# How to Start a NEMT Business in Iowa (2027)

Canonical URL: https://nemtguide.com/states/iowa/ · Updated 2026-09-28

To start a NEMT business in Iowa, form your company with the Secretary of State, insure your vehicles, and get an Iowa DOT passenger certificate before your first paid ride. Then apply to MTM Health, which arranges Medicaid rides for all three health plans and fee-for-service members, and has run the plans' rides since September 19, 2025. Drivers need a Class D chauffeur license unless an exception applies.

- MTM Health arranges Medicaid rides for all three Iowa health plans and for fee-for-service members, so an MTM agreement is the way into Medicaid ride work across the state.
- Get an Iowa DOT passenger certificate before your first paid ride. Iowa Code 325A requires one, and the application, form 441052, costs $150.
- Drivers who carry riders for pay need a Class D chauffeur license or a CDL unless an exception applies, and drivers of for-hire vans built for 7 to 15 people follow federal hours-of-service rules.
- Iowa has proposed adding NEMT for all Iowa Health and Wellness Plan members, because CMS stops approving the waiver that excludes them on January 1, 2027.
- A contract with the NEMT broker also qualifies you to give HCBS waiver rides to errands, jobs, and day programs, paid per mile or per trip.

## Iowa NEMT at a glance

| Fact | Details |
| --- | --- |
| Medicaid agency | Iowa Department of Health and Human Services (HHS). Health plans get a monthly capitation payment per member, and fee-for-service rides go through a broker. |
| How rides work | HHS lists a broker for each IA Health Link plan and one for fee-for-service. As of September 2026, all four are MTM Health. |
| Medicaid broker | MTM Health, for fee-for-service and all three health plans. Plan rides moved from Access2Care to MTM on September 19, 2025. |
| How to join | Fill out MTM Health's network application. Where MTM needs providers, a representative takes you through application, credentialing, and contracting. |
| State registration | An Iowa DOT motor carrier passenger certificate under Iowa Code 325A, on form 441052 for $150. The type depends on your vehicles, such as taxicab service for vehicles seating fewer than 7 passengers. |
| Insurance | MTM wants general and auto liability naming MTM, plus workers' comp. Iowa Code 325A.6: $1 million for taxicabs, $1.5 million up to 15 seats, $5 million for 16 or more. |
| Drivers | A Class D chauffeur license unless exempt. MTM's standard terms: at least 21, and 3 at-fault moving violations or 2 at-fault accidents in 36 months disqualify. |
| Vehicle inspections | MTM credentials each vehicle before its first trip. Commercial vehicles (10,001 pounds or more, or 16 or more seats) also need a federal inspection every 12 months. |
| Pay | MTM sets rates with each provider. Its standard agreement pays uncontested invoices within 30 days and refuses claims filed more than 90 days after the trip. |
| EVV | NEMT is not on the list. Iowa EVV covers personal care services (since January 1, 2021) and home health services (since January 1, 2024). |

Iowa HHS lists a ride broker for each Medicaid health plan and one for fee-for-service members. As of September 2026, all of them are the same company: MTM Health. To get that work, you need a registered company, an Iowa DOT passenger certificate, licensed drivers, and vehicles and insurance that meet the broker's terms. The rules below follow Iowa's NEMT rule, 441 IAC 78.13, as effective July 1, 2026.

## How Medicaid rides work in Iowa

The Iowa Department of Health and Human Services (HHS) runs Medicaid. In IA Health Link, the managed care program, each health plan gets a monthly capitation payment for its members and arranges their rides through a broker. For [fee-for-service](https://nemtguide.com/glossary/fee-for-service-medicaid/) members, HHS provides rides through a transportation brokerage. As of September 2026, HHS lists one broker for every group:

| Members | Broker |
|---|---|
| Iowa Total Care | MTM Health |
| Molina Healthcare of Iowa | MTM Health |
| Wellpoint Iowa | MTM Health |
| Fee-for-service | MTM Health |

The plans' rides moved from Access2Care to MTM on September 19, 2025, when Access2Care became MTM Health. HHS told members that the transportation provider network and the booking numbers stayed the same.

