How to start a NEMT business in Missouri: MTM, MO HealthNet rules, and credentialing
Missouri runs every Medicaid ride through one broker. MTM Health holds the state's fee-for-service contract and also arranges rides for all three MO HealthNet managed care plans. Transportation providers do not enroll with MO HealthNet. The path to trips is an MTM Health subcontract, plus a Family Care Safety Registry check for every driver.
Missouri NEMT at a glance
- Runs the program
- Missouri Department of Social Services, MO HealthNet Division (MHD)
- Program
- MO HealthNet Non-Emergency Medical Transportation (NEMT)
- How rides are arranged
- One statewide broker. MTM Health brokers fee-for-service rides under the state contract and arranges rides for Home State Health, Healthy Blue, and UnitedHealthcare members.
- Brokers you will contract with
- MTM Health
- State operating license
- No NEMT license. Intrastate for-hire passenger carriers need a certificate under RSMo 390.051 unless an RSMo 390.030 exemption applies. Taxicabs are exempt.
- EVV for NEMT trips
- Not required
- Medicaid enrollment
- 1,109,551 (May 2026, Medicaid only)
On this page
How Medicaid NEMT works in Missouri
The MO HealthNet Division pays for the least costly transportation that suits the participant's medical condition, and only when no free option (a private vehicle, a relative, a volunteer, a facility van) is available (13 CSR 70-5.010). Modes range from bus passes and gas reimbursement to taxis, wheelchair vans, stretcher vans, and nonemergency ambulance. Trips to fill prescriptions are not covered, except to a scheduled vaccination.
One statewide broker arranges the rides. For fee-for-service participants, MTM Health verifies eligibility, applies the travel standards, assigns each trip to a provider, and must keep a network large enough to reach every covered service. Participants enrolled in a managed care plan get rides from the plan, and Home State Health (including Show Me Healthy Kids), Healthy Blue, and UnitedHealthcare all route those rides through MTM Health.
Under the NEMT manual, transportation providers are not enrolled as MO HealthNet providers. They work through an arrangement or subcontract with the broker, and the broker decides which provider gets each trip. Rates are negotiated with MTM Health one provider at a time.
Governing rule:13 CSR 70-5.010: Nonemergency Medical Transportation (NEMT) Services
Who brokers Medicaid rides in Missouri
One broker covers the whole state, for fee-for-service and managed care alike. A contract with MTM Health is the only door to Missouri Medicaid trips.
| Broker | Serves | Provider sign-up |
|---|---|---|
| MTM Health | Fee-for-service MO HealthNet participants statewide under the state contract, plus Home State Health, Show Me Healthy Kids, Healthy Blue, and UnitedHealthcare members through the plans. | Provider pageScheduling and provider inquiries 866-269-5927 |
Participants book through the line for their coverage: MO HealthNet fee-for-service 866-269-5927, Home State Health 855-694-4663, Show Me Healthy Kids 877-236-1020, Healthy Blue 888-597-1193, and UnitedHealthcare 844-529-1801.
Some services never go through the broker: developmental disability and DHSS waiver services and most CSTAR and Community Psychiatric Rehabilitation services (those programs arrange their own rides), services in a child's school IEP, services delivered in the home, and hospital-to-hospital transfers.
MHD has interagency agreements with public transit systems in Columbia, Jefferson City, Kansas City, Springfield, and St. Louis, and the broker refers participants who qualify for those services to them.
How to become a NEMT provider in Missouri
Missouri skips the Medicaid enrollment step. Your work is getting authority, screening drivers, and credentialing with MTM Health.
Form the business
Register the company with the Missouri Secretary of State and get a federal EIN. MHD does not enroll NEMT companies, so there is no MO HealthNet provider application for this work.
Check whether you need a MoDOT certificate
RSMo 390.051 requires a certificate from the state highways and transportation commission to operate as a common carrier of passengers in intrastate commerce, with liability insurance filed under RSMo 390.126. RSMo 390.030 exempts taxicabs and trips wholly within one municipality or its commercial zone (except in counties over 300,000 people, where trips between separate municipalities are not exempt). Confirm your status with MoDOT before you start.
RSMo 390.051: Certificate required for common carriers of passengers
Screen every driver through the FCSR
The MO HealthNet NEMT manual bars the broker from using any driver or attendant who registers a hit on any list the Family Care Safety Registry checks. Register drivers with the FCSR before they drive. The registration fee rises from $15 to $16 on October 1, 2026.
