Building Profitable NEMT Business in Healthcare-Dense State

Illinois is one of the most attractive states to start a Non-Emergency Medical Transportation (NEMT) business. With 12.7 million residents and over 16% aged 65 and older—a figure expected to rise significantly by 2030—the state’s aging demographic drives steady demand for recurring transportation to dialysis centers, physical therapy, rehab, and outpatient visits.

The healthcare infrastructure is extensive: Illinois has 238 hospitals, more than 1,200 nursing homes, and 400–450 outpatient dialysis centers. Major hubs such as Chicago, Rockford, Aurora, and Peoria provide dense trip volume opportunities, while Cook County—home to many of the Midwest’s most prestigious hospitals—offers a particularly high concentration of discharge and follow-up transport needs.

Illinois is a Medicaid expansion state, and transportation for Medicaid recipients is managed through brokers such as ModivCare and MTM, as well as Managed Care Organizations (MCOs). This structure creates consistent ride volume for NEMT providers, but reimbursement rates are often low, heavily regulated, and subject to delays.

Operators who rely solely on brokered Medicaid trips face thin margins and limited control. To scale profitably, providers must follow Joel’s strategies by securing direct-pay agreements with hospitals, skilled nursing facilities, dialysis centers, and assisted living communities. These contracts allow for higher reimbursement, predictable scheduling, and more reliable cash flow.

One critical distinction in Illinois is that stretcher transports cannot be billed as NEMT services. Unlike states such as Georgia, Florida, California, and many other, Illinois limits stretcher transport to licensed ambulance providers unless advanced medical care is unnecessary and very specific local permits are obtained. For NEMT companies, this means the revenue model must be built around ambulatory and wheelchair transports.

This limitation underscores the importance of targeting the largest discharge category: wheelchair-accessible transport. The majority of patients being discharged from Illinois hospitals and skilled nursing facilities require wheelchair transport rather than ambulance or stretcher-level care. Many of these patients are Medicare-only, privately insured, or self-pay, making them ideal candidates for direct-pay contracts.

Hospitals and nursing facilities across Illinois report ongoing problems with delayed or missed discharges due to a shortage of reliable transportation vendors. These delays cause bed shortages, ER crowding, and increased costs. For facilities, having a trusted NEMT partner on-call is critical to patient flow.

NEMT providers that offer the following are more likely to become preferred providers:

• Consistent wheelchair transport availability
   
• Professional drivers trained in patient handling
   
• Clean, ADA-compliant vehicles

•  Nursing Homes / SNFs: ~1,200 licensed facilities serving 100,000+ residents; ~738 accept Medicaid.
   
• Hospitals: 238 total, supported by ~62 hospital systems employing 140,000+ staff.
   
• Dialysis Centers: 400–450 centers, many operated by DaVita and Fresenius, serving patients three times weekly.
   
• Assisted Living & Personal Care: Hundreds of assisted living facilities and ~2,910 personal care homes serve 55,000+ residents.
   

This network ensures steady, recurring demand for safe, reliable wheelchair and ambulatory transportation.

Operating in Illinois requires balancing the challenges of urban congestion in Chicago with the long distances in rural areas. Metro regions are competitive but dense with opportunities, while downstate counties offer less competition but higher mileage and lower trip efficiency. Providers with strong routing systems and diversified service contracts can succeed in both environments. 

Illinois offers a unique mix of high demand, Medicaid infrastructure, and manageable regulations that makes it a promising state for NEMT operators. But unlike in some states, stretcher transports remain outside the NEMT model, limiting providers to ambulatory and wheelchair services.

Entrepreneurs who focus on direct contracts, private-pay clients, and hospital discharge partnerships, rather than relying solely on Medicaid brokers, are best positioned to build independent, profitable businesses. In Illinois, the providers who deliver professionalism, reliability, and facility partnerships will be the ones who rise above the competition and achieve long-term scalability.