How to Start a NEMT Business in Idaho (2027)

Idaho runs every non-emergency Medicaid ride through one broker. MTM has arranged Medicaid NEMT trips statewide since March 6, 2018, and its current contract with the Department of Health and Welfare went live on September 1, 2023. To get that work, you need a registered company, DHW background checks on your drivers, Idaho Medicaid enrollment, and vehicles, drivers, and insurance that pass MTM’s credentialing. The rules below follow the state’s Transportation Services handbook of March 30, 2026, the Medicaid rules in effect July 1, 2026, and MTM’s 2023 Idaho provider handbook.

How Medicaid rides work in Idaho

The Idaho Department of Health and Welfare (DHW) runs Medicaid through its Division of Medicaid. Its rules call for one transportation broker to run a statewide network of NEMT providers. DHW pays the broker a fixed, actuarially sound amount per member per month, a capitation rate, and the broker pays the providers. There are no NEMT regions: one MTM contract covers the whole state.

Under IDAPA 16.03.26, the broker coordinates every Medicaid ride, contracts with transportation companies, runs the call center, authorizes each trip, pays providers, and makes sure they drive safely and professionally. A DHW Medicaid NEMT team oversees MTM. More than 1.1 million trips were completed under the current contract by November 2024, according to DHW’s December 1, 2024 report to the Legislature. That report also says the contract requires GPS tracking for every NEMT provider. MTM offers a free GPS option in its mobile app, and you may use your own GPS system if its data transfers to MTM. See GPS tracking for NEMT.

The broker pays only when every condition in IDAPA 16.03.26.342 is met:

• The trip is essential to reach a service Medicaid covers.
• The mode is the least costly one that fits the member’s medical needs.
• The trip goes to the nearest appropriate provider by the most direct route.
• The member has no personal vehicle, family, friends, or charity that can take them.
• MTM authorized and scheduled the trip, and you followed your MTM contract.

Members book at least two business days before an appointment, 24 hours a day. Urgent rides, which include urgent care, hospital and emergency room discharges, and will-call returns, are provided within one hour. Recurring rides can be booked up to six months at a time. Riders under 18 need an adult along unless a parent signs MTM’s consent form (ages 14 to 17) or DHW grants an exemption (under 14).

MTM gives each member the ride type that fits their medical needs, as listed in its September 2026 member handbook:

Ride type	Who gets it	Notes
Gas mileage	Members who can drive or be driven	$0.30 a mile, approved in advance
Public transit	Home and clinic within half a mile of a stop	Or any member who asks
Passenger vehicle	Members who can walk to the vehicle	May be a taxi
Rideshare	Ambulatory adults who opt in	Not in every area
Wheelchair van	Members who cannot transfer to a sedan	Level of Need form
Stretcher van	Members confined to bed	Level of Need form

A trip over 200 miles one way is long distance, and so is any trip more than 100 miles outside Idaho. Members request these at least 10 calendar days ahead, and some need a Distance Verification Form from their doctor. IDAPA 16.03.26 also covers meals, lodging, and a paid attendant when the trip cannot be made without them. See long-distance medical transport and rural NEMT for how to price them.

Where you base your company matters. MTM’s directory of contracted Idaho providers, dated August 20, 2025 and still posted in September 2026, lists 50 companies. Ada County is the main county for 13 of them, Canyon for 7, and Bonneville for 6. Custer, Lemhi, Butte, Owyhee, and Elmore counties have one each.

Idaho is also changing how Medicaid is run. House Bill 345, passed in March 2025, moves Idaho Medicaid to comprehensive managed care. DHW has delayed that switch to January 1, 2030 and plans to post the request for proposals later in 2027, with a blackout on discussing it from December 1, 2026.

How to join MTM, Idaho’s Medicaid broker

You contract with MTM, not with DHW. MTM says that when it needs providers in your area, you hear back quickly on next steps, and otherwise it keeps your information on file. Its process has six checkpoints:

1. Apply. Fill out the application on MTM’s Join Our Network page. It asks for your EIN, NPI, and Medicaid ID if you have them, the counties you serve, your service levels and vehicle counts, and your insurance carrier and limits. For Idaho, you must already be enrolled as a managed care provider with the state’s Medicaid Enterprise System, or MTM voids the application.
2. Interview. A network representative calls you to explain onboarding.
3. Contract. You sign MTM’s service agreement. MTM’s audits later confirm you have the provider handbook, a disclosure of ownership, and the signed agreement.
4. Credential. You send insurance certificates, driver files, background check clearances, and your business license, and each vehicle passes inspection. MTM’s system will not assign trips to a provider whose credentials have lapsed.
5. Train. Training is on demand, by video and reference guide. It covers accidents and incidents, credentialing, claims, MTM’s trip portal, fraud, waste, and abuse, HIPAA, and cultural competency. Every employee repeats the fraud, waste, and abuse and HIPAA courses each year.
6. Take your first trip. Trips arrive through MTM’s Electronic Trip Download, and you report trip status and submit claims in the same portal.

