Join our Newsletter and Stay in Touch with Industry Related News !

What is Home Care?

Is How to Build a Million Dollar Home Care Agency offered in ebook format?

What makes How to Build a Million Dollar Home Care Agency different from other Home Care “How to” resources?

How long does it take to start a home care agency?

How much does it cost to start a Home Care Agency?

If I already own and operate a medical transportation business, why would I want to start a home care agency?

Where do I find caregivers?

What is the difference between How to Build a Million Dollar Medical Transportation Company and other NEMT resources being sold on the internet?

Understanding the Medical Transportation Opportunity

How Medicaid and Brokers Influence Your Ability to Start Your Medical Transportation Business

How Much Is Insurance for Starting Your Medical Transportation Company?

"Owning" Your Transportation Business

How Much Money Should Your Business Be Saving & Investing?

Educate & Equip Your Medical Transportation Business to Deal with Brokers

NEMT versus Low-Fare Subsidized Transportation Services


What is Home Care?

The term "Home Care" is extremely broad and encompassing! There are a wide variety of levels of care, all of which require different levels of professional skill and licensing and registration. Further, each level of care garners various forms of reimbursement.

Because of these many variables, each type of home care is quite literally a different business model! Although we discuss the transition from one business model to another in How to Build a Million Dollar Home Care Agency, the primary strategy that I share is a "Private-Duty" home care business model.

The reason reason why I focus on this particular business model is because it is strictly Non-Medical, much like your transportation company. This specific strategy is most convenient in terms of (1) licensing and registration, (2) finding, training, and retaining your help, and most importantly, (3) in aligning and complimenting your transportation business!

As discussed in my manual, there are only 28 states that require state mandated licensing and registration for Private-Duty, non-medical home care agencies. And of these 28, in some states, it's literally harder to license your dog than your home care agency! Needless to say, I provide a list of these various states and contact information from which to request appropriate applications for license and certification.

top of page

Is How to Build a Million Dollar Home Care Agency offered in ebook format?

No, this resource is a physical manual that we will ship to your door via certified mail with the US Postal Service.

top of page

What makes How to Build a Million Dollar Home Care Agency different from other Home Care “How to” resources?

How to Build a Million Dollar Home Care Agency is different because I prepared it with a medical transportation perspective. Many, many of my clients started with a home care business and then diversified into the medical transportation industry and others have done just the opposite.

There is a great deal of synergy between the two industries, the home care industry and the medical transportation industry. Both compliment each other. However, the two businesses have separate and distinct missions. Therefore, how you meld these two ventures together can significantly affect your “bottom line.” When you successfully blend these two services you can dramatically increase your efficiency and profitability, strengthen strategic partnerships and opportunities, and cross promote both services.

top of page

  How long does it take to start a home care agency?

Honestly, this is one of the most attractive aspects of the home care agency! Because there are very few barriers to entering this industry, you can literally start relatively quickly! Especially if you already own and operate a non-emergency medical transportation business, you already have a HOT market that you will be able to leverage for prospective clients. Likewise, you probably already have a high degree of strategic partnerships with doctors, hospitals, nursing facilities, and more; people who can further refer and promote your home care services.

Slightly more than 50% of the States require licensing and registration for a non-medical home care agency. And of these states, in some instances, it is literally harder to get your pet licensed than it is to become licensed and registered for your home care agency! In those states that don’t require licensing, you can literally start your business as soon as possible. Just follow the steps for success that I share in How to Build a Million Dollar Home Care Agency.

top of page

How much does it cost to start a Home Care Agency?

This is a very good and common question. Unfortunately, there is no fixed number to share. It depends on your start point, how big you wish to start, where you’re located, and more. There are a host of variables. But the good news is that starting a home care agency is incredibly cost effective because it is relatively asset-free. In other words, you don’t have vehicles or equipment to purchase as you do for your medical transportation business or other business.

Especially if you already operate a medical transportation business, starting a home care agency is very cost effective. You already have an office, resources, contacts, strategic partnerships and more. Regardless of your circumstances, starting a home care agency is relatively low in terms of required capital.

top of page

If I already own and operate a medical transportation business, why would I want to start a home care agency?

