How to start a NEMT business in Iowa: MTM Health, Iowa Medicaid rules, and vehicle standards
Every Iowa Medicaid ride runs through one broker. MTM Health arranges NEMT for fee-for-service members and for all three IA Health Link managed care plans: Iowa Total Care, Molina Healthcare of Iowa, and Wellpoint. Iowa has no license specific to NEMT. The rules that matter are Iowa Medicaid's NEMT rule, 441 IAC 78.13, the vehicle standards in the state's managed care contracts, and MTM's credentialing.
Iowa NEMT at a glance
- Runs the program
- Iowa Department of Health and Human Services (Iowa HHS), Iowa Medicaid
- Program
- Iowa Medicaid non-emergency medical transportation (NEMT)
- How rides are arranged
- Health plans each contract a broker. Iowa Medicaid arranges fee-for-service rides through a transportation broker, and each managed care plan arranges its members' rides. MTM Health is the broker for all four.
- Brokers you will contract with
- MTM Health
- State operating license
- No NEMT-specific license. 441 IAC 78.13 governs the benefit, and the managed care contracts set NEMT vehicle standards. Iowa DOT passenger certificates under Iowa Code chapter 325A cover taxicab and charter services.
- EVV for NEMT trips
- Not required
- Medicaid enrollment
- 591,844 (May 2026, Medicaid only)
On this page
How Medicaid NEMT works in Iowa
Under 441 IAC 78.13, Iowa HHS makes NEMT available through a transportation brokerage to members eligible for full Medicaid benefits who need a ride to a Medicaid-covered service from an enrolled Iowa Medicaid provider. The broker approves the most economical ride that fits the member's needs: mileage reimbursement to the member or a volunteer driver, taxi, public transit, wheelchair or stretcher van, or airfare. Meals and lodging are covered when the appointment is more than 50 miles away one way.
Members must call at least two business days ahead, counting the appointment day but not the day of the call, and no more than 30 days ahead. Urgent trips such as post-surgical follow-ups, unexpected pre-operative visits, hospital discharges, new conditions or tests, and dialysis can be booked with less notice. Rides go to the closest qualified enrolled provider unless the requested provider is less than 10 miles farther or there is a medical reason.
The rule excludes trips to non-covered services and non-enrolled providers, rides for nursing facility and ICF/ID residents when the facility provides transportation within 30 miles, and transportation already paid as part of other services such as home health or supported community living. MTM Health handles fee-for-service trips and the trips of all three IA Health Link plans, so for a provider one broker controls the whole Iowa Medicaid market.
Governing rule:441 IAC 78.13: Nonemergency medical transportation
Who brokers Medicaid rides in Iowa
One broker, four member phone lines. Iowa HHS lists MTM Health as the broker for fee-for-service members and for each managed care plan.
| Broker | Serves | Provider sign-up |
|---|---|---|
| MTM Health (fee-for-service) | Iowa Medicaid fee-for-service members statewide. | Provider pageMember reservations 866-572-7662 |
| MTM Health (IA Health Link plans) | Iowa Total Care (877-271-4819), Molina Healthcare of Iowa (866-849-2062), and Wellpoint, formerly Amerigroup Iowa (844-544-1389). | Provider page |
Iowa Total Care members can book up to 30 days ahead, and up to 90 days ahead for dialysis, chemotherapy, or radiation.
For fee-for-service members, MTM books routine trips Monday through Friday, 8 a.m. to 5 p.m., and urgent trips 24 hours a day, seven days a week.
How to become a NEMT provider in Iowa
With one broker for every Iowa Medicaid trip, the MTM Health contract is the whole job. Get the vehicles, insurance, and drivers ready, then work through MTM's three-phase process.
Form the business
Register the company with the state and get a federal EIN. Use the same legal name on your MTM application and insurance certificates.
Apply to MTM Health's Iowa network
MTM recruits in three phases: application, credentialing, and contracting, each handled with a designated MTM representative. Start with the questionnaire on MTM's Iowa transportation provider page. Rates are negotiated with each provider.
Meet the state's NEMT vehicle standards
Exhibit F of the state's managed care contracts, including those of Iowa Total Care and Wellpoint, sets standards for specialized medical vehicles: current license and registration, proof of financial responsibility, proper mechanical condition, working heat and air conditioning, working restraints, lights, horn, brakes, windows, and mirrors, a safety inspection where law requires one, and a two-way radio or cell phone.
