How to Get Your First NEMT Trip From a Nursing Home or Rehab

The person who approves you at a nursing home or rehab almost never books a ride. Your first trip comes after the meeting, from the desks that do: admissions, the social workers and case managers who plan discharges, and whoever schedules residents’ appointments. Go back, meet those people, leave a direct number at each desk and offer to cover the rides the regular company can’t. Then run the first trip like the test it is.

Our facility outreach team calls nursing homes, rehabs and hospitals for NEMT owners every day, so I hear how these meetings go. Everyone’s friendly. They take your brochure. They say they’ll keep you in mind. Then nothing. A new owner in Southern California told me on a demo he’d heard that facilities will say “we’ll sign you up,” and then “you don’t even get any rides.” I told him that’s very common.

The administrator’s yes rarely sends trips on its own. You win a building one desk, and one tested first trip, at a time. This guide runs in the order you’ll live it, from the meeting to steady trips.

If the meeting isn’t booked yet, start with our guide to getting in the facility door. A warm route helps too: a rider you already drive from that building, or an administrator at a sister home who likes your work, since administrators talk to each other.

What should I bring to a meeting with a nursing home or rehab?

Bring a service agreement you could sign that day, a folder of proof and a few questions, because the meeting’s real job is learning how rides get booked there, and by whom.

Keep the agreement to one page in plain English: your services, your payment terms, and your fees for cancellations, no-shows and wait time, with your rates on a separate sheet. The folder holds your certificate of insurance, your licenses and permits, and photos of your vehicles.

The answers to these questions tell you how to sell the building:

1. Who pays when a resident rides?
2. Are you happy with the company you use now?
3. Do you run your own van, and what doesn’t it cover?
4. Who actually makes the calls for transport?

Don’t leave without an answer to the last one. I tell owners on demos to ask “who is actually making the calls for transport?” and to do it “during or immediately after that first meeting,” while you’re still in the building. If you can, ask whether the head case manager can sit in, or spare ten minutes afterward. If you’ve already left without asking, it isn’t too late: call or stop by, thank the administrator, and ask then.

Then ask what’s not working with transportation today, and stop talking. You might hear about the company that’s always late, the resident who waited two hours after a doctor’s appointment, or the weekends their own driver won’t cover. Write it all down. Every complaint is the job description for your first trip.

Who pays when a resident rides?

Who pays is the diagnosis that matters most, because each answer changes your pitch. Some facilities pay for resident transport out of their own budget and collect from the resident, family, or insurance on the back end. At others, residents or their families pay you directly, and the facility just coordinates. And sometimes the facility simply eats the cost, because a discharge is stuck and the open bed is worth more than the trip. Plenty of buildings run a mix.

Don’t hear “we don’t pay” as a no. Christopher Buell, who grew his first NEMT company to about 11 vans, gave us his cold-calling script for facilities on our podcast. He puts his prices on his brochure, because a lot of buildings “take your brochure and give it to their patients.” When staff say, “Oh, our facility doesn’t pay,” the patient still can ^[1].

Here’s how the pitch changes:

• The rider pays you. The facility only coordinates, and your real buyer is often a daughter two states away, or another relative who can’t do the driving. Sell the staff on easy booking that costs the building nothing, and sell the family on service they’ll rave about. Take payment like any private-pay ride: for scheduled rides, most providers take a card at booking and charge it at least 24 hours before pickup, or send a payment link that has to be paid at least 24 hours ahead.
• The facility pays you and bills the rider back. It’s a business-to-business sale, won on clean, complete invoices, fair rates and reliability the administrator can defend. Price weighs more here: as I put it to one owner, some places “will always call the cheapest one first because the facility is paying for it.” Even then, they’re “usually open-minded to work with someone who does a good job.”
• The facility absorbs the cost. The resident has to go now, so speed is what sells: same-day or even same-hour trips, a yes at odd hours. Say yes fast.

Then there’s Medicaid, and your state decides. In some states, a nursing home resident’s Medicaid ride goes through the broker or the health plan’s ride vendor like anyone else’s, so the building can’t hand it to you directly; it comes through that network, if you’re in it. Other states put some of those rides on the home itself. As of October 2026, Indiana and Michigan make the nursing home cover its Medicaid residents’ van rides out of its daily rate, per Indiana’s Medicaid transportation module and Michigan’s Medicaid provider manual. In Pennsylvania, the Medicaid long-term care program makes the home responsible for providing them, per its transportation fact sheet (revised in 2019).