Well, first and foremost, it is NOT difficult to start a home care agency – as long as you know what you’re doing and you strategically diversify into home care. The last thing you want to do is diversify into a home care agency only to diminish or reduce the effectiveness of your transportation business because you’re not sure of what you’re doing.

Diversifying into the home care agency can definitely increase the profitability because you’re literally creating a new business in a growing niche market. But also, by consolidating the two ventures, you will increase the profitability of the two entities. Further, with a home care agency, you can literally generate money around the clock 24/7. You will have clients that need help and assistance on the weekends, in the evenings and throughout the night. Patients requiring assistance don’t take weekends of holidays off! Rather, your clients will regularly require your help and assistance. This demand provides you with around-the-clock money-making opportunity!

top of page

Where do I find caregivers?

Your business is only as good as your caregivers. In How to Build a Million Dollar Home Care Agency I am going to share with you how and where to find quality caregivers and helpers as well as how to retain them. Your caregivers are your most important asset. Needless to say, I’m going to show you how to find, train, and retain your staff so that they also become your best sales-reps and so that they further increase your business.

top of page

What is the difference between How to Build a Million Dollar Medical Transportation Company and other NEMT resources being sold on the internet?

If you’re serious about starting your own Non-Emergency Medical Transportation Company, then there is no better foundational resource than “How to Build a Million Dollar Medical Transportation Company.”

Described by many as “The Bible” of the industry, since 2004 my best-selling e-manual has been helping an untold number of motivated entrepreneurs to start and achieve success in the NEMT industry.

“How to Build a Million Dollar Medical Transportation Company” has been revised several times and will continue to be revised as new information, rules and regulations, and opportunities become available.

And unlike authors of competing resources eager to make fast money online, you can rest assured that when you invest in “How to Build a Million Dollar Medical Transportation Company” you’re investing in the “right” information, real information, with time-tested strategies that I’ve personally used in my own NEMT business!

Starting with a single used vehicle in 1999, I literally built my NEMT business from the ground up! Within 2 ½ years I secured my largest contract that sent my competitor’s heads spinning! Additionally, on two separate occasions, I secured a total of a 33% increase in Medicaid reimbursement!

But rest assured, starting and NEMT business requires far more than getting a vehicle and simple marketing. In fact, building my NEMT business was not all successes. Like any business, I made mistakes and suffered setbacks. But the good news for you is that in my e-manual and DVD’s you’re going to learn not only of my successes, but you’re also going to learn of my failures. Why – so you don’t have to!

Unlike you, I had no ebook or DVD’s. I had no road map or anyone willing to help and show me the way. As a result, I literally wasted hundred of thousands of dollars over the first few years of my business!

But I’m very proud to say that I also experienced great success! But again, like any business, it wasn’t always problem-free! And as a coach and mentor, I believe it’s important that I share all aspects of this business, “the good, the bad, and the ugly!” Doing otherwise would be, in my opinion, disingenuous.

Today, I am so blessed to continue partnering with, training, educating, and coaching entrepreneurs both in and out of the NEMT industry from all over the country, Canada, and beyond! Just read and listen to some of the many testimonials featured on many of my websites.

I think that you too will be very proud of the continued accomplishments that my staff, strategic partners and I continue to create and develop for helping you and others within our industry. Together, we are creating a host of industry-related resources designed to help you start, succeed, and sustain your business long-term!

Just as you wouldn’t step foot in a plane piloted by a less than experienced pilot, nor would you take business advice from someone lacking business sense and experience.

Needless to say, in starting your NEMT business you can rest assured that you’re learning from someone that has literally “done it themselves” and is committed to preparing you for long-term success in our industry.

As founder of the United Medical Transportation Providers Group, we are here to help you elevate your business and empower you to success.

So definitely take your time and read my e-manual “How to Build a Million Dollar Medical Transportation Company” several times over. And if you’d like to receive a FREE copy of this resource, visit me at to learn more.

top of page

Understanding the Medical Transportation Opportunity

As we all know, we are currently enduring a struggling economy that is accompanied by rising inflation and an unemployment rate that is consistently holding close to 10%. In such times, there is now, more so than ever before, more and more people looking to pursue their entrepreneurial dreams in an effort of creating additional streams of income.

In light of such economic uncertainty, there are two niche markets that are not only continuing to rise, but are literally facing an explosion. With the doubling of the elderly population and the rapid growth of the medical industry, the demand for transportation will continue to increase for both niche markets.