Iowa Total Care contract (MEDIOMC26002), Exhibit F: NEMT standards
Insure the fleet
MTM requires general and automobile liability policies with MTM listed as certificate holder and additional insured, plus workers compensation that meets state requirements. Iowa's general auto floor is $20,000 per person, $40,000 per accident, and $15,000 property damage.
Credential your drivers
MTM sets credentialing standards for driver qualifications, motor vehicle records, and CPR, defensive driving, and passenger assistance training. All drivers must complete MTM's required training.
Know how disputes work
Under 441 IAC 78.13(4), a contracted provider in good standing may request a state fair hearing only over a denied or reduced claim, only on the member's behalf, and only with the member's signed written consent. Every other provider grievance ends in binding arbitration with an Iowa Medicaid designee as arbitrator.
Vehicle and driver requirements in Iowa
Iowa's vehicle standards come from the state's managed care contracts. Driver standards come from MTM Health's credentialing.
Vehicles
| Requirement | State rule | Broker contract |
|---|---|---|
| Registration and financial responsibility | Current license and registration, and proof of financial responsibility under Iowa Code chapter 321A and 761 IAC 910.5(1) as they apply (managed care contract, Exhibit F). | MTM listed as certificate holder and additional insured on general and auto liability. |
| Condition and comfort | Proper mechanical condition at all times, with working heat and air conditioning that keep the member comfortable. | Set in the MTM Health contract. |
| Safety equipment | Working passenger restraints, turn signals, lights, horn, brakes, front and rear windshield, windows, and mirrors, and a safety inspection if state or federal law requires one. | Set in the MTM Health contract. |
| Communication | Equipment for two-way emergency communication; a two-way radio or cell phone is acceptable. | MTM sends trip assignments electronically. |
Drivers
| Requirement | State rule | Broker contract |
|---|---|---|
| Screening | No driver standard in 441 IAC 78.13. Volunteer and family drivers paid mileage need a valid license and insurance on the vehicle. | MTM driver qualification and motor vehicle record standards. |
| Training | Not set by rule. | CPR, defensive driving, and passenger assistance training. |
| Trip confirmation | Members must cancel with the broker if they cannot attend. | MTM does not pay for no-shows. Confirm pickup with the member the day before, and cancel the trip if the member will not attend. |
Insurance minimums in Iowa
Iowa's general auto floor is low. The managed care contracts point brokers to a $1 million rule for publicly funded transit providers, and MTM adds general liability and workers compensation.
| Coverage | Minimum | Set by |
|---|---|---|
| Auto liability, any vehicle | $20,000 per person, $40,000 per accident, $15,000 property damage | Iowa Code 321A.1(11) |
| Vehicles used for publicly funded transit services | $1,000,000 per accident for all hazards, or an equivalent self-insurance fund | 761 IAC 910.5(1), cited in the managed care contracts' NEMT standards |
| MTM Health contract | General and auto liability, MTM listed as certificate holder and additional insured on both | Broker contract |
| Workers compensation | Coverage that meets state requirements | Broker contract |
Does Iowa require EVV for NEMT?
No. Iowa Medicaid ties electronic visit verification to in-home care documentation, such as attendant care and consumer-directed personal care under 441 IAC 78.34. The NEMT rule, 441 IAC 78.13, has no EVV requirement.
MTM Health checks trips against the rule instead. Rides go only to enrolled Iowa Medicaid providers, normally the closest qualified one, and member mileage claims must reach the broker within 120 days of the trip. Keep pickup, drop-off, and mileage records for every leg.
441 IAC chapter 78: Amount, duration and scope of medical and remedial services
What changed in Iowa in 2025 and 2026
Iowa had 591,844 people on Medicaid and 82,952 on CHIP in May 2026, according to CMS's preliminary monthly data.
Because MTM Health brokers fee-for-service and every IA Health Link plan, Iowa is effectively a one-contract market. MTM negotiates rates with each provider individually and does not pay no-shows.
Both state rules were reissued in 2026. Iowa HHS adopted a new version of chapter 78, including the NEMT rule, effective July 1, 2026 (ARC 0315D). The Iowa Department of Transportation adopted a new version of its transit coordination chapter, which holds the $1 million insurance rule, effective May 20, 2026 (ARC 0219D).