### Who qualifies and where rides go

Rides are for members with full Medicaid benefits who need to reach a Medicaid-covered service from a provider enrolled with Iowa Medicaid. The broker must use the most economical ride that fits the member's needs. A member who can get a free ride uses it, and a member with a working car, a license, and insurance, or a friend or relative who can drive, claims mileage instead.

The rule's ride types are mileage payments to the member or a volunteer driver, taxis, public transit where it fits, wheelchair and stretcher vans, and airfare when the member's condition calls for it. Meals and lodging are covered when the appointment is more than 50 miles away one way.

Rides go to the closest qualified Medicaid provider, unless the member's choice is less than 10 miles farther one way or the extra cost is medically justified. Members must also book appointments on the days a transportation provider sends a shuttle, with reasonable medical exceptions, so regular shared runs fit the rule. See [rural NEMT](https://nemtguide.com/guides/rural-nemt/) for how long shared trips pay.

### Who does not get NEMT

- **Most expansion adults.** Adults 19 to 64 with income up to 133 percent of the federal poverty level are covered through the Iowa Health and Wellness Plan (IHAWP). Iowa waives NEMT for this group through a Section 1115 waiver, and the state's managed care contract covers rides only for IHAWP members found medically exempt.
- **Hawki members.** HHS's benefit comparison of March 2026 shows no NEMT for Hawki, Iowa's children's health insurance program.
- **Facility residents.** Rides are not covered when a nursing facility or an ICF/ID provides them, which the rule describes as trips within 30 miles one way.
- **Other trips.** Rides to services Medicaid does not cover, to providers not enrolled with Iowa Medicaid, and emergency trips.

### The 2027 change for expansion adults

On September 17, 2026, HHS posted a proposed state plan amendment, SPA IA-26-0010, to add NEMT for the whole IHAWP population. HHS says CMS will no longer approve the NEMT waiver starting January 1, 2027, and that the new coverage would be the same as for other Medicaid members. HHS estimates the annual cost at $129,367 in total funds for state fiscal year 2027. Written comments are due by 4:30 p.m. on October 17, 2026. The amendment is a proposal until CMS approves it. See Iowa to add NEMT for expansion adults.

### How members book

Members call the broker at least two business days before the appointment, counting the appointment day but not the day of the call, and no more than 30 days ahead. Urgent trips can be booked with less notice. The rule's examples are follow-up care after surgery, unexpected pre-surgery visits, hospital discharges, new conditions or tests, and dialysis. MTM schedules routine trips Monday through Friday, 8 a.m. to 5 p.m., and urgent trips 24 hours a day.

## How to join MTM Health in Iowa

You do not enroll with Iowa Medicaid to give NEMT rides. HHS provides rides through a transportation brokerage, and MTM contracts the transportation companies for fee-for-service members and all three plans. MTM says it is always seeking providers for its statewide Iowa network. Its steps:

1. **Apply online.** Fill out the questionnaire on MTM's Join Our Network page. If MTM needs providers in your area, it contacts you about contracting. If not, it keeps your information on file and calls when a need opens.
2. **Work with your representative.** MTM's Iowa process has three phases: application, credentialing, and contracting. A designated representative takes you through each one.
3. **Credential your company, drivers, and vehicles.** Send driver licenses, background checks, driving records, drug and alcohol results, training certificates, and insurance certificates that name MTM. No driver or vehicle runs trips until it is credentialed.
4. **Sign the agreement and train your drivers.** Every driver must meet MTM's credentialing rules and finish its required training.
5. **Take trips.** MTM sends trip assignments to providers electronically.

Iowa HHS tells Medicaid providers to check three exclusion lists at hire and every month after: the Iowa Medicaid Sanctions List, the HHS OIG exclusion list, and the federal System for Award Management. See [the OIG exclusion list](https://nemtguide.com/glossary/oig-exclusion-list/).

Our [MTM Health guide](https://nemtguide.com/brokers/mtm-health/) covers the company across its other states, and [NEMT broker credentialing](https://nemtguide.com/guides/nemt-broker-credentialing/) lists the documents to gather.