Elderly and disabled people will be ever more in need of medical attention and assistance as well as medical transportation to and from treatments and appointments. Furthermore, as hospitals continue to increase their outpatient procedures and treatments, the need for more and more non-emergency medical transportation services are on the rise all across the United States and into related industrial countries.

The entrepreneurial opportunities in the medical transportation industry are growing more and more unprecedented and offering an increase in profitable solutions for many motivated entrepreneurs. The reason for such profitability is because the transportation needs of the elderly and disabled are indeed wide and diverse.

Many seniors remain ambulatory and in need of only limited transportation assistance. Although many seniors may require more time in walking, sometimes with a cane or walker, they do remain relatively independent in terms of mobility. However, in time, more and more seniors and disabled are finding the need for wheelchair and non-emergency stretcher assistance warranted for both safety and convenience concerns. Under such circumstances, non-emergency medical transportation vehicles, also known as ambulettes or medivans are used to meet the diverse transportation needs of such clientele.

Typically charged with taking clients to and from medical appointments, medical transportation companies are finding flourishing opportunities from both clients and facilities alike because of their diverse capabilities.

Ambulettes are typically equipped to accommodate a combination of wheelchair and ambulatory passengers as well as, in many instances, stretcher transports. With the assistance of hydraulic lifts mounted either in the rear or on the side of the vehicle, wheelchair-bound patients are safely lifted into and securely fastened via securing devices and a seat belt. These medical transportation vehicles are very much accommodating and comfortable for all passengers regardless of physical needs and conditions.

Medical transportation is not only limited to ambulettes and medivans. In many instances, ambulances are also used to meet the growing non-emergency transportation (NEMT) needs.

Ambulances, typically thought of only in regards to emergency transportation, are often enlisted to provide non-emergency transports in areas where there is a lack of adequate medivan services or areas where there is a failure in understanding of the convenience and cost-savings abilities of using ambulettes.

Unfortunately, many staff, facilities, and organizations fail to understand the versatility and cost saving opportunities that exist in using ambulettes versus using an ambulance. Typically, a NEMT being performed by an ambulette is, on average, 70 - 90 percent cheaper and more cost effective as compared to an ambulance performing the same transport of equal distance and dynamics.

The cause for this gross disparity in cost can be attributed to the simple overhead economics. The cost of vehicle, insurance, training, and equipment for an ambulance is considerably more as compared to that of an ambulette. Further an ambulance is always staffed by multiple certified EMT's; further driving up labor and training costs. Conversely, an ambulette can be staffed by a single licensed driver trained only in state and local mandated transportation requirements. But again, this is only feasible for NEMT exclusively.

In states, counties, facilities, and areas where more and more ambulettes are being called upon to meet the non-emergency transportation needs of the growing elderly and disabled, there is a greater reduction in financial costs to insurance companies, Medicaid and Social Services, brokers, hospitals, non for profit organizations, and the like. At a time when budgetary concerns are being critically tested, such savings in using more ambulettes for non-emergency transportation needs is not only sensible and practical, but it's critical. Rather than reimbursing an ambulance service thousands of dollars for a single non-emergency transport, the cost to private-paying clients and facilities alike for a comparable transport can literally be reduced to a hundred or so dollars!

Needless to say, as we move forward with ever growing medical and transportation needs, coupled with changes in health care practice and policies, the need for practical and cost effective non-emergency transportation solutions will become more apparent. The need for safe and adequate services will increase with a continued attention on overall cost of delivery of such services, hence, the growing opportunity of non-emergency transportation services.

top of page

How Medicaid and Brokers Influence Your Ability to Start Your Medical Transportation Business

One of the most common misconceptions regarding the non-emergency medical transportation industry is that you need to be Medicaid approved in order to operate. This could not be further from the truth. There are many ambulette services that only service Private-Pay and contracted work. In fact, for the first two years of my business, I was exclusively a Private-Pay transportation provider until I figured out how to gain my Medicaid Provider Number.

Under the Social Security Act, the Department of Social Services is mandated to reimburse medivan services for the non-emergency medical transportation of approved Medicaid recipients. However, Medicaid reimbursements rates can vary significantly not only between states, but between counties. There is no one single universal rate of reimbursement.

