How to Start a NEMT Business in Missouri (2027)

Missouri runs Medicaid rides through one statewide broker. MTM Health has managed MO HealthNet’s non-emergency medical transportation (NEMT) program since December 1, 2022, and the health plans use it too, so an MTM agreement is how you get Medicaid trips. You also need a registered company, MoDOT intrastate authority unless an exemption fits, a state license if you run stretcher vans, and drivers and vehicles that pass MTM’s credentialing. The rules below follow the MO HealthNet NEMT provider manual posted in April 2026.

How Medicaid rides work in Missouri

The MO HealthNet Division (MHD) of the Missouri Department of Social Services runs Medicaid. Its NEMT program uses one statewide broker, which decides which transportation provider takes each trip. The state’s FY 2027 budget request says MHD pays the broker a monthly capitation amount for each fee-for-service member, set by which of four regions of the state the member lives in.

MTM Health, based in Lake St. Louis, took over the statewide contract on December 1, 2022, for MHD and the Department of Mental Health. The budget request counts an average of 96,636 broker trips a month for fee-for-service members in state fiscal year 2025.

The manual leaves health plan members to their managed care plan. As of September 2026, Home State Health (which also runs Show Me Healthy Kids), Healthy Blue, and UnitedHealthcare each name MTM as their ride vendor, so MTM is the network to join for plan trips too. The current plan contracts run through June 30, 2027, so check which plans hold the next ones and which ride vendors they use.

Who qualifies and how members book

A member qualifies when covered by MO HealthNet on the day of the ride, with an appointment for a covered service and no free way to get there. Under 13 CSR 70-5.010, the state pays for the least costly ride that suits the member’s condition. Rides do not go to the pharmacy (except for a vaccination), waiver services, adult day care, care given at home, nursing home discharges, or between hospitals. Members who qualify for city paratransit in Columbia, Jefferson City, Kansas City, Springfield, or St. Louis use it instead.

Booking notice and distance limits depend on the member’s county:

Class	Counties
Urban	Clay, Greene, Jackson, Jefferson, St. Charles, St. Louis, and St. Louis City
Basic	Boone, Buchanan, Cape Girardeau, Cass, Christian, Cole, Franklin, Jasper, Johnson, Lincoln, Newton, Platte, Pulaski, St. Francois, and Taney
Rural	All other counties

Urban members book at least two business days before a routine appointment, and basic and rural members at least three. A primary care trip is limited to 10, 20, or 30 miles by class, and most specialists to 25, 50, or 100 miles, with exceptions for referrals and ongoing specialty care. Urgent trips and hospital discharges can be booked the same day. A member gets no more than three trip legs a day unless MHD approves more. Clinics can set up standing orders for recurring visits, recertified every 90 days except for dialysis. Children under 17 ride with a parent, a guardian, or an adult the parent names.

The level of service decides the vehicle:

• Ambulatory. Members who walk, including manual wheelchair users who can stand or pivot.
• Wheelchair. Members in an electric wheelchair, or in a manual one who cannot transfer.
• Stretcher. Bed-confined members, assessed on the broker’s Stretcher Assessment Form.
• Non-emergency ambulance. Members who need ambulance equipment, such as non-portable oxygen.

How to join MTM Health in Missouri

You do not enroll with MO HealthNet. The manual says transportation providers work through an arrangement or subcontract with the broker and are not MO HealthNet providers, and MHD’s NEMT page tells would-be providers to contact MTM. MTM says it is always seeking Missouri providers, as of September 2026. Its onboarding steps:

1. Apply. Fill out the online application from MTM’s Join Our Network page. It asks for your EIN, NPI, business start date, the counties you serve, your vehicles by service type, your insurance carrier and limits, and your workers’ compensation.
2. Interview. If your area has a need, a network representative calls you. If not, MTM keeps your information on file until a need opens.
3. Contract. You sign MTM’s transportation provider services agreement.
4. Credentialing. You send every company, driver, and vehicle document, and an MTM representative inspects each vehicle in person.
5. Training. Accidents and incidents, credentialing, claims, MTM’s provider portal, fraud, waste, and abuse with HIPAA, and cultural competency.
6. First trip. Trips start once you are fully credentialed, and MTM sends assignments electronically.

