GEMT (Medicaid) cost reporting — Iowa
GEMT cost reporting for Iowa ambulance services.
Iowa's Ground Emergency Medical Transportation program returns Medicaid supplemental payments to publicly owned and operated ambulance services — but only after a detailed annual cost report is completed and certified. Roe Consulting prepares that report end-to-end.
What GEMT is.
The Ground Emergency Medical Transportation (GEMT) program lets publicly owned or operated Iowa ambulance services recover the gap between what Medicaid pays for an emergency ground transport (base rate plus mileage) and what that transport actually costs. The state Medicaid agency pays the difference as a supplemental payment, drawing federal Medicaid matching dollars to do it.
Participation is voluntary. Eligibility requires:
- Provision of GEMT services to Iowa Medicaid members
- Active enrollment as an Iowa Medicaid provider for the period claimed
- Public ownership or operation of the ambulance service
For a full plain-English explainer, see What is GEMT?
What we handle.
From eligibility review through certified submission and audit support.
- Initial eligibility review and intergovernmental transfer (IGT) agreement coordination
Confirm provider eligibility and coordinate the IGT agreement with Iowa Medicaid so payments can flow once the report is filed.
- Indirect cost rate establishment
Required before any indirect costs can be claimed on Schedule 9. We work from your Cost Allocation Plan or coordinate negotiation with the cognizant federal agency.
- Cost determination across direct and allocated indirect expenses
Consistent with 45 CFR 75.412 federal cost principles. Direct vs. indirect classification stays consistent across every schedule.
- Annual cost report preparation
All required schedules — personnel, vehicles, equipment, supplies, allocations, indirect costs — built from source documents.
- Certified submission to Iowa HHS by November 30
Final review with your team, certification by an authorized official, and submission to Iowa Medicaid.
- Year-round support for documentation, audits, and follow-up
When Iowa Medicaid asks for clarification or supporting documentation after submission, we respond on your behalf.
Why bring in outside help.
The annual cost report is a detailed document with multiple schedules and a certification requirement. Done in-house, it can pull finance and admin staff off other work for weeks during the fall budget season — exactly when those people are needed most.
Done incompletely or inconsistently, it can leave Medicaid supplemental dollars on the table or trigger reconciliation issues with the state. Iowa's program rewards precision.
National firms charge accordingly. Roe Consulting offers a more reasonable Iowa-based alternative — same federal-compliance discipline, lower overhead, direct access to the consultant doing the work.
The Roe difference.
Local
Iowa-based. In-person meetings available across the state.
Personal
The consultant you talk to is the one doing the work. No account-manager layer.
Experienced
25 years as Fire Chief of Clive, Iowa. 8 years of GEMT cost reporting specifically.
Process.
Four phases from first conversation through certified submission.
- 01
Intake & eligibility review
A 30-minute call, a document checklist, and confirmation that your service is GEMT-eligible.
- 02
Data collection
Secure exchange of payroll detail, run/call data, financial statements, depreciation schedules, and indirect cost rate documentation.
- 03
Cost report build
Schedules 1–9 built from source documents. Indirect rate applied. Allocations documented.
- 04
Review, certify, submit
Final review with your team, certification by an authorized official, certified submission, audit support afterward.
Key dates.
The Iowa GEMT calendar runs on a single non-negotiable deadline.
- State fiscal year covered
- July 1 – June 30
- Cost report due to Iowa HHS
- November 30
- Prospective supplemental payments begin
- July 1 of the next state fiscal year
- Reconciliation window
- Up to one year after submission
Common questions.
Who qualifies for GEMT in Iowa?
Publicly owned or publicly operated Iowa ambulance services that provide emergency ground transports to Iowa Medicaid members and are enrolled as Iowa Medicaid providers for the period being claimed. Private services do not qualify under Iowa's current program.
What's the difference between the GEMT base payment and the supplemental payment?
The base payment is what Medicaid pays for each emergency ground transport — a base rate plus mileage. The supplemental payment is what the GEMT program adds on top, calculated from your actual cost per transport for Medicaid patients minus what you already received from Medicaid and other reimbursement sources. The supplemental payment is what makes the program worth doing.
Do we need an intergovernmental transfer agreement?
Yes. Participating GEMT providers must execute an intergovernmental transfer (IGT) agreement with the state. The IGT is the mechanism by which your government entity provides the non-federal share of the supplemental payment, which is then matched with federal Medicaid dollars and returned to you. We coordinate the IGT process as part of our cost report engagement.
What records do we need to provide?
At minimum: payroll detail for all transport-related personnel, run/call data for the state fiscal year, financial statements, depreciation schedules for vehicles and equipment, vendor invoices, and any existing indirect cost rate documentation. We provide a full document checklist at intake.
What happens if we miss the November 30 deadline?
You will not receive prospective GEMT supplemental payments for the upcoming state fiscal year starting July 1. The program is annual; missing one year does not disqualify you from the next, but it does forfeit a year of payments. This is the single biggest reason services bring in outside help — to make sure the deadline is met cleanly.
How is the supplemental payment amount calculated?
Iowa uses a cost-based, prospective methodology. The state reviews your completed annual cost report and calculates an average cost per GEMT transport. That figure, minus the Medicaid base + mileage already paid, becomes the per-transport supplemental amount paid prospectively over the following state fiscal year, then reconciled against actual transport volume.
Get started
Ready to talk through your GEMT cost report?
Call 515-238-7012 or send a note. We'll set a 30-minute intake call and confirm eligibility before anything else.