Buy a Non-Emergency Medical Transport Company in San Antonio, TX
The San Antonio NEMT Market
San Antonio's size makes it one of the stronger NEMT markets in Texas. The city's population skews older than the national average, Medicaid enrollment is high relative to median income, and CareLink, University Health, and a dense network of dialysis centers all generate consistent transport demand.
That demand is not going away. The aging population, the continued expansion of Medicaid managed care, and the shift toward outpatient care all point toward steady ride volume for well-positioned operators.
NEMT is also relatively recession-resistant. Patients need dialysis three times a week regardless of what the economy is doing. That recurring, contracted revenue is exactly what SBA lenders want to see.
NEMT Deal Economics in San Antonio
Based on national NEMT listing data across roughly 30 active listings, the median asking price is $587,500, with median annual cash flow around $200,000. That implies a 3.4x multiple, which sits comfortably within the SBA 7(a) sweet spot of 3x to 5x EBITDA.
According to Regalis Capital's deal team, the median asking price for a non-emergency medical transport company is $587,500, based on national listing data across approximately 30 active listings. At roughly $200,000 in annual cash flow, these deals trade at a 3.4x multiple, within standard SBA 7(a) underwriting parameters for acquisition financing.
A note on the cash flow figures: most NEMT listings report SDE, which includes the owner's salary and other personal add-backs. Discount SDE by 15% to 30% to approximate what a new owner-operator will actually clear after replacing themselves. Always verify cash flow against Medicaid remittance statements and bank deposits, not just the broker's spreadsheet.
Sample deal math at the median asking price:
| Line item | Amount |
|---|---|
| Asking price | $600,000 |
| SBA 7(a) loan (90%) | $540,000 |
| Seller note on full standby, 0% interest (5%) | $30,000 |
| Buyer cash (5%) | $30,000 |
| Total equity injection (10%) | $60,000 |
| Annual debt service (approx., 10-yr, ~10.5%) | $88,000 |
| Annual cash flow | $200,000 |
| DSCR | ~2.3x |
These are rough estimates based on market data. Actual terms depend on individual qualification and lender. The seller note on full standby means no payments during the SBA loan term, which is the structure we achieve on the large majority of our deals.
At a 2.3x DSCR, this deal clears our 2x target comfortably. Even at a 1.5x floor with a conservative cash flow haircut, the math holds for a qualified buyer.
What to Look for in a San Antonio NEMT Acquisition
Regalis Capital's analysis of NEMT acquisitions shows the most important due diligence items are Medicaid contract transferability, vehicle condition and fleet age, driver credentialing compliance, and broker rate agreements. Revenue concentration in a single payer or broker contract is the most common deal risk in this category.
Medicaid contract transferability. In Texas, NEMT Medicaid trips are coordinated through managed care organizations (MCOs) and brokers like MTM and Modivcare. Confirm that the contracts transfer to a new owner and that the broker relationships are not personally tied to the seller. If they are, you are buying a vehicle fleet, not a business.
Revenue concentration. A business doing $200,000 in cash flow from three MCO contracts is more defensible than one where 80% of revenue runs through a single broker. Ask for a payer-by-payer breakdown going back at least two years.
Fleet condition and compliance. Each vehicle needs to meet Texas HHSC requirements for NEMT. Request maintenance records, inspection reports, and odometer logs for every vehicle. Factor in deferred capital expenditures when building your acquisition model.
Driver credentialing. Texas requires NEMT drivers to hold a current defensive driving certificate and pass specific background check requirements under HHSC rules. Confirm the seller has current documentation on file for every driver. Compliance gaps here create immediate liability post-close.
Route density. Urban San Antonio routes are more efficient than rural county runs. Higher route density means lower cost per trip and better margins. Ask for a geographic breakdown of where trips are originating.
Local Considerations for San Antonio
San Antonio's NEMT market benefits from a large uninsured and Medicaid-eligible population. Bexar County's Medicaid enrollment figures consistently rank among the highest in Texas, which is a structural tailwind for any operator in this space.
CareLink, the city's indigent health care program, is a separate demand source worth understanding. It does not operate through standard MCO channels, so a seller with CareLink contracts may have revenue diversity that does not show up in a standard Medicaid analysis.
