Florida’s Growing Market for Non-Emergency Transportation

Florida offers one of the most attractive NEMT markets in the United States. With more than 21% of its residents aged 65 and older, the state has one of the largest senior populations in the country, creating recurring demand for medical appointment, dialysis, rehab, and discharge transportation. Florida is also home to more than 700 skilled nursing facilities (SNFs), 3,080 assisted living facilities (ALFs), nearly 2,000 retirement communities, and over 300 hospitals—a vast healthcare ecosystem that depends on safe, reliable non-emergency transportation. 

Florida’s Medicaid services are managed through transportation brokers such as MTM. While brokers offer access to a high volume of trips, they also limit control over pricing, create payment delays, and require rigorous onboarding. For operators who want higher margins and independence, Joel’s strategies—pursuing direct-pay contracts with hospitals, skilled nursing facilities, dialysis centers, and managed care organizations (MCOs)—offer the clearest path to building a scalable and profitable business. These agreements often deliver better reimbursement rates, more predictable revenue, and greater control than relying solely on Medicaid broker trips. 

Across Florida, hospitals and emergency rooms are struggling with insufficient wheelchair and stretcher transportation for patient discharges. In counties such as Lee, where nearly 29% of the population is over 65, discharge delays often force patients to remain hospitalized long after they are medically cleared. This creates a domino effect: ERs become overcrowded, bed turnover slows, and hospitals lose millions annually due to inefficiencies and uncompensated stays. Although Medicaid contracts technically allow for “urgent” discharge rides, these processes are often too slow to meet real-time needs—forcing hospitals to scramble for alternatives. NEMT providers who can reliably fill this gap are in prime position to secure premium-rate agreements. 

Florida operates as a “decentralized” state, meaning licensing requirements vary by county. Some counties require Certificates of Public Convenience and Necessity (COPCN) or specialized permits, while others have looser frameworks. Insurance standards are manageable compared to states like California: commercial auto liability typically ranges from $300,000 to $1 million, with additional general liability and workers’ compensation coverage as needed. Vehicles must be ADA-compliant for wheelchair or stretcher transport.  

Many NEMT companies in Florida start with a single sedan focused on low-paying Medicaid ambulatory trips. This model, while easy to launch, is not designed to scale. It limits revenue, avoids higher-demand wheelchair and stretcher services, and leaves operators without the infrastructure, training, or hospital relationships needed to grow. As a result, most providers fail to capitalize on the most lucrative segments of the market.

Stretcher transports often require two trained attendants and a specialized equipment, but they also command significantly higher per-trip reimbursement.  Providers who invest in being stretcher accessible quickly separate from the competition and further position their business to secure premium contracts with hospitals and nursing facilities that are desperate for reliable discharge solutions.

•  Skilled Nursing Facilities (SNFs): ~700–730 licensed facilities, with average occupancy near 87%.
   
• Assisted Living Facilities (ALFs): ~3,080 licensed, offering ~106,000 beds.
   
• Retirement Communities: ~1,975 statewide, including 375+ age-restricted 55+ communities.
   
• Hospitals: ~321 facilities, including acute care and specialty hospitals.
   
• Dialysis Centers: ~488 Medicare-certified clinics (with ~73% owned by DaVita and Fresenius).
   

Together, these facilities represent thousands of daily transport needs—an opportunity for NEMT providers who deliver reliability and compliance.

Florida’s combination of a large senior population, fragmented broker system, county-level regulations, and strained hospital discharge processes creates enormous opportunities for savvy entrepreneurs. By following Joel’s strategies, focusing on direct-pay contracts, private agreements, and higher-liability but higher-return services like wheelchair and stretcher transport, providers can break free from the limitations of Medicaid brokers, achieve independence, and build scalable businesses with strong ROI.