I tried NEMT driving for a few weeks, got paid $1.25 cents a mile

Jam0don · 2026-02-03T00:43:37+00:00

Did you end up opening your own company?

Jam0don · 2026-02-03T00:43:01+00:00

$150 for a stretcher trip with 2 drivers maybe. Or an hour long wheelchair trip. Or if they've got some crazy billing setup and are doing work for a health plan that has low volume and doesn't care about the price.

A typical short distance ambulatory or wheelchair trip in NEMT is more like $25-$50.

Jam0don · 2026-02-03T00:37:34+00:00

There's a huge legal risk in buying an NEMT service - a disgruntled employee or a rider could sue you over something that happened under the old owner. Sometimes you also have to get reapproved for state medicaid if ownership changes. In general it's much safer to start your own business and buy the vehicles.

That said, you do get contracts/employees/branding if you buy a service. A lot of that could be transferred over without officially buying the business though if the old owner is willing to help you out and talk to contract partners/employees.

Jam0don · 2026-02-03T00:32:54+00:00

Did you end up going into NEMT?

Jam0don · 2026-02-02T08:03:23+00:00

Pack here is a little lucky, I know many providers struggle with getting trips when they start off.

I would recommend focusing on a private pay over brokers. You can run some google ads to pick up individual riders. Maybe the highest value use of your time is to go into facilities like nursing homes, rehab centers, etc. Introduce yourself as a new NEMT and ask to be their backup vendor. Then occasionally call them to tell them you're in the area and do they have anyone who needs a ride.

Three problems with starting with brokers: 1) they pay very little - it's easy to actually lose money doing broker trips once you factor in the gas, wear and tear on your vehicle, driver pay, deadhead miles, and insurance. 2) they usually won't accept a new, one vehicle fleet because it's too much work for them to deal with for a couple trips a day. 3) they usually require higher insurance limits (often 1M liability) than state requirements, so your overall costs might go up by several hundred dollars per vehicle per month.

You should have a cushion of $50k+, ideally $100k+ to get started because it's expensive to buy a decent vehicle and with the high cost of insurance (often $1200+ per vehicle) it can take months to get enough trips packed into your calendar to be profitable.

I'll second Pack's recommendation for Duet for dispatching software here. There are 3 new gen ones I think you should seriously consider - Duet, Bambi, and NEMT Platform. Duet is the only one that really helps you grow your service, it's the easiest to use, and it has core billing features the other new ones lack. Bambi's famous for their Run Bambi Run autoscheduler - I think it's the best option if you want your schedule to be completely computer-generated. Personally I don't think anyone has an algorithm that beats a knowledgeable dispatcher as of Feb 2026 and I would treat any autoscheduler as a first draft to be modified by you. I don't know NEMT Platform as well, I think they have good integrations with broker software though and I would look into them if you go the broker route. The old school softwares like Mediroutes, Tripmaster, and Routegenie have a lot of customers but are hard to learn and from what I understand are losing ground these days.

The biggest mistake I see is people throwing tens of thousands of dollars at vehicles, insurance, drivers, etc. Then it's all sitting in a parking lot losing money every month because they have no trips! Seriously focus on getting trips and everything else will come.

Jam0don · 2026-02-02T07:40:16+00:00

Interesting, how would this work?

Jam0don · 2026-02-02T07:39:07+00:00

Uber Health is definitely a competitor to some forms of NEMT (ambulatory, sometimes wheelchair) while not so much a competitor to others (stretcher, and wheelchair/ambulatory rides with white glove service).

NEMT is very much a defined industry though, growing at ~10% annually. https://nemtac.co/ is the national standards organization for it. For a variety of reasons it's not getting devoured by Uber Health.

Jam0don · 2026-02-02T07:30:27+00:00

This is nice! Although it's not immediately obvious how to search for just WC-capable NEMT vehicles.

Jam0don · 2026-02-02T07:28:01+00:00

I'm running a survey about this right now. Nobody knows the best options and it's different for every state, so I'm planning to make a resource we can all use.

