NEMT Business Plan Template (2027): A Fill-In Plan With the Numbers Lenders Check

A lender reading your plan wants three answers. Who will pay you for each ride, how much and how fast, and will your cash last until the payments arrive? This template is built around those questions for a NEMT company. Fill in the parts, then check them against the lender rules and the sourced numbers after the template.

How to use this template

1. Fill in Parts 2 to 13 first. They follow the SBA’s traditional business plan, with the lines a NEMT lender asks about added. Write the executive summary in Part 1 last, once the numbers are settled.
2. Put a source beside every number. A rate comes from a broker rate sheet or a state fee schedule. A van price comes from a dealer quote, and insurance from a quote at the limits your payers require.
3. Use each payer’s real payment terms. Build Part 11 from the month money arrives, not the month the ride happens.
4. Start the cash flow before your first ride. Insurance, vehicle payments, and driver training begin before any payer approves you.
5. Check the plan against the lender rules in the section after the template.
6. Attach your proof: quotes, broker letters, license approvals, owner resumes, and your startup budget from the startup cost calculator.

If you have not picked a service area yet, start with NEMT market research. For every step from filing to first ride, see how to start a NEMT business and the NEMT startup checklist.

The template

Part 1: Executive summary

Item	Your answer
Company name and legal form
Counties you will serve
Services: ambulatory, wheelchair, stretcher
Main payers and where each contract stands
Vehicles at opening and at the end of year 3
Funding you are asking for, and what it pays for
Owner cash going in
Year 1 trips and revenue
Month cash flow turns positive
Owners and their experience

Part 2: Company and management

Item	Your answer
Legal name and any DBA
Entity type and state of formation
Industry code (NAICS 485991 is Special Needs Transportation)
EIN
Type 2 NPI and taxonomy code (343900000X for a van)
State Medicaid provider ID, or the date you applied
State transportation license or permit number
Office street address
Who runs dispatch and billing each day

Name	Role	Ownership	Years of experience	Guarantor (yes or no)

Part 3: Market

What you need	Where to find it	Your number	Date of the data
Medicaid members in your service area	Your state Medicaid agency’s enrollment reports
Residents 65 and older, and residents with a disability	Census Bureau, data.census.gov
Dialysis centers you can reach	CMS dialysis facility listing
Nursing homes and assisted living	CMS nursing home data and your state’s facility list
Hospitals and large clinics	Your own list
NEMT companies already in your area	NPI Registry, taxonomy “Non-emergency Medical Transport (VAN)”
Brokers and health plans that arrange rides	Your state Medicaid agency and the broker directory
Whether payers are taking new providers	State provider notices and each broker’s provider page

Competitor	Services	Payers	What they do well	How you differ

Part 4: Payers and contracts

Write each payer’s type: broker, health plan, state fee-for-service, facility, or private pay. Status is applied, credentialing, or signed.

Payer and type	Status	Rates	Pays within	Share of revenue

Part 5: Services and rates

Service	Billing codes	Base rate	Per mile	Other paid items	Share of trips
Ambulatory
Wheelchair
Stretcher
Private pay

Part 6: Fleet

Seats means seats and wheelchair positions.

Vehicle	Type and seats	Price	Down payment	Per month	Start month

Part 7: Drivers and staff

Role	How many	Pay rate	Wage benchmark	Start month	Training
Drivers
Dispatcher
Billing
Owner pay

Part 8: Licenses, enrollment, and insurance

Item	Office or company	Cost	Status	Date
Company formation	Secretary of State
EIN	IRS	$0
NPI	NPPES	$0
State transportation license or permit
Medicaid enrollment	State Medicaid agency
Broker and health plan credentialing	Each payer
Commercial auto liability
General liability
Workers’ compensation
City or county business license

Part 9: Marketing and growth

Target	Who you will contact	How	Trips a month	Start month
Dialysis centers
Nursing homes and assisted living
Hospital discharge planners
Private pay riders and families
Brokers and health plans

Part 10: Startup costs and funding

Use of funds	Amount	Where the number comes from
Vehicles (down payments, or full price)
Equipment for each vehicle
Licenses, permits, and fees
First insurance payment
Hiring, background checks, and training
Office, phone, and marketing
Cash reserve (months × monthly costs)
Total project cost

Source of funds	Amount	Share of total	Terms
Owner cash
SBA 7(a) loan
SBA microloan
Vehicle financing
Seller or family note on full standby
Grants
Total

Part 11: First 12 months of cash

Costs are everything you pay out except loan payments.

