Illinois is an attractive state to start a non-emergency medical transportation (NEMT) company due to its large and aging population, supportive Medicaid infrastructure, and dense network of healthcare facilities. As the sixth most populous state with approximately 12.7 million residents, Illinois has a growing senior population, currently over 16% of its residents are age 65 and older, a figure expected to rise significantly by 2030. This aging demographic fuels a steady demand for transportation to and from medical appointments, dialysis centers, physical therapy clinics, and outpatient procedures.
Illinois is also a Medicaid expansion state, meaning a significant portion of its population qualifies for Medicaid-funded NEMT services. The state uses managed care organizations (MCOs) and brokers like MTM and ModivCare to coordinate rides for Medicaid recipients, creating an opportunity for NEMT providers to receive consistent trip volume through these partnerships. In addition to Medicaid, there is a growing market of seniors and disabled individuals who either have private insurance or pay out-of-pocket, opening the door for higher-margin private pay and contracted facility transportation.
The state's urban and suburban layout further supports efficient NEMT operations. Major cities like Chicago, Rockford, Aurora, and Peoria are densely populated, enabling providers to maximize trip density and minimize fuel costs. Cook County, home to Chicago, has one of the highest concentrations of hospitals and outpatient care centers in the Midwest, including prestigious institutions like Northwestern Memorial, University of Chicago Medical Center, and Rush University Medical Center. Across Illinois, there are more than 200 hospitals, over 1,200 nursing homes and skilled nursing facilities, and hundreds of dialysis centers, all of which regularly require reliable discharge and recurring transportation services.
From a regulatory standpoint, Illinois is relatively business-friendly for NEMT startups. The state does not impose complex licensing requirements for wheelchair and ambulatory transport providers beyond local registration, commercial insurance, and ADA-compliant vehicle standards. Stretcher transport services may require additional licensing or oversight depending on the city or county but typically do not require EMS-level certification unless advanced medical care is provided during transport.
There is a consistent need for high-quality NEMT providers across Illinois. Many hospitals and care facilities report ongoing issues with unreliable or delayed transportation services. New providers who offer prompt, courteous, and professional service, especially those who implement modern dispatching systems, maintain clean and comfortable vehicles, and offer specialized services like stretcher or bariatric transport, can quickly differentiate themselves and secure long-term contracts. Overall, Illinois offers the right combination of demographic demand, healthcare infrastructure, and manageable regulation to support a scalable and profitable NEMT business.
While Medicaid brokers like ModivCare and MTM play a central role in coordinating transportation for Medicaid recipients, relying solely on these brokers is often not sufficient for building a sustainable and profitable non-emergency medical transportation (NEMT) business. Many providers quickly realize that brokered trips can be low-paying, inconsistent, and heavily regulated, often leaving little room for profit after accounting for driver wages, fuel, insurance, and vehicle maintenance. Furthermore, reimbursement delays and limited control over trip assignments can strain cash flow and limit a provider's ability to grow.
To build a truly successful NEMT operation in Illinois, providers must prioritize establishing direct pay contracts and service agreements with local hospitals, nursing homes, rehabilitation centers, dialysis clinics, and assisted living facilities. Using Joel's strategies for presenting and negotiating your rates, these direct relationships allow NEMT companies to negotiate higher, predictable rates and maintain control over their schedules, routing, and service standards.
Facilities benefit from having a dependable transportation partner they can call upon for discharges, recurring treatments, or last-minute appointments, rather than relying on overloaded broker networks that often result in delayed pickups or missed appointments. This reliability enhances the reputation of the facility and improves patient satisfaction, creating a strong incentive for administrators to work directly with trusted NEMT providers.
Direct contracts also open the door to private-pay opportunities, particularly for patients who do not qualify for Medicaid or who require stretcher or bariatric transport, which many brokers do not cover or reimburse adequately. In these cases, having a contractual relationship with the facility allows for streamlined billing, scheduled services, and better coordination of care. This is especially important in Illinois, where urban congestion and discharge delays can create operational bottlenecks for hospitals and skilled nursing centers, delays that NEMT providers with priority agreements can help resolve.
Hospitals, emergency rooms, and nursing facilities across Illinois face a growing and urgent need for reliable wheelchair transportation services, particularly when it comes to discharge planning. A significant percentage of patients ready for discharge are not medically eligible for ambulance transport, yet they are also not physically able to safely ride in a standard vehicle due to limited mobility, recent surgeries, or chronic conditions. These patients typically require wheelchair-accessible transportation to return home, go to rehabilitation centers, or attend follow-up appointments. Without timely and appropriate transport options, facilities are often forced to delay discharges, which leads to bed shortages, increased operational costs, and disruption to patient flow, especially in busy urban centers like Chicago.
It's estimated that a large portion of discharges requiring transportation fall into the wheelchair-accessible category, far more than those requiring stretcher or ambulance-level service. This is especially true among the elderly population, individuals recovering from orthopedic surgeries, or those with neurological or mobility-limiting conditions. Many of these individuals are not covered by Medicaid, either because they have Medicare only, private insurance that doesn't cover transportation, or because they fall into a financial gray area where they must pay out of pocket for these services. Hospitals and skilled nursing facilities are increasingly challenged with finding dependable transportation vendors willing to accommodate these private-pay patients quickly and affordably.
