NEMT Market Research in 2027: How to Size Demand in Your County Before You Buy a Van

A van is the biggest check most new owners write. Before you write it, spend an afternoon testing one county: how many riders live there, where they go, who hands out their trips, and how many companies already carry them. Every number below is free and public.

What NEMT market research has to answer

The Small Business Administration’s market research guide asks six questions of any new business. Here is what each one means for NEMT and where to find the answer.

SBA question	What it means for NEMT	Where to find it
Demand	Do Medicaid members in your state use rides, and how often?	CMS report to Congress on Medicaid NEMT
Market size	How many members live in your county?	Census table S2704, or your state’s county enrollment report
Economic indicators	How many residents are older, disabled, or without a car?	Census tables S0101, S1810, and DP04
Location	Where do riders go?	CMS dialysis, nursing home, and hospital data, and HRSA health center sites
Market saturation	How many NEMT companies already serve the county?	The NPI Registry and the broker
Pricing	What does each trip pay?	The broker’s rate sheet or your state fee schedule

NEMT adds a seventh question that decides most markets: who hands out the trips, and do they need you? A county can be full of riders and still have no room for a new company if the broker has enough providers.

Step 1: Count the Medicaid members in your county

Start at data.census.gov. Search table S2704, pick your county, and read the row for Medicaid or other means-tested public coverage. The American Community Survey gives it for every county in the country, averaged over 2020 to 2024.

Know what that number leaves out. It counts the civilian population outside institutions, so people living in nursing homes are not in it. It also includes CHIP and other means-tested coverage, not only Medicaid.

Some states post a current count, which is better when you can get it. Texas HHSC, for example, publishes Medicaid and CHIP enrollment by county, with a preliminary May 2026 report updated quarterly. Look on your Medicaid agency’s data or reports page before you settle for the survey number.

Membership can change. States must start the Medicaid community engagement requirement for certain adults no later than January 1, 2027, under a CMS rule published June 3, 2026. See what the work requirement means for NEMT.

Step 2: Turn members into ride days

CMS counted Medicaid NEMT use in every state in its Expanded Report to Congress of June 20, 2023. It counts ride days: each day a member rode at least once. A round trip on the same day is one ride day.

In 2021, 3.9 percent of Medicaid members used NEMT, and users averaged 1.5 ride days a month. Nationally that came to 6,504 ride days a year for every 10,000 members, down from 10,442 in 2019. CMS says ride days in 2021 were still about 30 percent below pre-pandemic levels.

Your state’s rate matters far more than the national one:

State	Ride days per 10,000 members, 2019	Ride days per 10,000 members, 2021	Members who used NEMT, 2021
United States	10,442	6,504	3.9%
Maryland	472	206	0.7%
California	2,838	2,096	1.5%
Pennsylvania	3,012	1,502	1.8%
Georgia	7,326	4,657	3.6%
Texas	11,589	6,069	3.0%
New York	19,512	11,987	6.4%
Arizona	26,286	14,681	8.4%
Wisconsin	50,405	30,665	7.3%

Find your state in Table B1.1a of the report, then do the math:

Ride days a year = members × your state’s rate ÷ 10,000

Use the 2019 rate as your high estimate and the 2021 rate as your low one. Treat both as floors. The data come from Medicaid claims, and CMS notes that some states pay part or all of NEMT as an administrative cost, which claims miss. In 2021, Colorado, Minnesota, and Wyoming reported all of their NEMT spending that way, and Georgia, Pennsylvania, Texas, and eight other states reported some of it.

Then check how rides were delivered in your state, in Table B5.4b. Nationally in 2021, a taxi was used on 32.5 percent of ride days and a van on 28.0 percent. In Georgia, a van was used on 75.0 percent. A ride day can use more than one mode, so the shares can add up to more than 100 percent. In a taxi-heavy state, a van company competes for a smaller slice.

Step 3: Map where riders go

Dialysis centers first

Dialysis is the steadiest NEMT work there is. The NIH kidney institute says most in-center patients get a fixed time slot, usually three times a week on Monday, Wednesday, and Friday or Tuesday, Thursday, and Saturday, for about 4 hours a session. That is about 312 one-way trips a year for one rider.

Medicaid members with kidney failure ride more than anyone. CMS found 47 percent of them used NEMT in 2021, on 5.5 ride days a month, and dialysis made up 68 percent of their ride days.

CMS lists every dialysis facility registered with Medicare, with its county, its number of stations, and whether it runs a shift that starts at 5 p.m. or later. Download the list for your county, or look centers up on Medicare’s Care Compare. Chair times cluster around each shift, so a center with more stations and more shifts needs more vans at more hours. See dialysis transportation for how to win and run this work.

Clinics, nursing homes, and hospitals

CMS found members most often used NEMT for preventive care, visits for acute and chronic conditions, lab and imaging, and behavioral health. List the places that serve them:

• Health centers. HRSA lists every federally funded health center site and look-alike site, with its county and weekly hours.
• Nursing homes. CMS lists each one with its certified beds. Residents ride to specialists and dialysis.
• Hospitals. CMS lists each hospital by county. Discharges need rides home, often the same day. See hospital discharge transportation.

Ask the people who book the rides

The SBA also describes direct research, such as in-depth interviews. Call dialysis social workers, hospital discharge planners, and nursing home staff. Ask how rides are arranged today, which service levels are hard to get, and which trips run late. If staff say they can rarely get a stretcher van in the late afternoon, that is a gap you could fill.

