New York: A High-Volume, High-Revenue Market for NEMT

New York is one of the most compelling states to start or expand a Non-Emergency Medical Transportation (NEMT) business. As the fourth most populous state, it is home to nearly 20 million residents, including 3.4 million aged 65 and older. This aging demographic creates consistent demand for safe, reliable transport to dialysis, chemotherapy, rehab, and routine medical appointments. 

With 7+ million residents enrolled in Medicaid—over 35% of the state’s population—New York maintains one of the largest Medicaid programs in the nation. The system is administered through a centralized brokerage model managed by Medical Answering Services (MAS), which authorizes and coordinates rides for eligible beneficiaries.

For NEMT providers, MAS offers steady trip volume. However, reimbursement rates are often low, with strict scheduling and documentation requirements. To build a sustainable and profitable business, operators must go beyond Medicaid brokers by following Joel’s strategies: cultivating private-pay clients and securing direct contracts with hospitals, nursing homes, dialysis centers, and managed care organizations. These agreements provide higher reimbursement, faster payment, and greater control over operations.

Unlike Illinois, where stretcher transport is restricted, New York authorizes NEMT providers to perform non-emergency stretcher trips. This capability significantly increases revenue potential.

• Wheelchair transports may reimburse $40–$80 per leg.
   
• Stretcher transports can yield $150–$300 per leg or more, depending on payer, distance, and timing.
   

This expanded scope allows providers to serve hospital discharges, nursing home transfers, and rehab patients who are non-ambulatory but do not require an ambulance. For hospitals, this is a critical gap, ambulance transport is expensive and unnecessary in many discharge cases. Providers who can reliably handle stretcher trips often become preferred partners, securing repeat referrals and exclusive contracts.

New York presents two distinct operating environments:

• Downstate (NYC, Long Island, Westchester): Dense populations, high trip volume, and a concentration of hospitals and dialysis centers. This creates opportunities for scale and private-pay diversification but comes with challenges—traffic congestion, parking restrictions, tolls, and higher insurance costs.
   
• Upstate (Albany, Syracuse, Rochester, Buffalo, rural counties): Lower operating costs, fewer competitors, and strong opportunities to build community relationships. However, lower population density can mean longer trips and higher deadhead mileage.
   

Successful NEMT companies often adapt by tailoring their fleet and dispatch protocols to each region, maximizing efficiency across both markets.

Hospitals, emergency rooms, and skilled nursing facilities across New York struggle with discharge delays due to unreliable wheelchair and stretcher transport. These delays cause:

• Bed blocking in hospitals, slowing ER admissions and creating overcrowding.
   
• Lost reimbursement for SNFs and rehab centers when patients miss dialysis or specialty appointments.
   
• Increased workloads for discharge planners who spend hours daily trying to secure transport.
   
• Lower patient satisfaction scores (HCAHPS), which can impact hospital reimbursement.
   

Providers who deliver on-time, professional wheelchair and stretcher transport can solve these problems, becoming indispensable partners in the healthcare system.

New York supports minority- and women-owned businesses (MWBEs) with certification programs, grants, and procurement preferences, creating opportunities for certified NEMT providers to gain competitive advantage and access state contracts.

Additionally, year-round demand ensures stability. Dialysis, chemotherapy, and rehab appointments continue through holidays and winter months, and in snowy upstate regions, NEMT providers are often the only safe option for frail patients who cannot navigate harsh weather.

•  Nursing Homes: ~600–604 facilities statewide, serving tens of thousands of residents.
   
• Hospitals: ~260–270 facilities, including large academic centers, VA hospitals, and community institutions.
   
• Dialysis Centers: ~330 Medicare-certified facilities, serving ~31,000 patients statewide.
   

This vast network ensures steady demand for ambulatory, wheelchair, and especially stretcher transport services.

New York combines dense demographics, high Medicaid enrollment, and unique regulatory allowances for stretcher transport to create one of the nation’s most lucrative NEMT markets. While MAS provides steady Medicaid volume, the real profitability lies in direct contracts and private-pay services, especially for wheelchair and stretcher transports tied to hospital and SNF discharges.

Entrepreneurs who build professional fleets, establish strong facility partnerships, and leverage New York’s MWBE and procurement programs can scale quickly and achieve high ROI in one of the country’s most dynamic healthcare environments.