Competition is real. There are established multi-vehicle operators in San Antonio, and broker rate compression over the past several years has squeezed margins on standard Medicaid trips. The deals worth buying are those with a mix of facility contracts, private pay, and MCO business, not ones running purely on broker dispatch at the floor rate.
Frequently Asked Questions
How much does it cost to buy an NEMT company in San Antonio?
Based on national listing data, the median asking price for an NEMT company is $587,500, with prices ranging from $130,000 for small owner-operator setups to well over $1M for larger multi-vehicle operations. San Antonio deals tend to price in line with national medians given the market's size.
Can I use SBA financing to buy an NEMT company in Texas?
Yes. NEMT companies are eligible for SBA 7(a) acquisition financing. The standard structure is 90% SBA loan with a 10% equity injection, split as 5% buyer cash and a 5% seller note on full standby at 0% interest. At the median asking price of $587,500, buyer cash out of pocket is roughly $29,000 to $30,000.
What is the typical cash flow for an NEMT company at this price point?
At a median asking price of $587,500 and a 3.4x multiple, the implied annual cash flow is approximately $170,000 to $200,000. That figure is typically reported as SDE, so expect to discount it 15% to 30% to account for a replacement owner-operator salary and normalized expenses.
What happens to Medicaid contracts when an NEMT company changes ownership?
Contract transferability varies by MCO and broker agreement. In Texas, most MCO-based contracts require advance notice of ownership change and approval from the managed care organization. Some broker agreements, particularly with Modivcare and MTM, include assignment clauses that need to be reviewed before close. This is a critical due diligence item and a common deal risk.
How long does it take to close an NEMT acquisition using SBA financing?
A standard SBA 7(a) acquisition takes 60 to 90 days from signed LOI to close, assuming clean financials and no major due diligence issues. NEMT deals can run longer if vehicle title transfers, HHSC licensing, or MCO contract reassignments require additional lead time. Build that into your timeline.
Considering an NEMT Acquisition in San Antonio?
Regalis Capital's deal team reviews 120 to 150 acquisition opportunities per week. We help buyers find, evaluate, structure, and finance NEMT acquisitions using SBA 7(a) lending, with a specific focus on getting full-standby seller notes and protecting buyers from the contract and compliance risks common in this industry.
If you are seriously evaluating an NEMT company in San Antonio or anywhere in Texas, start with a deal assessment so we can run the numbers with you.
Frequently Asked Questions
How much does it cost to buy an NEMT company in San Antonio?
Based on national listing data, the median asking price for an NEMT company is $587,500, with prices ranging from $130,000 for small owner-operator setups to well over $1M for larger multi-vehicle operations. San Antonio deals tend to price in line with national medians given the market's size.
Can I use SBA financing to buy an NEMT company in Texas?
Yes. NEMT companies are eligible for SBA 7(a) acquisition financing. The standard structure is 90% SBA loan with a 10% equity injection, split as 5% buyer cash and a 5% seller note on full standby at 0% interest. At the median asking price of $587,500, buyer cash out of pocket is roughly $29,000 to $30,000.
What is the typical cash flow for an NEMT company at this price point?
At a median asking price of $587,500 and a 3.4x multiple, the implied annual cash flow is approximately $170,000 to $200,000. That figure is typically reported as SDE, so expect to discount it 15% to 30% to account for a replacement owner-operator salary and normalized expenses.
What happens to Medicaid contracts when an NEMT company changes ownership?
Contract transferability varies by MCO and broker agreement. In Texas, most MCO-based contracts require advance notice of ownership change and approval from the managed care organization. Some broker agreements, particularly with Modivcare and MTM, include assignment clauses that need to be reviewed before close. This is a critical due diligence item and a common deal risk.
How long does it take to close an NEMT acquisition using SBA financing?
A standard SBA 7(a) acquisition takes 60 to 90 days from signed LOI to close, assuming clean financials and no major due diligence issues. NEMT deals can run longer if vehicle title transfers, HHSC licensing, or MCO contract reassignments require additional lead time. Build that into your timeline.
Note: Deal economics, pricing, and cash flow figures referenced on this page are estimates based on aggregated listing data and general SBA acquisition math. Actual deal terms vary by business, market conditions, and lender requirements. This content is informational only and does not constitute financial advice.
Seriously evaluating an NEMT company in San Antonio? Start a free deal assessment with Regalis Capital's acquisition team.
Start Your Acquisition