How to Start an NEMT Business in Missouri: A Several Part “Bambi Knows Best” State-By-State Series
Part 2: Develop a Business Plan and Get Registered in Missouri
Using the information from your Missouri NEMTmarket research in Part 1, create a comprehensive business plan. This plan is crucial for registration and securing funding. If you need additional support, consider reaching out to business consultancies in your area. While this directory is for St. Louis, these consultancies may also assist rural businesses, as they are proficient in various aspects of business development.
We also recommend furthering your research through Missouri SBDC and Missouri Business Portal. Starting a new business in Missouri involves several steps, including choosing a business structure, registering the business, obtaining necessary licenses and permits and understanding tax obligations.
Here’s a quick guide to help you navigate this process:
1 | Choose a Business Entity
Determine the legal structure of your business. Common structures include sole Proprietorship, Partnership, Limited Liability Company (LLC), Corporation (C-Corp or S-Corp). Each structure has different legal and tax implications so be sure to understand the differences.
Upon choosing the entity that best suits your situation you’ll want to come up with a name. Both will then need to be registered with the Missouri Secretary of State
Apply for an EIN from the IRS if you will have employees or operate as a corporation or partnership.
You’ll need to register with the Missouri Department of Revenue for state taxes such as sales tax and employer withholding tax.
Nice one! To move forward onto Part 3 on Missouri’s regulations and how to go about getting insured, click here or skip ahead to the other sections in the series by visiting the series’ table of contents here.
How to Start an NEMT Business in Missouri: A Several Part “Bambi Knows Best” State-By-State Series
Part 1: Research the Missouri NEMT Market
Prior to diving into a new business venture, it’s important to conduct thorough market research in Missouri. This will ensure that you’re not entering an oversaturated market and/or help you find that gap in the market of NEMT services already being provided. Perhaps you’ll find that, even though there are NEMT providers in your area of Missouri, they only offer wheelchair service. This leaves an open opportunity for building up your NEMT stretcher and/or ambulatory fleet, for instance. In this section we’ll outline how to get started on and where to go in your Missouri market research.
1 | Identify existing NEMT providers in your area
As of 2024, there are more than 400 NEMT providers in Missouri. Missouri’s NEMT program is managed by MTM, Inc., which oversees the coordination and delivery of these services statewide (Source: MyDSS and NCSL). Remember, these providers are your competition, but they could also become future partners, so if and when you approach them — which we recommend that you do to get some pointers in your market — do so thoughtfully. Below are some helpful directories of where to start your search for NEMT providers in Missouri:
2 | Assess the demand for NEMT services
Determine if there is sufficient need for your NEMT business to enter the market in your local area of Missouri. Also consider whether or not you'll be crossing multiple municipalities or operating within a small radius. To make this assessment you’ll want to research the local hospitals and health and wellness facilities such as the following places:
3 | Decide on a target market
Based on your findings from the NEMT market opportunities in your provider search and demand on your healthcare facilities search, decide who it makes most strategic sense to target. Will you cater to seniors, individuals with disabilities or a broader patient population? Specializing in a specific group will allow you to tailor your services and marketing strategies more effectively. Missouri has a state-wide population of 6,154,913 (Source: 2020 Decennial Census
4 | Choose a specific NEMT service (or offer them all!)
NEMT providers offer various services in their fleet of vehicles, including ambulatory, stretcher and wheelchair support. It's best to start with one service based on your target market’s needs and the gaps in the market, then scale from there. That’s the sustainable way, at least! The Missouri HealthNet Division contracts with MTM, Inc. to manage the NEMT program statewide, ensuring a wide range of transportation services for Medicaid beneficiaries, including those requiring wheelchair, stretcher and ambulatory access. While exact numbers of providers specifically focused on the different services aren't typically detailed in public resources, a significant portion of NEMT providers include wheelchair-accessible, stretcher-serviced and ambulatory vehicles to meet the needs of individuals with mobility challenges. This focus is part of the broader effort to ensure all Medicaid beneficiaries have access to necessary medical transportation, regardless of their mobility status (Sources: NCSLMissouri Medicaid Audit & Compliance).