The plan contracts are posted on Iowa HHS's contracts page. Iowa Total Care's current contract, MEDIOMC26002, anticipates service from July 1, 2025 and sets the NEMT vehicle standards in its Exhibit F. Molina (MED 24-005) and Wellpoint (MED 24-006) work under their own contracts and amendments.
Iowa Total Care's current managed care contract (MEDIOMC26002), with NEMT vehicle standards in Exhibit F, begins.
A new version of Iowa DOT's transit coordination rules (761 IAC chapter 910), including the $1 million per accident insurance standard, takes effect.
A new version of 441 IAC chapter 78, including the NEMT rule 78.13, takes effect.
Frequently asked questions
- Who is the NEMT broker in Iowa?
- MTM Health, for every Iowa Medicaid member. Fee-for-service members call 866-572-7662, Iowa Total Care members 877-271-4819, Molina members 866-849-2062, and Wellpoint members 844-544-1389.
- Does Iowa require a license to start a NEMT business?
- Iowa has no license specific to NEMT. Iowa Code chapter 325A requires Iowa DOT passenger certificates for taxicab services (vehicles seating fewer than seven) and charter carriers, so ask Iowa DOT whether your operation needs one. For Medicaid work you need a registered business, vehicles that meet the NEMT standards in the managed care contracts, the insurance MTM requires, and an MTM Health contract with credentialed drivers.
- How do I become a Medicaid transportation provider in Iowa?
- Contract with MTM Health, the broker for all Iowa Medicaid rides. MTM's process has three phases, application, credentialing, and contracting, with a designated representative. Start with the questionnaire on MTM's Iowa transportation provider page.
- What insurance does an Iowa NEMT provider need?
- Iowa's auto floor is $20,000 per person, $40,000 per accident, and $15,000 property damage. MTM requires general and auto liability with MTM as certificate holder and additional insured, plus workers compensation. The managed care contracts also cite a $1 million per accident rule that applies to publicly funded transit services.
- Does Iowa require EVV for NEMT?
- No. Iowa ties EVV to in-home care documentation such as attendant care and consumer-directed personal care. The NEMT rule, 441 IAC 78.13, has no EVV requirement.
- How far ahead do Iowa Medicaid members book rides?
- At least two business days ahead and no more than 30 days ahead, under 441 IAC 78.13. The two days count the appointment day but not the day of the call. Urgent trips, such as hospital discharges and dialysis, can be booked with less notice.
- When does Iowa Medicaid pay for meals and lodging?
- When the appointment is more than 50 miles away one way. Meals must fall within a trip that spans the whole meal period and are capped at the state employee allowance. Lodging needs detailed receipts. Check with the broker before the trip.
- Can an Iowa NEMT provider appeal a denied claim?
- Only in a narrow case. A contracted provider in good standing can request a state fair hearing over a denied or reduced claim on the member's behalf, with the member's signed written consent. Other provider grievances end in binding arbitration with an Iowa Medicaid designee.
Running NEMT in Iowa with HealthRide
Every Iowa Medicaid trip comes from one broker, so on-time pickups and clean records decide how much work you get. HealthRide's live map shows every vehicle in real time with late warnings, and the driver app captures signatures on screen for every leg.
The trip log exports as CSV or PDF, so pickup, drop-off, and mileage records are ready whenever MTM asks.
Official resources
- Iowa HHS: Medical transportation
- 441 IAC chapter 78 (including 78.13, nonemergency medical transportation)
- 761 IAC chapter 910: Coordination of public transit services
- Iowa Code 321A.1: Definitions (proof of financial responsibility)
- Iowa Code chapter 325A: Motor carrier authority
- Iowa HHS: Medicaid contracts and rates
- Iowa Total Care contract MEDIOMC26002 (Exhibit F: NEMT standards)
- Wellpoint (formerly Amerigroup Iowa) contract MED 24-006 (Exhibit F: NEMT standards)
- Iowa HHS: Provider enrollment
- MTM Health: Iowa
- MTM Health: Iowa transportation providers
- Iowa Total Care: Transportation
- CMS: Medicaid and CHIP monthly enrollment data
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