MTM’s standard agreement, in the January 1, 2023 version Pennsylvania posts, also requires each vehicle to send its location, trip events, and member signatures in real time, through MTM’s driver app or dispatch software MTM approves. Each vehicle also needs two-way voice contact with your office.

The manual bars the broker from using any driver or attendant with a hit on the Family Care Safety Registry (FCSR). Federal law also has states check that NEMT providers and drivers are not on the OIG exclusion list, that each driver is licensed, and that each provider has a way to handle drug law violations and to report each driver’s driving history.

Send inquiries, grievances, and appeals to your assigned MTM representative, through MTM’s website, or at 866-269-5927. MTM’s Missouri mailing address is 16 Hawk Ridge Drive, Lake St. Louis, MO 63367. As of March 2026, MHD’s Provider Communications line for NEMT program questions is 833-222-7916. See NEMT broker credentialing, our MTM Health guide, and the credentialing checklist.

Licenses and registrations

Your company

Form an LLC or corporation with the Missouri Secretary of State’s Corporations Division. Articles of organization for an LLC (form LLC 1) cost $50 online or $105 on paper, and articles of incorporation start at $58, under the fee schedule revised January 2025. The schedule lists an annual registration report for corporations, $20 online or $45 on paper, and none for LLCs. A fictitious name registration costs $7. See LLC for NEMT.

Get your employer identification number (EIN) free from the IRS. MTM’s application asks for your NPI too, so see how to get an NPI number. Ask your city or county whether you need a local business license.

In the St. Louis area, RSMo 67.1809 says the regional taxicab commission has no authority to license, supervise, or regulate medical transportation. Elsewhere, ask the city where you base your vans whether it licenses vehicles for hire and how it treats medical rides.

MoDOT Motor Carrier Services

The Missouri Department of Transportation (MoDOT) Motor Carrier Services regulates for-hire passenger carriers. As of September 2026, MoDOT says every for-hire carrier moving passengers wholly within Missouri needs intrastate operating authority, unless an exemption in RSMo 390.030 applies. Interstate authority does not cover trips inside Missouri.

Your service	What you need	From
Ambulatory or wheelchair rides for pay	Intrastate authority and a USDOT number	MoDOT
Stretcher rides	A stretcher van service license	DHSS
A car seating 5 or fewer riders	Usually none (taxicab exemption)	MoDOT

Passenger authority is a common carrier certificate if you serve the general public (RSMo 390.051), or a contract carrier permit if you carry passengers only under contracts (RSMo 390.061), with a copy of each contract on file. Three exemptions on MoDOT’s list matter most for NEMT:

• Taxicabs. A vehicle built, or permanently modified, to seat no more than five passengers, not counting the driver, that runs no set route.
• Trips inside one city. Trips within one municipality, between touching municipalities, or within a commercial zone. This does not cover trips between municipalities in the St. Louis and Kansas City areas.
• State-paid contracts. Rides under a contract with the state or a local government that pays the carrier directly. On broker trips, MTM pays you, not the state.

Confirm with MoDOT before you rely on an exemption. MoDOT’s FAQ of May 28, 2026 lists these steps to apply:

1. Get a USDOT number. See DOT number for NEMT.
2. Open a MoDOT Carrier Express account and file the online application.
3. Have your insurer file a Form E (or a Form G surety bond) with MoDOT.
4. Send a financial statement and your rates. A passenger carrier without interstate authority files its rates as a tariff before authority is granted. Under RSMo 390.061, MoDOT has no say over contract rates.
5. Pay the regulatory license fee of $10 per power unit, unless you are in the Unified Carrier Registration program. The license runs January 1 through December 31 and rides in the vehicle.

MoDOT’s rule 7 CSR 265-10.015 also asks for proof of good standing with the Secretary of State, a workers’ compensation certification, and a copy of each contract you list, and MoDOT stops considering an application whose documents are still missing after 45 days. If you run only inside Missouri, mark each vehicle with your USDOT number followed by “MO” (a van for 15 or fewer riders that needs no commercial license may show it on the rear), and file a new financial statement each year. Motor Carrier Services answers at 866-831-6277. See NEMT license requirements for other states.