Further, in some counties and regions across the United States, the Department of Social Services outsources their administrative responsibility to brokers. Rather than work directly with transportation providers themselves, the Department of Social Services will contract with these "middle men" to reduce the burden and hassle to Social Services. In turn, these brokers are responsible for organizing, contracting with, contacting, and coordinating essential medical transportation for Medicaid recipients.

As is typical with any form of brokerage system, the broker makes money by taking a percentage of each transport. For example, using fictitious easy numbers, if the Department of Social Services pays $50 for a one-way wheelchair transport, the money will go to the broker. The broker will pay you, the transportation provider, $40 and the broker keeps $10.

Now, what you do with Medicaid transports, either working through a broker or Social Services directly, has NO bearing on what you do with Private-Pay or contracted work. Once you've gained proper operating authority within your state, you're technically in business. You can begin soliciting facilities and customers alike to meet the transportation needs of Private-Pay clients as well as begin soliciting and negotiating contracted work.

Medicaid or brokers have no ability to grant you operating authority or have any influence in what you do with Private-Pay or contracted work. Again, there are many transportation providers across the country that performs no Medicaid transports. For them, the Medicaid reimbursement rates might be too low to make it profitable or they're simply too busy meeting the needs of their Private-Pay and/or contracted clients.

I typically use the analogy of bricks and mortar. Depending on where you live, either Private-Pay or

Medicaid will be the bricks of your foundation and the other will serve as the mortar that keeps generating further revenue and keeps your vehicles moving. Typically, Private-Pay clients will yield a higher profit margin. Thus, you will want to always focus on your Private-Pay clients and use Medicaid transports to keep your vehicles and drivers moving and generating additional sources of revenue.

top of page

How Much Is Insurance for Starting Your Medical Transportation Company?

One of the most common questions I receive is how much vehicle insurance costs for a medical transportation company. Needless to say, there is no one single answer as there is a host of variable that contribute to the cost of vehicle insurance.

First, where you're located does play a big part in the cost of your premiums. Like all insurance policies, if you're located in a higher crime area you are definitely subject to higher premiums.

Next, the amount of coverage you're seeking will have a direct impact on the cost of premiums. If your medical transportation company will be servicing Medicaid or Broker contracts then they will typically insist that you carry a higher rate of coverage. In such circumstances, you will typically find yourself seeking greater liability limits as compared to what you need to service Private Pay clients.

Another important variable that will determine how much you pay for vehicle insurance is your level of experience. Most insurance underwriters want to see your three year Loss-Run (L/R) Ratio. Your LR Ration is like a financial report card. It shows how much you paid in vehicle insurance compared to how much the underwriters paid out in claims. So, having a good LR Ratio is very important. The fewer the incidents the more cost effect your insurance premiums!

Now, in talking about Loss Run Ratios another common question is regarding what if you're a newer business with less than three years. Yes, you can still get insured but typically, as can be expected, you can find yourself paying a little more. I know that's not what any new entrepreneur wants to hear. But it's the nature of the beast and you have to look at it from the underwriter's perspective. Until you've proven yourself to be reliable in paying, you've proven to have a good safety program that properly trains and educates your drivers so that you limit your accidents, you really are a risk! Again, I know that's not great news for new entrepreneurs just starting out. But it goes with the territory.

Another obvious factor determining how much you pay in premiums is the number of vehicles you are insuring. The more vehicles you have, the greater the total volume you pay. However, if you do have a good Loss-Run Ratio you the more vehicles you are insuring the less you could be paying per vehicle as compared to if you were insuring a few vehicles.

Because the cost of vehicle insurance is a common question, I am very pleased to share with all of you that there is strength in numbers. More specifically, with the United Medical Transportation Providers Group we have the distinct ability to dramatically reduce member's insurance premiums. Over the last several months the UMTPG has been working closely with select brokers and underwriters to develop a discounted plan exclusively for UMTPG members. To say that this is a great opportunity is an understatement. In fact, this is a ground-breaking opportunity that is literally going to revolutionize the "bottom line" for NEMT owners around the country!