5 | Understand the different Medicaid delivery models
It’s how you’ll end up getting paid after all! State Medicaid programs are required to provide NEMT services as a Medicaid benefit, but their delivery models vary. States have discretion in choosing models to deliver NEMT, often using multiple approaches to meet diverse beneficiary needs, delivery systems and geographic considerations. States typically adopt one or more of the following models: paying for NEMT on a fee-for-service (FFS) basis, contracting with managed care plans for NEMT and other services and utilizing transportation brokers to manage the benefit (GAO 2016a). The most common model is the brokerage model, authorized under Section 1902(a)(70) of the Social Security Act.
In Missouri, Medicaid services are provided through the Mixed model, using two main delivery systems: state-managed care and fee-for-service (FFS). Here’s a breakdown of the key differences between these two systems.
Here are some fast MO facts according to report State-by-State Profiles for Examining the Effects of Non-Emergency MEdical Transportation Brokerages on Transportation Coordination:
Great work getting through this first — quite densely packed with data — part! Now to move onto Part 2 on how to develop a business plan, click here or skip ahead to the other sections in the series by visiting the series’ table of contents here.
See the full interview on YouTube.
Please don't forget to subscribe and like NEMT Experts Podcast on YouTube.
Also, available to watch on Spotify
And listen (audio only) on your other favorite podcast platforms Apple and Pandora.
Bambi CEO Nirav Chheda talks with John Maselli, the National Director of Van Sales for Model 1 Commercial Vehicles, about what NEMT business owners should think about in the process of buying NEMT vehicles.
Mobility issues can make it difficult to get from A to B-for-Bambi, especially for those who need a stretcher to get there. And for most, most of our family and friends don’t have the capability or space for a stretcher in their vehicles nor public transport to take when one might need a lift inclusive of a stretcher. This is where having a non-emergency medical transportation (NEMT) ride with plenty of space to store a stretcher would help those riders who need rely on them to reach the hospital, dialysis center, adult day care center — what be it — with care, comfort and ease.
Here’s why, as a NEMT broker or business owner, having stretchers onboard in, at least, some of your NEMT fleet is a Bambi essential:
Enhanced patient care
Stretchers ensure that you can safely transport patients who require lying down due to medical conditions or injuries. They provide a comfortable and stable platform for patients during transit, enhancing their overall comfort and well-being.
Versatility and flexibility
Having stretchers on hoof allows you to accommodate a much wider range of medical needs and emergencies. They can be quickly deployed when needed, ensuring readiness for unexpected circumstances.
Expertise and dependability
Equipping your NEMT fleet with stretchers showcases your dedication to delivering high-quality, comprehensive care. It improves your reputation as a dependable and compassionate NEMT provider.
Practicality and efficiency
Stretchers are designed to be compact and easy to store, saving space in your vehicle for other essential medical equipment like walkers and foldable wheelchairs. They improve the boarding and disembarking processes, ensuring efficiency and safety.
Patient Satisfaction and Safety
Patients and their loved ones will appreciate the comfort and security provided by stretchers, leading to higher satisfaction rates.They contribute to the overall safety of riders during transportation, minimizing the risk of injury or discomfort.
Regulatory Compliance
Including stretchers in your NEMT vehicles ensures compliance with regulations and standards governing medical transportation.It demonstrates your commitment to meeting and exceeding industry requirements for patient transport.
Adding stretchers into your NEMT operations is a strategic investment that enhances service quality, increases patient satisfaction and ups your competitive edge in the NEMT industry. It’s a small investment with big Bambi benefits, ensuring that your business stands out as a leader in providing reliable and compassionate NEMT services.
Following the release of our article, NEMT Brokers — The Real Bambis of the Industry, the non-emergency medical transportation sector experienced an uptick in new competitors entering the Bambi forest. While we jest, acknowledging our playful core values, the growth in this industry is no laughing matter. With the rise in chronic health issues and the aging population, the demand for NEMT services is steadily increasing.
