New York is a compelling state to start a non-emergency medical transportation (NEMT) business due to its dense population, large senior demographic, high Medicaid enrollment, and vast healthcare infrastructure. As the fourth most populous state in the U.S., New York is home to nearly 20 million residents, including over 3.4 million individuals aged 65 and older. This aging population often requires reliable transportation to access essential healthcare services such as dialysis, physical therapy, chemotherapy, and routine doctor visits - needs that are central to the NEMT industry.
Medicaid enrollment in New York is among the highest in the nation, with more than 7 million residents, over 35% of the state's population, covered under the program.This creates consistent reimbursement opportunity for NEMT providers under a centralized brokerage model currently managed by Medical Answering Services (MAS). Through this system, eligible patients are authorized for transportation to medical appointments, providing a predictable and steady stream of ride volume for Medicaid-compliant NEMT operators.
The rates paid by MAS for Medicaid-funded non-emergency medical transportation are significantly lower than those available through private pay and direct facility contracts. While MAS provides a steady flow of reimbursable trips, the profit margins are often thin due to low per-mile and per-leg rates, coupled with strict documentation and scheduling requirements. As a result, it behooves NEMT providers to adopt strategic approaches taught by Joel for cultivating private pay clientele and securing direct contracts with hospitals, nursing homes, dialysis centers, and managed care organizations. These relationships typically offer higher reimbursement rates, faster payments, and greater control over scheduling and service terms, ultimately allowing providers to scale more profitably and build a more financially sustainable business.
Geographically, New York offers a unique mix of urban, suburban, and rural markets. Major metropolitan areas such as New York City, Buffalo, Rochester, and Syracuse have dense populations and complex transit systems that are often inaccessible or impractical for elderly or disabled individuals. In these cities, reliable NEMT services are crucial. In contrast, upstate and rural areas often lack robust public transportation, increasing the reliance on NEMT companies to fill the transportation gap for medical appointments.
While New York operates a centralized Medicaid brokerage model through MAS, the realities of doing business in these two areas, upstate versus downstate, vary significantly due to the differences geographically, population density, operating costs, and market dynamics.
Downstate New York, which includes New York City's five boroughs, Long Island, and Westchester County, is densely populated and home to a high concentration of hospitals, dialysis centers, nursing homes, and specialist clinics. This creates a high volume of trip requests within a relatively small geographic area, allowing providers to complete more trips per day per vehicle. Additionally, the presence of private-pay clients, managed care organizations, and VA medical centers offers a more diverse payer mix.
Stretcher transportation is in particularly high demand due to the high volume of hospital discharges and emergency room discharge needs. However, operating downstate comes with its own set of challenges. Traffic congestion, parking limitations, tolls, and elevated insurance premiums contribute to significantly higher operating costs.
In contrast, upstate New York, which encompasses cities like Albany, Syracuse, Rochester, and Buffalo as well as numerous rural counties, offers a different kind of opportunity. Operating costs are generally lower - insurance premiums, wages, and fuel expenses are less burdensome. There is often a noticeable shortage of transportation providers upstate, especially in rural communities. This lack of competition can make it easier to form strong relationships with hospitals, nursing homes, and local care coordinators, leading to repeat business and contract opportunities. However, the lower population density can mean fewer ride requests in close proximity leading to distance trips, higher fuel usage, and potential deadhead miles.
Upstate offers more accessible entry points and lower costs, but scaling profitably requires strategic territory management and strong community relationships. Successful NEMT operators in New York understand these differences and structure their operations accordingly, sometimes even maintaining distinct fleets or dispatch protocols for each region to maximize efficiency and profitability.
New York offers significant support for business development, particularly for minority- and women-owned businesses (MWBEs). Certification programs and local procurement initiatives provide access to grants, state contracts, and preferred vendor opportunities, creating a strategic advantage for NEMT providers who qualify under these programs.
In addition, year-round demand ensures that medical transportation remains a stable industry regardless of season. Chronic treatment schedules, such as dialysis or chemotherapy, continue through holidays and winter months, and harsh weather conditions in regions like upstate New York can increase the demand for safe and reliable transportation services.
Operating in New York does come with its challenges. Insurance premiums, especially downstate in New York City, tend to be high. Vehicle inspections, licensing, and compliance requirements can be stringent, but for those providers who understand the landscape and build relationships directly with hospitals, clinics, and senior care facilities can position themselves for long-term profitability and community impact.
The ability for non-emergency medical transportation (NEMT) providers in New York State to perform stretcher transports presents a significant financial advantage compared to states that restrict NEMT services to only ambulatory and wheelchair transports. This expanded service capability opens up higher reimbursement rates, a broader client base, and a competitive edge in contract negotiations with hospitals and skilled nursing facilities.
Stretcher transports are typically reimbursed at a much higher rate than ambulatory or wheelchair trips due to the increased complexity, specialized equipment, and additional personnel required. While a standard wheelchair transport may reimburse $40-$80 per leg through Medicaid or private pay, a stretcher transport can yield $150-$300 per leg or more, depending on the region, payer, time of day, and trip distance. For providers operating in a high-volume area with frequent discharges, this translates into significantly higher revenue per trip.
Additionally, being authorized to perform stretcher transports allows a provider to serve a wider range of patients, particularly those being discharged from hospitals or skilled nursing facilities who are non-ambulatory but do not require emergency medical care. In many states, such patients must be transported by ambulance even if no clinical intervention is needed because NEMT regulations prohibit stretcher use. In contrast, New York providers can fill this non-emergency but essential transportation gap at a lower cost to the healthcare system while still earning higher returns than standard wheelchair trips.