Month	Trips	Billed	Collected	Costs	Loan payments	Net	Ending cash
1
2
3
4
5
6
7
8
9
10
11
12

Part 12: Five-year summary

Line	Year 1	Year 2	Year 3	Year 4	Year 5
Vehicles
Trips
Revenue
Payroll and payroll taxes
Fuel, repairs, and tires
Insurance
Other operating costs
Earnings before interest, taxes, depreciation, and amortization (EBITDA)
Loan payments, principal and interest
Debt service coverage (EBITDA ÷ loan payments)

Part 13: Risks and your plan for each

Risk	How likely	What you will do
Your largest payer cuts trips or ends the contract
A rate cut on your main service
Riders lose Medicaid coverage
Payments arrive later than planned
A van is out of service
A driver quits

The numbers lenders check

If you apply for an SBA-backed loan, the lender follows SBA’s Standard Operating Procedure 50 10 8.1. It applies to applications given an SBA loan number on or after October 1, 2026. These are the rules that shape a startup’s plan.

What the lender checks	The SBA rule	Where it goes
Your own money	A business that has generated revenue for 1 year or less is a startup. Every 7(a) loan to a startup needs an owner contribution of at least 10 percent of total project costs, meaning all costs to become operational.	Part 10
Repayment, loans over $350,000	Detailed projections with supporting assumptions that show debt service coverage of at least 1.15 within 2 years of funding	Parts 11 and 12
Repayment, 7(a) Small loans of $350,000 or less	Debt service coverage of at least 1.10. With 12-month projections, it must be reached within 1 year of funding.	Parts 11 and 12
Your assumptions	The lender must justify any revenue growth or expense cuts and compare them with industry trends	A source for every number
Working capital	Loans over $350,000 need an analysis of working capital for at least the next 12 months. On most loans, if half or more of the money is for working capital, the lender must explain why.	Part 11
Management	Time in business, experience in the industry, and who runs the business each day	Part 2
Guarantees	Each person owning 20 percent or more signs an unlimited personal guarantee	Part 2
Insurance	Hazard and liability insurance, and whether life insurance on an owner is needed	Part 8

Work out debt service coverage yourself before the lender does:

Debt service coverage = EBITDA ÷ yearly principal and interest on all business debt, including the new loan

With example numbers, EBITDA of $54,000 and loan payments of $36,000 give 1.50, which passes both SBA tests. The same EBITDA with $50,000 of loan payments gives 1.08, which fails both. Lenders also adjust cash flow for items such as owner’s draw and one-time income, so show your own pay in Part 7.

For the equity rule, total project costs of $120,000 (an example) mean at least $12,000 of your own money. Cash that is not borrowed counts, including a gift. So does a note on full standby, with no payments for the life of the SBA loan, and a grant with nothing to repay during the loan. Verified prepaid expenses count too. Fees paid to a loan agent do not.

For smaller amounts, SBA microloans go up to $50,000 through nonprofit lenders. The SBA says the average is about $13,000, terms run up to 7 years, and rates are generally 8% to 13%. They cannot pay off existing debt or buy real estate. The guide to NEMT business loans compares the options.

Where to find each NEMT number

Number	Where to get it	Published example
Pay per trip and per mile	Each broker’s rate sheet, or your state fee schedule for direct Medicaid billing	Colorado wheelchair van: $34.14 base and $2.74 a mile (July 1, 2026)
When payers pay	Each broker agreement or provider page	MTM Health pays uncontested invoices within 30 days of electronic submission (January 1, 2023 agreement posted by Pennsylvania). MediTrans processes clean claims in 7 to 14 business days and pays every other Friday (Louisiana provider page, September 2026).
Claim deadline	Each agreement	MTM Health: 90 days after the ride, unless the state or health plan it works for sets another limit. MediTrans: 365 days.
Driver pay	BLS wage data for your state or metro area	Median $17.93 an hour nationally for shuttle drivers and chauffeurs, the group that includes nonemergency medical transporters (May 2025)
Payroll taxes	IRS Publication 15	For 2026: Social Security of 6.2 percent on wages up to $184,500, Medicare of 1.45 percent, and federal unemployment tax of 0.6 percent on the first $7,000 per worker after the full state credit
Insurance	Quotes at the highest limits any payer requires	MTM Health: $500,000 general liability and $500,000 auto. MediTrans: $1,000,000 auto per occurrence.
Vehicle price	Dealer quotes	Wisconsin DOT estimates $85,477 for a new side-entry minivan with 2 wheelchair positions (2027 grant cycle)
Medicaid application fee	The CMS notice for each year	$750 for applications submitted in 2026
EIN and NPI	IRS and CMS	Free
Start-up cost tax deduction	IRS Publication 583	Up to $5,000 of start-up costs, reduced by the amount your start-up costs go over $50,000 (December 2024 edition)

The wage figure is a national midpoint. Wages in your area can be higher or lower, so use your state or metro figure from the same BLS tables. The Wisconsin figure is for a new vehicle built to state transit specifications, not a dealer price, so it works as a benchmark next to your quotes. See wheelchair van cost and NEMT insurance requirements for more on those lines.

