Ohio: A Prime Growth State for NEMT

Ohio is one of the most attractive states in the U.S. to launch or expand a Non-Emergency Medical Transportation (NEMT) company. With nearly 12 million residents and one in five over age 65, the state has a large and aging population that guarantees long-term demand for recurring medical transportation. From dialysis and chemotherapy to rehabilitation and routine doctor visits, Ohio’s seniors and disabled residents depend on NEMT to maintain access to essential care.

The healthcare infrastructure is extensive: Ohio is home to 930–960 nursing facilities with over 87,000 certified beds, 720 assisted-living/residential care facilities, 326 free-standing dialysis clinics, and more than 320 hospitals. Major systems such as Cleveland Clinic, OhioHealth, University Hospitals, and ProMedica anchor urban markets like Cleveland, Columbus, Cincinnati, Dayton, and Toledo, while rural regions remain underserved, creating steady demand for transport in both urban and rural settings.

Ohio’s Medicaid program is one of the largest in the country and includes non-emergency medical transportation as a covered benefit. The state partners with ModivCare, MTM, and MyCare Ohio to manage rides, while additional waiver programs such as PASSPORT and developmental disability waivers fund trips for seniors and disabled individuals.

This ensures that NEMT providers have multiple revenue streams, from Medicaid-covered rides to waiver-funded transports. However, as in other states, Medicaid reimbursement is often low and heavily regulated. To build long-term profitability, providers must follow Joel’s strategies, securing private-pay clients and facility contracts with hospitals, nursing homes, and dialysis centers. These agreements provide higher reimbursement, faster cash flow, and more predictable scheduling than brokered Medicaid trips.

Ohio hospitals and post-acute facilities face ongoing problems with delayed discharges due to lack of timely transport. Patients medically cleared for discharge often wait hours, or overnight, for a wheelchair van or stretcher-capable vehicle. This creates bed bottlenecks that block ER admissions, slow throughput, and reduce hospital efficiency.

Facilities also report missed pickups, last-minute cancellations, and lack of specialized vehicles as recurring problems. When no reliable NEMT option is available, hospitals often resort to using ambulances for non-emergency patients, wasting resources and inflating costs. Skilled nursing facilities face similar struggles when residents miss dialysis or specialty appointments due to unreliable transportation, risking reimbursement penalties and poor outcomes.

Dependable NEMT providers who can handle wheelchair, bariatric, and special-needs trips—and who offer bedside-to-bedside assistance beyond what ADA paratransit can provide—quickly become preferred vendors. Hospitals and senior care administrators increasingly seek long-term contracts with reliable providers to ensure smoother discharges and improved patient flow.

Unlike some states, Ohio does not require a statewide certificate of authority specifically for NEMT. Entry is relatively straightforward: providers must meet broker credentialing requirements, ADA vehicle standards, commercial auto liability insurance, and ensure driver training and background checks.

The state’s moderate entry requirements, combined with affordable insurance and vehicle costs, make Ohio a cost-effective environment to launch operations. Its lower cost of living and available workforce further support scalability compared to coastal states with higher overhead.

•  Nursing Facilities: 930–960 statewide; ~87,300 certified beds.
   
• Assisted Living / Residential Care: ~720 licensed facilities.
   
• Hospitals: 320+ facilities, most affiliated with large health systems such as Cleveland Clinic, ProMedica, and OhioHealth.
   
• Dialysis Clinics: 326 free-standing outpatient facilities serving chronic ESRD patients multiple times weekly.
   

This infrastructure ensures daily recurring trip demand and opportunities for long-term facility contracts.

Ohio offers the ideal combination of demand, funding, infrastructure, and accessibility to support new and growing NEMT businesses. Its large senior population, strong Medicaid program with multiple waiver-funded revenue channels, and dense healthcare landscape generate both Medicaid and private-pay opportunities.

Entrepreneurs who follow Joel’s strategies, focusing on direct contracts, private-pay relationships, and reliable discharge support, can build independent, scalable, and profitable NEMT businesses in Ohio. The state’s favorable business climate, moderate regulation, and growing healthcare needs make it one of the best environments in the Midwest for long-term NEMT success.