DHSS Bureau of Emergency Medical Services

A stretcher van service needs a license from the Department of Health and Senior Services (DHSS) under RSMo 190.528, regardless of the motor carrier laws. Missouri law defines a stretcher van as any vehicle other than an ambulance that is built and equipped to carry passengers lying down. Under 19 CSR 30-40.528, in effect since January 30, 2009:

• When to apply. Send the application to the EMS Bureau 30 to 120 days before the date you want the license.
• What it asks. Your trade name, where the vehicles are kept, how many you will run, your manager, the licensee, the chief executive officer, and any licensing actions against you in any state.
• Where to get it. The rule points to the EMS Bureau, PO Box 570, Jefferson City, MO 65102-0570. As of September 2026, the bureau’s forms page says service agency forms now sit in its online licensing portal and asks you to allow 30 business days for processing. Call 573-751-6356 or email EMSINFO@health.mo.gov for access.
• Inspection. DHSS inspects your service before it licenses it, and again after any change of ownership.
• How long it lasts. Five years.

A county or city that runs a licensed ambulance service can add its own stretcher van rules, as long as they are at least as strict as the state’s. Ask MoDOT whether your stretcher service also needs intrastate authority. See how to start a stretcher transportation business.

Vehicle rules

Up to three inspections can apply to each vehicle:

• MTM. An MTM representative inspects each vehicle in person before it enters the network. MHD’s NEMT FAQ, revised October 2024, says the broker then reinspects each vehicle every six months and puts its decal on each vehicle that passes. Renewals can be done by video call, as of September 2026, and MTM’s system assigns no trips to a provider whose credentials have lapsed.
• The state safety inspection. RSMo 307.350 requires an inspection every two years at an official station, except for vehicles within 10 years of their model year with fewer than 150,000 miles. Stations may charge up to $12, as of September 2026. A stretcher van must keep a current safety inspection whatever its age, and DHSS wants a preventive maintenance program with records it can inspect.
• The federal inspection. Missouri applies the federal motor carrier safety rules to trips inside the state (RSMo 307.400). MoDOT’s Safety and Compliance Manual, September 2023 edition, applies them to a passenger vehicle designed or used to carry 9 or more people, driver included, for pay, or rated over 10,000 pounds, and those need an inspection at least every 12 months under 49 CFR 396.17. The same manual lists the transportation of sick and injured people as an exception, so ask MoDOT how it applies to your trips. See FMCSA vehicle inspection rules.

The state manual requires vehicles to meet the federal motor vehicle safety standards in 49 CFR Part 571. MTM’s vehicle inspection sheet checks for:

• Working lights, wipers, doors, brakes, horn, mirrors, air conditioning, heat, and a spare tire and jack.
• Seat belts, belt extensions, a belt cutter, and a step stool where riders need one.
• A bloodborne pathogen kit, first aid kit, mounted fire extinguisher, three emergency triangles, and flashlight.
• A two-way radio or cell phone, registration, insurance card, accident forms, your company placard on both sides, and no smoking and seat belt signs.

Wheelchair vehicles also need a working lift or ramp with a lock, handrails, a shoulder belt and lap belt, four floor straps for a forward-facing position, a parking brake and engine interlock, an emergency manual lift, and reflector tape on the lift. See wheelchair securement.

On MTM’s sheet, stretcher vehicles 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 anchorages, an oxygen tank holder, clean linens, and disinfection supplies. The DHSS rules add:

• A vehicle built by a qualified manufacturer to the federal safety standards, with a stretcher and mount that meet KKK-A-1822 or AMD Standard 004.
• An automated external defibrillator and body substance isolation supplies.
• A stretcher area with washable surfaces and no carpet or cloth.
• No emergency lights, and no “ambulance” lettering or Star of Life.
• Voice contact with your dispatcher or 911, and a policy for calling 911 in an emergency.

Run through our vehicle inspection checklist before each inspection.