## Licenses and registrations

### Your company

Form an LLC with the Iowa Secretary of State by filing a Certificate of Organization, which costs $50 as of September 2026. Articles of incorporation for a corporation also cost $50, and both can be filed online.

An LLC files a biennial report between January 1 and April 1 of each odd-numbered year, starting with the first odd-numbered year after it forms. An LLC formed in 2026 files its first report in 2027. The fee is $30 online or $45 on paper. Corporations file in even-numbered years, for $60. If an LLC's report is more than 60 days late, the Secretary of State may start to dissolve it.

Get your employer identification number (EIN) from the IRS, which issues it free and online right away. If a health plan or facility asks for an NPI, see [how to get an NPI number](https://nemtguide.com/guides/how-to-get-an-npi-number-for-nemt/).

Cities that license taxicabs can add their own rules, and an Iowa DOT taxicab certificate does not override them. Check with your city before you start.

### Iowa Department of Transportation

Iowa Code chapter 325A treats anyone who carries passengers for pay on Iowa highways as a motor carrier of passengers. You need a certificate from the Iowa DOT for your type of operation, and you cannot start operating until it is issued. The law has no separate NEMT category. The application, form 441052, offers these passenger certificates:

| Certificate | What it covers |
|---|---|
| Taxicab service | Vehicles seating fewer than 7 passengers, not on a regular route |
| Charter | A vehicle let to one group for a set price, trip, and time |
| Regular route | Scheduled service on regular routes, open to the public |
| 16 or more passengers | Vehicles designed for 16 or more people, driver included |

A nonprofit or government carrier that mainly serves elderly and disabled riders, gets public operating funds, and does not duplicate a regular-route service gets a DOT permit instead of a certificate.

Describe your vehicles and trips to the DOT's Motor Carrier Services (515-237-3268, 6310 SE Convenience Blvd, Ankeny) before you apply, so you file for the right one. The application needs:

- **Form 441052**, with its safety self-certification.
- **Proof of insurance**, which your insurer files with the DOT on Form E. The policy must be written for at least a year, and the DOT gets 30 days' written notice before any cancellation.
- **A USDOT number** if the Federal Motor Carrier Safety Administration requires one. A taxicab service application must include one. See [whether NEMT companies need a USDOT number](https://nemtguide.com/guides/dot-number-for-nemt/).
- **The $150 application fee**, by card, cash, check, or money order.

Keep a copy of the certificate in every vehicle, on paper or electronically, for any officer who asks. Before a vehicle goes into service, mark both sides with your company name and any USDOT number followed by "IA", in letters readable from 50 feet. Put your certificate number in every ad. Report a name or address change within 30 days, for $25. The DOT says a taxicab service certificate stays valid as long as the company operates, unless the DOT suspends it.

Carriers with commercial vehicles also complete the DOT's online safety seminar, $200 for up to three staff, within six months of getting the certificate. Under Iowa law, a commercial vehicle has a gross vehicle weight rating of 10,001 pounds or more or is designed for 16 or more people, driver included. A passenger carrier with no commercial vehicles skips the seminar, and its certificate reads "limited to noncommercial vehicles only." Ask Motor Carrier Services whether a heavy wheelchair van changes that for you.

Iowa's transit coordination rule, 761 IAC chapter 910, reaches providers that receive public funds, directly or indirectly, for rides to the public or to specific client groups. They request a certification of compliance from the Iowa DOT, and to be found compliant, their vehicles must be insured for $1 million per accident. Ask the DOT's Modal Transportation Bureau (515-233-7870) whether your contracts need one. For the layers of licensing NEMT companies face in every state, see [NEMT license requirements](https://nemtguide.com/guides/nemt-license-requirements/).

## Vehicle rules

Iowa's NEMT standards, in the state's current managed care contract, apply to plan rides. Every specialized medical vehicle must:

- Have current license and registration, and the proof of financial responsibility Iowa law requires.
- Be kept in proper mechanical condition at all times.
- Have working heat and air conditioning, kept at a temperature comfortable for the rider.
- Have working passenger restraints, turn signals, lights, horn, brakes, front and rear windshields, windows, and mirrors.
- Pass a safety inspection where state or federal law requires one.
- Carry two-way emergency communication. A two-way radio or a cell phone is enough.