Step 4: Find out who hands out the trips

Most Medicaid trips come from a broker, a health plan, or the state itself, depending on where you are. Find yours in NEMT brokers by state, then call its provider line and ask:

1. Do you need more providers in this county?
2. Which service levels are short: ambulatory, wheelchair, stretcher, or bariatric?
3. What does each trip pay, and when do you pay?
4. How long does credentialing take?

The answer to the first question can end the search. Georgia uses Verida as its one statewide broker, in all five regions since April 1, 2026. Verida reviews each Request for Qualifications to decide whether the applicant’s region needs new providers. It asks for an interview only if a need exists. If a broker has no need, read what to do when a broker network is full.

The state can also be closed to new companies. Minnesota is not enrolling new NEMT providers located in its seven-county Twin Cities metro area from January 27, 2026 to January 27, 2027. North Dakota stopped enrolling new NEMT agencies statewide on June 11, 2026, for 6 months unless it extends the freeze. Florida law lets its Medicaid agency deny an application when that is in the program’s best interest, and it may weigh how many providers of the same type are already enrolled in the area. See enrollment moratoriums and the Minnesota enrollment freeze.

Pricing comes from the same call. Brokers set their own rates, so get the rate sheet in writing before you build a budget. Your state’s fee schedule is a useful benchmark. See NEMT reimbursement rates and how much to charge for NEMT.

Step 5: Count the companies already there

Search the free NPI Registry by taxonomy. Pick Non-emergency Medical Transport (VAN), code 343900000X, and enter your city and state. Each record shows the company’s primary taxonomy code and the date it got its NPI.

Read the count with care. Not every NEMT company has an NPI, and a registration does not prove a company still runs trips. Two numbers still tell you something: how many are registered, and how many registered in the last two years. A long list of new registrations means many others had the same idea you did.

Then ask around. Brokers may not share their provider lists, but dialysis centers and discharge planners will tell you which companies they call.

A worked example: Bibb County, Georgia

Here is the full test for Bibb County, home of Macon, with public data as of September 2026.

What you check	Source	Bibb County
People with Medicaid or other means-tested coverage	Census ACS, 2020 to 2024, table S2704	42,998, or 28.1% of residents
Georgia ride days per 10,000 members	CMS report, June 20, 2023	7,326 (2019), 4,657 (2021)
Estimated ride days a year	42,998 × rate ÷ 10,000	About 20,000 to 31,500
Estimated ride days a week	Ride days ÷ 52	About 385 to 606
Share of Georgia ride days that used a van, 2021	CMS report, Table B5.4b	75.0%
Estimated van ride days a week	Weekly ride days × 75%	About 290 to 455
Dialysis centers	CMS dialysis list, June 16, 2026	9 centers, 191 stations, none with a shift starting at 5 p.m. or later
Nursing homes	CMS provider information, August 1, 2026	11 homes, 1,163 certified beds
Acute care hospitals	CMS hospital information, July 22, 2026	3
Health center sites	HRSA, September 29, 2026	10, including 3 in schools
NPIs with the NEMT van taxonomy as primary, Macon address	NPI Registry, September 29, 2026	29, including 12 registered since January 2024
Who hands out Medicaid trips	Georgia Medicaid	Verida, the statewide broker

What the numbers say:

• Demand is real. Bibb County’s Medicaid share is well above Georgia’s 18.2 percent, and nine dialysis centers sit inside the county.
• Supply is crowded on paper. Spread evenly over 29 registered companies, 290 to 455 van ride days a week is about 10 to 16 each. Some of those companies may not run Medicaid trips, and riders from nearby counties may travel to Macon for dialysis and hospital care, so the real picture may be better.
• One call decides it. Verida adds providers only where a region needs them. Its provider line, 877-236-1352, serves every Georgia region. Ask whether the county needs your service level before you buy anything.

Put your own county’s numbers into the NEMT business plan template. Then use the break-even calculator to see how many trips a week your van needs, and compare it with your share of the estimate.

Look beyond Medicaid

Medicaid is only one payer. Census tables show who else might ride and pay:

Measure (ACS, 2020 to 2024)	Bibb County	Georgia	United States
Medicaid or other means-tested coverage	28.1%	18.2%	20.9%
People with a disability	16.1%	13.1%	13.3%
Residents 65 and older	16.4%	15.0%	17.2%
Households with no vehicle	11.3%	5.9%	8.4%

Older residents and people with disabilities are the core of private pay NEMT. Households without a car need rides for more than medical visits. Some Medicare Advantage plans add rides as an extra benefit; see Medicare Advantage transportation.

Nursing homes, hospitals, and dialysis centers can also pay you directly under a contract. See how to get NEMT facility contracts.

How to read your results

Good sign	Warning sign
The broker says it needs your service level in your county	The broker keeps your form on file with no need
Several dialysis centers within a short drive	The nearest center is far away
Your state’s ride rate is at or above the national rate	Your state’s rate is far below it
Facilities name gaps no one fills, such as stretcher or late returns	Facilities are happy with the companies they use
Few NEMT companies registered nearby	Many new registrations in the last two years
The state is enrolling new NEMT providers	A moratorium covers your county
Private pay and facility work look possible	Every trip would come from one broker

No single number makes the decision. A county with fewer riders but a broker that needs wheelchair vans beats a county with more riders and a full network. Write down each answer with its source and date, and repeat the test for the next county over before you choose. The guide to whether NEMT is a good business covers the rest of the decision.