Medicare is simpler. Original Medicare doesn’t pay for wheelchair vans or any other non-ambulance ride: Medicare’s claims manual says it “simply does not provide any coverage at all” for them. So during a Medicare-covered rehab stay, the van ride is usually the home’s cost or the resident’s, depending on the building.

Even a broker ride can open the door. Marqus Johnson, who runs a wheelchair and stretcher company in Tampa and coaches NEMT owners, said on our episode about turning drivers into a sales force: “The broker trip to the facility is your warm lead now.” Once you’re inside, find out who decides which company gets the call for discharges, or when the broker’s provider doesn’t show.

So ask how each ride gets paid. If your state sends residents’ Medicaid rides through a broker or a health plan’s ride vendor, get into that network before you count on the building’s Medicaid residents.

Should I ask the facility to sign a contract?

No: ask for a short service agreement, or just a spot on the facility’s list as the backup for the rides its regular company can’t cover. Christopher’s free lesson on our podcast was blunt: “Don’t ever say contract. … Nobody wants to sign contracts. People will sign service agreements.” ^[1]

How much paper you need depends on who owns the building. At a small independent building, there’s often no contract at all: once they’ve met you and trust you with their residents, the administrator’s yes can be enough to start the calls. When a corporate owner runs dozens of nursing homes, expect to be added to an approved vendor list first. Either way, I wouldn’t push for a contract. Read the payment terms in any paper they hand you, because facilities pay on invoice terms, often a month or more after the trip, and some now ask for 90 days.

Lower the bar on what you’re asking to be, too. An Alabama operator, interviewed on another industry podcast, didn’t even ask for a service agreement. He told facilities “we don’t want to take over, but we would like to stand in the gap” when their regular company or their own van couldn’t cover. After one of those visits, the call came, he said, “as soon as I sat down at my desk”: could he take someone today? Backup is a low bar to clear, and it’s often where the first call comes from.

Why isn’t the facility calling after they said yes?

A facility that approved you but never calls usually isn’t turning you down: the staff who book rides don’t know you yet, and a big building may still be vetting you.

A Detroit-area owner-operator told me on a demo about a facility whose contact had her send over her fees and her service contract, and said they were interested in using her as a backup. Then the contact never reached back out. She kept calling, emailing and leaving messages, all to the one contact who’d shown interest. “Never got nothing.” It’s the trap I warn owners about: once a big building approves you, “if you stop there, you will get no trips ever from them, despite being approved.” Stopping at the person who said yes is the mistake.

The reason is who makes the call, and it’s rarely the person who approved you. As I told that new owner in Southern California, “the nurse is going to have their favorite person.”

Big buildings often vet you before the first trip, too, for their own reasons. The federal nursing home requirements bar a home from using anyone with an abuse finding, contractors included, and the federal health department inspector general’s guidance for nursing facilities tells homes to check the federal exclusion list for contractors. The home’s infection-control program covers contractors too, which is why some ask your drivers for a TB test. The paperwork can include insurance certificates that name the building as an additional insured, plus a W-9. Send whatever they ask for right away, and ask whether anything’s still pending.

Meanwhile, staff check you out. After you leave, they pull out your business card and look you up, to see whether you look like a real company.

Who actually books rides at a nursing home or rehab?

Three desks usually book the rides at a nursing home or rehab: admissions for residents arriving from the hospital, the social workers and case managers who plan discharges, and a transportation or unit coordinator for appointment runs. On demos I describe the person who books looking at a “notepad with five different NEMT numbers on it,” and “you want them to call you first.”

Each desk wants something different:

1. Admissions books the inbound trips from the hospital. An admissions director or coordinator wants a fast yes on short notice and a smooth first day for new families.
2. Case managers and social workers, along with discharge planners, arrange the discharges. They want the discharge to happen today, with a rider they can hand off safely. In the federal guidance nursing home inspectors use, getting residents outside services such as “community wheelchair transportation” falls under social services.
3. A transportation or unit coordinator schedules the recurring appointment runs. Whoever does it, a coordinator, a unit clerk or the weekend charge nurse, wants on-time pickups both ways and one number that always answers.

Titles vary from building to building, and sometimes the front desk makes the calls, so ask. One desk calling you means you’ve sold one desk out of three.

How do I get the first call?

Go back after the paperwork and sell the desks that book the rides, in person, then make yourself the easiest number in the building to reach.

