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:
MTM, Inc .MTM significantly influenced Missouri's NEMT program by creating an innovative brokerage system . MTM’s dedication to Missouri's NEMT sector extends beyond the statewide program, as they have consistently offered NEMT services to various MO HealthNet Managed Care Organizations (MCOs), facilitating approximately 132,000 trips each year.Missouri Department of Social Services PAN Foundation provides a directory of NEMT services across the states. Just add Missouri in the search field and a list of providers will populate.Uber Health OATS, Inc ., offers rural transportation in Missouri since 1971. It services at least 87 counties and offers a variety of services including NEMT. Some Missouri NEMT brokerages use OATs’ service as part of their fleet.Your favorite search engine. Of course, one can always do an internet search via the keywords, “NEMT providers in Missouri” or get more granular with your search by putting in specific municipalities (i.e. “NEMT companies in St. Louis county”).
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:
Adult Day Care (ADC) Centers. Missouri has more than 100 licensed adult day care centers, with nearly 60% of them based in the St. Louis area. Kansas City hosts approximately 20 centers, while Springfield has just three. These facilities offer vital care and social activities for seniors and adults with disabilities, helping to alleviate the responsibilities of caregivers (Source: MCQC ).Dialysis Clinics. Missouri has approximately 170 dialysis centers . This includes various facilities operated by major providers such as Fresenius Kidney Care and DaVita , as well as numerous hospital-affiliated centers across the state (Source:, DPC EdCenter , Barnes-Jewish Hospital and Fresenius Medical Care ). These centers provide critical care for patients with end-stage renal disease (ESRD) and offer services such as in-center hemodialysis, home dialysis options and support for kidney transplant patients. Physical Therapy Centers. As of 2024, there are approximately 350 physical therapy centers throughout the state of Missouri.This number includes a variety of facilities that provide physical therapy services, such as specialized clinics, hospital-based centers, and wellness centers offering a range of therapeutic treatments. (Source: Rentech Digital , Chamber of Commerce , Greater Therapy Center and Missouri Baptist Sullivan ).Hospitals. These are an obvious place to utilize your NEMT service for their discharged patients. Missouri is home to around 140 hospitals of varying sizes and specialties, including both general acute-care and specialty hospitals. For the most up-to-date and specific information, it's recommended to contact the Missouri Hospital Association or the Missouri Department of Health and Senior Services .Rehabilitation centers. According to the Missouri Department of Social Services, the state supports numerous facilities providing adaptive training, physical therapy, occupational therapy, and speech therapy for various needs. In total, Missouri hosts 42 rehabilitation centers focused on different types of therapy and rehabilitation services (Sources: ARK Behavioral Health ), Cause IQ: Intelligence on nonprofits and myDSS ). Nursing homes. As of the most recent data, there are approximately 510 nursing homes in Missouri (KCUR ) (myDSS ). This figure includes various types of facilities that provide long-term care for the elderly and individuals with disabilities. Assisted living facilities. Missouri has approximately 327 assisted living facilities (Source: AssistedLiving.org and MO Health Dept. ). This number includes facilities that provide a range of services designed to support seniors who need help with daily activities but do not require the intensive medical and nursing care provided in nursing homes. Outpatient care centers. As of 2024, there are approximately 512 outpatient care centers in Missouri. This number includes various types of outpatient facilities that provide services such as diagnostics, treatment and minor procedures that do not require an overnight stay (Pell Research and IBISWorld ).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: NCSL Missouri 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
NEMT Model is part is part Managed Care Organization and Statewide Broker The Operating Authority is 1902(a)(70) State Plan Amendment NEMT expense is classified as a “Medical Expense” (Source: Kaiser Family Foundation) 15% live below poverty (US Census 2015 5-Year Estimates) 57% live in Urbanized Areas (US Census 2010) $41.5 Million is the estimated annual NEMT 2013 expense (Source 2014 National NEMT Survey) 1,227,356 is the 2013 estimated annual NEMT trips <4% of NEMT is public transportation 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.
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