How to Start an NEMT Business in Oregon: A "Bambi Knows Best" State-By-State Series

Part 1: Research the Oregon NEMT Market

Before you set sail on your NEMT adventure in Oregon, it’s crucial to dig into the market and understand the state's unique healthcare and transportation needs. From Portland’s eclectically “weird” vibes to the serene beauty of the Willamette Valley and the rugged coastline, Oregon’s diverse landscape demands a tailored approach to NEMT services. Here’s how to get started:

1 | Identify Existing NEMT Providers in Oregon

Understand the current NEMT landscape in Oregon to spot opportunities and manage competition. For instance, it’s important to know that the Oregon Health Authority (OHA) oversees Medicaid-funded NEMT services, ensuring compliance with provider regulations. Key NEMT provider players in the state include:

• Ride Care: A major NEMT provider offering services across the state.
• Trillium Community Health Plan: Coordinates transportation services in various Oregon regions.
• Local Transit Systems: Many regions have their own transit systems providing NEMT services, including TriMet in Portland and Lane Transit District in Eugene.
• Uber Health: Operates statewide with a HIPAA-compliant platform for scheduling and tracking rides.

Check local directories and online resources to find additional providers in cities like Salem, Bend or Medford.

2 | Assess the Demand for NEMT Services

Evaluate demand by focusing on key healthcare facilities and community needs across Oregon:

• Adult Day Care Centers: There are approximately 150 to 200 centers providing support for the elderly and disabled. Consult the Oregon Department of Human Services for updated information.
• Dialysis Clinics: There are numerous clinics statewide, including those operated by major providers like DaVita and Fresenius. 
• Physical Therapy Centers: Numerous PT facilities are available throughout Oregon. The Oregon Physical Therapy Association can provide current details.
• Hospitals: There are around 60 to 70 hospitals, including major ones like Oregon Health & Science University and Legacy Emanuel Medical Center.
• Nursing Homes and Assisted Living: There are approximately 150 licensed nursing homes. Be sure to check with the Oregon Department of Human Services for the latest data on this front.
• Outpatient Care Centers: These centers are key for Oregon’s healthcare network. Contact local providers and hospitals for information on NEMT needs.

3 | Decide on a Target Market

Identify your target demographic based on the demand from various healthcare facilities. Whether focusing on seniors, individuals with disabilities or a broader patient base, tailor your services to meet these needs and enhance your marketing efforts.

4 | Choose Specific NEMT Services

Determine which NEMT services are in high demand in Oregon. Specializing in areas such as senior transportation, medical appointments or specialized care facilities will help you address local needs and carve out your niche in the market.

5 | Understand Medicaid Delivery Models in Oregon 

Oregon’s Medicaid program, known as the Oregon Health Plan (OHP), utilizes Coordinated Care Organizations (CCOs) to deliver most healthcare services, including NEMT. The Oregon Health Authority (OHA) oversees Medicaid and works with CCOs to manage NEMT services.

Key aspects include:

• NEMT Model: Coordinated Care Organizations (CCOs) manage Medicaid services, including transportation.
• Operating Authority: Federal Section 1115 Demonstration Waiver
• NEMT Expense Classification: Medical Expense
• Poverty Rate: Approximately 15% live below the poverty line
• Urban Population: About 62% live in urban areas.
• Estimated Annual NEMT Expense: $40.5 million
• Estimated Number of Annual NEMT Trips: 1.5 million
• Public Transportation: 22% of trips provided by public transit

6 | Getting Paid

Oregon Medicaid compensates transportation providers primarily through CCOs. Here’s how payment methods generally work:

• Coordinated Care Organizations (CCOs): Providers contract with CCOs for coordination and payment of NEMT services.
• Fee-for-Service (FFS): In some cases, providers may submit claims directly to Medicaid for reimbursement.

Ensure compliance with Medicaid billing guidelines when submitting claims. For specific details, consult the Oregon Health Authority or the designated CCOs.

Prepare to navigate Oregon’s NEMT landscape with insight and precision. Stay tuned for Part 2, where we’ll guide you through developing a business plan tailored to Oregon’s unique regulations and market conditions. Continue with us or jump ahead in the TOC to explore more in our series to pave your path to success!