IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 09/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 09/24/23 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) 208,395 275,507 433,126 132,794,856.79 637.23 482.00 FEDERAL ONLY, PRESUMP(886) 3 2 7 123.34 41.11 61.67 TOTAL FEDERAL ONLY - MONEY PAYMENT 208,398 275,509 433,133 132,794,980.13 637.22 482.00 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 120 130 400 78,782.35 656.52 606.02 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 120 130 400 78,782.35 656.52 606.02 TOTAL FEDERAL ONLY 208,518 275,639 433,533 132,873,762.48 637.23 482.06 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 6,361 6,799 13,508 4,724,499.60 742.73 694.88 SSI DISABLED 36,605 41,102 86,409 65,178,186.89 1,780.58 1,585.77 FOSTER CARE 861 1,114 2,170 407,571.33 473.37 365.86 SUBSIDIZED ADOPTION 9,335 9,740 20,733 4,793,902.87 513.54 492.19 SSA RCF IHHRC 140 9,065 17,113 41,185,591.07 294,182.79 4,543.36 SUBSIDIZED ADOPTION-INTERSTATE 95 104 212 73,069.30 769.15 702.59 TOTAL FEDERAL-STATE - MONEY PAYMENT 53,397 67,924 140,145 116,362,821.06 2,179.20 1,713.13 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 18,792 11,070 22,317 54,242,683.00 2,886.48 4,899.97 NON-INTERMEDIATE CARE FACILITY 68,022 87,706 153,656 49,293,537.26 724.67 562.03 CMAP 1,049 1,289 2,521 427,969.54 407.98 332.02 SUBSIDIZED ADOPTIONS 1,676 1,717 3,610 1,036,458.47 618.41 603.65 NO MONEY - ADC - VOLUNTARY 131,595 148,928 268,231 45,776,499.21 347.86 307.37 NO MONEY - SSI-SSA - VOLUNTARY 6,434 6,329 11,967 4,753,615.01 738.83 751.08 MED NEEDY - NO SPEND - CHILDRN 84 69 150 25,757.89 306.64 373.30 MED NEEDY - WI SPEND - CHILDRN 0 1 2 2,816.72 0.00 2,816.72 MED NEEDY - NO SPEND - AGED 14 12 61 3,393.39 242.39 282.78 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 09/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 09/24/23 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 1 1 0.00 0.00 0.00 MED NEEDY - WITH SPEND - DISAB 0 3 16 1,067.39 0.00 355.80 MED NEEDY - NO SPEND - CRTKR 1 1 3 375.55 375.55 375.55 MED NEEDY - WITH SPEND - CRTKR 0 1 1 93.00 0.00 93.00 MAC SOBRA - PREGNANT WOMEN 12,080 13,779 20,956 5,491,826.60 454.62 398.56 MAC SOBRA - INFANTS 28,908 37,857 66,968 19,185,426.26 663.67 506.79 MAC SOBRA - CHILDREN 112,117 130,400 213,630 23,283,707.14 207.67 178.56 QUALIFIED MEDICARE BENE - AGED 6,960 2,615 7,472 409,541.28 58.84 156.61 QUALIFIED MEDICARE BENE - DISA 4,498 1,809 5,201 295,930.53 65.79 163.59 PRESUMPTIVE ELIG - PREG WOMEN 0 1 4 220.38 0.00 220.38 MAC (SOBRA/TXXI) CHILD 15,746 14,575 24,808 2,778,114.77 176.43 190.61 BREAST CERVICAL CANCER 96 102 192 275,352.24 2,868.25 2,699.53 ICARE PMIC MHI 300% 865 786 2,222 2,278,548.51 2,634.16 2,898.92 STATE ONLY - NO MONEY PAYMENT 2 3 6 732.30 366.15 244.10 BLENDED FAMP PME PREG WOMEN 1 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 6,989 8,712 14,751 1,710,186.24 244.70 196.30 LEGAL PERMANENT RESIDENT TXXI 775 808 1,192 130,019.89 167.77 160.92 FEDERAL ST, EX MIYA (375) 1,015 1,051 1,786 291,619.98 287.31 277.47 TOTAL FEDERAL-STATE - NO MONEY PYMT 417,719 469,625 821,724 211,695,492.55 506.79 450.78 TOTAL FEDERAL-STATE 471,116 537,549 961,869 328,058,313.61 696.34 610.29 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 280 307 767 2,667,163.70 9,525.58 8,687.83 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 280 307 767 2,667,163.70 9,525.58 8,687.83 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 12,705 12,139 30,549 91,991,551.16 7,240.58 7,578.18 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 12,705 12,139 30,549 91,991,551.16 7,240.58 7,578.18 TOTAL FEDERAL-COUNTY 12,985 12,446 31,316 94,658,714.86 7,289.85 7,605.55 STATE ONLY STATE ONLY - MONEY PAYMENT IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 09/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 09/24/23 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 5 5 6 818.08 163.62 163.62 TOTAL STATE ONLY - MONEY PAYMENT 5 5 6 818.08 163.62 163.62 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 2,205 134 193 17,560.02 7.96 131.04 TOTAL STATE ONLY - NO MONEY PAYMENT 2,205 134 193 17,560.02 7.96 131.04 TOTAL STATE ONLY 2,210 139 199 18,378.10 8.32 132.22 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 4 2 18 5,706.99 1,426.75 2,853.50 TOTAL FEDERAL-COUNTY-STATE NO MONEY 4 2 18 5,706.99 1,426.75 2,853.50 TOTAL FEDERAL-COUNTY-STATE 4 2 18 5,706.99 1,426.75 2,853.50 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,845 1,395 3,971 138,015,266.53 74,805.02 98,935.67 TOTAL UNDEFINED SUBTOTAL 1,845 1,395 3,971 138,015,266.53 74,805.02 98,935.67 TOTAL UNDEFINED 1,845 1,395 3,971 138,015,266.53 74,805.02 98,935.67 TOTAL S T A T E 696,678 827,170 1,430,906 693,630,142.57 995.63 838.56 * * * E N D O F R E P O R T * * *