On our podcast, I told the funniest referral story I’ve heard in NEMT ^[4]. An owner who was struggling to get into facilities moved her mom into a local nursing home. Her mom loved to talk to everyone there, and “a month or two later” the home was sending them dozens of riders, because they’d become “the default service.” The owner joked to me that she’d have to move her mom to the next nursing home. Most owners need the slower moves:

• Do an in-service. Offer to bring the van in and show the staff how it works. Tony Jackson, an Orlando operator with 35 years in the business, tells companies to “come in with your best vehicle” and “bring that lift down” ^[2].
• Chat with the front desk, and start with the nurses. An owner-operator in Missouri said on a community call I sat in on, “I always start with the nurses.” He catches them on a break outside, gets a name and follows up by email: “No one answers the phone,” but “if you email, they’re likely to email you back.”
• Meet the weekend crew. Go in once on a Saturday, so the weekend charge nurse knows your face and your number.
• Leave your number where staff dig for one. I tell owners to leave pens, fridge magnets and notepads with their phone number, because facility staff are “always digging around trying to find a number to call urgently for transport” ^[3]. Think of those as your phone number in a useful form, and keep anything you bring small and for the whole staff to share. Never tie any of it to referrals, past or future: federal anti-kickback law sets no minimum dollar amount for a gift meant to win Medicaid business.
• Drop in, and ask. Tony’s advice is to come by “every once in a while” and ask, “Did you have anything for us?” Sometimes the answer is a resident whose regular company is running late: “I’m so glad you … popped in.”

Then aim at the gaps. A facility that runs its own van often has a staff driver who works eight to five, which leaves the early mornings and the returns after five. One Los Angeles provider, interviewed on an industry podcast, takes same-hour trips when he can fit them in, and that’s what “a lot of my facilities love,” he said. “They call me last minute.”

Then be reachable, because the first call is usually a test. Three more operators interviewed on that podcast show how. A Dallas operator walked into a facility that had its own vehicles and offered to cover its trip conflicts. The staffer asked whether he’d come pick up the facility’s patients if she called at 2 a.m. He said yes, and she signed the contract.

Another owner won two months of an assisted living’s rides while its drivers were out sick. It had emailed half a dozen companies around 9 or 10 at night, and he answered from his couch right away. Most of the others, the facility told him later, “never replied or replied in two weeks.”

A third kept stopping by one facility to introduce herself. About five months after she launched, its regular company didn’t come for the residents, and the front desk called her: “Can you help us out today?” She’s handled that facility ever since.

What should the first trip look like?

Run the first trip like the audition it is, because the staff who booked it are deciding whether to call you again. Five rules:

1. Drive it yourself or send your best driver. In my experience, a building will usually give you a couple of trips to try you out, to test whether it wants to work with you. A one-van operator, interviewed on an industry podcast, said you probably have to “show up as the driver the first time” a facility asks, “to demonstrate that you’re there and present.”
2. Quote a window you can hit. If they ask for a 2:00 pickup you can’t make, say so and offer the 3:00 to 3:30 window you can. The facility passes your window along, and a window you keep beats a time you miss.
3. Treat the rider like the whole account. At a rehab, Tony says, residents stay about 30 days, and once you’ve brought one in, the follow-up rides go to the company they know. “Your job is that patient, it should be the VIP,” he said. His 30 days holds up: a Medicare-covered rehab stay averaged about a month by the count of MedPAC, the commission that advises Congress on Medicare: 30.7 days in 2024.
4. Confirm the facility’s way. Some facilities need no confirmation call at all. At others, one call to the desk confirms all of that day’s riders. Jing, my cofounder, said on our dispatching episode that at “a lot of facilities, the caregivers actually confirm the pickups,” often two or three riders in one call ^[5].
5. Call whoever booked it after the trip. A Georgia operator on that community call makes “that live call” to facility staff after trips, to say how it went and ask for their feedback.

The home cares about reliability for its own reasons, too. A missed appointment because no ride showed up can end up in the home’s federal inspection report: a 2024 Indiana inspection cited one under the quality-of-care rule.

How long until a nursing home sends regular trips?

A nursing home often keeps you as its backup for a month or two, sometimes much longer, and moves you up when its own van, or its regular company, lets it down.

Here’s the arc I describe on demos. The director you met says, in effect, “you’re my backup provider now.” A week later the regular company can’t take a trip, so the building calls you. The rider has a great experience and tells the director. It happens again the next week, and the building starts sending riders to you first instead of second. Then the volume comes, and then the contract. That can take a month or two, or more.