Apply to MTM Health
Submit MTM Health's letter of intent online. MTM's process runs in three phases (application, credentialing, contracting) with a designated representative.
Pass credentialing and training
MTM Health tracks licensure, background checks, certifications, insurance, and vehicle inspections, and its system will not assign trips to a provider whose credentials have lapsed. Every employee completes fraud, waste, and abuse and HIPAA training each year.
Run trips to the broker's standards
Confirm each pickup with the participant the day before. Arrive no later than the scheduled pickup time, wait 10 minutes past it before reporting a no-show in real time, and pick up will-call returns within 60 minutes of the call. MTM Health does not pay for no-shows.
Vehicle and driver requirements in Missouri
Missouri's NEMT manual sets a few firm state rules, mainly driver screening and vehicle safety. MTM Health's credentialing covers the rest.
Vehicles
| Requirement | State rule | Broker contract |
|---|---|---|
| Licensing | Providers must meet city, county, state, and federal licensing and certification rules for personnel and vehicles. Intrastate passenger carriers need an RSMo 390.051 certificate unless exempt. | MTM Health checks licensure at credentialing and monitors it after. |
| Safety standards | Vehicles must comply with Federal Motor Vehicle Safety Standards (49 CFR Part 571). | Vehicle inspections are part of MTM Health credentialing. |
| Level of service | Ambulatory (including manual wheelchair users who can stand or pivot), wheelchair, stretcher, and nonemergency ambulance. Trips are limited to three legs a day without MHD approval. | MTM Health assigns the vehicle type for each trip. |
| Pickup records | The provider documents the actual pickup time on every trip, and pickup must be no later than five minutes after the scheduled time. Standing-order trips get a 15-minute grace period before the facility calls the Where's My Ride line. | Arrive no later than the scheduled pickup, never more than 15 minutes early, and report no-shows in real time. |
Drivers
| Requirement | State rule | Broker contract |
|---|---|---|
| Background screening | No driver or attendant with a hit on any Family Care Safety Registry list (MO HealthNet NEMT manual). | Background checks tracked in MTM Health credentialing. |
| Training | None in the NEMT rule or manual. | Annual fraud, waste, and abuse and HIPAA training for every employee, plus MTM training on accidents and incidents, credentialing, claims, and cultural competency. |
| Qualifications | None beyond licensing and FCSR screening. | Driver credentialing and qualifications, including training elements, set in the MTM Health provider agreement. |
| Participant contact | Children under 17 must ride with a parent or guardian. | Confirm the pickup time with the participant 24 hours ahead. |
Insurance minimums in Missouri
Missouri sets a general auto floor and requires filed liability coverage for certificated carriers. MTM Health sets the working minimum.
| Coverage | Minimum | Set by |
|---|---|---|
| Auto liability, any vehicle | $25,000 per person, $50,000 per accident, $25,000 property damage | RSMo 303.190 |
| Certificated passenger carriers | Liability insurance or bond filed with and approved by the state before operating | RSMo 390.126 |
| General liability | $2,000,000, with MTM Health listed as certificate holder and additional insured | MTM Health contract |
| Automobile liability | $2,000,000, with MTM Health listed as certificate holder and additional insured | MTM Health contract |
| Workers compensation | Coverage that meets Missouri requirements | MTM Health contract |
Does Missouri require EVV for NEMT?
No. Missouri requires electronic visit verification for personal care and home health care services under Medicaid. Nonemergency transportation is not included.
The broker checks trips instead. Providers record the actual pickup time on every trip, MTM Health reviews timeliness reports and runs field monitoring, and its credentialing system blocks trip assignments to any provider with expired credentials.
What changed in Missouri in 2025 and 2026
MO HealthNet covered 1,109,551 people in May 2026, plus 134,279 children in CHIP, according to CMS preliminary monthly data. Every trip for them runs through MTM Health.
Travel standards cap how far a ride can go, based on the participant's county. Urban counties are Clay, Greene, Jackson, Jefferson, St. Charles, St. Louis, and St. Louis City. Fifteen counties, including Boone, Buchanan, Cape Girardeau, Cole, and Jasper, are basic, and the rest are rural. A primary care visit is limited to 10, 20, or 30 miles, and most specialists to 25, 50, or 100 miles, unless the participant has a referral, a care history with the provider, or no appointment within 30 days.