Driver rules and training

Missouri license and screening

• Class E for-hire license. Missouri’s Driver Guide, revised August 2026, says a driver paid to drive a vehicle carrying 14 or fewer passengers needs a Class E license, from age 18. A Class F holder takes a written test on the commercial vehicles chapter plus vision and sign tests, with no driving test. It costs $24 for three years or $48 for six.
• Family Care Safety Registry. Each driver and attendant must clear the registry run by the Department of Health and Senior Services. Registration costs $16 from October 1, 2026 ($15 before), plus a $0.57 card fee online. It checks open Missouri criminal records, the sex offender registry, child abuse and neglect findings, and the state’s worker disqualification lists.
• Stretcher crews. Each stretcher van carries at least two crew members on every trip. Each needs CPR certification at the community and workplace level, at least one must be trained on the defibrillator, and each driver needs a driver safety or vehicle operations course on file.
• Federal driver rules. Drivers of vehicles under the federal safety rules need a DOT medical card, and a vehicle designed for 16 or more people needs a commercial license. See do NEMT drivers need a CDL.

MTM’s driver standards

MTM’s standard agreement (the January 1, 2023 version) 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. Each needs a background check and a three-year driving record at hire and yearly, plus drug and alcohol tests before hire, after an accident, on reasonable suspicion, and at random. It bars anyone with:

• A suspended, expired, or revoked license.
• Three or more at-fault moving violations, or two or more at-fault accidents, in the past 36 months.
• Any conviction for a sexual crime or a crime of violence, or 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.

Ask your MTM representative which terms your Missouri agreement uses. See driver background checks and driver drug testing.

Training and records

MHD’s NEMT FAQ, revised October 2024, lists the training you give each driver: defensive driving, safety equipment, basic first aid and precautions for body fluids, lifts, ramps, and wheelchair securement, handling wheelchairs and other mobility aids, lifting and transferring riders, and what to do when problems come up. It also lists a Missouri State Highway Patrol criminal record check and a negative drug test for each driver. MTM says every employee of every provider repeats fraud, waste, and abuse and HIPAA training each year. Keep a file for each driver and attendant with the license, background checks, driving records, drug tests, and training certificates. See the driver file checklist and NEMT driver training.

Report every accident and incident on MTM’s form by the end of the next business day, report any injury by phone within three hours, and call the police to any vehicle accident.

Trip rules and how you get paid

MTM’s handbook and the state’s rules set these standards:

• Confirm. The member gets all trip details at least 24 hours ahead. Confirm the pickup time the day before, and cancel if the member will not go.
• Pickup. Arrive no later than the scheduled pickup time. You may arrive up to 15 minutes early, but the member does not have to board before the scheduled time.
• No-shows. Wait 10 minutes past the scheduled pickup at the correct address, then report the no-show to MTM in real time before you leave. MTM does not pay for no-shows.
• Returns. Pick up a will-call return within 60 minutes of the call.
• Shared rides. No member rides more than 45 minutes longer than a direct trip would take. See multiloading.
• Standing orders. You get a 15-minute grace period past the appointment and pickup time. After that, the facility calls MTM’s Where’s My Ride line, 866-269-5944.
• Pickup records. Log the time the member actually boarded on every trip, on your trip log. The manual says it must be no later than five minutes from the scheduled pickup, and trips completed or canceled because you ran late still go in that report.
• Stretcher limits. A stretcher van may not carry anyone admitted to a hospital or going to one for admission or emergency care, and the crew must call a ground ambulance if a passenger’s condition gets worse.

MO HealthNet does not pay transportation providers directly, and MTM sets rates with each provider individually, as of September 2026. The state’s program description says NEMT does not include unloaded miles or provider wait time, so ask how your rate covers them. MTM’s standard agreement pays uncontested invoices within 30 days of online submission and refuses claims filed more than 90 days after the date of service, unless the client sets another limit. Never bill the member. See how to bill NEMT brokers.

The broker must resolve provider grievances and appeals on time and tell you each outcome in writing.

