Your NEMT Business Doesn't Start When the Broker Says Yes
The biggest mistake I see new NEMT providers make—and how to build your business while everyone else is waiting.
Table of Contents
By Rachel Scholler
Founder, NEMT Growth Consultants
www.nemtgc.com
A few weeks ago, I spoke with someone who was excited to launch his NEMT business. He had already invested in a wheelchair-accessible van, formed his company, and started working through the licensing and credentialing process.
Then he told me something I hear almost every week.
“I’m just waiting for the broker.”
The problem?
At the time, Wisconsin had a moratorium on onboarding new providers in his area. There was no timeline for when that might change, meaning his entire business plan depended on something completely outside of his control.
I asked him one simple question.
“What are you going to do while you’re waiting?”
He didn’t have an answer.
Unfortunately, that conversation isn’t unique.
I have versions of it every week. Some people are waiting for MTM. Others are waiting for Modivcare, Verida, or another transportation broker. The company changes, but the mindset is always the same.
Somewhere along the way, aspiring NEMT owners started believing their business couldn’t begin until a broker approved them. But the reality is that starting an NEMT business involves much more than waiting for a broker to say yes.
I see it differently.
Not because broker contracts aren’t valuable—they absolutely are. Many successful NEMT companies rely on them, and I encourage every startup to begin the credentialing process as early as possible.
But I believe too many people confuse broker approval with building a business.
Those are two very different things.
The Most Expensive Word in Business
The most expensive word I hear during consulting calls isn’t insurance.
It isn’t vehicles.
It isn’t even Medicaid.
It’s the word waiting.
Waiting for approval.
Waiting to hire.
Waiting to market.
Waiting until everything feels perfect.
Here’s what happens while you’re waiting.
Your insurance premium still arrives every month.
Your vehicle payment still arrives every month.
Your business expenses don’t pause.
And perhaps most importantly, your momentum disappears.
Momentum is one of the most valuable assets a new business has. Once it’s gone, it’s surprisingly difficult to rebuild.
That’s why I encourage nearly every startup client to think differently.
Instead of asking,
“How quickly can I get a broker contract?”
I want them asking,
“How quickly can I start building relationships and generating revenue in my community?”
That one shift in thinking changes everything.
Because businesses don’t fail from having too many customers.
They fail when they run out of cash.
Cash flow gives your business options. Waiting takes those options away. That’s why building strong business systems early can help you create momentum and keep moving forward, even while other parts of your business are still taking shape.
My Philosophy Is Different
If you’ve spent any time in NEMT Facebook groups or talking with other providers, you’ve probably heard the same advice.
“Get credentialed.”
“Apply to every broker.”
“Wait for approval.”
None of that advice is wrong.
In fact, I encourage every startup to begin the credentialing process as early as possible because it can take months.
Where I disagree is what happens during those months.
Too many business owners put everything else on hold.
They wait to market.
They wait to build relationships.
They wait to generate revenue.
They wait to start acting like a business.
I don’t believe that’s the best path.
I believe credentialing should happen in the background while you’re actively building your business in the foreground.
Those two things should happen simultaneously.
That’s the philosophy I teach every startup client.
Build while you wait.
It isn’t a complicated strategy.
It’s a mindset.
While your applications are moving through someone else’s process, you should be building the things no broker can give you.
- Cash flow.
- Relationships.
- Experience.
- Confidence.
- A reputation in your community.
When you focus on those five things, something interesting happens.
The broker contract becomes an opportunity to grow your business—not permission to start one.
That means building a business for the future, so you have a strong foundation in place before new opportunities arrive.
A broker contract should accelerate your business—not start it.
That one shift in thinking changes everything.
Why I Encourage Private Pay First
Whenever I tell someone to pursue private-pay transportation while they’re waiting for broker approval, I sometimes get pushback.
People assume I’m telling them not to work with brokers.
I’m not.
Broker contracts can become an important part of a successful transportation company, and I encourage providers to pursue them. At the same time, understanding how Medicaid transportation works can help you prepare for the opportunities and requirements that come with serving broker-managed clients.
I simply don’t think they should be the first revenue your business ever earns.
Here’s why.
1. Cash Flow Keeps Businesses Alive
Every business needs revenue.
The sooner you begin bringing money into your company, the sooner you stop relying entirely on savings while waiting for someone else’s timeline.
Cash flow creates options.
It allows you to invest in marketing, improve your operations, and make decisions from a position of strength instead of desperation.
