How to Start an NEMT Business in Illinois: A Several Part “Bambi Knows Best” State-By-State Series Part 1: Research the Illinois NEMT Market
Before embarking on a new business venture, it's crucial to conduct comprehensive market research in your state of Illinois. This ensures that you're not entering an oversaturated market. It also helps you identify any particular gaps in the existing NEMT services that are already being offered. For example, you might discover that while there are NEMT providers in your area of Illinois, they only offer wheelchair services. This presents an opportunity to establish and expand your NEMT fleet to include stretcher and ambulatory services. In this section, we'll outline how to begin and where to focus your market research efforts in Illinois.
1 | Identify existing NEMT providers in your area There are quite a few NEMT providers across the state of Illinois from those servicing rural zones to the big-city slickers of Chicago. There are directories aggregating providers, but also specific healthcare facilities that partner with NEMT providers — so it’s a good idea to look into all the options and be Bambi brave and start phoning them up for pointers! Because even though these providers may be your competition, they could also become future business partners. If and when you approach them — which we recommend that you do to gain insights into your market — do so thoughtfully. Below are some helpful directories to start your search for NEMT providers in Illinois:
Illinois Public Health Association (IPHA) Directory Illinois Department of Healthcare and Family Services (HFS) Access Community Health Network offers NEMT services as part of its community health services, focusing on low-income and medically underserved populations.MedEx Ambulance Service Elite Ambulance Service Provides comprehensive NEMT services, including specialized transportation for bariatric patients and medical appointments.American Medical Response (AMR) Pace Bus is the name of the public transportation system in Chicago. They’re not technically an NEMT service provider (so not a direct competitor, rather a second-tier competitor), but they do have specific ADA requirements and are able to provide support for mobility impaired. PAN Foundation provides a directory of NEMT services across the states. Just add Illinois in the search field and a list of providers will populate.Uber Health OATS, Inc ., While they primarily operate in Missouri, they do not have a presence in Illinois, offering rural transportation for older adults.Your favorite search engine. Of course, one can always do an internet search via the keywords, “NEMT providers in Illinois” or get more granular with your search by putting in specific municipalities (i.e. “NEMT companies in Chicago”).
2 | Assess the demand for NEMT services Find out if there is sufficient demand for your NEMT business to enter the market in your local area of Illinois. Also, consider whether you'll be crossing multiple jurisdictional lines or operating within a small radius. To make this assessment, you’ll want to research the local hospitals, health and wellness facilities, including establishments such as:
Adult Day Care (ADC) Centers. Illinois has approximately 110 adult day care centers throughout the state. Adult Day Services Network is an aggregator of the ADCs in Illinois and Active Day is one of the most prevalent chains operating in Illinois.Dialysis Clinics. As of 2024, there are numerous dialysis clinics across Illinois, serving patients with chronic kidney disease who require regular dialysis treatments. Here are a some of the major dialysis providers across Illinois to get you started on your search: Dialysis Care Center , Fresenius Kidney Care , DaVita Kidney Care and U.S. Renal Care .Physical Therapy Centers. There are numerous physical therapy centers across Illinois, providing a range of rehabilitation services to patients. Here are a couple of the major physical therapy providers to get you started on your search: Athletico Physical Therapy and NovaCare Rehabilitation .Hospitals: Illinois has approximately 200 hospitals in total — all across the state with a concentration in urban areas like Chicago, Peoria, Springfield, Rockford, Champaign-Urbana and the Quad Cities. Some of the major hospital systems are Advocate Aurora Health , Northwestern Medicine and University of Illinois Hospital & Health Sciences System .Rehabilitation centers. For exact numbers, we recommend reaching out to the Illinois Department of Public Health or professional organizations like the Illinois Physical Therapy Association or the American Physical Therapy Association (Illinois Chapter) . They can provide more detailed statistics and resources regarding the number and types of rehabilitation centers across the state of Illinois.Nursing homes and assisted living facilities. As of the latest data, Illinois has approximately 1,200 licensed nursing homes. These facilities provide a range of services including skilled nursing care, rehabilitation services and long-term care for elderly and disabled individuals. For the most accurate and up-to-date information, we recommend consulting the Illinois Department of Public Health.Outpatient care centers. There are a significant amount of outpatient care centers throughout the state — talk to your local hospitals for more information on this.3 | Decide on a target market Based on your research into NEMT market opportunities and demand from healthcare facilities, determine which demographic it strategically makes the most sense to target. Will you focus on seniors, individuals with disabilities or a broader patient population? Specializing in a specific group will enable you to tailor your services and marketing strategies more effectively.