From an operational standpoint, NEMT companies can become preferred partners with hospitals, nursing homes, and rehabilitation centers. Discharge planners and case managers often struggle to find reliable stretcher transportation that doesn't involve costly ambulance services. Providers who can meet this need with dependable stretcher transport quickly become indispensable, leading to repeat referrals, exclusive contracts, and increased market share.
Hospitals, emergency rooms, and skilled nursing facilities across New York face ongoing challenges in securing reliable wheelchair and stretcher discharge transportation, and the consequences of these gaps in service can be both operationallydisruptive and financially costly. One of the primary issues is the delay in patient discharges caused by a lack of dependable transportation. When a patient is medically cleared but cannot be transported home or to another facility due to unavailable or late NEMT services, it creates a bottleneck. In hospitals, this results in bed blocking, where an occupied bed is unavailable for incoming patients. This is especially problematic in emergency departments (EDs), which rely on the constant flow of admissions, discharges, and transfers to maintain throughput. When discharge is delayed, Emergency Departments become overcrowded, ambulance drop-offs are slowed, and incoming patients may face extended wait times or even diversion to other hospitals, all of which compromise patient care and institutional efficiency.
Skilled nursing facilities (SNFs) and rehabilitation centers face similar struggles. Timely transportation is often essential for transferring patients to specialty appointments, dialysis, or returning them home. Without reliable wheelchair and stretcher transportation, SNFs can lose Medicare or Medicaid reimbursement eligibility for certain services if patients miss critical appointments. Additionally, facilities often end up having to pay out-of-pocket for more expensive transportation options, such as ambulance services, when lower-cost NEMT solutions are not available.
Another costly consequence is the increased workload and stress on discharge planners and care coordinators. These professionals spend considerable time each day trying to secure transportation, calling multiple vendors, verifying insurance, and rescheduling appointments, which diverts them from higher-value patient care coordination tasks. When transportation providers no-show, arrive late, or lack the appropriate equipment, the entire discharge workflow is disrupted.
Moreover, frequent delays or inconsistent service can damage patient satisfaction scores, which are closely tied to hospital reimbursement in value-based care models. Patients who experience long waits for discharge or transport after treatment often report dissatisfaction, which affects performance metrics like HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems). Lower scores can lead to financial penalties and reputational harm.
In short, hospitals, emergency rooms, and skilled nursing facilities urgently need reliable, professional NEMT providers, especially those who can perform wheelchair and stretcher transports. These providers play a critical role in smoothing discharge processes, reducing operational inefficiencies, and protecting against financial losses caused by delays, rerouted patients, and missed revenue opportunities. NEMT businesses that can meet this demand with dependable service, prompt scheduling, and appropriate vehicles are not only providing a much-needed service-they're positioning themselves as essential partners in the healthcare ecosystem.
New York Fact & Figures:
New York State is currently home to approximately 600 to 604 licensed nursing homes. According to the New York State Department of Health, there are about 599 nursing homes statewide, though some advocates cite that figure as potentially conservative given recent bed losses and facility closures (Spectrum Local News). Another source confirms that there are 604 nursing homes licensed in the state, likely including facilities with varying levels of care and certification (New York State Health Profiles).
These long-term care facilities play a vital role in New York's healthcare continuum. Offering short-term rehabilitation, long-term care, and hospice services, nursing homes are distributed across urban and rural regions alike. Approximately 60% of these facilities are forprofit, with the remainder operated by nonprofits or municipal entities (timesunion.com).
Recent years have seen structural strain on the sector. Since 2019, over 5,600 nursing home beds have been lost due to closures and decertifications, reducing overall capacity and placing greater pressure on the remaining facilities to accommodate a growing elderly population (Spectrum Local News).
New York State currently operates approximately 260 to 270 acutecare hospitals, with some variation depending on the source and classification criteria. The American Hospital Directory lists 261 active hospitals in New York State as of 2022, including 210 facilities with staffed beds, totaling around 64,500 beds (Wikipedia). According to Definitive Healthcare, New York accounts for 266 hospitals, about 3.6% of all U.S. hospitals tracked in their data set (Definitive Healthcare).
These hospitals are a mix of community hospitals, specialty hospitals, psychiatric facilities, VA institutions, and large academic or teaching hospitals spanning the state from New York City to upstate regions (Wikipedia). Additionally, some New York-specific directories reference 219 general hospitals covered under the state's Healthcare Reform Act, though this figure may exclude VA and federal facilities (profiles.health.ny.gov).
New York State is home to approximately 330 Medicare-certified dialysis facilities, which serve patients across the continuum of care, including standalone centers and ones embedded within hospitals, nursing homes, and VA hospitals (IPRO ESRD Network). These facilities are overseen by IPRO ESRD Network 2, which as of early 2025 supported around 31,000 patients receiving dialysis within New York State (IPRO ESRD Network).
Historically, the number of such facilities was slightly higher; for example, in 2020 the IPRO ESRD annual report noted New York operated around 350 Medicare-certified dialysis centers alongside 14 transplant centers and a few VA facilities (IPRO ESRD Network). The slight decline to ~330 by 2025 likely reflects industry consolidation and operational changes over recent years. Together, these ~330 dialysis facilities play a critical role in supporting chronic kidney disease patients throughout New York State.