Idaho Medicaid transportation fee schedule: per-mile pay, bus passes, and the statewide broker

Two kinds of transportation, two ways of paying

Idaho runs medical rides and waiver rides on completely different money. A NEMT company working in Idaho needs to know which one a trip belongs to before it can know what the trip pays.

• Non-emergency medical transportation (NEMT). Rides to Medicaid-covered care. Under IDAPA 16.03.26, section 343, the Department gives the broker a fixed payment for every member each month, set at a level meant to be actuarially sound. The broker, which the Idaho Medicaid Provider Handbook (March 30, 2026) names as MTM Health, authorizes every non-emergency, non-ambulance ride and pays its contracted providers. No state fee schedule sets those trip rates. MTM’s Idaho page for transportation providers says rates are worked out with each provider individually.
• Non-medical transportation (NMT). Trips to a grocery store, a worship service, or other community activities for participants in the Aged and Disabled (A&D) waiver or the Adult Developmental Disabilities (DD) waiver. Idaho Medicaid pays enrolled providers for these directly, by the mile or as a bus pass, from the waiver fee schedules.

The handbook is explicit that NMT adds to NEMT rather than substituting for it. A medical appointment goes to MTM even when the rider is a waiver participant. The Idaho state guide covers MTM credentialing and the state background check.

Waiver mileage rates, July 1, 2026

Both waiver fee schedules, effective July 1, 2026 and last reviewed May 1, 2026, pay NMT under A0080 per mile, with the bus pass under A0110. Commercial carriers get a higher amount for the day’s opening mile and a lower per-mile rate after that.

A hypothetical commercial carrier day shows how the two A0080 lines combine. A first trip of 8 miles pays one mile at $4.03 and seven at $1.12, or $11.87. A second trip of 8 miles that day pays all eight at $1.12, or $8.96.

The handbook adds billing rules that apply to every NMT claim:

1. Each claim line is a single trip. That means from the rider’s starting point to the intended destination. A round trip is two trips, and claim lines with a date span are denied.
2. First trip without the modifier. A commercial provider’s first trip of the day bills without a modifier, and every trip after it that day carries 76. The Adult DD fee schedule prints 76 beside the first-mile line too, so confirm the coding with Idaho Medicaid provider services at Gainwell Technologies before billing DD waiver trips.
3. Diagnosis R69 and place of service 99. NMT claims go on the CMS-1500 with ICD-10-CM R69 in field 21, and place of service 99 goes in field 24B.
4. Prior authorization first. Claims do not pay without authorization obtained before the ride, from the Bureau of Developmental Disability Services for DD waiver participants or the Bureau of Long Term Care for A&D waiver participants.

NMT is capped at 1,800 miles per year, and bus passes are authorized only for public transportation providers holding a valid provider agreement. Personal care providers are not paid for NMT. The non-medical transportation entry explains how this service differs from NEMT in other states.

The September 2025 rate cut

Every Idaho Medicaid provider rate dropped 4 percent for services delivered on or after September 1, 2025. Information Release MA25-17, dated August 22, 2025, announced the cut after the Department projected 19 percent General Fund growth for the year against the 8 percent the budget assumed. Information Release MA25-19, amended November 4, 2025, confirmed it for non-exempt fee-for-service claims after a 30-day comment period, and said claims would be reprocessed back to the effective date. NMT was not on the exempt list.

The waiver schedules effective July 1, 2026 carry the reduced amounts forward. MA25-19 told providers to keep charging their usual and customary fee. For most services Idaho Medicaid pays the lesser of the billed amount or its maximum allowable fee, and the Department tells providers not to use the fee schedule to set their prices.

How the waiver rates were built

The handbook explains where the NMT numbers come from. Rates were set by actuarial analysis that weighed driver wages, vehicle maintenance, fuel, vehicle purchase cost, insurance, and administrative costs. A separate study looks at the fuel costs a typical non-commercial provider actually incurs in a vehicle averaging 15 miles per gallon. Any update to the rates needs legislative approval.

Travel lines on the numerical fee schedule

The quarterly numerical fee schedule covers medical services generally, and only a handful of its lines are transportation. These are the amounts in the July to September 2026 schedule (version 1.4), with the July to September 2025 amounts for comparison.

A0140 (air travel) and A0170 (parking and tolls) appear at $0.00, which the schedule says means the line is priced by hand, and A0140 needs prior authorization from the Medical Care Unit. Each change between the two years is the 4 percent cut.

For a NEMT company in MTM’s network, meals, lodging, and attendant costs are a broker matter. IDAPA 16.03.26, section 342, says the broker reimburses a contracted provider for these travel-related services when the conditions are met:

• Meals in transit. For the participant, and for one family member or attendant, when there is no other practical way to get food.
• Lodging. For the participant when the round trip and the service cannot be done in one day and nothing cheaper is available, and for one family member or attendant when an overnight stay is required.
• A non-family attendant’s wages. When an attendant is medically necessary or the participant is too vulnerable to travel alone, and no unpaid attendant is available.

What MTM’s trips depend on

Section 342 lets the broker pay a contracted provider only when the ride is needed to reach a covered service, uses the cheapest mode that suits the participant’s medical needs, goes by the most direct route to the nearest appropriate provider, and was authorized and scheduled by the broker. Other options, such as a personal vehicle, family, friends, or charities, must be unavailable or impractical. The provider must also follow the terms of its broker contract.

On the MTM side, these terms shape the work and what each trip earns:

• No pay for no-shows. A member who does not show earns the provider nothing. MTM’s provider page pairs that rule with advice to check each pickup time with the member a day ahead.
• Insurance. $1,000,000 or more in general liability and the same in auto liability, both policies listing MTM as certificate holder, with MTM also added as an additional insured, plus the workers’ compensation coverage Idaho law calls for.
• Booking lead time. Members book two or more business days ahead, apart from urgent trips and hospital discharges, and MTM delivers trip assignments using its Electronic Trip Download (ETD) system.
• Urgent rides. MTM’s Idaho member page treats urgent care, discharges from a hospital, facility, or emergency room, and will-call return rides as urgent, and promises those rides in one hour or less.

MTM’s network process is on the MTM Health guide.

Ambulance codes sit outside the broker

Ambulance service is priced on Idaho Medicaid’s own schedule rather than by the broker. The July to September 2026 schedule pays $232.28 for basic life support on a scheduled, non-emergency run (A0428), $278.74 for non-emergency advanced life support level 1 (A0426), and $7.99 per mile (A0425). Information Release MA26-14 added a Medically Unlikely Edit from July 1, 2026 that limits ambulance providers to 250 reimbursed miles on A0425 without prior authorization. These are ambulance codes, billed by ambulance services. Where one service ends and the other begins is covered in NEMT versus ambulance.

Finding the current schedule

The Department of Health and Welfare posts the numerical fee schedule each quarter, in PDF and Excel, in the Fee Schedules folder of its public documents site, with the waiver schedules in an HCBS and LTSS folder beside it. The Department says rates can change during the year without an update to the posted schedule. Ask the Office of Reimbursement about pricing at (208) 287-1180. The national code definitions are in NEMT billing codes.

Running Idaho trips in HealthRide

An Idaho waiver claim has to be backed by the date, time, pickup and drop-off points, and mileage of each trip. HealthRide’s driver app records pickup and drop-off times, GPS-verified miles, and an on-screen signature for each ride, and you can download the trip log as a CSV or PDF when the Department asks for records. Waiver payments and MTM payments can both be recorded in invoicing, so all of your Idaho money sits in one ledger.