Iowa Medicaid transportation rates: broker mileage, agency charges, and waiver wheelchair van trips

One broker, one contract, no state ride rate

Every Iowa Medicaid NEMT ride a transportation company carries comes through MTM. Iowa HHS names MTM on all four of its ride lines, covering fee-for-service members and each IA Health Link plan:

• Iowa Total Care: 877-271-4819
• Molina Healthcare: 866-849-2062
• Wellpoint: 844-544-1389
• Fee-for-service: 866-572-7662

Iowa Admin. Code 441-78.13, as amended effective July 1, 2026, provides nonemergency medical transportation through a transportation brokerage and limits rides to the most economical transportation that fits the member’s needs, with the broker’s advance approval. Wheelchair and stretcher vans are on the list of covered modes, alongside member mileage, taxis, public transit, and airfare.

What a van company earns on those trips is set in its MTM agreement. MTM’s Iowa provider page says each provider’s rates are worked out with that provider alone, that no-shows go unpaid, and that the general and auto liability policies must each carry MTM as an additional insured and as the certificate holder, with workers’ compensation at the state-required level. The Iowa state guide covers licensing and MTM credentialing, while the MTM Health guide explains how its network works.

The three schedules Iowa HHS does post

Iowa HHS publishes three schedules with transportation amounts: the Medical Transportation Providers Fee Schedule, the HCBS Waiver Transportation Upper Rate Limits, and the Disability Services Fee Schedule used in the state’s safety net system. None of them sets what MTM pays a van company. Each covers a different kind of trip under its own rules, so confirm which program a trip belongs to before you price it.

Individual drivers and agencies

The Medical Transportation Providers Fee Schedule on Iowa HHS’s Medicaid fee schedule page describes two provider types:

• Individual. A person, possibly a volunteer, who is not driving as an employee of a transportation agency. The schedule pays $0.30 a mile for each member transported.
• Agency. A public or private organization, for profit or not, such as a regional transit agency, a metropolitan bus service, or a taxi company. It is paid its usual and customary charge, meaning its price to the general public for substantially the same ride, but no more than the most economical public transportation in the area would charge.

Payment is based on a single round trip, and the most direct route must be used. The schedule’s own example has a public transportation company carrying two members from their town to University of Iowa Hospitals and Clinics and back, a 104-mile round trip. The company’s published fare for 81 to 120 miles is $75 a person, so the claim is $75 for each member, $150 in all, even though the driver made the trip twice that day.

The same $0.30 figure shows up in the member mileage policy Iowa HHS still links from its medical transportation page. That policy was revised in May 2021, when Access2Care was the broker, and pays $0.30 per loaded mile. Members and their drivers should confirm today’s mileage amount with MTM before relying on it.

HCBS waiver transportation: caps by region

Waiver transportation is a separate home and community-based service, billed by HCBS providers per mile on S0215 or per one-way trip on T2003, outside the broker. Iowa Admin. Code 441-79.1(2) sets its upper limit as the fee schedule in effect July 1, 2024, and the newest HCBS fee schedule, dated October 1, 2026, keeps pointing back to it for S0215, T2003, A0130, A0130 U3, and T2001.

The July 1, 2024 schedule sets a cap per loaded mile for each mental health and disability services (MHDS) region, based on where the member lives. You bill your own per-mile cost up to that cap and keep the cost records to prove it on review.

T2003 prices a one-way trip by multiplying that per-mile rate by the member’s door-to-door miles. The schedule’s worked example is a Clay County member carried 10 miles by a provider with costs at the $1.70 cap, billed $17.00 for the trip. A provider with costs below the cap bills the lower figure. The spread between regions is wide: the same 10-mile trip is capped at $17.00 for a Clay County member and $101.00 for a Wapello County member.

One rule keeps waiver and NEMT money apart. Under 441-78.13(2)(f), the NEMT program does not reimburse HCBS and Medicaid providers for transportation that is part of another covered service, such as personal care, home health, or supported community living.