If you haven't yet joined the UMTPG Newsletter, I encourage you to visit us at and join so that you can stay abreast of the latest news and info regarding this revolutionary insurance opportunity among other opportunities.

top of page

"Owning" Your Transportation Business

A common mistake that I find with many entrepreneurs both in the medical transportation industry and other industries is that they allow others to "own" and dictate their business. What I mean by this is that some business owners allow other people or external sources to dictate their prices and, thus, establish the perceived value of their products or services.

Now, so as to ensure that you do not misconstrue my message, I am all for providing great deals and discounts to your clients! In fact, as many of you have heard me stress before, especially in the early stages of your business, the best thing you can do to promote your business is to literally "give" your business away in the form of free or discounted transportation! Further, I always stress that you work to increase the "added value" to your customers. However, especially in service-based businesses such as the medical transportation industry, all too often I witness business owners allowing others to establish their pricing structure and, thus, defining the value of their business.

In the NEMT industry, it is not uncommon for customers to haggle prices and for contractors and brokers to try and dictate your prices. Periodically, you encounter customers that wish to talk you down in price. In shopping around for the "best deal" they will call and ask your prices in advance or they will wait until you have already provided service and then they will attempt to talk you down in price.

Needless to say, we are all looking for great deals and we would all like to spend less money in the process. So understanding a customer's desire to save money is acceptable. But our desire to deal with such haggling as business owners can be bothersome. However, when you're business is high in added value, reputation, and customer service you should never be ashamed to stand firm in your pricing - especially when it risks you not making a profit or altogether risk losing money!

Again, especially for clients that use your services frequently, offering discounts is acceptable and even advisable. However, I can assure you that clients who only base their decision on price are not "regular" clients that you wish to retain long-term. Why? Because the moment they realize a cheaper opportunity, irregardless of the level of value, they will abandon you without hesitation! Trust me, it's true and will always be true!

Regardless of your business or industry, there is always someone that has to be the cheapest in price - but that doesn't mean that it has to be you! In fact, when I see a business that focuses on being the cheapest in price I can typically point to three key things such as (1) their clientele is based exclusively on price and not on quality relationships or added value, (2) they haven't established or defined their value, and (3) they, in most instances, don't understand how to determine or define their costs in relation to profits.

Think of any popular name brand product versus generic. How many times have you seen the same product side by side, looking almost identical, accomplishing the same mission, typically made of the same materials and ingredients. Which one do you always instinctively prefer to go with - the name brand product. Why? First, you recognize and have a degree of trust in the name brand product. Next, because of your recognition and the perceived value you have in the name brand product, you're willing to pay more - it "eases" your mind. You rest easier because you have more confidence in the name brand! The same holds true with your service. You need to become the "name brand" service in the minds of your customers. When you do, price is no longer the deciding factor.

Brokers can be notorious for trying to dictate prices to young medical transportation providers. Some could argue that their approach can even border on bullying tactics! Brokers rarely hesitate to tell you what they "will" pay for various transports. They will insist that you accept these rates and that they are non-negotiable. However, trust me, in working with clients from all across the country I can assure you that when you position yourself correctly, brokers WILL negotiate! Why, because it's in their best interest to find and partner with transportation providers that are going to be around long-term. In many instances, brokers receive compensation for every transport performed. Further, brokers do not wish to waste their time with fly-by-night vendors. And, in speaking with an inside source in a prominent brokerage, brokers know which transportation providers they can "walk over" and with whom they "work with!" And trust me, they're not the same!

Many inexperienced entrepreneurs go into business thinking that all they have to do is "build it and they will come." Once they build it, they think that all they have to do is be the cheapest in price and then their success is guaranteed. In such instances, it typically is not long before they realize that clients didn't come and thus, their doors are in the process of closing. This flawed strategy is common in all businesses regardless of industry. Needless to say, there are many skills, tactics, and strategies that need to be implemented by you, the business owner, to ensure your viability and success. To be successful, you need more than a promising opportunity offered at cheap prices. You need strategic implementation and methodology that ensures your success.

top of page

How Much Money Should Your Business Be Saving & Investing?

