State Medicaid agencies across the country are facing an unexpected challenge: finding qualified vendors to manage their Non-Emergency Medical Transportation (NEMT) programs. Over the past 18 months, we've observed a telling pattern—procurement deadlines being extended not once, but multiple times. This isn't just administrative inconvenience; it signals a fundamental shift in the NEMT marketplace that demands attention.
The NEMT industry has experienced significant consolidation, with major brokers acquiring smaller regional players at an unprecedented pace. While consolidation can bring operational efficiencies, it's creating unintended consequences for state procurement processes. Fewer competitors mean fewer responses to RFPs, limiting states' ability to select vendors that best meet their unique needs and forcing procurement teams back to the drawing board.
Modern NEMT procurements come with substantial requirements: sophisticated technology platforms, extensive reporting capabilities, and stringent Service Level Agreements (SLAs) backed by liquidated damages. These requirements are necessary to ensure program integrity and member access, but they create a high barrier to entry.
Regional transportation providers, smaller entities, and emerging healthcare technology companies that bring innovation and local expertise to the table often lack two critical components: the financial reserves to absorb potential liquidated damages and the demonstrated experience at scale that scores well in procurement evaluations. This creates a catch-22—states need diverse vendor options, but the very requirements designed to protect their programs may be limiting their choices.
Too often, current RFPs unintentionally stifle innovation. By focusing heavily on traditional broker models and established operational frameworks, procurement requirements often leave little room for transformative approaches that technology-enabled solutions can offer. The irony is that while states seek modernization, their RFPs may be anchored in legacy thinking that prevents truly innovative solutions from competing.
This isn’t just theoretical—HMA’s interviews with state Medicaid officials revealed that states themselves are recognizing the need to expand traditional broker models and welcome technology companies that bring fresh perspectives on efficiency, transparency, and member experience.
When procurement options narrow, states lose more than just choice. They lose negotiating leverage, innovative solutions, and the competitive pressure that drives continuous improvement. Extended procurement timelines delay program improvements and can leave current contracts in limbo, ultimately affecting the members who depend on these services.
States have a chance to redefine NEMT procurement—not just to fill contracts, but to build interoperable, transparent systems that restore accountability and trust.
“When states repeatedly extend NEMT procurements, they're telling us the market needs transformation, not just iteration," said Sufian Chowdhury, CEO of Kinetik. "State Medicaid agencies need partners who can deliver more than traditional broker models—technology platforms that modernize how the NEMT benefit is delivered, providing real-time visibility, reducing program integrity risks, and creating the transparency needed to serve their most vulnerable populations.”
This shift requires a multi-faceted approach:
Expand beyond traditional broker models State Medicaid agencies should consider opening their doors to non-traditional partners. Technology companies are already transforming benefit delivery through innovative program models, backed by proof of concept from leading health plans. These new entrants bring fresh perspectives on efficiency, transparency, and member experience that traditional brokers may struggle to match.
Create innovation forums States should establish formal opportunities for technology companies to present new ideas, concepts, and case studies before RFPs are written. These innovation sessions would allow states to understand emerging capabilities and real-world results from new delivery models, ensuring future procurements can accommodate and encourage these advances.
Design RFPs for tomorrow, not yesterday Armed with insights from innovation forums and pilot programs, states can craft RFPs that welcome rather than exclude transformative approaches. This means moving beyond prescriptive requirements that assume a single delivery model and instead focusing on outcomes while allowing flexibility in how vendors achieve them.
Consider tiered opportunities Creating pathways for vendors to demonstrate capabilities through pilot programs or limited-scale implementations can build a stronger, more diverse vendor ecosystem while managing risk.
This approach aligns with findings from Health Management Associates’ 2025 State Medicaid Non-Emergency Medical analysis, where health policy experts emphasize the importance of stakeholder engagement before RFPs are written.
The extended procurement timelines we're witnessing aren't just administrative delays—they're symptoms of a market in transition and an opportunity for transformation. By embracing technology partners, creating space for innovation, and designing procurements that reflect the art of the possible, states can build a more competitive, innovative NEMT ecosystem.
The goal isn’t just to fill today’s procurements—it’s to build a market where innovation thrives, competition drives progress, and members get to care on time. The future of NEMT lies not in choosing between traditional brokers and new technology companies, but in creating a marketplace where both can compete, collaborate, and drive the industry forward.