Non-emergency medical transportation (NEMT) has experienced tremendous growth over the past decade. The industry is no longer dominated solely by large transportation companies. The rise of rideshare technology and more accessible business opportunities has opened the door for entrepreneurs across the country to enter the market. As demand for reliable transportation continues to grow, many aspiring business owners have become attracted to the NEMT industry as a way to build a meaningful and profitable business while providing an essential service to their communities.
If you are starting a Non-Emergency Medical Transportation (NEMT) business, one of the most important decisions you will make is choosing the right wheelchair accessible vehicle.
Unfortunately, this is also where many new operators make their first expensive mistake.
New business owners often receive advice from other transportation providers based solely on their own experience. Others call a mobility dealer and assume the salesperson will help them determine exactly what they need. Sometimes they will. Other times, the recommendation is influenced by what happens to be sitting on the dealer’s lot.
Before purchasing anything, you need to understand the different types of wheelchair accessible vehicles, what each is designed to do, and—equally important—what you probably don’t need.
For most NEMT startups, a rear-entry wheelchair accessible minivan is one of the most practical places to begin.
First: Understand the Two Types of Rear-Entry Conversions
Although several minivan chassis can be converted for wheelchair accessibility, not every minivan can be converted. Before purchasing a vehicle with plans to have it converted, always confirm that the exact year, make, model, and configuration is compatible with the conversion you intend to purchase.
Once you have selected an appropriate chassis, rear-entry minivan conversions generally fall into two categories:
- Short-channel conversion
- Long-channel conversion
The difference is extremely important.
Short-Channel Rear-Entry Conversion
The short-channel conversion—often called a “short cut” within the mobility industry—lowers the floor from the rear of the vehicle forward to approximately the second-row seating area.
It is generally designed to accommodate:
- One wheelchair passenger
- Two ambulatory passengers in the second-row factory seats
The primary advantage is simplicity and cost. Because less of the vehicle floor is modified, a short-channel conversion is typically less expensive than a long-channel conversion.
This can be an excellent choice for an NEMT provider whose business consists primarily of ambulatory transportation but occasionally receives wheelchair transportation requests.
However, if wheelchair transportation will be an important part of your business, the long-channel conversion provides considerably more flexibility.
Long-Channel Rear-Entry Conversion
A long-channel conversion extends the lowered floor farther forward into the second-row area.
Depending upon wheelchair size and configuration, a long-channel van can potentially accommodate:
- One standard wheelchair
- Two wheelchairs positioned front-to-back
- One larger tilt-in-space wheelchair
- A stretcher
- Ambulatory passengers when the second-row seats are deployed
This versatility is one of the primary reasons we generally prefer long-channel conversions for NEMT applications.
There is, however, an important tradeoff.
When transporting two wheelchair passengers, a large tilt-in-space wheelchair, or a stretcher, the second-row seats normally must be folded out of the wheelchair channel.
Most quality long-channel conversions accomplish this by remounting the factory second-row seats onto specialized bases that allow the seats to flip outward toward the sliding doors. Within the mobility industry, these are commonly referred to as “butterfly seats” because the seats resemble wings when folded outward.
When the seats are deployed normally, they provide comfortable factory seating for ambulatory passengers. When additional wheelchair space is required, they can be moved out of the way.
That flexibility is extremely valuable in NEMT.
What About Stretcher Transportation?
A properly configured long-channel rear-entry minivan can also accommodate a stretcher.
Because of the stretcher’s length, it will generally occupy both the second- and third-row areas. Therefore, the conventional second-row seating cannot normally be occupied at the same time.
Stretcher transportation also requires specialized securement equipment commonly referred to as an “antler system.” This equipment secures the stretcher to the vehicle during transportation.
Do not assume that simply having enough interior room makes a vehicle properly equipped for stretcher transportation. The appropriate securement equipment and vehicle configuration are essential.
Understanding Wheelchair Securements
Wheelchairs must also be properly secured during transportation.
Commercial wheelchair accessible vehicles commonly use retractable wheelchair restraints that attach to L-track installed in the vehicle floor. L-track is widely used throughout the commercial transportation and mobility industries because it allows securement equipment to be positioned where needed.
A single wheelchair position requires a complete wheelchair securement system. A vehicle configured to transport two wheelchairs will require securement equipment for both wheelchair positions.
Two of the best-known manufacturers in this industry are Q’STRAINT and Sure-Lok. New NEMT operators should familiarize themselves with wheelchair tie-down and occupant restraint systems before transporting their first passenger.
This is not equipment you want to learn about after your first customer is already sitting in the van.
Be Careful With “Jump Seats”
Some rear-entry conversion manufacturers offer small aftermarket seats instead of retaining the factory second-row seating. These are commonly referred to as jump seats, and commercial seating manufacturers such as Freedman Seating produce several configurations.
Jump seats can serve a legitimate purpose, but new operators need to understand what they are—and what they are not.
These seats are generally compact and designed for commercial applications where maximizing interior space is more important than long-distance passenger comfort. They can be useful for an attendant, caregiver, nurse, or other accompanying passenger, particularly when a wheelchair or stretcher occupies much of the interior.