Entering an industry with job security and a focus on ensuring the safety of others is not only reasonable but also provides a pathway to long-term business success. Here's a simple guide on how to become a Broker or Bambi, as we affectionately call it in the forest of NEMT.
While we previously covered how to become an NEMTpreneur, providing valuable insights for newcomers to the industry, this article focuses on navigating the intricacies of the business once you're established. We'll assume you have the foundational knowledge of setting up a business but may require guidance on connecting the dots and serving as the intermediary between hospitals, transportation companies, technology providers and more.
Again, assuming you have your business plan and even a name for your Bambi-heart driven biz, first things first. And that you’ll need to obtain the necessary licenses and certifications. Every jurisdiction is different so be sure to research and obtain the required licenses and permits to operate as an NEMT broker in your local area. And depending on where you’ll operate, ensure compliance with local, state and federal regulations governing the provision of your transportation services.This foundational step sets the stage for a solid and legally sound business framework.
With your necessary operating licenses secured, the next step is assembling your caregiving team — carefully. These individuals are the backbone of your Bambi biz, capable of making or breaking its success. It's imperative to hire people who genuinely care, as their dedication is pivotal to the services you provide. Fortunately, nurturing comes naturally to those with Bambi blood; a little training is all it takes to harness their inherent caregiving instincts.
Next up, you'll require the right tech support to empower your team. At Bambi, we're proud to offer our all-in-one aiNEMT solution, designed to dispatch, dash, and drive — deerly. However, beyond our soft, simple and streamlined SaaS lies a myriad of other technology providers eager to accelerate your NEMT service's growth. Take the time to explore local providers; after all, supporting local initiatives fosters sustainability for our one and only planet while thinking globally.
And lastly, embrace the power of partnerships. Form robust connections with healthcare providers, hospitals, clinics and rehabilitation centers. Cultivate valuable relationships with transportation companies, such as taxi services (they'll come in handy), specialized NEMT fleets and even ride-sharing platforms — you’ll be surprised at how all the technologies tend to
connect amongst each other. These collaborations ensure reliable transportation solutions for your clients. By fostering these strategic partnerships, you elevate your service quality and cement your reputation as a trusted Bambi in the NEMT industry.
All in all, in becoming an NEMT broker you’ll nurture not only that of your business but also the well-being of those you serve. So embrace your inner Bambi, and let your caregiving journey be one full of discovery and growth, gentle guidance, compassion and connection.
Welcome to Missouri, famously known as the "Show-Me State." This state slogan speaks to the pragmatic, no-nonsense attitude of its hard-working residents, who value actions over words. It's a state where showing what you can do matters — making it the perfect place to showcase your entrepreneurial skills. But Missouri doesn't just show; it cares. This strong sense of community and commitment to well-being makes it an ideal state to start your non-emergency medical transportation (NEMT) business.
The NEMT industry plays a vital role in ensuring everyone has access to the healthcare they deserve. If you're passionate about patient care — maybe you even work in healthcare already, and just keen to swap your scrubs for some software — and possess a strong entrepreneurial spirit, starting an NEMT business in Missouri could be a very rewarding venture.
And as a care-tech company dedicated to supporting our customers and their passengers, we aim to ensure that your NEMT business is set up for success from the get-go. We take pride in providing not only informative content on the NEMT industry and streamlined product features like Run Bambi Run, designed to save you time in your day-to-day operations, but also in supporting everyone from seasoned NEMT brokers to new NEMTpreneurs in how to start and run a sustainable NEMT business, sustainably. We’re friends of the forest afterall!
This Bambi Knows Best several part (it’ll MOst likely be seven parts — see what we did there? — but we don’t want to hold ourselves back if we think of another angle to add to the evolving series that might help your NEMT biz grow and succeed) will guide you through each crucial step in starting your own certified NEMT business in Missouri. From researching the local market and developing a business plan to understanding regulations, securing funding, building your fleet, hiring and training your dream team and managing the necessary technology, we’ve got you covered.