Disability services fees from April 1, 2026

Iowa HHS’s Disability Services Fee Schedule pays long-term services and supports for people in the state’s safety net system, through the Safety Net Management Information System (SNMIS). Its transportation lines, effective April 1, 2026, are flat amounts:

The fee schedule and the August 2026 SNMIS billing manual set the conditions:

• Enrollment. You must be enrolled with Iowa Medicaid under the applicable provider type, HCBS-certified for the service, and registered for the SNMIS line of business. SNMIS claims use Payer ID 18049, the same as Medicaid, but Receiver ID 0028.
• Last resort. SNMIS pays only when no other source covers the service. Anyone eligible for Medicaid is billed to Medicaid, and SNMIS cannot be billed as secondary to another payer.
• Deadlines. Electronic claims go in within 45 days of the service date, and no claim is paid once 180 days have passed.
• Payment in full. Providers accept the SNMIS amount as the whole payment and cannot collect a copay from the person served.

Broker rules that limit what a trip pays

The amended 441-78.13 shapes which broker trips exist and how far they go. The provisions an operator runs into most:

• Nursing facilities. NEMT excludes residents of nursing facilities and ICF/ID facilities when the facility provides the ride; the rule’s shorthand for that is within 30 miles one way of the facility.
• Closest provider. The broker sends members to the nearest qualified Medicaid provider. A farther one is allowed when the gap is less than 10 miles one way, or when the member’s history with that provider, its expertise, or a referral justifies the added cost.
• Notice. A member has to book a minimum of two business days out from the visit (the visit day counts toward the two; the call day does not) and never more than 30 days out. Hospital discharges, dialysis, and unexpected pre-operative visits are among the urgent exceptions.
• Own vehicle first. Members with a working, licensed, insured vehicle and a valid license must use it and claim mileage, and friends or family who can drive are considered too.
• Pharmacies and equipment. No rides to a pharmacy with free delivery, except for new prescriptions, or to an equipment supplier that delivers free unless a fitting is needed.
• Meals and lodging. Reimbursed to members only for appointments over 50 miles away one way, backed by detailed receipts.
• Member claims. The broker denies any member claim filed more than 120 days after the service.

Disputes with the broker

The same rule decides how far a transportation company can take a payment fight. A contracted provider in good standing gets a state fair hearing in only one case: a claim was denied or paid less, the provider acts for the member, and the member signed consent beforehand. That consent has to tell the member that protected health information may come up and become public. Any other grievance a provider raises goes to binding arbitration, decided by someone Iowa Medicaid designates. Keep trip records strong enough to win at the broker level, because the routes after it are narrow.

January 1, 2027: NEMT for all Iowa Wellness Plan adults

Iowa has used an 1115 waiver to exclude NEMT for adults in the Iowa Health and Wellness Plan (IHAWP), its Medicaid expansion group, except for EPSDT services and members with medically frail status. Iowa HHS says the waiver ends December 31, 2026, and that every IHAWP member gets NEMT from January 1, 2027.

A public notice for SPA IA-26-0010 went up on September 17, 2026. The amendment adds NEMT to the Alternative Benefit Plan with the same coverage other Medicaid members have. According to the notice, CMS stops approving the waiver on January 1, 2027, and the annualized cost for state fiscal year 2027 comes to $129,367 (all funds), including a $15,697 state share. The comment deadline is October 17, 2026, at 4:30 p.m., and comments must be in writing. The draft benefit page attached to the notice puts these rides under 441-78.13 and the broker’s advance approval, so the new trips will come through MTM like the rest. If your service area has many expansion adults, talk to MTM about capacity before January.

Pricing Iowa trips in HealthRide

Iowa pays waiver trips by the loaded mile, door to door, and expects providers to back up their costs, while MTM trips follow each provider’s own contract. HealthRide stores each leg’s GPS-recorded mileage and time-stamps its pickup and its drop-off, and invoicing builds each payer’s invoice from those records. When a reviewer wants mileage history, pull it from the trip log export in reports.