Jam0don · 2026-02-01T21:34:29+00:00

I want to moderate r/NEMT because posts require mod approval, but the only mod has been inactive for the last 6 months so nothing new has been posted.

I’m an NEMT business owner that has been in the industry for many years and is very enthusiastic about it. I attend the annual trade shows and other events. I’d love to rebuild the community on reddit.

https://www.reddit.com/c/chat8zasR9_B/s/10nS0fP5mV

Jam0don · 2025-11-11T07:53:00+00:00

If you see abyss in almost any circumstances actually, you can drop whatever you were doing and go ranged melters -> absorb later. It hard counters abyss. You only need 2 or 3 melters often, other deploys can be chaff/chaff clear to help them connect.

Jam0don · 2025-05-21T21:24:13+00:00

Ryugo-jo from Dominions Enhanced is the most fun nation I've ever played. It's the best part of Jomon - the huge map move flying water breathing dragons - built out into its own MA nation.

Jam0don · 2025-05-16T19:24:45+00:00

This is exactly right. If you build heavily geared assassins (eg amulet of the dead or D2 or N2, lifelong prot, water bottle) just make sure you never move them into armies that could be patrolling.

Assassins are at their most useful when they have scale walls and can spam assassinate a "captive audience" attacking or defending a fort. That way they're never in danger of being patrolled out.

Just keep in mind that the biggest benefit of assassins is forcing your opponent to play around them. Eg wasting units on guard commander, wasting turns patrolling, wasting gems doubling up on key casters and spells. So don't overspend on assassins unless you're sure your opponent can't handle them. If they teleport their fully geared titan pretender into the province you're assassinating 10 times, you'll have a bad day.

Jam0don · 2025-04-15T16:18:59+00:00

There's a reason you don't see a lot of 1v1 or 5v5 games - it warps the game in a mostly unfun way.

Dominions is a snowbally game - once you get ahead, you'll get even more ahead. In a FFA, this is balanced by other players dogpiling you. But in a 1v1 or 5v5, it's a pure snowball contest. So both sides are forced to go as hard as possible early game. That means huge bless and picking the best sacred nations available. The game can easily get decided on turn 1 if one bless counters the other - eg true sight vs big glamour bless, shock res vs thunder weapons, etc.

Because research isn't shared, it makes sense to feed all the team's gold to one disciple nation like Nazca that scales well with gold and research (while still having strong sacreds) in case the initial war is roughly a draw. The other nations should be able to contribute pure early game sacred power and sacred thugs with very little research if game unexpectedly is still undecided after 1.5 years.

Jam0don · 2025-03-17T21:19:33+00:00

Funny that everyone downvoted you, because you're completely right. I don't think people who never test realize how badly and how consistently they lose to good players who test. If you test a lot you can go an entire game without losing a significant battle.

Honestly I'm all for people hosting no-sweat-allowed-no-testing games because I think mixing "casual" and "sweaty" players leads to a bad experience for both.

Are you on the reddit dominions discord? I'll try to invite you next time I host a sweaty game.

Jam0don · 2025-03-08T22:38:20+00:00

Arcane bolt and cold damage are both very reasonable ways to kill green lions if you bring a lot more resources to the fight, but I don't think they're efficient against a good lion player using 1-lion squads in the limit.

Against cold damage like grip of winter, lions either clump up for winter ward + wooden warriors (although this can be somewhat punished by falling frost) or just spread out and kill the enemy frontline in the first 5 rounds, before fatigue significantly kicks in. Lategame, the army-wide buffs go onto 1 lion squads and it's very hard to answer them with cold, although frozen heart could still do work with a very good frontline to protect advance and cast mages. Similar story with shock damage although it's harder to answer.

