The Overlooked Revenue Stream in Home Care: Getting Paid Twice for the Same Client

The Conversation No One Is Having

In the home care industry, most conversations sound the same:

• How to get more clients
• How to staff caregivers
• How to pass surveys
• How to increase hours

But there’s a smarter question that more CEOs should be asking:

👉 How do you increase revenue without increasing your client load?

Because the truth is…

Many agencies are already sitting on untapped revenue — not because they lack clients, but because they haven’t expanded how they serve them.

One of the most overlooked opportunities?

Non-Emergency Medical Transportation (NEMT)

Getting Paid for the Same Client — The Right Way

In healthcare, services are segmented.

That means:

• Personal care = one billing structure
• Skilled services = another
• Transportation = separate

So when a client needs:

• In-home care
• Transportation to appointments
• Transportation to dialysis
• Transportation to social activities

👉 These are not bundled services

They are billed separately.

Which means:

One client can generate multiple streams of revenue — legally and strategically.

What Is NEMT vs. Transportation in Home Care?

This is where many agencies get confused.

NEMT (Non-Emergency Medical Transportation)

A standalone service that provides rides for individuals to:

• Medical appointments
• Dialysis
• Therapy
• Behavioral health visits

👉 You are billing for the transportation itself

Transportation in Home Care

When agencies say they “provide transportation,” they usually mean:

• A caregiver accompanies the client
• The caregiver assists during the visit

👉 You are billing for caregiver time — NOT the ride

Key Compliance Insight

You cannot bill for both:

❌ Transportation as a separate service
AND
❌ Home care services for the same trip

…under the same structure.

This is why NEMT is often set up as a separate business entity.

What Does NEMT Pay?

Rates vary by state, broker, and service level, but here’s a realistic breakdown:

🚐 Medicaid (Broker-Based)

• Base rate: $20 – $50 per trip
• Mileage: $1.50 – $3.50 per mile
• Wait time: Additional in some cases

💳 Private Pay

• Base rate: $50 – $150 per trip
• Hourly wait time: $25 – $75+

🔁 Real Revenue Insight

One dialysis client:

• 3 trips per week
• ~$40–$70 per trip

👉 $480 – $840/month
👉 $5,000+ annually

From one client

The Demand Is Already There

The most requested trips include:

Weekly:

• Dialysis (3x/week)
• Physical therapy
• Adult day programs

Monthly/Ongoing:

• Doctor visits
• Specialist appointments
• Mental health services

Lifestyle:

• Grocery trips
• Church
• Social outings

👉 This is recurring, predictable demand

 Where the Work Actually Comes From (Brokers)

Here’s what many people don’t realize:

👉 You don’t find most of your clients — the system already has them.

NEMT operates through brokers and managed care networks that assign trips to providers.

Key Brokers Include:

• ModivCare (major player in VA, SC, and multiple states)
• MTM (Medical Transportation Management)
• Verida
• Tennessee Carriers (primary in TN)

 How the System Works

Medicaid
⬇
Managed Care Organizations
⬇
Brokers
⬇
You (Provider)

👉 Brokers control:

• Trip assignments
• Scheduling
• Payments

State Insight: What to Expect

Some states are more structured than others.

🔒 More Regulated:

• New York
• California
• Maryland
• Virginia

⚖️ Moderate Structure:

• North Carolina
• Florida
• Tennessee

🟢 Opportunity Markets:

• South Carolina
• Georgia

Common requirements include:

• Commercial insurance
• Vehicle inspections
• Driver background checks
• Broker credentialing

What Smart Operators Are Realizing

Recently, I hosted a training with:

👉 15 Home Care CEOs
From:
Maryland, Virginia, Tennessee, North Carolina, South Carolina, Florida, and Georgia

They all showed up for similar reasons:

• Clients are already asking for transportation
• They see the demand
• They want to expand their revenue

 What Attendees Are Saying

“I’m so excited to add this new service to my roster.”

“Very informative! Great information was shared.” ⭐⭐⭐⭐⭐

The Strategic Advantage

Adding NEMT allows you to:

• Increase revenue per client
• Control more of the client experience
• Reduce reliance on outside providers
• Build a multi-service business model

The Cost of Ignoring This

If you are currently:

• Driving clients yourself
• Coordinating transportation
• Referring clients out

Then:

👉 Someone else is getting paid for your client

The future of home care is not just about care.

It’s about integration.

The agencies that grow the fastest are the ones that:

👉 Expand their services
👉 Recognize patterns
👉 Act on opportunity

Because opportunity doesn’t always show up loudly…

Sometimes it shows up in what you keep seeing over and over again.

 Closing Question

Are you just serving your clients…

Or are you maximizing the opportunity they represent?