Each provider gets a vendor account manager, who is your main contact for credentials, insurance changes, and performance. MTM’s Idaho provider help desk is 888-828-1183, or tphelpdesk@mtm-inc.net. Our MTM Health guide covers the company in its other states.

Enroll with Idaho Medicaid through Gainwell

Gainwell Technologies, Idaho Medicaid’s enrollment vendor, says in its May 20, 2026 guide that all managed care providers, MTM’s NEMT network included, must enroll with it. Depending on your provider type, you enroll either as a full Medicaid provider or through Gainwell’s managed-care-only option, called ORP/MCO. MTM’s application says it voids Idaho applications from companies without this enrollment. A company that also wants to bill Idaho Medicaid directly, for the waiver rides described at the end of this page, needs full enrollment.

Create a Trading Partner Account on idmedicaid.com first, then start the application. Once started, you have 14 days to add to it or submit it before it is deleted, and each saved login resets the clock. Idaho’s provider type list, dated August 19, 2026, puts transportation companies under Non-Emergent Transportation Providers, shows which enrollment option each type may use, and marks agency and commercial transportation as atypical, which means you can enroll with or without an NPI. Gainwell’s enrollment line is 866-686-4272, option 1. For questions about the program itself, DHW’s Medicaid NEMT team is at 800-296-0509 or MedicaidTransport@dhw.idaho.gov. See how to get an NPI number if you decide to get one.

The DHW background check

Idaho’s Transportation Services handbook adds one state rule of its own: every NEMT provider who serves a participant must pass a background check through DHW’s Background Check Unit. The steps are in the driver section below.

Licenses and registrations

Your company

Form an LLC or corporation with the Idaho Secretary of State on SOSBiz. A Certificate of Organization for an LLC costs $100 online, and a paper filing costs $120 because of a $20 manual processing fee (September 2026 fees). Expedited service adds $40 and same-day service adds $100. Business filings were taking about 7 to 10 days in September 2026. You need a registered agent with a physical Idaho street address, and you can serve as your own.

Idaho Code 30-21-213 requires an annual report each year by the end of the month your company was formed, starting the year after. Filing it costs nothing. A certificate of assumed business name, if you use a trade name, costs $25 online.

Get your employer identification number (EIN) from the IRS, which never charges for one. MTM’s provider audit checks that you hold “a current and valid business license,” so ask your city or county which license it issues. For the licensing layers every state adds, see NEMT license requirements.

Idaho State Police and your city

Idaho Medicaid’s rules leave vehicle and driver standards to MTM’s contract. The state’s motor carrier rules, run by the Idaho State Police, apply to larger vehicles:

If you run	You need
Vehicles carrying 8 or fewer passengers, in Idaho only	No USDOT number under ISP rules
Vehicles carrying more than 8 passengers, in Idaho only	An intrastate USDOT number and the federal safety rules
Vehicles that leave Idaho and meet the federal commercial vehicle test	An interstate USDOT number
Vehicles designed for 16 or more people, driver included	A commercial driver’s license

The ISP says a carrier that stays in Idaho needs an intrastate DOT number for vehicles transporting more than 8 passengers, and FMCSA issues both kinds online. IDAPA 11.13.01 then applies the federal safety rules, including driver qualification, drug and alcohol testing, insurance, and inspection, to intrastate passenger vehicles that meet the federal commercial motor vehicle definition. That definition counts the driver among the more than 8 passengers, so call ISP Commercial Vehicle Safety (208-884-7220) if a van is close to the line. These carriers may hire drivers from age 18. See the USDOT number guide for the application.

Some cities license business vehicles. Boise’s City Clerk licenses commercial vehicles and asks for a vehicle safety inspection, $500,000 in liability insurance with the city as certificate holder, a DOT medical certificate every two years, a driving record dated within 10 days, a valid Idaho license, and your Secretary of State registration. Call your city clerk before your first paid trip.

Vehicle rules

An MTM representative inspects each vehicle in person before it enters the network, using MTM’s Idaho vehicle inspection sheet. Renewal inspections can be done by video call, which MTM says can take as little as one to two days. MTM’s audit form also checks that you do daily pre-trip inspections. A vehicle fails if any starred item on the sheet is missing, or if more than five of the other items are.