MTM's standard agreement adds:

- A GPS-capable, internet-connected device that sends the vehicle's location, trip events, and rider signatures in real time. MTM's own driver app meets this. Other dispatch software works only if MTM approves it and it sends the data to MTM.
- A two-way voice system linking every vehicle to your office. Pagers do not count.
- A posted no-smoking sign, and a sign telling riders that drivers do not take responsibility for personal items.

The agreement also requires every vehicle that carries riders in mobility devices to meet the federal ADA vehicle rules. See [wheelchair securement](https://nemtguide.com/guides/wheelchair-securement/) for tiedowns and training.

Iowa's Department of Public Safety (DPS) applies the federal motor carrier safety rules to commercial vehicles, and 49 CFR 396.17 bars using one unless it passed an inspection in the last 12 months, with proof on board. DPS officers also audit new motor carriers within 18 months of the day they start business. MTM does not pay for a trip in a vehicle it has not credentialed. Run through our [vehicle inspection checklist](https://nemtguide.com/templates/nemt-vehicle-inspection-checklist/) before each broker review, and see [NEMT vehicle requirements](https://nemtguide.com/guides/nemt-vehicle-requirements/) for vehicle types.

## Driver rules and training

### Iowa license and hours rules

Iowa law calls anyone who drives people for pay a chauffeur, and a chauffeur needs a Class D license. A Class D license also works as a regular Class C license, and a driver with a CDL does not need one. The exception that matters most for NEMT covers drivers of taxicabs that seat fewer than 7 passengers and do not run a regular route. Iowa issues no chauffeur license to anyone under 18. A CDL is needed for any vehicle designed for 16 or more people, driver included, even if it was modified to carry fewer riders with disabilities.

DPS applies the federal hours-of-service rules, 49 CFR part 395, to drivers of for-hire vehicles designed for 7 to 15 people, driver included. These drivers cannot use the federal 150-air-mile exemption from logbooks, so keep a log for each one. The rule does not apply to vehicles used mainly within one city and regulated by that city. Under 49 CFR 395.5, a driver may not:

- Drive more than 10 hours after 8 hours in a row off duty.
- Drive after being on duty 15 hours following 8 hours off.
- Drive after 60 hours on duty in 7 days, or 70 hours in 8 days if your company runs every day.

See hours of service rules for how to log them.

### MTM's driver standards

MTM's standard agreement, in the January 1, 2023 version Pennsylvania posts, requires every driver and attendant to:

- Be at least 21, a U.S. citizen or legal resident alien, and able to read, write, and speak English.
- Hold a valid license for the vehicle, as the state and city require.
- Pass a criminal background check before hire and every year after, with a three-year driving record pulled every year.
- Pass drug and alcohol tests before hire, after an accident, on reasonable suspicion, and at random. See NEMT driver drug testing.

It rules out drivers with any of these:

- A suspended, expired, or revoked license.
- Three or more at-fault moving violation convictions, or two or more at-fault accidents, in the past 36 months.
- Any conviction for a sexual crime or a crime of violence.
- A felony in the past seven years, unless MTM's client approves.
- Drug or alcohol treatment, or a positive drug test, in the past five years.
- Current work release, probation, or parole, or a pending charge that would disqualify them.

Client contracts can add to this list, so ask your MTM representative for the Iowa credentialing checklist.

Your driver training program must cover fraud, waste, and abuse and HIPAA, and client contracts can add defensive driving and passenger assistance with wheelchair securement. On the job, drivers may not eat or drink in the vehicle or let riders smoke or vape, must allow service animals, must make every rider wear a seat belt, and may not allow weapons in the vehicle.

Keep a file for every driver and attendant, owner-drivers included, with the license, background checks, driving records, drug and alcohol results, and training certificates. Our [driver file checklist](https://nemtguide.com/templates/nemt-driver-file-checklist/) tracks them.

