Medicare-certified home-care agency or non-emergency medical transport serving Mercy Lourdes and Baptist Health discharge volume across a five-county regional trade area.

Two hospitals, simultaneous capex landing 2026 — Mercy Health Lourdes Hospital (~359 beds; 275 medical staff) completes a $98M tower-plus-central-utility-plant modernization Q2 2026 and the CON-approved radiation cancer-treatment facility is on an 18-month build from a 2024 award. Baptist Health Paducah (373 beds; ~2,000 employees) is mid-cycle on the Baptist Health Foundation Paducah first-ever comprehensive capital campaign.

Combined 732 beds across ~67K county population is 10.9 beds per 1,000 — regional-hub density. Effective trade area is the 5-county Jackson Purchase plus southern Illinois (Massac, Pope, Pulaski IL) plus west Tennessee (Weakley, Obion) — roughly 130K–160K.

Level-3 NICU is the only one in the region. Post-NICU discharge to home routinely needs skilled nursing visits, home phototherapy, apnea-monitor management, lactation support, and transport to follow-up neonatology clinic — a statutorily-reimbursed home-care line.

Cancer-center build adds outpatient transport demand. Radiation oncology runs 5-day-a-week courses for 4–8 weeks per patient; daily wheelchair and stretcher-van demand is real and recurring against a 10.9-beds-per-1,000 trade area.

Aging demographic plus cross-state pull. McCracken median age tracks above the Kentucky median; the 5-county Jackson Purchase trade area is older still. Mercy Health Home Care (225 Medical Center Dr, Suite 203) and Compassus Paducah Home Health both operate, but the published agency footprint is thin against the discharge denominator.

Calvert City wage-pull is the labor headwind. The Marshall County chemical corridor (~15 miles east) pulls hourly healthcare and transport workers out of Paducah on a wage basis; the home-care and NEMT bench is thinner than the discharge denominator alone would predict.

Statutory recurring reimbursement. Medicare home-health is reimbursed under the Patient-Driven Groupings Model (PDGM) at roughly $2,000–$3,000 per 30-day episode depending on case mix; Medicaid PCS and HCB waiver lines pay hourly. Kentucky NEMT is routed through the Medicaid transportation broker. The current broker is Verida (formerly Southeastrans); as of May 2026, we have not confirmed the active CHFS contract cycle.

Path A — Medicare-certified home-care agency: $150K–$400K total launch capital. SBA 7(a) viable; healthcare-services lenders include Live Oak, Huntington, Wells Fargo Practice Finance, First Citizens. KY OIG + CMS application + survey-readiness consulting $20–50K. Office lease + buildout (1,500–2,500 sf clinical office; no on-site patient-care space required) $15–40K. EMR + billing software + Year-1 SaaS + IT $25–60K. Licensure + bonding + malpractice + general liability + workers' comp Year 1 $20–45K. First 6–9 months of payroll through the certification gap $80–180K. Working capital + marketing + payor-credentialing-lag float $20–50K.

Path A stress scenario: $325K SBA 7(a) loan, 10.5% interest, 10-year term, monthly P&I ~$4,380, ~$52.5K/year debt service. Year 3 steady-state revenue (mid-range) $1.4M gross. Direct caregiver labor (40–50% of revenue under PDGM) $560–700K. Clinical leadership + scheduling/intake + biller (3–4 FTE) $230–310K. Office + EMR + insurance + overhead $90–140K. Debt service $52.5K. Owner take-home Year 3: $150–300K on $1M–$2M revenue (Medicare-heavy mix at the top, Medicaid-PCS-heavy at the bottom).

Path B — non-emergency medical transport: $200K–$500K total launch capital. Fleet acquisition (2–6 vehicles, new + late-model used) $120–350K. DOT compliance + commissioning + driver training $10–25K. Dispatch + scheduling software + IT $10–25K. Office + dispatch space $10–25K. Insurance Year 1 (the single largest fixed cost) $40–100K. First 4–6 months of payroll through Medicaid-broker payment-cycle lag $50–120K. Working capital + marketing $10–30K.

Path B stress scenario: $400K SBA 7(a) loan, 10.5%, 10-year term, monthly P&I ~$5,400, ~$64.7K/year debt service. Year 3 steady-state revenue (mid-range) $1.0M gross (4-vehicle fleet running 8,000–12,000 trips/year). Driver wages + dispatcher $380–460K. Fuel + maintenance + tires $90–140K. Insurance $55–110K. Office + software + overhead $40–70K. Debt service $64.7K. Owner take-home Year 3: $120–250K on $0.9M–$1.5M revenue.