The starred items include the horn, two outside mirrors, an inside mirror, every exterior light, the parking brake, tires, a spare tire and jack, the windshield and wipers, seat belts, upholstery, working windows, heat and air conditioning, doors, body condition, the current registration, an insurance card, and your company placard on both sides. The sheet also lists:

• Seat belt extensions and a seat belt cutter.
• A step stool and an ice scraper where needed.
• A working speedometer, odometer, clock, interior lights, and flashlight, and spare fuses.
• A bloodborne pathogen kit, a first aid kit, a mounted fire extinguisher, and three emergency triangles.
• A two-way radio or cell phone, maps or a GPS app, incident and accident forms, and a complaint procedure form.
• An inside placard with MTM’s contact information, and signs for no smoking, eating, or drinking, and for seat belts.

Wheelchair vans need a working lift or ramp with an emergency manual lift, handrails, secured lift controls inside the vehicle, a lift lock, reflector tape, a non-skid plate, a parking brake and engine interlock, and four floor straps for a forward-facing position, a lap belt, and a shoulder restraint. See wheelchair securement.

Stretcher vans need a non-porous mattress at least 3 inches thick, chest, hip, knee, and upper torso straps with metal-to-metal quick releases, center-mounted stretcher anchorages, an oxygen tank holder, clean linens, blankets, and pillows, waterless hand wash, and disinfection supplies with a soiled linen bag. Members ride in either vehicle only with a Level of Need form from their health care provider on file. Run our vehicle inspection checklist before each MTM inspection.

Driver rules and training

Every driver who serves Medicaid riders must pass a DHW background check. IDAPA 16.05.06 bars a driver for good after a conviction for crimes that include:

• Abuse, neglect, exploitation, or abandonment of a vulnerable adult.
• Murder, manslaughter, felony vehicular manslaughter, kidnapping, robbery, or arson.
• Rape, incest, lewd conduct with a minor, or sexual abuse or exploitation of a child.
• Human trafficking, felony stalking, felony domestic violence, or attempted strangulation.
• Any felony punishable by death or life in prison.

Any other felony, misdemeanor domestic violence, public assistance or insurance fraud, identity theft, and misdemeanor vehicular manslaughter bar a driver for five years from conviction. A felony DUI or felony drug delivery bars a driver for three years. A listing on a sex offender registry, the federal OIG exclusion list, or Idaho’s Medicaid exclusion list also means a denial.

The check works like this:

1. Register your company with the Background Check Unit to get an agency number and the pay code your drivers use.
2. Have each driver apply online. The fee is up to $70 per person, and DHW can invoice your company if you pay it for your drivers.
3. Get fingerprints within 21 days of the application, at a DHW location or on an FD-258 card mailed in.
4. Decide on provisional work. Once you review the application and it shows no disqualifying crime, the driver may work on a provisional basis until DHW issues a clearance or denial.

A clearance carries over to a new employer if it is less than three years old and the new employer runs a state-only Idaho State Police check within 30 days. Once you have a clearance, report any new charge or conviction to DHW right away. The Background Check Unit is at 208-332-7990, 800-340-1246, or bcu@dhw.idaho.gov. See NEMT driver background checks for how these compare with other states.

MTM sets its own standards for driver qualifications, driving records, and CPR, defensive driving, and passenger assistance training, and gives you the details at credentialing. Its audit checks that you keep written policies on driver training, annual training, orientation, performance, accident investigation, and drug screening, that drivers wear a badge or uniform, and that each driver road tests in the type of vehicle they will drive. MTM audits the files of at least 10% of approved drivers. Keep them in order with our driver file checklist.

On the job, drivers help riders into the vehicle and with seat belts, use a phone only in hands-free mode, and never smoke or vape in the vehicle. They do not enter a rider’s home without MTM’s approval, except in an emergency.

Trip rules and how you get paid

MTM’s Idaho handbook sets these service standards:

• Pickup. Arrive within a half-hour window, 15 minutes either side of the scheduled time, and wait at least 15 minutes. Do not drop a rider more than 30 minutes before the appointment unless asked. See pickup windows.
• Confirmation. Call each rider the day before to confirm the pickup time, and give them your phone number.
• Returns. Pick up a will-call return within one hour of the call, and a scheduled return within 15 minutes.
• Ride time. Keep each ride under twice the normal direct commute. On shared rides, no one rides more than 45 minutes longer than a direct trip, except on long-distance trips.
• Extra stops. Unscheduled appointments and pharmacy trips need MTM’s approval first, or they are not paid.
• Turning trips back. Tell MTM within 24 hours of receiving a trip, and at least 48 hours before the appointment. Inside 48 hours, call the helpdesk.