The following is a great question that I recently received regarding investing money and building the net worth of your business. Because I think that this is a very important topic that countless entrepreneurs overlook, let me share with you the following:

"Hello Joel, I have some quick questions I am hoping you can assist me with. My husband and I have been studying your DVD Series for which we can't express our appreciation more! They are an invaluable tool for educating and helping us all in getting started in the industry….My questions are (1) in saving money and building a portfolio for our business, how much money should we be saving, and (2) what are the tax ramifications of saving this money in our business? Won't this mean that we are showing a profit and, therefore, make us pay more in taxes? Thank you again, Joel, for all you do and all of your great information." Jennifer Holden

First, thank you very much for your great questions, Jennifer. The obvious reason why I share them on this post is because I know for a fact that others have similar thoughts, questions, and concerns.

Now, as you referenced, I do discuss the importance of saving money in my DVD Series. There are several reasons why you should be saving money as I discuss in my information. But, in looking at the BIG picture, the reason why you want to save money is because it literally builds the net worth of your business. More specifically, should you plan on selling your business in the future for a nice profit you will literally be able to illustrate to prospective buyers that you're a profitable business. Nothing speaks more loudly and profound than cash money! When you can literally illustrate that your net worth has grown over the life of your business you just became instantly "attractive" to prospective buyers. And yes, you will definitely receive a higher sales price!

So what method do you actually use to save money? There are several. But honestly, I strongly suggest that you work closely with and consult your financial advisor and/or accountant. Sit down and discuss the kind of financial "vehicle" you wish to use to invest money over time. For my business, we started with a simple mutual fund account in my company's name. Understanding my exit strategy, we were aggressive for the first years in terms of risk level and then we began to gradually and purposefully become more conservative to limit potential losses.

The two primary benefits to saving money and building the net worth of your business is that, again, you're able to illustrate to prospective buyers that your business is profitable. And next, when you actually leave the business, you leave with a nice "pot of gold!"

In terms of how much money you should save, that is a very complicated answer that is unique to you. It's very difficult and uncomfortable to offer you specific number amounts as there is no right or wrong answer. Further, I don't know the particular dynamics of your business, your local market, and your financial circumstance.

However, what I can tell you is that saving money will most likely be an incremental measure over time. As your business grows and becomes for profitable you should gradually and proportionately increase your amount of savings and investments. Trust me. I know that it is very difficult to save money while you're working to build your business. But I can't stress to you enough the need to, once you're generating positive cash flow, begin saving and investing money on behalf of your business. Start with $100 a week. As your business goes, work to gradually expand and grow to $100 per day and so on and so forth.

What are the tax consequences? Well, again, there is no one single one-size-fits-all answer. There are many variable and components associated with such a question to include your type of legal structure, the amount and value of your assets and much more. In short, yes, if you show a profit you will be obligated to pay some degree of tax. But the good news is that with a growing transportation business you should have asset depreciations costs, possible tax credits, and more that can help negate some of your taxes. Again, this is why it's critical that you align your business with a good financial adviser and accountant or tax preparer. They can provide you with much more targeted specifics unique to your business.

Now let's be realistic. Does paying taxes stink? Heck yeah! I can assure you that to this day I have never grown accustomed to it! But regardless, it is necessary and goes with the territory. Further, showing profits and paying taxes will actually help keep the IRS off your back. If you keep showing losses after losses it is probably only a matter of time before it raises suspicion with the IRS which can lead to an audit. So is it an inconvenience? Of course - paying taxes is always an inconvenience. But conversely, it can actually help to protect and preserve your business while you're increasing your net worth.

Think about this. If you can save a daily average of ONLY $100, that's roughly $36,000 per year! Over several years with compounding interest and increasing investment amounts you will literally walk away from your business with a nice "pot of gold" in addition to your sales revenue.

In my biased opinion, if you're business is at least two years old and you're not able to save and invest at least $100 per day then your business model IS definitely broken! And if you do fall into this category, then it's time for a business "overhaul." You need to study my DVD's and you NEED to attend my upcoming MDT Boot Camp Seminar. We will be discussing a great many topics to include diversification, increasing revenue and opportunity, and much, much more.

top of page

Educate & Equip Your Medical Transportation Business to Deal with Brokers

Since launching my "Boot Camp Seminar DVD Series" I have been receiving a flood of emails and questions regarding Medicaid and the whole broker system. Needless to say, the broker system is a very real "system" that is not going to go away. Rather, if anything, it is going to continue to grow.

As is stipulated in Article 1915 of the Social Security Act, through the Department of Social Services, the government will reimburse transportation providers for Non-Emergency Transportation of Medicaid recipients. However, the reimbursement process can vary significantly by state, county, and even regional municipalities.