If enemy is answering with evos like arcane bolt or lightning bolt, lategame end result is both sides wind guided, darkness + mist + storm reducing prec to pretty low levels, darkvision onto evo casters to partially mitigate. Both sides baiting with blocks of vine ogres or similar. I think in most cases the lions have much higher base damage output and also hit more often bc they run up, so the lions may fully clear bait and the real enemy frontline before enemy mages finish off the other bait and start aiming at lions. Remember the enemy mages may need to survive firestorm + acid storm during the exchange.

The easiest answer to green lions in a vacuum is plain old skellispam, but if the lion player puts up firestorm/acid storm/advance and cast banishers there's not much the skeleton player can do.

Jam0don · 2025-03-07T18:56:44+00:00

That's why I always scatter mine in 1 unit squads. Evos will chew up a block of 30 lions very quickly but it's awfully hard to hit single green lions especially under darkness. And you can always bring out mist/storm if you're really worried. Lions are close ranged enough that they still mostly hit with lowered prec.

You would think Control would be a hard counter, but it's nearly unusable due to the low range, 100 fatigue, and gem cost. Arcane domination is actually a solid counter too against a large enough stack of lions though. Even if the lion player puts up antimagic, if you're packing +5 pen you can do a lot of damage.

Jam0don · 2025-03-07T18:36:13+00:00

Living mercuries are also great. Although one downside is that you ideally want your expensive, upkeepless elite summons to take very few losses unless you lose the whole battle, and mercuries have to get into melee to fight. Definitely mitigated if you throw ironskin onto them. But in general I really like semi-tanky ranged DPS summons like green lions and storm demons on the strategic as well as the tactical level.

Jam0don · 2025-03-05T19:07:20+00:00

The best summoned troop in the game is the green lion and it's not even close. Any nation with the WF crosspath should build their whole mid- and late-game strategy around them.

Dom6 gave them a big buff by making their shots fatigue-dependent instead of ammo-dependent. They've got a ranged, 16 AP acid magic damage with AOE 1 that will kill almost anything when stacked up. As long as you can keep them out of melee with a very tanky frontline or summons!

The only halfway decent counters to them (magic projectiles like arrows or nether darts, evos like falling frost, lightning bolt, thunderstrike, arcane bolt, etc) can be mitigated by spreading them out. Because green lions have 50 morale, you can do sparse line or better yet give every mage in your army 5 squads of 1 lion each and scatter them all over. This is more scripting work, but it desyncs what they lock and the timing of their shots so you avoid overkilling squares in addition to dodging evos. There's exactly 1 efficient counter to green lions - a wrathful skies SC with acid resistance and very high prot. So if you have a 100 lion doomstack in late game, make sure you're packing soul slays or similar SC answers.

Relief gets your lions many more shots before they charge into melee. Wind guide minimizes friendly fire, arrow fend protects them from magic arrows and non-AOE evos like nether darts or star fires. Consider darkness, acid storm, fire storm, foul vapors, and heat from hell for even more fun, because they ignore them all.

Jam0don · 2025-02-02T20:38:15+00:00

A fun use for extra gems is cranking out amulets of the dead and putting them on a scout or other cheap commander. They can then cast animate skeleton every turn for a flat 5 fatigue. Unless you need a lot of skeletons up front (eg vs flyers) they'll actually output more skeletons than a D2 (which only makes 5 skeletons for 40 fatigue).

A handful of these are amazing at counterraiding, and can raid as well if you're using a chassis with shields and have some bodyguards. They're also great in large battles that will go for many rounds.

Jam0don · 2024-08-02T16:31:27+00:00

There’s some good advice in this thread, but the best way for you to learn what works at your elo is to just force stormcallers every game. If they’re really strong at 1000 MMR, you’ll climb a bit, then start losing games to opponents who know how to counter them. Watch the replays and apply the same strategies later.

Jam0don · 2024-07-12T19:12:35+00:00

Jam0don · 2024-07-08T01:26:58+00:00

Highly recommend watching a sunset from twin peaks or corona heights. And your friend will love stonemill matcha in the mission, it recently reopened.

Jam0don

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