Every leg needs the rider’s signature on the trip log at the time of the trip, with the date, pickup and drop-off times, and your driver’s signature. A caregiver, parent, guardian, or medical provider may sign for a rider who cannot. Missing signatures or times mean a denied claim. Our trip log template holds every field.

Idaho does not set NEMT rates for providers. MTM sets rates with each company one at a time. The amount on each trip assignment is payment in full, every trip counts as one way, and where MTM pays mileage, its own mapping system sets the shortest distance whatever route you drive. If the price, the level of service, or the mileage (by 3 miles or more) on a trip is wrong, tell MTM before you do the trip.

MTM does not pay for no-shows. Report a rider no-show when it happens, or MTM may record a provider no-show against you. Being late so a rider misses an appointment can bring corrective action and liquidated damages. Report accidents and incidents in writing within 24 hours, and injuries by phone within three hours.

If you disagree with a claim denial or other decision, file a grievance with MTM’s Transportation Provider Helpdesk, which the 2023 Idaho handbook lists at 888-597-1180, weekdays 6 a.m. to 7 p.m. If the answer does not settle it, you can appeal within 30 days, including by mail to MTM Quality Management.

Insurance requirements

MTM’s Idaho provider page sets these minimums as of September 2026:

Item	What MTM asks for
General liability	At least $1,000,000
Auto liability	At least $1,000,000
Workers’ compensation	What Idaho law requires

MTM must be certificate holder and additional insured on both liability policies. Its 2023 Idaho handbook lists $500,000 combined single limits, asks for an endorsement that notifies MTM of any cancellation, and wants MTM as certificate holder on workers’ compensation too. Ask your recruiter which limits your agreement uses before you buy. See NEMT insurance requirements for what other brokers ask.

Idaho Code 49-117 defines the minimum auto liability for every vehicle:

Limit	Amount
Injury to one person	$25,000
All injuries in one accident	$50,000
Damage to others’ property	$15,000

Idaho requires workers’ compensation once you have one employee, full or part time, and it must be in place before the first hire. Owners of a sole proprietorship, working members of an LLC, and corporate officers who own at least 10% and are directors are exempt, but may choose coverage. An uninsured employer can owe a penalty of $2 per employee per day or $25 per day, whichever is more, and can be personally liable for an injured worker’s benefits. See workers’ comp for NEMT.

What it costs and how long it takes

These are the fees Idaho sets as of September 2026. Vehicles, insurance, and equipment depend on your quotes. See what it costs to start a NEMT business.

Item	Cost	Paid to
EIN	Free	IRS
LLC filing	$100 online, $120 on paper	Secretary of State
Annual report	No fee	Secretary of State
Assumed business name	$25 online	Secretary of State
Background check	Up to $70 per person	DHW

A workable order, from first call to first trip:

1. Call MTM’s provider help desk. Ask whether MTM needs providers in your county and at which service levels.
2. Form your company on SOSBiz, which takes about 7 to 10 days, and get your EIN.
3. Get any city or county license your area requires.
4. Buy insurance that meets MTM’s limits, with MTM named on the certificates.
5. Register with the Background Check Unit and have each driver apply and get fingerprinted within 21 days.
6. Enroll with Gainwell as a managed care provider, finishing within 14 days of starting the application.
7. Get a USDOT number if any vehicle carries more than 8 passengers.
8. Equip your vehicles to MTM’s inspection sheet.
9. Apply to MTM, then interview, contract, credential, pass the in-person inspection, and finish training.

MTM sets the pace. It adds providers where it has a need and keeps other applications on file. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

Four other sources of rides are worth a call.

• Waiver transportation. Idaho Medicaid pays for non-medical transportation for members on the Aged and Disabled waiver and the Adult Developmental Disabilities waiver, to reach the grocery store, a place of worship, and other community activities. Unlike NEMT, this is billed straight to Idaho Medicaid: you enroll as a provider, pass the same DHW background check, and get prior authorization from the Bureau of Long Term Care or the Bureau of Developmental Disability Services before the rides happen. Commercial providers bill A0080 per mile, with a higher rate for the first mile of the day and modifier 76 on later trips, up to 1,800 miles per member a year. See how to become a waiver transportation provider.
• Public transportation grants. The Idaho Transportation Department’s Public Transportation Office administers federal transit grants, including Section 5310, and posts a local coordinated human service transportation plan for each of its six districts. Call (208) 344-4492 to find the transit programs near you.
• Veterans. The VA pays for special mode transportation, such as a specially equipped vehicle, when a VA provider decides the veteran’s condition requires it and VA approves the trip in advance. Ask your nearest VA health facility how it books these rides.
• Facilities and private pay. Dialysis centers, hospitals, and senior living communities, along with riders who pay for themselves, add work that does not depend on one broker. See how to get NEMT facility contracts.