NEMT Startup Cost Calculator (2027): How Much Cash You Need to Open

What the startup cost calculator adds up

The calculator splits the money you need into two parts, the way the SBA’s startup cost guide does. One-time costs are what you pay to open. Monthly costs are what you keep paying, and you need enough of them in the bank to reach the day payments come in.

• One-time costs: vehicles, equipment, licenses and fees, the first insurance payment, hiring, and office setup.
• Cash reserve: your monthly running costs times the months you want covered.

The total is the cash to have in hand before your first ride. It is for anyone planning a new NEMT company or adding vehicles to a small one. For the line-by-line costs behind each box, read the guide to what it costs to start a NEMT business.

How to use the calculator

1. Enter how many vehicles you will start with.
2. Enter the cash each vehicle takes: the down payment if you finance, or the full price if you pay cash.
3. Enter the equipment each vehicle needs on top of that.
4. Enter your licenses and fees, first insurance payment, hiring and training, and office and marketing costs.
5. Enter your monthly running costs and the months of reserve you want.
6. Read the cash you need to start at the top of the results. Under it are the one-time costs, the vehicle line, and the reserve.

The results change as you type. Reset to example puts the example numbers back, and Show the formula lists every step of the math.

What each number means

Box	What to include	Where to find the number
Vehicles	Every van or sedan you will run on day one	Your plan for the first contracts
Cash per vehicle	The down payment, or the full price if you buy outright	A dealer quote and a lender’s terms
Equipment per vehicle	Securement straps, safety kit, camera, signage, and any gear your state or broker requires	Your state’s vehicle rules and your broker’s inspection list
Licenses and fees	Business filing, state and city licenses, permits, vehicle inspections, and the Medicaid application fee	Your secretary of state, your state transportation or health department, and your state Medicaid agency
First insurance payment	The deposit or first premium due before your policy starts	Quotes at the limits your state and your brokers require
Hiring and training	Background checks, drug tests, driving records, and driver training	Vendor quotes, checked against your broker’s driver list
Office and marketing	Phone, computer, website, and printed material for clinics and facilities	Your own quotes
Monthly running costs	Payroll, fuel, repairs, insurance, loan payments, phone, and dispatch for one month	Your budget, with yearly bills divided by 12
Months of cash reserve	How many months of running costs you want in the bank on opening day	How fast your payers pay (see below)

Broker driver lists set most of the hiring and training box. As of September 2026, Modivcare’s provider page, for example, asks for a hands-on wheelchair transport training certificate (PASS), first aid and CPR, defensive driving, a drug screen, a motor vehicle report, and a background check. Search every hire on the HHS OIG exclusion list too, since OIG warns that anyone who hires a person on that list may face civil monetary penalties.

The guide to NEMT vehicle requirements lists the equipment programs ask for, so the equipment box matches what an inspection will check.

A worked example

The calculator opens with example numbers. They show how the math works. They are not quotes or market prices, so replace them with your own.

Step	Math	Result
Vehicles and equipment	1 vehicle × ($15,000 + $2,000)	$17,000
One-time startup costs	$17,000 + $1,500 + $4,000 + $1,000 + $1,500	$25,000
Cash reserve	$8,000 a month × 3 months	$24,000
Cash you need to start	$25,000 + $24,000	$49,000

In this example the reserve is almost half the total. A plan that covers only the van and the paperwork runs short in the first months, while the rides are running and the payments have not arrived yet.

How to use the total

Treat the total as the amount to have in hand before your first ride. If it is more than you have, change one box at a time: fewer vehicles, a financed vehicle instead of cash, or a shorter reserve if your main payer pays quickly.

Take the numbers with you when you ask for funding. The SBA says investors and lenders compare expected costs with projected revenue to judge whether a business can make a profit, and it suggests writing your startup costs up as a formal report. The NEMT business plan template has a place for them.

If you need to borrow part of the total, look at SBA microloans. As of September 2026, the SBA’s microloan page says they go up to $50,000 through nonprofit lenders, and the average is about $13,000. Terms run up to seven years, and rates are generally 8% to 13%. The guide to NEMT business loans compares the other options.

Pair the total with the trip price calculator and the break-even calculator, so your plan shows what you spend, what you charge, and how many trips it takes to cover your costs.

How many months of reserve to hold

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

1. Before your first paid ride. Payers want insurance in force and vehicles and drivers approved first. New Jersey requires a certificate of insurance before it licenses a mobility assistance vehicle service (N.J.A.C. 8:40-3.3). MTM Health’s standard agreement pays nothing for trips run with drivers or vehicles it has not credentialed. Insurance and vehicle payments start before revenue does.
2. Between a ride and its payment. MTM Health’s standard agreement, in the January 1, 2023 version Pennsylvania posts, pays uncontested invoices within 30 days of electronic submission. It does not pay a claim submitted more than 90 days after the date of service. If you bill once a week, a ride can wait more than a month to be paid.
3. While your trips build. Until you run enough trips to cover your fixed costs, the reserve pays the difference. The break-even calculator shows how many trips that takes.