Where buyers sometimes get confused is capacity.
A salesperson may explain that a particular configuration technically allows two wheelchair positions while retaining additional seating. That may be physically possible, but “possible” and “practical for everyday NEMT service” are two very different things.
Do not purchase a vehicle around an extremely rare transportation scenario while compromising the comfort and usefulness required for the overwhelming majority of your trips.
For most startups, the likelihood of routinely transporting two wheelchair users plus multiple ambulatory passengers simultaneously is extremely low.
Buy for the business you expect to perform every day—not the unusual trip you might encounter once in a great while.
Do You Need a Full-Size Wheelchair Van?
New operators are sometimes convinced that they need to begin with a full-size commercial van such as a Ford Transit or Ram ProMaster equipped with a hydraulic wheelchair lift.
For most startups, we believe this is unnecessary.
A properly equipped full-size commercial wheelchair van can easily represent a $70,000–$90,000 investment depending upon the chassis, lift, seating configuration, and equipment.
You also need to consider:
- Higher acquisition cost
- Greater fuel consumption
- More expensive commercial equipment
- Hydraulic lift maintenance
- Additional potential downtime
- Higher replacement and repair costs
For an established transportation company with multiple vehicles, these expenses may make sense for certain routes or passenger requirements.
For a startup operating one vehicle, downtime can be devastating.
Your vehicle isn’t simply transportation—it is your revenue-producing equipment. If the van isn’t moving, you aren’t generating transportation revenue.
Why We Prefer Manual Rear-Entry Ramps
One of the greatest advantages of a rear-entry accessible minivan is its simplicity.
Most commercial rear-entry minivans use a manually operated, spring-assisted and counterbalanced bi-fold ramp. The ramp can be deployed and stowed in seconds without complicated electronics or hydraulics.
That means there is very little to maintain.
In the NEMT business, simple is good.
Every unnecessary motor, hydraulic pump, electronic controller, sensor, or mechanical component represents another potential failure point. For a startup without a backup vehicle, reliability should take priority over bells and whistles.
As the business grows, instead of purchasing one extremely expensive full-size vehicle, an operator can add additional rear-entry minivans to the fleet.
And remember: one $90,000 van still cannot be in two places at once.
Two properly configured minivans can.
That is why MHVans generally recommends building an NEMT fleet around reliable rear-entry accessible minivans and adding specialized full-size vehicles only when actual transportation volume demonstrates a legitimate need.
Understanding ADA Dimensions
NEMT operators should also understand the dimensional requirements that may apply to their vehicles, contracts, and operating jurisdiction.
For ADA-oriented commercial applications, two dimensions you will frequently encounter are approximately:
- 56 inches of vertical entrance clearance
- 30 inches of usable ramp width
However, vehicle compliance should never be determined from two measurements alone. ADA, DOT, state, local, Medicaid, broker, and contract requirements can vary depending upon how and where the vehicle is operated.
Before purchasing a vehicle, verify the requirements applicable to your specific business and transportation contracts.
Don’t Get Distracted by the “Widest Ramp”
Ramp width has become a major marketing point among wheelchair conversion manufacturers.
You will see ramps advertised at 30, 32, 34, and even 36 inches wide.
Naturally, a new buyer assumes wider must be better.
Not necessarily.
A ramp can be extremely wide at the rear entrance while the usable interior wheelchair channel becomes narrower farther inside the vehicle. The wheelchair still has to fit through the entire usable space—not simply across the ramp.
For most NEMT applications, a properly designed ramp and interior channel in the 32- to 34-inch range will accommodate the overwhelming majority of wheelchair passengers.
Extremely large bariatric wheelchairs represent a much smaller segment of the market and may require a full-size commercial vehicle equipped specifically for bariatric transportation.
Trying to configure your first vehicle around every conceivable passenger can result in spending substantially more money to serve a very small percentage of potential trips.
That is backwards.
A startup should concentrate first on the vehicle capable of reliably serving the largest percentage of its anticipated business.
The Bottom Line
For someone entering the NEMT business, vehicle selection should be based on reliability, versatility, operating cost, passenger comfort, and the types of transportation requests you will realistically receive.
For most startups, a long-channel rear-entry wheelchair accessible minivan provides an excellent balance.
It can handle standard wheelchair transportation, potentially accommodate two wheelchairs when properly configured, provide additional room for larger tilt-in-space wheelchairs, and can be configured for stretcher transportation. At the same time, factory-style second-row seating can remain available for ambulatory passengers when the additional wheelchair space isn’t required.
Most importantly, the manually operated rear-entry ramp keeps the conversion mechanically simple and inexpensive to maintain.
Don’t buy your first NEMT vehicle based on the biggest ramp, the longest equipment list, or what happens to be sitting on someone’s lot.
Buy the vehicle that makes financial and operational sense for the transportation business you are actually building.
At MHVans.com, we have spent decades working with wheelchair accessible vehicles and understanding what works—and what creates unnecessary expense. This NEMT education series is designed to help new transportation providers understand the equipment before they spend their money.
Because the least expensive mistake in this business is the one you avoid before you buy the van.