Because of growing logistical burden between recipients, facilities, and providers and others, more and more of states and municipalities are utilizing brokers. In serving as a "middle-man," these national and regional-based brokers offer the Department of Social Services a cost-cutting process that will save the Department considerable money while overtaking the daily obligations of coordinating and managing suitable non-emergency transportation for their Medical recipients. Although this process is well intentioned, in many instances, for the transportation providers, this broker system proves to be more harm than good.

It is without question that brokers are well funded! In many instances, individual brokers receive hundreds of millions of dollars in government sponsored grant money and revenue. Logisticare, for example, the largest of all national brokers, boasts annual revenue of half a BILLION dollars and posted more than 40 million dollars in performance and payment bonds for various Medicaid and Managed Care programs. In addition to double digit profit margins, some brokers such as MTM, Medical Transportation Management, boast almost 40% return on invested capital.

Unfortunately, with such high profits and revenues, overall, a disproportionate percentage of reimbursement is awarded to transportation providers. Now, trust me. I am NOT nor will I ever attempt to play "class warfare" as do many politicians and social groups. To the contrary, I am a true capitalist and support everyone's ability to make money and high profits. However, because I have the pleasure of working with countless transportation providers across the country, I witness first hand how brokers strategically and financially mislead and shortchange providers by encouraging them to commit to disadvantageous contractual agreements. In turn, such Agreements lead to limited profit margins, if any, for the transportation providers which further leads to inadequate customer service.

Now please do not gather the impression that I am suggesting that brokers are "the devil" and that there is some grand conspiracy to prevent transportation providers and entrepreneurs from succeeding. However, because broker's first and foremost priorities are earning reports and return on investments, as a result, they operate with extremely "tight fisted" margins with regards transportation providers reimbursements. However, when dealing with and negotiating with brokers the old adage "the best defense is a good offense" is very much appropriate. And a "good offense" starts with proper education and effective execution!

For new transportation providers or when a new broker enters the market, a common strategy that I continue to see all over the country time and time again is brokers contacting transportation providers with proposed rates of reimbursement and then encourages the provider to sign as soon as possible. The broker positions themselves to appear as though they are doing the transportation provider a great service. Brokers tell the providers that they can "start immediately" once they have received the signed contract.

Again, I cannot tell you how many times I witness this "expeditious" strategy in working with clients. The more I see it the more I am beginning to think that all these brokers operate off of the same "script" or that they maybe even go to the same sales school or something!

The reason why brokers appear to be your friend and act as though they are doing you a favor by encouraging you to sign as soon as possible is because they want to lock you into your rates before you have the ability to seriously evaluate and analyze the legitimacy of their proposed rates! They don't want you to seriously evaluate the profitability or lack thereof of their proposal, hence, the reason they stress the expeditious nature and the potential sales volume.

Sadly, novice transportation providers jump at the first chance to sign these proposals enticed by what they think are possibilities! The broker, in typical fashion, will promise providers that they will send them considerable business. And many times, when brokers are able to get these naive transportation providers, they will use them and send them as much business as possible. Why - because the proposed rates are always low-balled, unprofitable transports that provide little to no profit margin for the transportation providers but healthy profits for the brokers.

Rest assured, brokers are well experienced and well funded. Further, brokers are NOT stupid. They are well versed with the costs associated with supporting logistics and transportation. And they know when and how to take advantage of transportation providers. So you might be asking yourself, why would brokers do this? Why wouldn't they seek to provide greater, more reasonable rates of reimbursement to transportation providers so that providers can be more stable to provide greater, more reliable and longer lasting service?

Well there are a few things that you have to consider. First, when it comes to the brokers, it is all about the numbers. This is big business and business is a numbers game. To brokers, it makes more sense for them to low ball naive transportation providers. It's easier to leverage small time, mom-and-pop gypsy services. Brokers "gamble" that those naive enough to accept such nominal rates of reimbursement will not be around long. Brokers will, in turn, give these gypsy services what I refer to as "nickel and dime" transports - short, local transports that are nominal in cost and reoccurrence yet still profitable for the broker. When these gypsy services go out of business because they are not profitable, brokers have little invested, made a lot of money over that period of time, and simply await the next gypsy businesses.