Advance notice follows the same map. Participants in urban counties call at least two business days ahead and those in basic or rural counties at least three. Urgent trips and hospital discharges can be booked the same day. Standing orders need recertification every 90 days, except dialysis standing orders, which do not expire.
Rates are set one provider at a time. MTM Health negotiates rates with each provider individually, and participants who drive themselves receive gas reimbursement at no less than the IRS medical mileage rate. The current state manual is dated April 2026, and the Family Care Safety Registry fee rises to $16 on October 1, 2026.
Frequently asked questions
- Who is the Medicaid transportation broker in Missouri?
- MTM Health. It brokers fee-for-service MO HealthNet rides under the state contract, and all three managed care plans (Home State Health, Healthy Blue, and UnitedHealthcare) route their members' rides through MTM Health too. The fee-for-service scheduling line is 866-269-5927.
- Do I need to enroll with MO HealthNet to be a NEMT provider?
- No. The MO HealthNet NEMT manual states that transportation providers are not enrolled as MO HealthNet providers. You work under an arrangement or subcontract with MTM Health, which assigns and pays for trips.
- Do I need a license to start a NEMT business in Missouri?
- There is no NEMT license. A common carrier of passengers in intrastate commerce needs a certificate under RSMo 390.051, with liability insurance filed under RSMo 390.126, unless an RSMo 390.030 exemption applies. Taxicabs and trips wholly within one municipality or its commercial zone are among the exemptions, with limits in counties over 300,000 people.
- What background checks do Missouri NEMT drivers need?
- The state manual bars any driver or attendant who registers a hit on a Family Care Safety Registry list, so every driver should be registered with the FCSR before driving. The fee is $15 and rises to $16 on October 1, 2026. MTM Health runs its own background checks as part of credentialing.
- What insurance does MTM Health require in Missouri?
- At least $2 million in general liability and $2 million in automobile liability, with MTM Health listed as certificate holder and additional insured on both, plus workers compensation that meets Missouri requirements. The state auto floor is $25,000 per person, $50,000 per accident, and $25,000 property damage.
- Does Missouri require EVV for NEMT?
- No. Missouri EVV applies to personal care and home health care services. NEMT providers record actual pickup times, and MTM Health monitors timeliness and credentials.
- How far can a Missouri NEMT trip go?
- It depends on the county and the provider type. A primary care visit is capped at 10 miles in urban counties, 20 in basic counties, and 30 in rural counties. Most specialists are capped at 25, 50, and 100 miles. Exceptions cover referrals, established care, and cases with no appointment available within 30 days.
- Does MTM Health pay for no-shows in Missouri?
- No. Confirm each trip with the participant the day before, wait 10 minutes past the scheduled pickup time, and report the no-show in real time through MTM Link or by phone before leaving.
Running NEMT in Missouri with HealthRide
Missouri fleets live by MTM Health's pickup rules: on time, a 10-minute wait, and will-call returns within the hour. HealthRide keeps flexible return trips on the dispatch board until the passenger is ready, shows every vehicle on a live map with late warnings, and records wait times on no-shows.
Official resources
- Missouri DSS: Non-Emergency Medical Transportation
- Missouri DSS: NEMT FAQs for participants
- MO HealthNet: Non-Emergency Medical Transportation provider manual
- MO HealthNet: NEMT manual (April 2026 file)
- 13 CSR 70-5.010: Nonemergency Medical Transportation (NEMT) Services
- RSMo 390.051: Certificate required for common carriers of passengers
- RSMo 390.030: Vehicles exempted
- RSMo 390.126: Liability insurance required
- RSMo 303.190: Motor vehicle liability policy limits
- Missouri DHSS: Family Care Safety Registry
- Missouri DSS: Electronic Visit Verification
- CMS: Medicaid and CHIP monthly enrollment data
- MTM Health: MO HealthNet NEMT
- MTM Health: Missouri transportation providers
- MTM Health: Join the transportation provider network
- MTM Health: Transportation provider handbook (August 2022)
- Home State Health: Transportation services
- Healthy Blue Missouri: Medicaid benefits
- UnitedHealthcare Community Plan of Missouri: MO HealthNet benefits
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