The same ride on two fee schedules

Take one 10-mile wheelchair trip with the rider on board the whole way.

State fee schedule	Base (A0130)	Miles (S0209)	Pay for the trip
Colorado, rates effective July 1, 2026	$34.14	10 × $2.74 = $27.40	$61.54
Arizona fee-for-service, trips starting in the Phoenix or Tucson area, rates effective October 1, 2026	$11.15	10 × $1.54 = $15.40	$26.55

The same ride pays 2.3 times as much in one state. A plan built on the wrong rate is wrong from its first line. From January 1, 2027, every Colorado NEMT trip is scheduled and paid through the statewide broker MediDrive, so use the rate in its contract. For more on rates, see NEMT reimbursement rates and the A0130 billing code.

Who rides and how often

CMS’s report to Congress on Medicaid NEMT (June 20, 2023) gives use rates you can quote in Part 3. In 2021, slightly less than 4 percent of Medicaid members used NEMT, and users averaged fewer than 2 ride days a month. CMS says these national figures undercount use.

Medicaid members, 2021	Share who used NEMT	Ride days a month per user
All members	Slightly less than 4%	Fewer than 2
Chronic kidney disease with end-stage renal disease	47%	5.5
Home and community-based waiver participants	22%	2.6
Eligible for both Medicare and Medicaid	14%	1.7
Eligible because of a disability	14%	2.0
Eligible because of age, 65 and older	14%	1.4

Use varies widely by state, from 1 percent of members in Maryland to nearly 11 percent in Alaska in 2021. CMS counts ride days, not rides, and one ride day can include more than one ride.

A rough demand estimate multiplies three numbers: members in your area, the share who use NEMT, and ride days per user. With example numbers, 20,000 members × 4% × 1.5 ride days gives 1,200 ride days a month, shared by every provider in the area. CMS found that members with end-stage renal disease used NEMT at the highest rate, on 5.5 days a month per user, so list every dialysis center you can reach.

Then check supply. Count the NEMT companies near you in the NPI Registry, and ask each broker whether it needs providers in your counties. As of September 2026, MediTrans says acceptance depends on regional saturation and fleet needs.

Risks your plan should answer

Risk	A real example	What to put in Part 13
A broker cuts trips or ends the contract	MTM Health’s standard agreement (January 1, 2023 version) guarantees no minimum trips, and either side can end it on 30 days’ written notice	Trips from more than one payer, plus facility and private pay work
The state stops enrolling new providers	Minnesota is not enrolling new NEMT providers in its seven-county metro area from January 27, 2026 to January 27, 2027	Proof that enrollment is open before you buy vans
The state changes who pays	Colorado moves every NEMT trip to one statewide broker on January 1, 2027	A contract with the new broker before the change
A rate falls	Colorado’s mobility van base rate (A0120) fell from $36.40 to $12.15 on July 1, 2026	A second version of Part 12 with your main rate cut
Riders lose coverage	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	A lower trip count in the second version
Payments come late or not at all	MTM Health pays uncontested invoices within 30 days of electronic submission, and pays nothing on a claim submitted more than 90 days after the ride	A cash reserve sized for your slowest payer, and a weekly billing routine

More on each: the Minnesota enrollment freeze, Medicaid work requirements and NEMT, and NEMT payer mix. The break-even calculator shows how many trips a month cover your costs at each rate.

Mistakes that weaken a NEMT business plan

• Revenue from a rate you have not seen in writing. Get the rate sheet or the fee schedule first.
• Trips counted before approval. MTM Health pays nothing for rides by drivers or vehicles it has not credentialed.
• No cash for the wait. MTM Health allows itself 30 days after you bill, and you bill after the ride. Plan it month by month with the cash flow forecast template.
• One payer for all revenue. A single 30-day notice can end it.
• Loan payments left out of costs. They are the bottom half of the debt service coverage test.
• No owner pay. Lenders adjust for owner’s draw, so a plan that pays you nothing looks better on paper than it will run.