Iowa Proposes NEMT for All Medicaid Expansion Adults From January 1, 2027

On September 17, 2026, the Iowa Department of Health and Human Services (HHS) posted a proposed state plan amendment, SPA IA-26-0010, to add non-emergency medical transportation (NEMT) for the whole Iowa Health and Wellness Plan (IHAWP) population. These are the adults Iowa covers under its Medicaid expansion. Since 2014, Iowa has left most of them without Medicaid rides through a waiver.

That waiver is ending. CMS told Iowa in a letter dated November 28, 2025 that the NEMT waiver sunsets on December 31, 2026 and will not be extended, even if the rest of Iowa’s demonstration is. HHS says Iowa will cover NEMT for all IHAWP members beginning January 1, 2027. The amendment itself stays a proposal until CMS approves it, and written comments are due by 4:30 p.m. on October 17, 2026.

What is changing

Item	Detail
Who	IHAWP members: adults 19 to 64 with income up to 133 percent of the federal poverty level, about $21,227 a year for one person (April 1, 2026 figures)
Rides today	None for most IHAWP members. Members with medically frail status, and members aged 19 and 20 who qualify for EPSDT, already get rides
Rides from January 1, 2027	The same NEMT coverage as other Iowa Medicaid members, under the proposed amendment
Federal decision	CMS approval letter of November 28, 2025: the waiver sunsets December 31, 2026
State filing	SPA IA-26-0010, public notice posted September 17, 2026. It adds NEMT to Iowa’s Alternative Benefit Plan, the benefit package for expansion adults, on pages 32 and 33
HHS cost estimate	$129,367 a year in total funds, $15,697 of it state money, annualized for state fiscal year 2027
Comments	By 4:30 p.m. on October 17, 2026, by email to QIMP_Public_Comment@hhs.iowa.gov with “NEMT ABP SPA” in the subject line
Status	Proposed. Watch for CMS approval of the amendment

The waiver removed Iowa’s duty under federal rule 42 CFR 431.53 to ensure transportation to care for this group. That is the assurance of transportation every state plan carries. The draft benefit pages posted with the notice check that assurance for expansion adults. For how a demonstration can switch off parts of Medicaid, see Section 1115 waiver.

Why CMS ended the waiver

The NEMT waiver started with the Iowa Wellness Plan on January 1, 2014, the day Iowa’s Medicaid expansion began. It was set to end on December 31, 2014, and CMS extended it several times after Iowa compared survey answers from these adults with those of other Medicaid members.

In its November 28, 2025 letter, CMS said extending the waiver past 2026 would not likely promote the goals of Medicaid. It pointed to Iowa’s 2016 member survey, in which 23 percent of respondents with an unmet need for routine care said they could not get transportation. It also noted that Congress wrote NEMT into the Social Security Act in the Consolidated Appropriations Act, 2021. CMS said it considered ending the waiver right away, but picked December 31, 2026 so Iowa had time to change its contracts and systems.

How rides will work for the new members

The draft benefit pages follow Iowa’s existing NEMT rule, 441-78.13 of the Iowa Administrative Code. Rides need the broker’s advance approval, but no prior authorization.

• Free rides first. A member with a car must drive and claim mileage. Rides are covered only when the member has no free option.
• Ride types. Mileage to the member or a volunteer driver, taxis, public transit where it works, wheelchair and stretcher vans, and airfare when the member’s condition calls for it.
• Meals and lodging, backed by receipts, when the appointment is more than 50 miles away one way.
• Closest provider. Rides go to the closest qualified Medicaid provider, unless the member’s choice is less than 10 miles farther one way or the extra distance is medically justified.
• Notice. Under the rule, members book at least two business days ahead. Urgent trips, such as hospital discharges and dialysis, can be booked with less notice.
• Not covered. Trips to services Medicaid does not cover or to providers not enrolled with Iowa Medicaid, emergency trips, and trips a nursing facility provides within 30 miles.

Members book through the broker. As of September 2026, Iowa HHS lists MTM Health as the broker for Iowa Total Care, Molina Healthcare, Wellpoint, and fee-for-service members, so the new trips flow through MTM Health.

What NEMT providers should do now

1. Join MTM Health’s Iowa network if you are not in it yet. MTM says it is always seeking providers for its statewide network, and its process runs through application, credentialing, and contracting. See NEMT broker credentialing.
2. Know MTM’s Iowa terms. MTM sets rates with each provider, does not pay for no-shows, and requires general and auto liability policies that list MTM as certificate holder and additional insured, plus workers’ compensation.
3. Plan your January schedule. Ask your MTM representative what volume it expects in your area once the new members can book.
4. Check eligibility before every ride. IHAWP work requirements start December 1, 2026 for people who apply on or after that date, and apply at renewal from February 2027 for current members. A member who loses coverage loses rides. See Medicaid work requirements.
5. Comment by October 17, 2026 if you see a problem in the proposal, and watch for CMS’s decision.

For brokers, licensing, and waiver rides in the state, see the Iowa state guide.