The lack of reliable wheelchair transportation options can result in delayed discharges, prolonged patient stays, and increased risk of hospital readmissions, all of which can negatively affect a facility's operational efficiency and bottom line. To address this gap, many healthcare facilities in Illinois are seeking partnerships with NEMT providers who can offer consistent, professional wheelchair transport services on both a scheduled and on-demand basis. Providers that are equipped to handle private-pay clients in addition to Medicaid passengers, and who can respond reliably during peak discharge hours, are in a strong position to secure facility contracts and become preferred vendors.
Operating a non-emergency medical transportation (NEMT) business in Illinois can be rewarding and doesn't have overly burdensome statewide NEMT licensing for basic wheelchair and ambulatory transport, it does comes with a unique set of challenges. Having to negotiate higher rates of reimbursement with Medicaid brokes such as ModivCare and MTM can be difficult for new and inexperienced providers.
Another challenge is urban congestion and geographic coverage. In densely populated areas like Chicago and Cook County, traffic congestion, limited parking, and unpredictable travel times make routing and on-time performance difficult. Meanwhile, rural and downstate areas may offer less competition but present logistical issues due to long distances between patient pickup and drop-off locations. This can create inefficiencies and increases operational costs, particularly if reimbursements don't account for mileage or wait times adequately.
There is a competitive landscape in major metro areas which can make it hard for new or undercapitalized providers to gain a foothold. Many facilities already have preferred vendor relationships, and standing out requires a high level of professionalism and marketing effort.
Illinois Facts & Figures
Illinois is home to approximately 1,200 licensed nursing homes, serving over 100,000 residents across the state. These facilities are regulated and inspected by the Illinois Department of Public Health (IDPH), which ensures compliance with safety and care standards. Of these, around 738 nursing homes participate in the Medicaid program, serving roughly 55,000 Medicaid-supported residents in long-term care settings, according to data from the Centers for Medicare & Medicaid Services (CMS) and the Illinois Department of Healthcare and Family Services.
This extensive network of nursing homes presents a significant opportunity for non-emergency medical transportation (NEMT) providers. While Medicaid-funded trips provide a steady volume of transportation requests, they often come with low reimbursement rates and strict scheduling limitations imposed by state-contracted brokers like ModivCare and MTM. As a result, relying solely on brokered Medicaid trips may not be sufficient for long-term business success.
The broader landscape includes hundreds of nursing facilities that care for Medicare-only, privately insured, or private-pay residents who are not eligible for Medicaid. These residents still require wheelchair-accessible transportation for discharges, medical appointments, and ongoing therapies. For NEMT providers, this gap creates a valuable opportunity to establish direct contracts and private-pay agreements with nursing homes. These arrangements not only allow providers to set their own pricing and scheduling terms but also offer higher profit margins and greater operational control compared to brokered trips.
Illinois is home to a substantial healthcare network, with approximately 238 hospitals located across the state, according to Definitive Healthcare's January 2025 data(Definitive Healthcare). These facilities span urban, suburban, and rural regions, providing broad geographical coverage and a wide variety of services, from large academic medical centers to small community hospitals.
This network is supported within larger health systems: there are roughly 62 community hospital systems operating across Illinois, collectively employing nearly 140,000 staff and generating over $21 billion in revenue(Cause IQ). Those 238 hospitals serve millions of residents and help form a vital ecosystem for primary care, emergency services, specialist clinics, and long-term care coordination.
For non-emergency medical transportation (NEMT) providers, this density of hospitals, combined with the high volume of discharges, follow-up visits, and post-acute care transitions, translates into significant demand for reliable transport services. Hospitals frequently require wheelchair-accessible transportation for discharged patients who aren't appropriate for ambulance services but need safe, assisted travel, many of whom are not Medicaid recipients. Establishing direct contracts and service agreements with these hospitals can unlock private-pay opportunities and more profitable, dependable revenue streams compared to relying solely on Medicaid brokered rides.
Illinois is home to approximately 400 to 450 outpatient dialysis centers, according to the most recent data from the Centers for Medicare & Medicaid Services (CMS). These facilities are spread across the state and serve tens of thousands of patients who require life-sustaining dialysis treatment multiple times each week. The majority of these centers are operated by large national providers such as DaVita and Fresenius Medical Care, both of which maintain a strong presence in Illinois as part of their extensive nationwide networks.
For non-emergency medical transportation (NEMT) providers, the density and consistency of dialysis appointments present a valuable business opportunity. Most dialysis patients require treatment three times per week, often early in the morning or late in the afternoon. Many of these individuals are wheelchair-bound or have limited mobility due to chronic illness, making them dependent on specialized transportation services to travel safely and comfortably. While a portion of these patients are Medicaid recipients, a significant number are covered by Medicare or private insurance, and therefore fall outside the Medicaid broker system. These patients often pay privately or through direct arrangements with dialysis providers, creating the potential for higher-margin, recurring trips.