For new medical transport operators
Start a medical transport service with one vehicle: the numbers
Your first vehicle is the biggest check you will write, and it decides which trips a broker can give you. Here is what dealers are asking for used paratransit buses now, the federal rules the vehicle has to meet, and the other costs to quote before you buy.
What a used paratransit bus costs
Median asking prices on our listings as of October 31, 2026. Asking prices, not sale prices.
| Model year | Median asking price | Median mileage | Listings |
|---|---|---|---|
| 2024 and newer | Too few listings | 3 at 2 dealers | |
| 2019 to 2023 | $32,188$27,750 to $39,400 | 90,000 mi | 18 at 2 dealers |
| 2013 to 2018 | $24,800$19,835 to $31,638 | 150,000 mi | 19 at 2 dealers |
| 2012 and older | Too few listings | 3 at 1 dealer |
The rules the vehicle has to meet
- Accessibility. A company in the business of transporting people that buys a new vehicle with 8 or more seats for on-demand service must make it wheelchair accessible, unless its service as a whole is equivalent for riders with disabilities (49 CFR 37.103).
- License. Under federal rules, a vehicle built for 15 or fewer people including the driver and rated under 26,001 lb needs no CDL. Count each wheelchair position. The CDL checker tests a specific bus.
- State and broker rules. Your state Medicaid program or its broker sets vehicle age, inspection, equipment and driver rules. Get them in writing before you choose a vehicle.
Costs to quote before you buy
- The vehicle, inspected, with a working lift or ramp and securement positions
- Commercial auto and liability insurance, quoted for medical transport
- Enrollment with your state Medicaid program or its transportation broker
- Driver background checks, drug testing and training your state or broker requires
- Business registration and any state or city transport permits
- Dispatch and trip-logging software the broker may require
- Fuel, maintenance and lift servicing
Choosing between a lift and a ramp? Compare them here.
Common questions
How does an NEMT business get paid?
Most NEMT trips are a Medicaid benefit. Your state pays for them directly or through a transportation broker that assigns trips to enrolled providers. You enroll with the state or the broker, meet its vehicle and driver rules, and bill per trip. Private-pay and facility contracts are the other sources.
Does an NEMT vehicle have to be wheelchair accessible?
Under federal ADA rules, a private company primarily in the business of transporting people, running on-demand service, must buy new vehicles with 8 or more seats accessible, unless its service as a whole gives riders with disabilities equivalent service (49 CFR 37.103). Brokers usually want accessible vehicles anyway, because wheelchair trips are part of the work.
Do I need a CDL to drive an NEMT bus?
Not under federal rules if the vehicle is built for 15 or fewer people including the driver and rated under 26,001 lb. Count wheelchair positions as seats. Use the CDL checker to test a specific bus.
How much does it cost to start an NEMT business?
The vehicle is the largest single cost, and this page shows what dealers are asking for used paratransit buses now. The rest depends on your state and broker, so get quotes for insurance, enrollment and permits before you buy the vehicle.