Ohio is one of the most attractive states in the country to start and grow a non-emergency medical transportation (NEMT) business because of its large and aging population, strong private pay market, Medicaid support, and moderate entry requirements. As the seventh most populous state with nearly 12 million residents, Ohio also has a higher-than-average senior population, with nearly one in five residents over the age of 65. This demographic creates sustained demand for transportation to essential recurring medical services such as dialysis, chemotherapy, and rehabilitation, making the state a reliable market for NEMT providers.

Ohio has a big, aging customer base and dense care infrastructure that constantly generates discharge and recurring demand. The state licenses roughly 720 assisted-living/residential care facilities, 930 - 960 nursing homes, 326 free-standing dialysis clinics, and 300 plus hospitals - all of which create daily private-pay needs.

Ohio generally aligns with national private-pay ranges and beat Medicaid by a wide margin. Competition from ADA paratransit exists, but it’s only for eligible riders and typically requires advance scheduling, limited windows, and no bedside-to-bedside assistance, so hospitals and families still turn to private NEMT for speed and higher-touch help, especially for discharges and special-needs transports.

Another advantage is Ohio’s robust Medicaid program, which is one of the largest in the nation and includes non-emergency medical transportation as a covered benefit. The state partners with national and regional brokers such as ModivCare, MTM, and MyCare Ohio to manage rides for Medicaid members. In addition, Ohio offers multiple waiver programs, including PASSPORT and developmental disability waivers, that fund transportation for seniors and disabled individuals. This ensures that providers have multiple revenue channels, ranging from Medicaid-covered rides to specialized waiver-funded trips.

Ohio’s central location and healthcare infrastructure further increase its attractiveness. The state has several major metro areas including Cleveland, Columbus, Cincinnati, Dayton, and Toledo. Each anchored by large hospital systems like Cleveland Clinic, OhioHealth, and University Hospitals. These medical hubs consistently generate high trip volume and create opportunities for providers to partner with hospitals, nursing homes, and rehabilitation centers. Rural communities also offer opportunities, as they are often underserved and require longer-distance trips to healthcare facilities.

Unlike some states with heavy regulations, Ohio does not require a state-level certificate of authority specifically for NEMT businesses. Instead, the focus is on meeting Medicaid broker requirements, carrying appropriate levels of commercial auto insurance, ensuring ADA compliance for wheelchair vehicles, and conducting driver background checks and training. This lighter regulatory environment makes it faster and less costly to launch operations.

Ohio’s business climate is favorable because of its relatively low cost of living, affordable insurance and vehicle expenses compared to coastal states, and an available workforce with healthcare and transportation backgrounds. These factors, combined with a growing senior population and consistent medical demand, make Ohio a strong environment for both urban and rural NEMT operations. In short, Ohio offers the right mix of demand, funding, infrastructure, and accessibility to support entrepreneurs looking to build and scale a sustainable NEMT business.

Hospitals, emergency departments, and post-acute care facilities in Ohio face persistent challenges in arranging prompt and reliable assisted discharge transportation for patients. These problems stem from both structural issues in the healthcare system and gaps within the transportation industry.

One of the primary issues is delayed patient discharges due to lack of timely transportation. Hospitals often identify patients who are medically cleared to go home or transfer to another facility, but discharges can be delayed for hours—sometimes even overnight—because a wheelchair van, stretcher transport, or ambulatory ride is unavailable. These delays create bed bottlenecks, particularly in emergency rooms, where admitted patients remain boarded in the ER due to inpatient beds being occupied by patients awaiting discharge transport. This directly affects hospital throughput, length of stay, and overall patient flow.

Another challenge is the unreliability and fragmentation of existing transport providers. Many facilities in Ohio contract with brokers or rely on a limited pool of local NEMT providers, but these companies may be understaffed, overbooked, or unable to provide specialized equipment such as bariatric stretchers or vehicles with wheelchair lifts. Missed pickups, extended wait times, or last-minute cancellations frustrate both patients and staff, while also straining relationships between facilities and transportation companies.

Complex patient needs add another layer of difficulty. Many discharges require more than just a ride; patients may need assistance getting from bed to chair, wheelchair-to-vehicle transfers, or stretcher support. Some also require monitoring during transport, oxygen handling, or specialized safety measures. When facilities cannot find providers who can meet these requirements, staff may resort to calling emergency ambulances for non-emergency situations, which is costly and inappropriate for the level of care needed.

Cost and insurance coverage are also significant problems. While Medicaid does provide for non-emergency transportation in Ohio, coverage does not always align with hospital discharge needs. Private pay patients or those in managed care plans may face gaps in coverage, leaving facilities scrambling to find affordable options that patients or families can accept. Hospitals often end up absorbing the cost when patients cannot pay, creating financial strain on already stretched discharge departments.

Finally, there is a communication and coordination gap between healthcare facilities and transportation providers. Discharge planners and case managers frequently struggle with outdated scheduling systems, long hold times with brokers, and lack of real-time tracking to know when transport will arrive. Without reliable communication, staff cannot effectively manage discharges, families are left in the dark, and patients experience unnecessary stress.

Ohio currently has between 930 and 960 active nursing facilities, depending on the source. The Ohio Department of Health reports that the state licenses and certifies about 960 facilities, while the Ohio Department of Aging’s Care Navigator tool lists closer to 930 active nursing homes. A comprehensive 2021 study from the Scripps Gerontology Center placed the number at 959 facilities, which is consistent with the official state figures.

Collectively, these nursing facilities represent a significant share of Ohio’s long-term care infrastructure, with roughly 87,300 certified beds across the state. Ownership is predominantly private, with about 79% of facilities operated by for-profit organizations, 19% managed by non-profits, and around 2% run by public entities such as counties. A notable portion—about 16%—are part of Continuing Care Retirement Communities (CCRCs), while nearly two-thirds (63.9%) belong to multi-facility chains.

Geographically, Ohio’s nursing facilities are concentrated in urban areas, with roughly 72% located in metropolitan regions that tend to have higher population density and healthcare demand. Many facilities also specialize in serving residents with specific needs: approximately one-third (34%) offer dedicated memory care services or units. This combination of widespread distribution, large capacity, and diversified ownership underscores the important role that nursing facilities play in Ohio’s healthcare landscape.

Ohio is home to more than 320 hospitals, most of which are part of larger integrated delivery networks (IDNs) or health systems such as Bon Secours Mercy Health, Cleveland Clinic Health System, University Hospitals Health System, OhioHealth, and ProMedica (Axios, Definitive Healthcare). These systems streamline operations across multiple facilities—Bon Secours Mercy Health, for instance, has 41 affiliated hospitals while Cleveland Clinic Health System has 26 (Definitive Healthcare).

Within these networks, OhioHealth operates 16 hospitals, along with over 300 clinical and outpatient locations serving 55 counties (Wikipedia). Kettering Health, another significant network based in southwestern Ohio, manages nine hospitals throughout the region (Wikipedia).

Ohio currently has 326 freestanding dialysis clinics operating across the state. These facilities are all licensed by the Ohio Department of Health and certified by the Centers for Medicare & Medicaid Services (CMS) to serve residents with end-stage renal disease (ESRD) (ohiorenalassociation.org).

This number reflects outpatient dialysis centers specifically (those not embedded within hospitals). While hospital-affiliated dialysis units also exist, the 326 figure is significant since it covers the expansive network of community-based clinics where most Ohioans receive routine in-center dialysis treatments from week to week.