How to Start a NEMT Business in Missouri

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.

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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!

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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!)

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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
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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.

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In This Guide

• Part 1: A Several Part “Bambi Knows Best” State-By-State Series PART 1
• Part 2: A Several Part “Bambi Knows Best” State-By-State Series PART 2
• Part 3: A Several Part “Bambi Knows Best” State-By-State Series Part 3
• Part 4: A Several Part “Bambi Knows Best” State-By-State Series Part 4
• Part 5: A Several Part “Bambi Knows Best” State-By-State Series Part 5
• Part 6: A Several Part “Bambi Knows Best” State-By-State Series Part 6
• Part 7: A Several Part “Bambi Knows Best” State-By-State Series Part 7

Part 1: A Several Part “Bambi Knows Best” State-By-State Series PART 1

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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.

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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:

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• MTM, Inc. headquartered in St. Louis, Missouri, was founded in 1995 and has since become one of the largest providers of Non-Emergency Medical Transportation (NEMT) services in the United States. In 1997, 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 administers social service programs in Missouri, including Medicaid, SNAP, TANF, child care assistance, adult protective services and more. They are a good source for inquiring about NEMT Missouri providers.
• 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 operates in Missouri providing transportation for healthcare-related trips, and so is considered an NEMT provider in Missouri.
• 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”).

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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

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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)​.

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5 | Understand the different Medicaid delivery models

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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.

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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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Part 2: A Several Part “Bambi Knows Best” State-By-State Series PART 2

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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.

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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:

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1 | Choose a Business Entity

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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.

2 | Register Your Business Name and Entity

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

3 | Obtain an Employer Identification Number (EIN)

Apply for an EIN from the IRS if you will have employees or operate as a corporation or partnership.

4 | Register for State Taxes

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.

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Part 3: A Several Part “Bambi Knows Best” State-By-State Series Part 3

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To successfully start your NEMT business in Missouri, it's crucial to navigate both state and federal regulations. This involves understanding the specific requirements for registration and compliance in your state, as well as adhering to overarching federal guidelines.

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1 | Find out Missouri's NEMT Requirements

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Missouri has specific licensing requirements for NEMT providers. Visit the State Department of Health and Senior Services (DHSS) website for detailed information from the MO HealthNet Division (MHD) obtaining the necessary NEMT licenses and permits.

2 | Stay on top of federal NEMT regulations

NEMT services also fall under federal regulations established by the Centers for Medicare & Medicaid Services (CMS). Ensure you're also familiar with the federal requirements before you begin operating your business.

3 | Get insured

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Securing the right insurance coverage is crucial in establishing a reliable and legally compliant NEMT business. NEMT insurance protects your company, employees and patients in the event of accidents, injuries or other unforeseen incidents. ITR is one insurance provider to cover some aspects, but there are also multiple types of insurances you’ll need.

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4 | Obtain necessary licenses and permits

Check with local city and county offices, as well as the Missouri Division of Professional Registration for specifics around NEMT businesses.

5 | Know your employer responsibilities

If you hire employees, you’ll need to comply with employment laws, including workers' compensation insurance, unemployment insurance and reporting new hires. The Missouri Department of Labor is a great source of information on this topic!

By following these steps and utilizing available resources, you can ensure that your new business in Missouri is properly established and compliant with state regulations.

You’re keeping up a great pace on learning all about NEMT biz in MO — be sure to be Bambi proud! Now to move onto Part 4 on how to secure funding in Missouri, click here or skip ahead to the other sections in the series by visiting the series’ table of contents here.

Part 4: A Several Part “Bambi Knows Best” State-By-State Series Part 4

Startups cost to start up. So be realistic about the initial investment required. Factor in vehicle purchases, licensing fees, insurance costs, marketing expenses and operational overhead — and then see about securing adequate funding to get your NEMT business off the ground and sustaining it during the initial stages.

The following are places where you can look for financial support. Explore funding options such as small business loans, seeking angel investors or even crowd-funding platforms.

Here’s a comprehensive list of some of your options in Missouri:

1 | Small Business Loans

The SBA offers various loan programs for small businesses, including the 7(a) loan program, which provides financial assistance for businesses with special requirements.SBA Loans. Missouri Small Business Development Centers (SBDC). The SBDC provides guidance on funding opportunities and can help you prepare business plans and loan applications.

2 | Financial incentives

Missouri Department of Economic Development (DED) offers several programs and resources for new businesses, including financial assistance and incentives.

3 | Grants

While direct grants for starting a business are rare, there are grants available for specific purposes like technological innovation, rural development — and if you’re an NEMT servicing Missouri rural residents, you might just have a chance at a grant! — and more. Grants.gov is a comprehensive resource for finding federal grants.You’re over half way there in this comprehensive series! In order to move onto Part 5 on how to flesh out your NEMT fleet, click here or skip ahead to the other sections in the series by visiting the series’ table of contents here.

Part 5: A Several Part “Bambi Knows Best” State-By-State Series Part 5

Select your vehicles: Invest in comfortable and accessible vehicles that cater to your chosen patient population. Consider features like wheelchair ramps or lifts, ensuring compliance with Americans with Disabilities Act (ADA) regulations.

Pick your supporting equipment: There is a variety of equipment you can purchase to accompany your fleet, such as ramps, lifts and first-aid kits. Conduct local research to find the best brands that support your sustainability efforts. Supporting Missouri businesses can also be more efficient and environmentally friendly.

Maintain regular vehicle checks: Develop a comprehensive maintenance plan to guarantee your fleet is safe for everyone and the planet!

So close! Now to move onto Part 6 on hiring and training up your dream team, click here or skip ahead to the other sections in the series by visiting the series’ table of contents here.

Part 6: A Several Part “Bambi Knows Best” State-By-State Series Part 6

Part 7: A Several Part “Bambi Knows Best” State-By-State Series Part 7