Established NEMT Transportation Business, Illinois Non-Emergency Medical Transport

$720K

SDE

1.7x

Multiple

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Full Editorial Writeup

An excellent opportunity to acquire an established and profitable Non-Emergency Medical Transportation (NEMT) business operating in Illinois with multiple revenue channels and an established customer...

Why we like it

The reported cash flow of $720K against a $1.2M ask is a 1.67x multiple, which is unusually low for a healthcare-linked recurring-revenue service. If the earnings hold up in diligence, the payback period is well under two years, which gives a buyer real downside protection and room to service acquisition debt comfortably.
NEMT demand is non-discretionary and largely payer-funded. Patients on dialysis need three rides a week whether or not the economy is in recession, and those trips are billed to Medicaid, managed care, or facilities rather than a consumer's wallet, which makes the revenue sticky and defensible.
The listing cites multiple revenue channels and an established customer base, which suggests the business is not tied to a single broker contract. Diversified payer and facility relationships reduce the risk that one contract loss craters the P&L and give a buyer several levers to expand volume.
Aging demographics and rising chronic-care volumes in the Chicago suburbs create a structural tailwind. NEMT is a fragmented, mom-and-pop industry, which means an operator who professionalizes dispatch, billing, and driver retention can grow share and eventually roll up smaller competitors.

How to improve it

Audit and tighten the billing and claims process in the first 90 days. NEMT profitability lives or dies on clean Medicaid and broker claims submission, and small improvements in denial rates and days-to-collect can add meaningful cash flow without adding a single new ride.
Build a driver recruiting and retention engine. Turnover is the number one operational drag in this business, so standardizing hiring, pay bands, and scheduling reduces cancelled trips, protects on-time performance ratings with brokers, and directly increases billable volume.
Pursue additional broker and managed-care contracts. If the business runs through a limited set of payers, adding relationships with brokers like ModivCare or LogistiCare and direct dialysis-center accounts diversifies revenue and fills idle fleet capacity.
Implement routing and dispatch software to raise vehicle utilization. Better trip batching means more rides per vehicle per shift, which drops the marginal cost of each trip and expands margin on the existing fleet before any capital spend.
Formalize preventive maintenance and fleet lifecycle planning. Unplanned vehicle downtime kills revenue and reputation, so a disciplined maintenance schedule and staggered replacement plan protects both service ratings and capital budgeting.
Reduce owner dependence by documenting SOPs and installing a dispatch or operations manager. A low multiple often reflects a hands-on owner, so making the business manager-run both de-risks the transition and lifts the exit multiple down the road.

Diligence notes

Verify the $720K cash flow with tax returns, bank statements, and a full add-back schedule. NEMT deals frequently include aggressive owner add-backs, so reconcile reported SDE against actual deposits and confirm what expenses are being normalized out.
Map payer and customer concentration in detail. Ask what percent of revenue comes from each broker, managed-care org, and facility, because a business leaning heavily on one Medicaid broker carries real risk if that contract renews on worse terms or is lost.
Confirm the fleet's ownership, age, mileage, and condition. Understand whether vehicles are owned free and clear or financed, what the near-term replacement capex looks like, and whether that capex is baked into the earnings picture.
Review licensing, insurance, and regulatory standing. Confirm state and county NEMT authority, driver credentialing, DOT compliance where applicable, and the commercial auto insurance loss history, since claims exposure and licensing lapses can materially impair the business.
Investigate the reason for the low 1.67x multiple. Press on why the seller is exiting and whether the discount reflects owner burnout, a looming contract change, driver shortages, or reimbursement pressure, because the cheap price is only cheap if the earnings are durable.

Source

Originally listed on BizBuySell. View original listing →