Secondly, brokers always tell providers that they do not negotiate their rates and that everyone is paid the same. Trust me. This could not be further from the truth! I have worked with providers in the same region on several occassions and I can assure you that they are NOT all receiving the same rates of reimbursement. Further, yes, brokers do absolutely negotiate when you position and force them to negotiate!

Brokers not only negotiate with legitimate and credible transportation providers, but with all honesty, they will actually respect you and treat you more like a legitimate strategic partner when you reject their proposal and counter with substantiated and realistic numbers. I stress the word substantiated because it's important that you demonstrate that you "know your numbers," the cost and expenses associated with doing business.

Furthermore, when you engage in legitimate negotiations with brokers and you demonstrate that you know your numbers not only do they identify such transportation providers as more legitimate but they also award such providers with more regular and profitable transports such as dialysis patients and distance transports.

As you can imagine, negotiating on a serious and legitimate level does require a great deal of skill and even "guts." As the old saying goes, you need to "know when to hold 'em, know when to fold 'em, know when to walk away, and know when to run." Negotiations do require an effective "poker face." And, it can take serious time. You have to use skill and be patient to allow things to develop. I can't tell you how many times I have advised providers to walk away, end communication, and await for the brokers to return with a counter offer. With all sincerity, I can't tell you how many times I have been right and the broker returns and accepts our counter offers - further illustrating that yes, brokers DO negotiate! You just need to know how to position and package yourself and know your points of leverage.

If you are or you're planning on working for a broker, I welcome the opportunity to assist you in your application and negotiation process. If you would like to enlist my help, One-on-One, then visit me at

Also, if you would like to learn even more about the details of positioning yourself, learning about the Medicaid/brokerage system, then I would definitely encourage you to invest in my "Boot Camp Seminar" DVD Series. This is an outstanding six (6) disc set that is definitely going to educate and enlighten you while further teaching you about diversifying and investing your business horizontally.

top of page

NEMT versus Low-Fare Subsidized Transportation Services

There are a wide variety of government subsidized shuttle programs servicing cities, communities and even some rural areas all across the country that charge a very modest amount of fare. One of the most common questions I receive is “How can my transportation service compete with such low fares?”

Well, truth be told, you can’t! There is absolutely NO way that you can compete with such low fares that can range from a single to a few dollars per transport. But the good news is, you don’t have to compete with these low-fare services because they are NOT your target market!

The following are some quick facts about such low-fare, government subsidized transportation services:

  • Typically operate shuttle-type minibuses that accommodate both ambulatory and wheelchair bound passengers
  • Many low-fare services operate via fixed route systems, similar to that of traditional bus lines
  • Services that do accommodate personalized pickup locations require appointments to be made according to the schedule of the serviced versus that of the client
  • Such low-fare services are strictly curb-to-curb services
  • Although passengers riding these low-fare services may receive assistance getting in and out of the vehicle, no further assistance is available beyond the vehicle

Although these services definitely help and service a niche need within many of our communities, they are, however, very limited, thus, the reason why these low-fare shuttle services should not be perceived a competitor or threat to your NEMT service.

The following are just a few facts that demonstrate the ever increasing need for your medical transportation business in addition to the limitation of these low-fare services:

  • Low-fare, government subsidized shuttle services cannot accommodate stretcher-bound patients
  • Shuttle services cannot accommodate patients that require assistance in regards to mobility and cognizant skills
  • Many NEMT services can accommodate 24-hour transportation needs to include hospital and emergency room discharges
  • NEMT are typical through-the-door services versus curb-to-curb like low-fare transportation services
  • NEMT services specialize in direct transportation to and from medical appointments and destinations with little to no additional stops
  • Ambulette drivers are trained and prepared to offer more individual customer attention and accommodations as compared to shuttle drivers
  • Low-fare shuttle services typically accept cash or vouchers only versus NEMT services which can accept various forms of compensation
  • NEMT services can usually accommodate last minute reservations without interruptions in service

top of page

Other materials regarding the home care industry can literally cost thousands of dollars! And none of them incorporate or include the knowledge and perspective of the non-emergency medical transportation industry! This is definitely one-of-a-kind material! Invest & Start Today!

Maximus Management Group, Inc. P.O. Box 10 Bible School Park, NY 13737

Terms of Service