Accessible & Medical Transport Fleet
The industry — Other transit and ground passenger transportation
Base industry report for 4859 →- Establishments · CanadaA
- 451
- Under 10 employeesA
- 72%
- Establishments · USA
- 5,996
- Employment · USA
- 86,874
- Payroll · USA
- $3.2B
Of 451 Canadian establishments with employees, 72% have fewer than ten — mostly small operators.
Entry signal — what decides who wins here
Execution decidesThe hurdles here are ones a better operator clears. That is not a promise of success — it is the absence of a structural reason you cannot win.
Get to the buyer. The product is reachable and the need is real; the channel is owned by someone else, and a route to it — a partner, a reseller, a trade relationship, a book of clients bought outright — is what has to be built.
Measured, not forecast: the share of US establishments opening in one year that were still active later. It counts good operators and bad ones together, which is exactly why it is the honest answer to “what are the odds”. It is for the whole sector rather than this market, and the ten-year figure comes from an older cohort because no younger one has reached ten years.
This is not a probability of success, and it is not a verdict on you. No survival probability is published per market, and inventing one would be worse than saying so. What the bar reads is how much of the outcome sits inside an operator's control: green means the hurdles are ones a better operator clears, red means the binding constraint is capital, an asset or a permission rather than execution. Someone arriving with an advantage this screen did not assume can win a market shown in red.
Companies named in this market · 3
The binding constraint — distribution
A residual code, screened through its two reachable niches: special-needs and non-emergency medical transport, and airport or hotel shuttles. The rest was not examined. (School bus contracting is its own record at 4854, despite the pre-screen note.) Entry is genuinely easy — a converted van, a commercial policy, a municipal licence — and the counts show it: 217 of 451 Canadian establishments have one to four employees [A], and the US industry is 5,996 establishments averaging about fourteen people on roughly $36,700 of payroll per head [A]. Demand is ageing-driven and not going away. The cut is that the operator never sells to the passenger. Trips are assigned by an intermediary that holds the payer's contract — in Canada the transit agency's paratransit programme or a health authority; in the US a Medicaid broker. Modivcare, the largest broker, shows how much of the money reaches the fleet and on what terms: on $1,957M of NEMT revenue in 2024, up 0.3%, it paid $1,505M to transport providers and kept an 11.7% gross margin, down from 12.4% [A] — and still filed Chapter 11 in August 2025 [A]. The payer squeezes the broker, the broker squeezes the per-trip rate, and the van owner at the end of the chain has no say in volume, routing or price and can be replaced by the next van. Airport shuttle, the other niche, lost its shared-ride customer to ride-hailing, the same shift the Taxi, Limousine & Rideshare Fleet record (4853) describes. Paratransit scheduling software is screened separately.
Trips begin and end inside one community and are dispatched under one payer's programme or one airport's permit. An operator's market is the volume that intermediary assigns within that territory; national spending on specialised transport is not addressable by a fleet.
Who you would be competing with
The operators already at scale here, and whoever is buying these businesses. In most of these industries the competition an entrant meets is local, so this is who sets the terms rather than a list of everyone in the trade.
Financials & market size — sourced
Figures that came from a filing, a results release or reputable reporting, each carrying its evidence tier.
Market size, derived
Built from the competitor set upward rather than quoted from a forecast. Published TAMs in these categories are frequently reverse-engineered from each other, so any published figure is checked against the vendor arithmetic rather than trusted on its own.
Disclosed revenue from 1 of 4 named vendors. The market is at least this large.
No vendor has both a disclosed revenue and a published share.
Only a revenue floor is known — the true market is larger by whatever the undisclosed vendors earn.
Competitor set · 4 named · 1 disclose revenue
| Name | Revenue | Share | Note |
|---|---|---|---|
| ModivcareA | $2.0B | — | FY2024 NEMT segment revenue — The US broker, not a fleet. It is the counterparty an operator negotiates with, and its own margin is 11.7%. |
| Transdev CanadaB | not disclosed | — | Bids for the paratransit and medical transportation programme itself, which is the layer that assigns the trips. Canadian revenue not disclosed. |
| Pacific Western Group of CompaniesB | not disclosed | — | Student Transportation of America's Canadian arm; 5,200+ employees on contracted student and employee transport. No revenue published. |
| The single-van owner-operatorA | not disclosed | — | 217 of 451 Canadian establishments have one to four employees. An entrant competes with these on nothing but availability and the rate the intermediary offers. |
Evidence
Evidence. Modivcare's segment figures were read in its FY2024 results release on EDGAR and the Chapter 11 terms in its August 2025 8-K [A]; the 77% share is derived by division. Counts are Statistics Canada and US County Business Patterns, with per-establishment and per-head figures derived [A]. Limits: Modivcare is a US Medicaid broker, and its distress owes much to its debt and its other segments, not only to NEMT. Canada funds this transport differently — mostly through municipal paratransit and provincial health programmes — and no Canadian contract rate, operator margin or programme budget was sourced, so the claim that the Canadian intermediary holds the same power over the fleet owner is reasoning by analogy. Nothing else in this residual code, including sightseeing-style and other shuttle services, was examined. The cut factor is analyst judgment.
Where the industry talks
The associations, forums and events where people in this trade actually talk shop — where to listen before entering, and where the first customers are found. Each link was opened on the date shown.
Community, paratransit and NEMT operators; annual EXPO conference (May 2026 Omaha). No member count stated.
ANSI-accredited nonprofit that sets NEMT standards and accredits providers; brings providers, brokers and payers together. Its old nemtac.org domain is parked.
NEMTAC's annual industry conference; 16-19 Aug 2026, JW Marriott Grande Lakes, Orlando; for providers, brokers, health plans, Medicaid agencies. No attendance figure stated.
Motor coach, shuttle and group-travel operators since 1929; runs the Ontario Transportation Expo (bus show) and OMCA Marketplace. No member count stated.
National body for coach and bus operators (scheduled, charter, transit, tour); member-funded. No member count stated.
No Canadian association for NEMT or accessible-van operators was found; Canadian operators surface through coach associations and municipal contracting. US NEMT owners also gather in vendor-run groups (e.g. Tobi's NEMT Growth Network), not listed.
Software serving this industry
Vertical software markets filed along the same branch of NAICS — who sells to these businesses, and who an entrant would have to displace.