It’s important to note that Illinois boasts a diverse statewide population of approximately 12.8 million people, making it the sixth most populous state in the United States. The population is varied and includes urban centers like Chicago, as well as suburban and rural areas. (Source: 2020 US Census Bureau ).
4 | Choose a specific NEMT service (or offer them all!) NEMT providers offer a range of services in their vehicle fleets, including ambulatory, stretcher and wheelchair support. It's advisable to begin with one service based on the needs of your target market and the gaps in the market, then expand from there. This approach is the sustainable way forward! So see what the others are doing and do different or find that niche of a neighborhood that could use your support and start with an equipped fleet to meet the needs of that particular service be it servicing ADCs or PT centers.
5 | Understand the different Medicaid delivery models
Illinois operates under a brokerage model for NEMT, where a third-party broker arranges and coordinates transportation services for Medicaid beneficiaries. The broker is contracted by the state's Medicaid agency to manage the NEMT program, coordinating with various transportation providers to arrange rides to medical appointments, dialysis, hospital discharges and other necessary services. The broker is also responsible for payment to these transportation providers. This model ensures efficient and cost-effective transportation for Medicaid recipients who lack private transportation options. (Sources: Illinois Department of Healthcare and Family Services and Illinois Medicaid Program ).
In 2001, HFS created the Non-Emergency Transportation Services Prior Authorization Program (NETSPAP) to comply with federal requirements. First Transit oversees NETSPAP, evaluating transportation requests based on HFS regulations. The Rural Medical Transportation Network (RMTN), supported by Southern Illinois University and funded by the Illinois Department of Transportation, identifies and coordinates NEMT services for rural residents. (Source: Illinois Department of Healthcare and Family Services )
Here are some fast IL facts according to report State-by-State Profiles for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination :
NEMT Model is part is part Managed Care Organization The Operating Authority is Federal Section 1115 Demonstration Waiver NEMT expense is classified as a “Medical Expense” (Source: Kaiser Family Foundation) 14% live below poverty (US Census 2015 5-Year Estimates) 80% live in Urbanized Areas (US Census 2010) $78.9 Million is the estimated annual NEMT 2013 expense (Source 2014 National NEMT Survey) 2,795,855 is the 2013 estimated annual NEMT trips 6 | Getting Paid In Illinois, NEMT services are reimbursed based on a fee schedule set by the Illinois Department of Healthcare and Family Services (HFS) , which administers the state's Medicaid program. Here’s how it works:
The fee schedule includes rates for different types of transportation services, such as mileage for various vehicle types and waiting time. Providers must adhere to these rates when billing Medicaid for services.
Illinois Medicaid operates under a managed care model, with some recipients enrolled in Managed Care Organizations (MCOs). MCOs have their own contracts and fee schedules with NEMT providers. Providers must follow the rates and guidelines set by the MCOs.
Providers submit claims for services provided to Medicaid recipients, detailing the service type, mileage, and waiting time. Claims are processed by the Illinois HFS or the relevant MCO to ensure compliance with the fee schedule and guidelines.
Once verified, providers receive reimbursement based on the fee schedule rates. Payments are issued by the Illinois HFS or the MCOs, as per the specific arrangements.
Great job making it through this densely packed first part! Now, let's move on to Part 2 on how to develop a business plan . Click here to continue, or skip ahead to other sections in the series by visiting the table of contents.
Part 1: Research the Illinois NEMT market
Part 2: Develop a business plan and get registered in Illinois
Part 3: Study Illinois’ regulations and get insured
Part 4: Secure funding in Illinois
Part 5: Flesh Out Your NEMT Fleet in Illinois
Part 6: Hire and Train Up Your NEMT Dream Team
Part 7: Take Care of That Tech
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