs about $3,816 a month. Insurance, the loan payment, and hiring checks come from your own quotes.

### What does Medicaid charge to enroll a NEMT company?

CMS set the provider application fee at $750 for applications submitted from January 1 through December 31, 2026. States charge it to institutional providers, and each state decides whether NEMT companies count. Arizona and Ohio charge NEMT companies $750, and North Carolina charges $850 because state law adds $100. CMS announced the 2024, 2025, and 2026 fees in November or December of the year before.

### Can I start a NEMT business with no money?

Not with none. Insurance must be in force before your first ride, a vehicle must pass inspection, and some states charge the Medicaid application fee. You can lower the cash you need by financing the vehicle. SBA microloans go up to $50,000 through nonprofit lenders, with an average of about $13,000, terms up to seven years, and rates generally between 8% and 13% as of September 2026.

### How much is insurance for a NEMT van?

Your insurer sets the premium from your vehicles, drivers, claims history, and limits, so get quotes before you buy a van. The limits are public. MTM Health's standard agreement, in the January 1, 2023 version Pennsylvania posts, asks for $500,000 of general liability, a $500,000 combined single limit of auto liability, and workers' compensation at your state's amounts. New Jersey requires $500,000 per vehicle for licensed mobility assistance vehicle services.

### How many months of cash should I have before I open?

Enough to cover your fixed costs while you wait for approvals, plus your full running costs until payments arrive. AHCCCS in Arizona generally processes enrollments within 60 days. MTM Health pays uncontested invoices within 30 days after electronic submission. The SBA suggests counting at least one year of monthly expenses in your plan, and five years is ideal.

### Can I deduct my startup costs on my taxes?

Partly. IRS Publication 583 says you can elect to deduct up to $5,000 of business start-up costs and up to $5,000 of organizational costs. Each limit shrinks by the amount your costs go over $50,000, and the rest is deducted over time. Vehicles and equipment are usually recovered through depreciation, so ask your tax preparer.

### Does it cost three times as much to start with three vans?

Close to it. The down payment, equipment, driver pay, fuel, and insurance all grow with each van. Some fees do not: in Ohio, the $99 LLC filing, the $750 Medicaid fee, and the $100 ambulette license stay the same, while the $100 a year in permit and inspection fees applies to each van.

## Official resources

- [SBA: Calculate your startup costs](https://www.sba.gov/counseling/plan-your-business/#startup-costs)
- [IRS: Get an employer identification number (free)](https://www.irs.gov/businesses/small-businesses-self-employed/get-an-employer-identification-number)
- [CMS: NPPES, apply for an NPI (free)](https://nppes.cms.hhs.gov/)
- [Federal Register: 2026 Medicaid and Medicare application fee notice](https://www.federalregister.gov/documents/2025/12/03/2025-21877/medicare-medicaid-and-childrens-health-insurance-programs-provider-enrollment-application-fee-amount)
- [Florida DOT TRIPS: Minivan contract and order form](https://www.tripsflorida.org/mv19.html)
- [IRS: Standard mileage rates](https://www.irs.gov/tax-professionals/standard-mileage-rates)
- [IRS: Publication 583, Starting a Business and Keeping Records](https://www.irs.gov/publications/p583)
- [SBA: Microloans](https://www.sba.gov/funding-programs/loans/microloans)