Payer-mix discipline for the SBA underwriter. A 7(a) lender treats Medicare-dominant home-care as single-customer concentration risk — Medicare is one payer, not many, and a single Medicare-policy change can compress reimbursement system-wide. The bankable Year-3 mix on Path A targets no single payer above 45%: Medicare 35–45%, Medicaid Personal Care Services plus Home and Community-Based Services waiver 25–35%, private-pay 10–15%, long-term-care insurance 5–10%, VA Aid and Attendance 5–10%. The Aid and Attendance program reimburses up to roughly $2,300 per month for an eligible veteran's home-care, and the Paducah VA Outpatient Clinic at 2620 Perkins Creek Drive is the local referral channel. Long-term-care-insurance policy-holders pay $25–$45 per hour direct against carriers like Genworth, John Hancock, and Mutual of Omaha. On Path B, no single payer above 50%: Medicaid NEMT broker book 40–50%, direct hospital-discharge transport contracts 25–35%, dialysis-center contracts 15–25%, private-pay 10–15%.

• Mercy Health — Lourdes Hospital Case Management and Discharge Planning

  Referral source

  Active in market

  1530 Lone Oak Rd, Paducah 42003; 270-444-2444. We have not confirmed the current Director of Case Management as of May 2026.
• Baptist Health Paducah Case Management and Level-3 NICU discharge channel

  Referral source

  Active in market

  2501 Kentucky Ave; only Level-3 NICU in the region. We have not confirmed the current Director of Care Coordination as of May 2026.
• ContinueCARE Hospital at Baptist Health Paducah

  Step-down referral source

  Institution

  Long-term acute care unit on the Baptist campus; step-down to home is a structurally consistent referral source.
• Mercy Health Home Care — Paducah (225 Medical Center Dr, Suite 203)

  Mercy-system in-house competitor

  Active in market

  Reference benchmark on payor mix.
• Compassus Paducah Home Health

  National hospice + home-health operator

  Out-of-county

  Closest national-chain competitor in Paducah.
• Verida (current Kentucky Medicaid NEMT broker, formerly Southeastrans)

  Medicaid transportation broker

  Out-of-county

  As of May 2026, the active CHFS contract cycle has not been confirmed.
• Kentucky Office of Inspector General + CMS Region IV

  Licensure + Medicare certification

  Out-of-county

  902 KAR 20:081; 42 CFR Part 484 Conditions of Participation.

Three viable founder paths — none requires an MD/DO. (1) Retiring hospital case manager or discharge planner — a Mercy Lourdes or Baptist Health Paducah case-management RN or social worker with 15–25 years of inpatient-discharge experience knows the referral pattern, the families, the post-acute network, and the gaps. Often paired with a spouse handling business operations. Highest founder-quality lane for Path A; carries referral relationships into the new agency on day one. (2) Operator-founder with healthcare-admin background plus hired RN clinical leadership — former Baptist or Mercy administrator, or a 10–15-year veteran of Compassus, Mercy Home Care, Hospice of Western Kentucky, or VNA Health At Home, who runs the business while a hired director of nursing carries the clinical license. Capital-heavier because clinical leadership is paid through the certification gap. (3) Transportation or paramedic founder for Path B — former EMS paramedic, retired ambulance-service operator, or a former NEMT driver and dispatcher who has watched the demand-supply gap firsthand. Lower clinical bar, higher fleet-capex and insurance-management bar.

Not viable: out-of-state national chain entering on a corporate-staffed model (the explicit competitive risk hedge in §9, not a viable founder entry); pure-investor financial buyer with no operator on the ground (CMS and KY OIG both require a named, qualified administrator with day-to-day operational responsibility).

Payor-mix discipline: target 50–65% Medicare + 25–40% Medicaid + 10–20% private-pay / VA / LTC-insurance to avoid single-payor concentration. On Path B, build direct-hospital and dialysis and private-pay contracts to at least 30–40% of trip volume so the business is not 100% broker-dependent.

• — Specific Mercy Lourdes and Baptist Health Paducah case-management director names and current discharge-planning referral patterns by post-acute level — confirmable through direct outreach.
• — Current Kentucky Medicaid NEMT broker contract cycle (Verida versus Modivcare versus a successor) against the active CHFS contract.
• — Specific 2024–2026 newly-licensed Paducah home-health or NEMT entrants — the Kentucky CHFS home-health-agency roster and CMS home-health-agency enrollment public file were not pulled for this report.
• — Mercy Lourdes radiation cancer-center exact opening date — Certificate of Need approved in 2024 on an 18-month build; Q2 2026 is the planning midpoint.
• — Paducah-MSA-specific home-health and NEMT reimbursement-rate primary data against the local Medicare Administrative Contractor (Palmetto GBA) 2026 rates.

Tonight, this week, this month — in that order. Each step produces a yes/no or a number, not a deeper understanding.