IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 06/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/25/23 T I T L E X I X R E P O R T O F E X P E N D I T U R E S (BY ELIGIBILITY PROGRAM) AID CATEGORY NUMBER OF RECIPIENTS NUMBER OF TOTAL AVERAGE PAYMENT PER RECIPIENT ELIGIBLE SERVED CLAIMS PAYMENT ELIGIBLE SERVED FEDERAL ONLY FEDERAL ONLY - MONEY PAYMENT FEDERAL ONLY, IHAWP (531/501) 249,491 270,965 496,958 145,990,727.77 585.15 538.78 FEDERAL ONLY, PRESUMP(886) 0 1 1 2.31 0.00 2.31 TOTAL FEDERAL ONLY - MONEY PAYMENT 249,491 270,966 496,959 145,990,730.08 585.15 538.78 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 74 59 192 33,622.13 454.35 569.87 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 74 59 192 33,622.13 454.35 569.87 TOTAL FEDERAL ONLY 249,565 271,025 497,151 146,024,352.21 585.12 538.79 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 6,416 7,054 13,828 3,942,154.97 614.43 558.85 SSI DISABLED 36,324 42,701 117,567 67,229,488.61 1,850.83 1,574.42 FOSTER CARE 946 1,115 2,611 518,433.65 548.03 464.96 SUBSIDIZED ADOPTION 9,388 9,682 26,642 5,512,373.21 587.17 569.34 SSA RCF IHHRC 148 8,874 17,367 36,854,984.37 249,020.16 4,153.14 SUBSIDIZED ADOPTION-INTERSTATE 102 104 232 74,989.44 735.19 721.05 TOTAL FEDERAL-STATE - MONEY PAYMENT 53,324 69,530 178,247 114,132,424.25 2,140.36 1,641.48 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 19,454 11,651 24,927 51,174,522.85 2,630.54 4,392.29 NON-INTERMEDIATE CARE FACILITY 82,040 88,395 188,131 54,671,029.77 666.39 618.49 CMAP 1,139 1,312 3,033 521,808.02 458.13 397.72 SUBSIDIZED ADOPTIONS 1,733 1,745 6,083 1,368,171.59 789.48 784.05 NO MONEY - ADC - VOLUNTARY 145,126 148,737 302,603 51,539,719.99 355.14 346.52 NO MONEY - SSI-SSA - VOLUNTARY 6,696 5,041 9,939 3,184,607.46 475.60 631.74 MED NEEDY - NO SPEND - CHILDRN 77 54 115 19,486.48 253.07 360.86 MED NEEDY - WI SPEND - CHILDRN 0 1 8 2,993.96 0.00 2,993.96 MED NEEDY - NO SPEND - AGED 14 14 41 20,628.88 1,473.49 1,473.49 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 06/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/25/23 T I T L E X I X R E P O R T O F E X P E N D I T U R E S (BY ELIGIBILITY PROGRAM) AID CATEGORY NUMBER OF RECIPIENTS NUMBER OF TOTAL AVERAGE PAYMENT PER RECIPIENT ELIGIBLE SERVED CLAIMS PAYMENT ELIGIBLE SERVED MED NEEDY - NO SPEND - DISABLE 0 2 33 50.64 0.00 25.32 MED NEEDY - WITH SPEND - AGED 1 4 49 18,678.70 18,678.70 4,669.68 MED NEEDY - WITH SPEND - DISAB 0 1 1 2.31 0.00 2.31 MED NEEDY - NO SPEND - CRTKR 1 1 6 4.83 4.83 4.83 MED NEEDY - WITH SPEND - CRTKR 2 3 4 17,034.19 8,517.10 5,678.06 MAC SOBRA - PREGNANT WOMEN 14,579 14,045 26,337 6,377,767.25 437.46 454.10 MAC SOBRA - INFANTS 33,630 36,833 73,233 17,559,538.28 522.14 476.73 MAC SOBRA - CHILDREN 125,696 131,878 259,740 28,824,244.37 229.32 218.57 QUALIFIED MEDICARE BENE - AGED 7,076 2,837 8,015 408,840.19 57.78 144.11 QUALIFIED MEDICARE BENE - DISA 4,556 1,824 5,282 287,887.32 63.19 157.83 MAC (SOBRA/TXXI) CHILD 15,690 14,547 28,500 3,210,870.03 204.64 220.72 BREAST CERVICAL CANCER 105 108 204 221,441.75 2,108.97 2,050.39 ICARE PMIC MHI 300% 872 787 4,182 3,135,631.62 3,595.91 3,984.28 STATE ONLY - NO MONEY PAYMENT 3 3 6 706.63 235.54 235.54 LEGAL PERMANENT RESIDENT TXIX 7,960 8,459 16,646 1,896,753.59 238.29 224.23 LEGAL PERMANENT RESIDENT TXXI 885 845 1,547 167,729.08 189.52 198.50 FEDERAL ST, EX MIYA (375) 1,110 1,058 2,051 334,606.97 301.45 316.26 TOTAL FEDERAL-STATE - NO MONEY PYMT 468,445 470,185 960,716 224,964,756.75 480.24 478.46 TOTAL FEDERAL-STATE 521,769 539,715 1,138,963 339,097,181.00 649.90 628.29 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 288 307 1,946 2,475,639.04 8,595.97 8,063.97 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 288 307 1,946 2,475,639.04 8,595.97 8,063.97 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 12,371 11,993 54,501 87,425,704.03 7,066.99 7,289.73 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 12,371 11,993 54,501 87,425,704.03 7,066.99 7,289.73 TOTAL FEDERAL-COUNTY 12,659 12,300 56,447 89,901,343.07 7,101.77 7,309.05 STATE ONLY STATE ONLY - MONEY PAYMENT IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 06/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/25/23 T I T L E X I X R E P O R T O F E X P E N D I T U R E S (BY ELIGIBILITY PROGRAM) AID CATEGORY NUMBER OF RECIPIENTS NUMBER OF TOTAL AVERAGE PAYMENT PER RECIPIENT ELIGIBLE SERVED CLAIMS PAYMENT ELIGIBLE SERVED STATE ONLY - MONEY PAYMENT 4 4 8 1,018.62 254.66 254.66 TOTAL STATE ONLY - MONEY PAYMENT 4 4 8 1,018.62 254.66 254.66 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 1,409 112 169 14,908.72 10.58 133.11 TOTAL STATE ONLY - NO MONEY PAYMENT 1,409 112 169 14,908.72 10.58 133.11 TOTAL STATE ONLY 1,413 116 177 15,927.34 11.27 137.30 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY TOTAL FEDERAL-COUNTY-STATE MONEY 0 0 0 0.00 0.00 0.00 FEDERAL-COUNTY-STATE NO MONEY EXTENDED SLMB - BLIND 3 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE NO MONEY 3 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE 3 0 0 0.00 0.00 0.00 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 955 987 2,470 30,866,940.46 32,321.40 31,273.50 TOTAL UNDEFINED SUBTOTAL 955 987 2,470 30,866,940.46 32,321.40 31,273.50 TOTAL UNDEFINED 955 987 2,470 30,866,940.46 32,321.40 31,273.50 TOTAL S T A T E 786,364 824,143 1,695,208 605,905,744.08 770.52 735.19 * * * E N D O F R E P O R T * * *