## Trip rules and how you get paid

MTM asks Iowa members to call if a driver is more than 15 minutes past the scheduled pickup time, or more than an hour after they call for a return ride that was not booked ahead. Plan to beat both marks. See [will-call trips](https://nemtguide.com/glossary/will-call-trip/) for handling returns.

MTM discusses and sets rates with each provider individually. Its standard agreement adds:

- **Payment.** MTM pays properly submitted, uncontested invoices within 30 days of electronic submission.
- **Deadline.** Claims submitted more than 90 days after the date of service, or past the client's limit, are not paid.
- **Credentials.** Trips run by uncredentialed drivers or in uncredentialed vehicles are not paid.
- **Members.** You bill only MTM, never the rider, even if MTM does not pay.
- **Denied claims.** MTM has an appeals process, and it can recover overpayments from future payments.

MTM does not pay Iowa providers for no-shows or cancellations at the door. Confirm each trip with the member the day before, and cancel it if the member will not go. See [NEMT no-shows](https://nemtguide.com/glossary/no-show/), and keep a [trip log](https://nemtguide.com/templates/nemt-trip-log-template/) for disputes.

Iowa's NEMT rule requires the broker to run a grievance process for transportation providers, then gives you two routes past it:

1. **State fair hearing, for payment disputes only.** A provider in good standing with the broker can ask for one over a denied or reduced claim, acting for the member. You need the member's or guardian's prior signed written consent, and the form must warn that health information may become public at the hearing.
2. **Binding arbitration, for everything else.** Any other provider grievance ends in binding arbitration, with a designee of Iowa Medicaid as arbitrator.

NEMT is not part of Iowa's electronic visit verification (EVV) program. EVV covers personal care services, required since January 1, 2021, and home health services, required since January 1, 2024.

## Insurance requirements

MTM's Iowa insurance terms:

| Item | What MTM asks for |
|---|---|
| General liability | Required, naming MTM as certificate holder and additional insured |
| Auto liability | Required, naming MTM as certificate holder and additional insured |
| Workers' comp | Coverage that meets Iowa's requirements |

MTM's standard agreement sets a floor of $500,000 per occurrence and $500,000 aggregate for general liability, and a $500,000 combined single limit for auto, with notice of cancellation to MTM. See additional insured for what that endorsement means.

State law sets higher limits for passenger carriers. Iowa Code 325A.6 ties them to the federal passenger carrier limits in 49 CFR part 387, with a separate rule for taxicabs:

| Vehicle | Minimum liability |
|---|---|
| Taxicab, under 7 passengers | $1 million, primary auto |
| 15 or fewer seats, driver included | $1.5 million |
| 16 or more seats, driver included | $5 million |

Insure each vehicle to the state limit for its size. The state's managed care contract tells the broker to confirm your coverage meets the rules that apply, and Iowa's general auto floor of $20,000 per person, $40,000 per accident, and $15,000 in property damage is not enough for passenger work. See [NEMT insurance requirements](https://nemtguide.com/guides/nemt-insurance-requirements/).

Iowa requires most employers to carry workers' compensation insurance or register as self-insured. Iowa law does not count LLC members, sole proprietors, partners, or independent contractors as employees, and those owners may file a nonelection of coverage. Up to four corporate officers (president, vice president, secretary, and treasurer) may reject coverage for themselves. See workers' comp for NEMT drivers.

## What it costs and how long it takes

These are the fees Iowa sets as of September 2026. Vehicles, insurance premiums, and equipment depend on your quotes. See [what it costs to start a NEMT business](https://nemtguide.com/guides/how-much-does-it-cost-to-start-a-nemt-business/) for those.

| Item | Cost | Paid to |
|---|---|---|
| EIN | Free | IRS |
| LLC or corporation filing | $50 | Secretary of State |
| LLC biennial report | $30 online, $45 paper | Secretary of State |
| Passenger certificate | $150 | Iowa DOT |
| Safety seminar (commercial vehicles) | $200, up to 3 staff | Iowa DOT |
| Certificate name or address change | $25 | Iowa DOT |

A workable order, from first call to first trip:

1. **Apply to MTM's network early.** MTM moves ahead where it needs providers, so learn early whether your counties need you.
2. **Form your company** and get your EIN.
3. **Buy insurance** at the state limit for your vehicles, naming MTM as certificate holder and additional insured.
4. **Apply for your Iowa DOT passenger certificate** on form 441052, with a USDOT number if you need one, proof of insurance, and the $150 fee. Carry no paid riders until it is issued, and check your city's taxicab rules if you run as a taxicab service.
5. **License and schedule your drivers.** Confirm each driver's Class D chauffeur license, unless an exception applies, and set up hours-of-service logs for vans built for 7 to 15 people.
6. **Equip your vehicles** to the state and MTM lists.
7. **Credential with MTM.** Send your documents, sign the agreement, and train your drivers.
8. **Take the safety seminar** within six months if you run commercial vehicles.

The IRS issues an EIN online right away, and the DOT issues your certificate once every requirement is met. MTM sets the pace for the rest. For the same steps in any state, see [how to start a NEMT business](https://nemtguide.com/guides/how-to-start-a-nemt-business/).

## Work beyond Medicaid

### HCBS waiver rides

Iowa's home and community-based services (HCBS) waivers pay for non-medical rides, and a transportation provider that contracts with the NEMT broker qualifies to give them. That holds for the elderly, intellectual disability, brain injury, and physical disability waivers. Waiver rides take members on errands and essential shopping, to and from work or day programs, and out into the community to reduce isolation. The waiver does not pay for anything the member can get through regular Medicaid, so medical trips stay with NEMT.

Waiver rides bill as [S0215](https://nemtguide.com/glossary/s0215/), per loaded mile, or [T2003](https://nemtguide.com/glossary/t2003/), per one-way trip. HHS caps the per-mile rate by the mental health and disability services region where the member lives. The caps effective July 1, 2024 run from $1.70 to $10.10 per loaded mile, and a one-way trip pays your per-mile rate times the door-to-door miles. The HCBS fee schedule effective October 1, 2026 still uses those caps, and it also lists [A0130](https://nemtguide.com/glossary/a0130/) for wheelchair van trips (with modifier U3 for group trips) and [T2001](https://nemtguide.com/glossary/t2001/) for escorts. Iowa Medicaid plans a uniform fee schedule for all HCBS waiver services starting January 1, 2027, so check the rates then.

To get this work, enroll with Iowa Medicaid on the HCBS Waiver Provider Application, form 470-2917 (revised February 2026), and attach your MTM welcome letter or contract. A first-time enrollee also files the provider agreement (470-2965), the electronic funds transfer form (470-4202), an IRS W-9, and the designated contact form (470-5112). Then finish each health plan's credentialing. The Provider Enrollment Unit is at 800-338-7909, option 2. See how to become a waiver transportation provider.

### Transit systems, facilities, veterans, and private pay

- **Public transit.** Iowa has 19 urban and 16 regional transit systems, and a regional system serves every county. Most regional systems run demand-response and contract service, and systems seeking state and federal funds post hearing notices for private providers on the Iowa DOT's Private Sector Notification Clearinghouse.
- **Facilities.** Nursing facilities and ICF/IDs that transport their own residents, dialysis centers, and hospitals are worth a call. See [how to get NEMT facility contracts](https://nemtguide.com/guides/how-to-get-nemt-facility-contracts/).
- **Veterans.** The VA pays for special mode transportation, such as a specially equipped vehicle, when the veteran's local VA health facility approves it in advance. Ask your nearest VA health facility how it books those rides.
- **Private pay.** Riders who pay for themselves add work that does not depend on the broker. See [private-pay NEMT](https://nemtguide.com/guides/private-pay-nemt/).

## Frequently asked questions

### Do I need a license to run a NEMT business in Iowa?

Yes. Iowa Code chapter 325A requires anyone who carries passengers for pay on Iowa highways to hold a motor carrier passenger certificate from the Iowa DOT before the first paid trip. Apply on form 441052 with proof of insurance and the $150 fee. The law has no NEMT category, so ask Motor Carrier Services which certificate fits your vehicles. Your drivers also need a Class D chauffeur license unless an exception applies, and cities that license taxicabs can add their own rules.

