IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 08/31/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 08/28/23 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) 218,948 276,717 444,623 135,153,305.97 617.28 488.42 FEDERAL ONLY, PRESUMP IH(881) 0 1 3 158.33 0.00 158.33 FEDERAL ONLY, PRESUMP(886) 3 2 3 8.61 2.87 4.31 TOTAL FEDERAL ONLY - MONEY PAYMENT 218,951 276,720 444,629 135,153,472.91 617.28 488.41 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 117 94 260 46,580.62 398.12 495.54 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 117 94 260 46,580.62 398.12 495.54 TOTAL FEDERAL ONLY 219,068 276,814 444,889 135,200,053.53 617.16 488.41 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 6,603 6,924 13,619 4,564,598.20 691.29 659.24 SSI DISABLED 40,351 41,666 87,714 66,183,936.37 1,640.21 1,588.44 FOSTER CARE 891 1,155 2,187 418,877.45 470.12 362.66 SUBSIDIZED ADOPTION 9,363 9,790 20,721 4,699,863.31 501.96 480.07 SSA RCF IHHRC 8,276 9,135 17,145 41,984,386.98 5,073.03 4,595.99 SUBSIDIZED ADOPTION-INTERSTATE 96 104 201 84,312.27 878.25 810.69 TOTAL FEDERAL-STATE - MONEY PAYMENT 65,580 68,774 141,587 117,935,974.58 1,798.35 1,714.83 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 10,645 11,613 22,740 56,210,751.98 5,280.48 4,840.33 NON-INTERMEDIATE CARE FACILITY 69,164 90,135 160,504 50,758,221.16 733.88 563.14 CMAP 1,044 1,348 2,687 430,539.93 412.39 319.39 SUBSIDIZED ADOPTIONS 1,698 1,733 3,646 991,380.65 583.85 572.06 NO MONEY - ADC - VOLUNTARY 136,107 149,386 272,275 46,081,821.18 338.57 308.47 NO MONEY - SSI-SSA - VOLUNTARY 6,564 5,789 11,061 4,108,200.24 625.87 709.66 MED NEEDY - NO SPEND - CHILDRN 81 57 135 22,292.63 275.22 391.10 MED NEEDY - NO SPEND - AGED 14 12 21 507.26 36.23 42.27 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 08/31/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 08/28/23 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 - WITH SPEND - AGED 0 2 2 264.38 0.00 132.19 MED NEEDY - WITH SPEND - DISAB 0 1 13 294.94 0.00 294.94 MED NEEDY - NO SPEND - CRTKR 1 1 10 185.91 185.91 185.91 MED NEEDY - WITH SPEND - CRTKR 0 4 6 141,134.30- 0.00 35,283.58- MAC SOBRA - PREGNANT WOMEN 12,849 13,931 22,240 5,810,090.66 452.18 417.06 MAC SOBRA - INFANTS 29,950 38,016 67,381 17,483,332.14 583.75 459.89 MAC SOBRA - CHILDREN 117,196 131,825 223,313 23,825,763.36 203.30 180.74 QUALIFIED MEDICARE BENE - AGED 6,996 2,748 7,701 381,461.20 54.53 138.81 QUALIFIED MEDICARE BENE - DISA 4,454 1,851 5,354 310,556.03 69.73 167.78 PRESUMPTIVE ELIG - PREG WOMEN 0 2 5 341.18 0.00 170.59 MAC (SOBRA/TXXI) CHILD 15,764 14,301 24,671 2,725,811.66 172.91 190.60 BREAST CERVICAL CANCER 95 105 181 255,830.49 2,692.95 2,436.48 ICARE PMIC MHI 300% 865 763 1,763 2,118,328.67 2,448.93 2,776.32 STATE ONLY - NO MONEY PAYMENT 2 3 6 714.48 357.24 238.16 BLENDED FAMP PME PREG WOMEN 4 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 7,424 8,774 15,244 1,687,773.64 227.34 192.36 LEGAL PERMANENT RESIDENT TXXI 794 809 1,417 144,197.47 181.61 178.24 FEDERAL ST, EX MIYA (375) 1,027 1,039 1,813 301,354.47 293.43 290.04 TOTAL FEDERAL-STATE - NO MONEY PYMT 422,738 474,248 844,189 213,508,881.41 505.06 450.21 TOTAL FEDERAL-STATE 488,318 543,022 985,776 331,444,855.99 678.75 610.37 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 276 307 841 2,465,141.93 8,931.67 8,029.78 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 276 307 841 2,465,141.93 8,931.67 8,029.78 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 11,031 12,029 29,637 91,423,077.74 8,287.83 7,600.22 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 11,031 12,029 29,637 91,423,077.74 8,287.83 7,600.22 TOTAL FEDERAL-COUNTY 11,307 12,336 30,478 93,888,219.67 8,303.55 7,610.91 STATE ONLY STATE ONLY - MONEY PAYMENT IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 08/31/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 08/28/23 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 6 787.98 197.00 197.00 TOTAL STATE ONLY - MONEY PAYMENT 4 4 6 787.98 197.00 197.00 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 1,962 139 189 20,384.45 10.39 146.65 TOTAL STATE ONLY - NO MONEY PAYMENT 1,962 139 189 20,384.45 10.39 146.65 TOTAL STATE ONLY 1,966 143 195 21,172.43 10.77 148.06 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,563 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE MONEY 1,563 0 0 0.00 0.00 0.00 FEDERAL-COUNTY-STATE NO MONEY EXTENDED SLMB - BLIND 4 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE NO MONEY 4 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE 1,567 0 0 0.00 0.00 0.00 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,595 1,175 3,428 8,897,408.44 5,578.31 7,572.26 TOTAL UNDEFINED SUBTOTAL 1,595 1,175 3,428 8,897,408.44 5,578.31 7,572.26 TOTAL UNDEFINED 1,595 1,175 3,428 8,897,408.44 5,578.31 7,572.26 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 08/31/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 08/28/23 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 TOTAL S T A T E 723,821 833,490 1,464,766 569,451,710.06 786.73 683.21 * * * E N D O F R E P O R T * * *