Taking advantage of available small business resources can also help you make smarter decisions as you build your company and manage those early expenses.
I’ve seen too many new business owners spend months waiting for approval while their expenses continue to pile up.
It doesn’t have to be that way.
2. Relationships Become Your Best Marketing
Every private-pay client introduces you to someone new.
A family member.
A discharge planner.
A social worker.
A case manager.
An assisted living community.
A rehabilitation facility.
Those relationships often become your strongest source of future referrals because they’re built on trust, not contracts.
When people know you, trust you, and have confidence in your service, they remember your name when transportation needs arise.
You simply can’t build those relationships sitting at home waiting for an email.
3. Experience Builds Better Businesses
Every trip teaches you something.
How to communicate with clients.
How to schedule efficiently.
How to solve problems.
How to handle unexpected situations.
How to deliver exceptional customer service.
Those lessons are much easier to learn while completing a handful of trips than after a broker suddenly starts sending you dozens every week.
Private-pay transportation gives you the opportunity to refine your systems before your business begins to scale.
4. Confidence Changes Everything
The first time someone chooses your company—and pays you for your service—you stop feeling like someone who’s waiting for permission.
You start thinking like a business owner.
That confidence changes how you answer the phone.
How you market your company.
How you network.
How you introduce yourself.
Most importantly, it changes how you make decisions.
You’re no longer waiting for your business to begin.
You’re already building it.
Build Relationships Before You Need Them
One of the biggest advantages of building your business before broker approval is that you have something many established companies don’t.
Time.
Most new providers spend that time refreshing their email, hoping to see an approval notice.
I think there’s a much better use for it.
Introduce yourself to hospitals.
Visit assisted living communities.
Meet with rehabilitation facilities.
Talk to dialysis centers.
Connect with senior living communities.
Keeping an eye on trends in the aging population can also help you identify communities where the need for reliable transportation services may continue to grow.
Get to know discharge planners, case managers, and social workers.
Will every conversation lead to business?
Of course not.
Relationships rarely work that way.
But every introduction plants a seed.
Some opportunities develop next week.
Others take months.
Either way, you’re building a network that didn’t exist before.
One of the biggest lessons I learned while building Lakeshore Transportation was that people don’t refer companies they don’t know.
They refer companies they trust.
That trust wasn’t built through advertising alone.
It was built by consistently answering the phone, showing up when we said we would, communicating well, and treating every client with respect.
Long before people remembered our company name, they remembered our reputation.
That’s exactly what you’re building while everyone else is waiting.
Marketing isn’t about asking people for rides.
It’s about making sure the right people know who you are before they need you.
You’re Building More Than Revenue
Most people think private-pay transportation is simply a way to generate income while waiting for broker approval.
It certainly does that.
But I believe its greatest value is something much bigger.
It teaches you how to run a business.
When a broker assigns you a trip, much of the sales process has already happened.
When you’re building a private-pay business, you’re responsible for everything.
You answer the phone.
You explain your services.
You earn someone’s trust.
You quote your pricing.
You solve problems.
You follow up.
Those aren’t transportation skills.
They’re business skills.
And those skills stay with you no matter how your payer mix changes in the future.
Every private-pay customer teaches you something that makes you a stronger operator.
That’s why I don’t think of private pay as a temporary strategy.
I think of it as training for the business you’re ultimately trying to build.
The Difference Between Waiting and Building
Imagine two companies that submit their broker applications on the same day.
The first company decides to wait.
Eight months later, the approval finally arrives.
Now they’re learning dispatch.
Scheduling.
Customer service.
Billing.
Driver management.
Everything is new.
The second company spends those same eight months building relationships, serving private-pay clients, refining systems, and learning from real experience.
When the broker approval arrives, they’re not wondering how to run an NEMT company.
They’re already running one.
The broker didn’t create their business.
It expanded it.
That’s a completely different position to be in.
And it’s exactly why I encourage providers to think beyond the next approval email.
Ready to Build Your NEMT Business?
Starting an NEMT company can feel overwhelming, especially when you’re trying to navigate licensing, insurance, broker credentialing, and marketing all at once.
The good news is you don’t have to figure it out alone.
After building and successfully selling my own NEMT company, I now help providers across the country avoid costly mistakes, build profitable businesses, and create systems that support long-term growth.
Whether you’re just getting started or looking to improve an existing operation, I’d love to help.
👉 Schedule a one-on-one consultation to discuss your goals and build a plan that’s right for your market.
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