The cash reserve calculator works out the months from how long each payer takes to pay. Enter its answer in the months of cash reserve box. The SBA’s startup guide goes further for planning: it says to count at least one year of monthly expenses, and five years is ideal, so you can see how much money you need and when.

Fees and prices you can check before you open

Some boxes have published numbers you can look up today.

Cost	Published amount	Where it comes from
Employer identification number (EIN)	$0	IRS: you never have to pay a fee for an EIN
National Provider Identifier (NPI)	$0	CMS: the NPI is free of charge
Medicaid application fee	$750 for applications submitted January 1 through December 31, 2026	CMS notice in the Federal Register, December 3, 2025
New Jersey mobility assistance vehicle (MAV) service license, new provider	$1,500 plus $100 per vehicle	N.J.A.C. 8:40-2.5, readopted effective September 25, 2023
New side-entry wheelchair minivan, two wheelchair spaces	$85,477 estimated	Wisconsin DOT grant guide for 2027, based on its 2026 vehicle purchase

The Medicaid application fee. Under 42 CFR 455.460, states collect it before signing a provider agreement. Individual physicians and nonphysician practitioners are exempt, and so are providers already enrolled in Medicare or another state’s Medicaid or CHIP, or who paid the fee there. CMS sets a new amount for each calendar year. See NPI numbers for NEMT for the free steps that come before enrollment.

State licenses. These vary by state and city. New Jersey licenses mobility assistance vehicles, which carry ambulatory and wheelchair riders who cannot safely use a taxi, bus, or car, and its fee above is one example. The guide to NEMT license requirements explains what to look up in your state.

The vehicle. The Wisconsin figure is the state’s estimate for a new vehicle built to its standard specifications, bought with federal Section 5310 grants that go to nonprofits and local governments. It is not a dealer price for a private company, but it is a public benchmark for a new wheelchair minivan. Transit-style vans on the same list run $87,004 to $88,560. At $85,477 with 20% down, the cash per vehicle would be $17,095. The vehicle loan calculator shows the monthly payment, which belongs in your running costs, and the guide to wheelchair van cost covers used vans and conversions.

Insurance. Your limits drive the first payment. MTM Health’s standard agreement (January 1, 2023 version) asks for at least $500,000 per occurrence of commercial general liability, a $500,000 combined single limit on auto liability, and workers’ compensation at your state’s required amounts. New Jersey requires at least $500,000 per occurrence of combined bodily injury and property damage coverage for each vehicle, plus $300,000 of general liability (N.J.A.C. 8:40-3.3). Modivcare lists general liability, sexual abuse and molestation coverage, auto liability, and workers’ compensation where required, and says limits vary by state. Quote the highest limits any of your payers require. See NEMT insurance requirements.

Starting with more than one vehicle

The calculator multiplies the cash and equipment per vehicle for you. The other boxes you raise yourself, because some grow with each vehicle and some do not.

Box	Does it grow with each vehicle?
Cash per vehicle and equipment per vehicle	Yes, the calculator multiplies them
Licenses and fees	Partly: New Jersey, for example, adds $100 per vehicle to its license fee
First insurance payment	Usually. A scheduled auto policy lists each vehicle, and MTM Health requires you to report every vehicle you add
Hiring and training	Yes, for each driver and attendant
Office and marketing	Mostly not
Monthly running costs	Yes for payroll, fuel, repairs, insurance, and loan payments; less for the office

Here is the example grown to three vehicles. The numbers are illustrations, not quotes.

Line	One vehicle	Three vehicles
Vehicles and equipment	$17,000	$51,000
Licenses and fees	$1,500	$2,500
First insurance payment	$4,000	$12,000
Hiring and training	$1,000	$3,000
Office and marketing	$1,500	$1,500
One-time startup costs	$25,000	$70,000
Cash reserve, 3 months	$8,000 × 3 = $24,000	$22,000 × 3 = $66,000
Cash you need to start	$49,000	$136,000

Three vehicles take nearly three times the cash of one. The reserve grows the most, because payroll and fuel rise with each vehicle. If one vehicle is enough for your first contract, the guide to starting with one van shows when a second van pays for itself.

Mistakes that leave you short

• Counting only the van and the paperwork. In the example, the reserve is almost half the total.
• Forgetting costs that start before the first ride. Insurance and vehicle payments begin while you wait for approval.
• Leaving the loan payment out of running costs. Financing lowers the cash per vehicle but adds a monthly bill.
• Holding a reserve shorter than your slowest payer. Check each payer’s terms before you pick the months.