When it goes well, it goes fast. On our podcast, I told Josh Hagen of Careway Mobility what happens once residents start praising your drivers to the staff. You “could very quickly go from your first ride to like 90% of a facility’s business in a month or two” ^[3]. It can also take much longer. The cofounder of a Cincinnati company, on that community call, looks for five people in one senior community his team can give rides to regularly. Then, he said, “usually after 3 to 6 months you start getting noticed by the front desk.”

A Kansas operator, interviewed on an industry podcast, started as pure overflow at senior buildings that ran their own vans: “anything that you can’t handle, send it over to us.” Within a year, one of his buildings was calling him first and using its own van as the backup, because it had a hard time finding drivers. At the others, he was still the backup. A lot of NEMTs work with facilities that have their own vans, and in my experience those vans are always breaking down.

The same operator learned what overbooking costs. Early on, “excited about making the money,” he crammed in too many trips and had to call facilities to cancel because his driver was still out with another resident. A couple of facilities “stopped calling for about a couple of months.” Tell the building how many trips a day you can run well, and say no past it.

Getting the meeting is the half we’ve turned into a service. Our facility outreach team builds the facility list, makes the calls in your company’s name and books meetings with activities directors, discharge planners and administrators. If we booked your meeting, this guide is your owner’s manual for the room. The meeting is yours to run, and so are the agreement and the first trip. And once a building is calling, if you run Duet, its staff can get their own login to Duet’s facility portal to request rides and track the ones you’ve booked, at no extra cost with the software.

Either way, the handshake pays nothing. The first trip is the win. Go get it, and then answer the phone at 2 a.m. when they test whether you meant it.

Facility first-trip FAQ

How much notice will a nursing home give me for a ride?

Less than you’d like, at first. Routine appointments are usually booked a day or more ahead, and recurring rides often run on a standing schedule with the company the building already uses. That leaves a new provider the short-notice calls: a same-day trip, a late return, a ride the regular company can’t make. Say yes to those, and the scheduled work tends to follow.

Should I go back through the administrator or straight to the desks?

Both. Call or stop by to thank the administrator, ask who actually makes the calls for transport and whether they’d introduce you, then go meet those people. Keep the administrator in the loop. Christopher Buell’s reason: if a ride ever goes wrong, the family will ask the administrator, “did you meet them or did you just call a number?” The administrator “better say, no, I met with them and they made a great impression.”

Do I need a NEMTAC certification to get facility trips?

No. Accreditation from NEMTAC, the NEMT industry’s accreditation commission, is a nice-to-have. It means your training, paperwork and vehicles are in order, which lowers your odds of accidents and legal trouble. But it’s expensive and time-consuming, and right now few people in health care know what it is, so telling a facility you’re accredited is unlikely to win you trips. It can be worth it for a service going for premium branding with plenty of profit to spend. If cash is tight, spend it on what gets trips. NEMTAC’s heart is in the right place, and if health care starts recognizing the accreditation, it’ll be worth getting.

What if the first trip goes wrong?

Call whoever booked it before they call you, tell them what happened, and say what you’re changing. If you’re running late for a pickup at a hospital, Tony Jackson’s rule is to call the hospital and tell the bedside nurse, so the hospital doesn’t call the facility that booked you. Move fast, because one bad ride can cost you more than one building: Marqus Johnson points out that a nursing facility may be part of a group, and “one bad transport can destroy an entire contract.” It can be repaired, though. A Kansas operator, interviewed on an industry podcast, once took two hours to go back for a resident, and the facility called to chew him out. He smoothed things over, and the facility came back.

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Sources

[1] Duet NEMT Growth Podcast, Ep. 14: “How to CALL Facilities with Christopher Buell,” March 3, 2026. https://www.youtube.com/watch?v=MhEijJdU8ys

[2] Duet NEMT Growth Podcast, Ep. 10: “How To Win NEMT Facility Contracts” (Tony Jackson), October 24, 2025. https://www.youtube.com/watch?v=it0DufVkvXk

[3] Duet NEMT Growth Podcast, Ep. 24: “New to NEMT? A Manager’s Questions, Answered” (Josh Hagen of Careway Mobility), September 14, 2026. https://www.youtube.com/watch?v=A9rhPunK5aI

[4] Duet NEMT Growth Podcast, Ep. 9: “How To Retire Rich From NEMT,” October 15, 2025. https://www.youtube.com/watch?v=1qtTMvHKieE

[5] Duet NEMT Growth Podcast, Ep. 12: “Mastering NEMT Dispatching” (Jing Zhu), December 29, 2025. https://www.youtube.com/watch?v=5j-t582MNk8