How to Start an NEMT Business in California: A Several Part “Bambi Knows Best” State-By-State Series Part 1: Research the California NEMT Market Welcome to California, where the opportunities for launching your NEMT business are as golden as the state itself. Before diving into the intricacies of setting up your venture, conducting thorough market research is paramount. This initial step will enable you to navigate California's expansive landscape and varied communities effectively, ensuring you identify underserved areas and avoid entering oversaturated markets.
1 | Identify existing NEMT providers in your area California has one of the largest Medicaid populations in the entire country, with over 14.2 million enrollees. To meet the non-medical needs of this population is support offered by Medicaid in California (Medi-Cal) . Within their managed care health plans are NEMT services. The Department of Health Care Services is another great place to look for information on NEMT providers across the state. Here are some of the NEMT brokers and/or providers offering NEMT services today:
Modivcare: One of the largest NEMT brokers in the United States, managing transportation services for Medicaid and Medicare recipients across multiple states, including California.MTM, Inc . : MTM provides NEMT services nationwide, including California, and works with government agencies, managed care organizations and healthcare providers to arrange transportation for patients.American Logistics Company (ALC) : Based in California, ALC offers a range of transportation solutions, including NEMT services. They partner with health plans, transit agencies and school districts.CareLinx : This company provides in-home care and transportation services, including NEMT. They operate throughout California, offering personalized care solutions.MedTrans : MedTrans is a regional provider specializing in NEMT services across California, focusing on safe and reliable transportation for medical appointments.USF Health : Although not exclusively an NEMT provider, the university hospital connects healthcare providers with transportation services, including NEMT, to improve patient access to care.Veyo : Veyo is now an MTM company — as they were recently acquired — but nothing has changed in terms of their quality service, and Veyo is still able to operate pseudo-independently. In fact, their Independent Driver Provider (IDP) tech is driving this VeyoRide initiative ! Uber Health : Provides non-emergency medical transportation services in San Diego, LA and other cities in California. They offer a HIPAA-enabled platform for healthcare providers to request and monitor patient rides.Your favorite search engine. Of course, one can always perform their own search with the keywords, “NEMT providers in California” or get more granular with your search by typing in specific municipalities (i.e. “NEMT companies in San Diego”). 2 | Assess the demand for NEMT services Embracing the golden opportunities for your NEMT business in the sunny California landscape starts by understanding the demand in your local area and deciding whether to serve multiple jurisdictions or focus within a specific radius. Dive into research on nearby hospitals, healthcare facilities, wellness centers and other health-focused establishments. Think outside the obvious and look beyond the usual methods to uncover unique opportunities that set your business apart.
Adult Day Care (ADC) Centers. California has a robust network of Adult Day Care centers to support its large and diverse senior population. For the latest statistics and information, refer to the California Department of Aging (CDA) or the California Department of Social Services (CDSS) . These agencies oversee and regulate adult day care centers and provide databases or lists of licensed facilities throughout the state.Dialysis Clinics. While specific data points are unavailable, California's vast and diverse population ensures numerous dialysis clinics are located across the state. Some of the largest clinics with a significant presence include Fresenius Medical Care , DaVita Kidney Care and U.S. Renal Care .Physical Therapy Centers. Due to diverse reporting methods and California's extensive healthcare network, obtaining an exact number of physical therapy centers can be challenging. For the most accurate information, we recommend consulting the California Department of Public Health (CDPH) records , professional associations such as the California Physical Therapy Association (CPTA) , or industry reports focusing on California healthcare facilities.Hospitals. California has approximately 416 hospitals. This includes both general acute care hospitals and specialized facilities. For the most accurate and up-to-date information, you can refer to the California Office of Statewide Health Planning and Development (OSHPD) , which maintains detailed records on the state's healthcare facilities.Rehabilitation centers. We don’t have an up-to-date number on these, but many hospitals partner with rehab centers so it’s always best to contact those 416!Nursing homes and assisted living facilities. California has many nursing homes and assisted living facilities to cater to its elderly population. There are approximately 1,230 nursing homes and over 7,000 assisted living facilities in the state. These facilities provide long-term care services, including skilled nursing care and assistance with daily living activities, for elderly residents who require ongoing medical and personal care. For the most up-to-date information, consult the California Department of Public Health (CDPH) or the Centers for Medicare & Medicaid Services (CMS) .Outpatient care centers. Similar to rehab facilities, California boasts numerous outpatient care centers statewide. For more details on these estimates, consider consulting your local county’s hospitals.3 | Decide on a target market Upon thoroughly researching the NEMT market opportunities to learn about the demand across the state, it’s time to identify the most viable demographic to target — whether seniors, individuals with disabilities or a broader patient population. Honing in on a targeted group allows you to tailor your services and marketing strategies ever more efficiently.
4 | Choose a specific NEMT service (or offer them all!) Dive into the California NEMT service wave by focusing on the one (or two) most in demand to effectively meet your community's needs. This strategic approach ensures a solid foundation and sets the stage for long-term success. Keep an eye on competitors and stand out by offering unique services or targeting underserved niches. Launch with a top-tier fleet designed for your specific area, whether transporting individuals to adult day cares, physical therapy centers or other vital destinations.
5 | Understand the different Medicaid delivery models In California, Medi-Cal oversees NEMT services, ensuring they're available when a Medicaid recipient's medical condition makes public or private transportation impractical. This policy means only those meeting specific criteria can access NEMT assistance. Public transportation is considered a typical option, which affects the program's size and reach. Medi-Cal assumes existing services can handle most Medicaid transport needs, impacting both fee-for-service and managed care enrollees across 30 counties. Health plans also adhere to these guidelines when authorizing medical transportation for Medicaid recipients. Here are some fast California facts according to the report State-by-State Profiles for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination :
NEMT Model is a blend of In-House Management and Managed Care Organization The Operating Authority is the 11902(a)(70) State Plan Amendment NEMT expense is classified as a mix between being a “Medical Expense” and an “Administrative Expense” 15% live below poverty (US Census 2015 5-Year Estimates) 90% live in Urbanized Areas (US Census 2010) $136.1 Million is the estimated annual NEMT 2013 expense (Source 2014 National NEMT Survey) 4,823,202 is the 2013 estimated number of annual NEMT trips 6 | Getting Paid In California, NEMT providers receive payment through several methods under the Medi-Cal (California's Medicaid program):
Fee-for-Service (FFS) : Providers submit claims directly to Medi-Cal for each NEMT service provided. Reimbursement rates are determined by Medi-Cal and vary based on the type of transportation service and other factors.Managed Care Organizations (MCOs) : California has a managed care model where MCOs are contracted by Medi-Cal to manage healthcare services, including transportation. NEMT providers contract with these MCOs to deliver services and receive payment according to negotiated terms and rates set by the MCOs.Brokers : Some MCOs or third-party brokers may coordinate NEMT services for Medi-Cal beneficiaries. Providers can contract with these brokers and receive reimbursement based on agreed-upon terms and rates.Providers in California must comply with Medi-Cal billing guidelines and procedures when submitting claims for reimbursement. For detailed information and specific requirements, providers should refer to the California Department of Health Care Services (DHCS), Medi-Cal Managed Care Division or their contracted MCO. By thoroughly researching the California NEMT market, you'll lay a solid foundation for launching and scaling (and surfing) up your business. Stay tuned for Part 2 , where we'll guide you through crafting a comprehensive business plan tailored to California's regulatory framework and market dynamics. Or want to go back to skip ahead via the series’ table of contents here.
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