And know that as you delve deeper into your own research, we recommend hiring local consultants and connecting with other NEMT business owners in your area for valuable insights. Build those friendships with your competition — Bambi is all about fostering a community of friends over frenemies!
Below is a table of contents per se allowing you to follow along or click through to the articles that pertain to your needs MOst (ops, we did it again — we just can’t help ourselves!)
Part 1: Research the Missouri NEMT market
Part 2: Develop a business plan and get registered
Part 3: Study Missouri’s regulations and get insured
Part 4: Secure funding in Missouri
Part 5: Flesh Out Your NEMT Fleet in Missouri
Part 6: Hire and Train Up Your NEMT Dream Team
Part 7: Take Care of That Tech
All in all, starting an NEMT business in Missouri requires dedication, planning and a commitment to providing exceptional patient care. By thoroughly researching the Missouri market, rules and regulations; securing funding, fleets and a skilled team; as well as leveraging technology, you can be sure you’ll navigate the challenges nimbly like Bambi and build that thriving NEMT business to make a positive impact on your local Missouri community.
We return again for our final installment in our Bambi Knows Best three-part series, Along for the Ride, to meet one last group of the varying kinds of NEMT passengers.
In this third and final issue, we look to riders who need to be serviced and supported with a stretcher. These individuals require taking their non-emergency medical transportation while lying down due to their particular medical condition(s) and/or recovery from a surgery.
Stretcher-bound passengers present quite the unique set of challenges and require a much higher level of care and attention during their journeys. Because for one, there’s a lot more bells and whistles on the contraption from straps to be mindful of (and not get tripped up on) to wheels to roll around. They also tend to take up a lot more real estate in an NEMT vehicle than a wheelchair would, so it really makes a difference how many other passengers — or dear Bambi friends — can be picked up on this same route. There’s a good chance it’ll be a lift for the sole stretcher rider and potentially only their plus one of a helping hoof caretaker.
Just like their wheelchair-bound and ambulatory counterparts, stretcher-requesting riders bring their own niche needs and experiences to the journey. Caring for these types of passengers involves more than just providing the stretcher and a vehicle that it fits in — it requires stretching your mind to lean into that forethought — not only future-proofing your vehicle by planning head for these stretcher-needing passengers, but sustaining your NEMT business for the long-haul as there will always be vulnerable folk who need to travel via stretcher. Specialized equipment to hook, lock in and secure the stretcher are additional things to think about, as well as hiring highly trained staff to take care of these intricate devices that come in many sizes, shapes and at varying price points.
In general, it’s important to equip your NEMT fleet with the necessary space and tools to safely transport stretcher-bound patients. Do you have protocols in place to handle the loading and unloading of stretchers efficiently and safely?
Here are a few other necessary things to keep in mind when taking care of riders needing stretchers:
Communication is vital: Drivers should be trained to communicate clearly with stretcher-bound passengers and their caregivers to ensure all needs are met throughout the journey. Do they need special medical equipment to accompany the stretcher during transport? Are there any specific instructions for handling the patient? What injuries should you be mindful of as you strap in the patients?
Accessibility stretches beyond the van: Ensuring that pickup and drop-off locations are suitable for stretcher use is important. Vehicles must be equipped with the right stretchers and securing systems that fit the vehicle’s interior specs perfectly to guarantee patient safety. Some may require it, other stretchers may not, but find out if yours will need a ramp and/or lift to in- and off-load.
Emergency preparedness: NEMT drivers must be trained to respond effectively to emergencies and coordinate with medical professionals when necessary as folks who need to ride via stretchers are, in most cases, more vulnerable than wheelchair-bound and ambulatory riders. Can your team handle unexpected medical situations during the ride? Are your drivers trained beyond that basic first aid and emergency procedures to ensure confidence in not only the driver but the patient, too?
Always evolving: The billion-dollar NEMT industry is constantly transforming, and providers should always strive for continuous improvement in their services. Fielding feedback from passengers who request stretchers and actually implementing such feedback will enhance the overall experience for future stretcher-requesting riders.