### Who is the Medicaid NEMT broker in Iowa?

MTM Health. As of September 2026, Iowa HHS lists MTM as the ride broker for fee-for-service members and for all three IA Health Link plans: Iowa Total Care, Molina Healthcare, and Wellpoint. The plans' rides moved from Access2Care to MTM on September 19, 2025, when Access2Care became MTM Health. HHS told members the transportation provider network and the booking numbers stayed the same.

### Do I enroll with Iowa Medicaid to give NEMT rides?

Not for broker rides. Iowa HHS provides NEMT through a transportation brokerage, and you contract with MTM Health, which credentials your company, drivers, and vehicles. You do enroll with Iowa Medicaid if you also want to give HCBS waiver rides to errands, jobs, and day programs. A contract with the NEMT broker qualifies you: file the HCBS Waiver Provider Application, form 470-2917, with your MTM welcome letter or contract attached.

### How much does MTM Health pay for NEMT trips in Iowa?

MTM discusses and sets rates with each provider individually. Its standard agreement pays properly submitted, uncontested invoices within 30 days of electronic submission and refuses claims filed more than 90 days after the trip. MTM does not pay for no-shows in Iowa. HCBS waiver rides are different: HHS caps them by region at $1.70 to $10.10 per loaded mile, under the limits effective July 1, 2024.

### Will Iowa Medicaid expansion adults get NEMT rides in 2027?

Iowa has proposed it. Today, Iowa Health and Wellness Plan members get NEMT only if they are found medically exempt, because Iowa waives the benefit through a Section 1115 waiver. HHS says CMS will no longer approve that waiver starting January 1, 2027. On September 17, 2026, HHS posted SPA IA-26-0010 to add NEMT for the whole group, with comments due by 4:30 p.m. on October 17, 2026. It stays a proposal until CMS approves it.

### Do Iowa NEMT drivers need a chauffeur license?

In most cases. Iowa law calls anyone who drives people for pay a chauffeur, and a chauffeur needs a Class D license, which Iowa issues only at 18 or older. A driver with a CDL does not need a separate Class D. Drivers of taxicabs that seat fewer than 7 passengers and do not run a regular route are exempt. A CDL is needed for vehicles designed for 16 or more people, driver included. MTM's standard agreement also requires drivers to be at least 21.

### How long does it take to start a NEMT business in Iowa?

The state steps are quick. The IRS issues an EIN online right away, the Secretary of State takes company filings online, and the Iowa DOT issues your passenger certificate once every requirement is met. The safety seminar, needed only for commercial vehicles, can follow within six months. MTM Health sets the pace for the rest: it contracts where it needs providers and pays for no trip until each driver and vehicle is credentialed.

## Official resources

- [Iowa HHS: Medical Transportation and brokers by plan](https://hhs.iowa.gov/medicaid/services-care/medical-transportation)
- [Iowa Administrative Code 441-78.13, Nonemergency medical transportation](https://www.legis.iowa.gov/docs/iac/rule/441.78.13.pdf)
- [MTM Health: Iowa transportation providers](https://www.mtm-inc.net/iowa/transportation-providers/)
- [MTM Health: Join our network](https://www.mtm-inc.net/service-providers/)
- [Iowa DOT: Form 441052, motor carrier certificate application](https://iowadot.forms.govos.com/f/IowaApplicationforMotorCarrierPermitCertification)
- [Iowa DOT: Motor carrier forms and contacts](https://iowadot.gov/motor-carriers/forms)
- [Iowa Secretary of State: Business entity forms and fees](https://sos.iowa.gov/businesses/business-entity-forms-and-fees)
- [IRS: Get an employer identification number](https://www.irs.gov/businesses/small-businesses-self-employed/get-an-employer-identification-number)
- [Iowa DIAL: Workers' compensation compliance](https://dial.iowa.gov/hearings/workers-comp/compliance)
- [Iowa HHS: Medicaid provider enrollment (for HCBS waiver rides)](https://hhs.iowa.gov/medicaid/provider-services/provider-enrollment)