Insurance requirements

MTM’s Missouri provider page lists these minimums, as of September 2026:

Item	What MTM asks for
General liability	At least $2 million
Auto liability	At least $2 million
Certificate	MTM named as certificate holder and additional insured on both policies
Workers’ compensation	Coverage that meets Missouri’s rules

Confirm each limit with your MTM representative before you buy. See NEMT insurance requirements for other brokers.

MoDOT’s insurance requirements sheet sets its own floor for carriers with intrastate authority, by passenger capacity:

Limit	12 or fewer	More than 12
Injury to one person	$100,000	$100,000
All injuries in one accident	$300,000	$500,000
Damage to others’ property	$50,000	$50,000

Under 7 CSR 265-10.030, your insurer keeps proof on file on Form E in MoDOT Carrier Express and must give MoDOT 10 days’ notice before it cancels. A licensed stretcher van service needs at least $250,000 for one person, $500,000 for one accident, and $100,000 for property damage under 19 CSR 30-40.528, and its proof of insurance must show the stretcher van license number.

Missouri requires workers’ compensation once you have five or more employees, and smaller employers may elect it. Sole proprietors and partners are not covered unless they choose to be, while LLC members and close family members who work for you are presumed covered unless they opt out. Report a work injury to your insurer within five days of the injury, or of the day the worker tells you about it if that is later. See workers’ comp for NEMT.

What it costs and how long it takes

These are the fees Missouri sets, as of September 2026. For vehicles, insurance, and equipment, see what it costs to start a NEMT business.

Item	Cost	Paid to
EIN	Free	IRS
LLC articles	$50 online, $105 paper	Secretary of State
Corporation articles	From $58	Secretary of State
Fictitious name	$7	Secretary of State
Regulatory license	$10 per vehicle a year	MoDOT
FCSR registration	$16 per worker from October 1, 2026	DHSS
Class E license	$24 for 3 years, $48 for 6	Department of Revenue
Safety inspection	Up to $12	Inspection station

A workable order, from first call to first trip:

1. Form your company, get your EIN, and get an NPI.
2. Get insurance quotes to MTM’s limits, since its application asks for your carrier and limits.
3. Send MTM’s application and ask whether your area needs providers and which levels of service are short.
4. Get a USDOT number and apply for MoDOT intrastate authority unless an exemption fits. For stretcher service, apply to DHSS 30 to 120 days before you want to start.
5. Buy insurance, add workers’ compensation, and have your insurer file Form E.
6. Hire drivers with a Class E license, register them with the FCSR, and run driving records and drug tests.
7. Equip each vehicle to MTM’s inspection sheet and get a state safety inspection if one is due.
8. Finish MTM’s steps: interview, contract, credentialing, vehicle inspection, and training.

MTM’s need in your area sets the pace. MoDOT drops an application whose documents are still missing after 45 days, so apply once your insurer can file the Form E. For the same steps in any state, see how to start a NEMT business.

Work beyond Medicaid

• Developmental disability waiver rides. Rides to waiver services and community activities in a member’s plan are not NEMT. They run through the Department of Mental Health in all four DD waivers, and the provider needs a DMH contract. Under the waiver manual posted in September 2026, each trip bills by zone (A0110 up to 10 miles, T2002 for 10 to 20, T2003 over 20, with modifier HE for a vehicle modified for non-ambulatory riders), up to two per-trip units a rider a day.
• Senior and disability transit funds. MoDOT’s Section 5310 program pays 80 percent of vehicle costs for agencies such as senior centers, disability boards, sheltered workshops, and nonprofit medical agencies. Its state MEHTAP program helps them pay for rides, and half of its general revenue goes to the 10 Area Agencies on Aging. Ask those agencies near you how they arrange rides. See Section 5310 grants.
• Veterans. The VA pays for special mode transportation in a specially equipped vehicle when a VA provider decides a veteran needs it and the trip is approved in advance. Ask the beneficiary travel office at your nearest VA facility how it buys these rides.
• Facilities and private pay. Dialysis centers, hospitals, senior living communities, and private pay riders add work that does not depend on one broker. See how to get NEMT facility contracts, dialysis transportation, and private pay NEMT.