And as you know by now, each passenger will have their own story and set of challenges, so it's your due diligence and duty to be empathetic, patient and respectful as you provide them with the dignified care they deserve.
Well that’s it folks! That’s the end of the road of Along for the Ride, for now. We’re Disney fans after all, so even when we close a chapter, it doesn't mean we’ll never open up that fairy tale again — to add more tales and tails to the story. In fact, it just stretched across our minds that it might be fun to look at those passengers considered “plus ones” to the riders going for their medical appointments. Just like our dears, we see these caretakers as not sure helping hooves, but heroes in the lives of NEMT riders.
So stay tuned! We might just have a Season Two of Along for the Ride. No promises, but maybe we’ll create a spin-off (or wheel-off!) series someday.
Meet the marvelous mix of NEMT passengers in our Bambi Knows Best three-part series, Along for the Ride, dedicated to exploring the diverse world of those who rely on non-emergency medical transportation.
In this first installment, we look at the unique needs and experiences of wheelchair-bound riders, from those who navigate manually to those whose mobility is enhanced by technology — yes, those electric wheelchairs and scooters that go zoom!
While we've previously delved into the perspective of first-time riders, we recognize the importance of understanding the journey from the viewpoint of NEMT brokers and drivers. After all, ensuring a safe and comfortable trip for every passenger is our ultimate, utmost priority when we continue to improve our inclusive care-tech. That's why we turn to Bambi, our near and deer expert, to shed light on the various characters you may encounter during your travels.
Caring for wheelchair-bound passengers entails more than just providing transportation — it requires a keen attention to detail and specialized equipment. Are your vehicles equipped with ramps and lifts to facilitate seamless boarding and disembarking? Do you have sufficient space to accommodate different types of wheelchairs, from standard manual models to sophisticated e-wheelchairs? These are questions that every NEMT provider must consider to ensure a smooth and safe experience for their passengers.
Moreover, it's essential for drivers to possess the skills and knowledge necessary to navigate the nuances of wheelchair transportation. From maneuvering different types of wheelchairs to addressing the unique needs of each passenger, drivers play an integral role in ensuring the safety and well-being of their riders.
As you get to know more about and better understand your wheelchair-bound NEMT riders (you might even make some new friends like Bambi), it’s important to prioritize empathy, patience and respect. Always. Because each passenger has their own story and challenges, and it's your due diligence and duty to provide them with the support and care they deserve.
Here are a few other necessary things to keep in mind when taking care of of wheelchair-bound passengers:
Communication is key: Effective communication between drivers, brokers and passengers is essential for a successful NEMT experience, and drivers should be trained to communicate clearly with wheelchair-bound passengers to ensure their particular needs are met throughout the journey. Do they need an e-lift or a ramp to embark? How will they be secured once inside the vehicle? Will they be riding solo or with an accompanying helping hoof?
Accessibility goes beyond transportation: Accessibility doesn't stop with the vehicle itself. It's important for NEMT providers to consider the accessibility of pickup and drop-off locations, as well as the varying facilities passengers may need to access at their destination.
Emergency preparedness: NEMT providers should have protocols in place for handling emergencies, including medical emergencies that could arise during transport. Drivers should be trained to respond effectively to emergencies and to coordinate with medical professionals when needed.
Always improving: The NEMT industry is constantly evolving, and brokers and providers should strive for continuous improvement in their services for everyone. Soliciting feedback from wheelchair-bound passengers and implementing changes based on it, will only enhance the overall experience for wheelchair-bound riders.There’s more where this came from! Stay tuned for the next installment of Along for the Ride, where we'll explore the experiences of ambulatory passengers and the intricacies of providing NEMT services to this unique group of riders ready to roll with you.
See the full interview on YouTube.
Please don't forget to subscribe and like NEMT Experts Podcast on YouTube.
Also, available to watch on Spotify
And listen (audio only) on your other favorite podcast platforms Apple and Pandora.
Bambi CEO Nirav Chheda talks with Price Wooding, Owner of "DME for Me Consulting", about how NEMT business can diversify into doing DME (Durable Medical Equipment) work.
