IAMM3800-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 11/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/25/23 ICF & ICF-ID VENDOR PAYMENTS BY COUNTY ICF ICF-ID TOTAL COUNTY RECIPIENT UNITS OF TOTAL RECIPIENT UNITS OF TOTAL RECIPIENT UNITS OF TOTAL SERVED SERVICE PAYMENTS SERVED SERVICE PAYMENTS SERVED SERVICE PAYMENTS ADAIR 3 93 $39,492 0 0 $00 3 93 $39,492 AUDUBON 1 31 $12,705 0 0 $00 1 31 $12,705 BENTON 1 30 $7,887 0 0 $00 1 30 $7,887 BLACK HAWK 3 36 $16,032 1 31 $13,347 4 67 $29,379 BOONE 0 0 $00 1 31 $43,971 1 31 $43,971 BREMER 2 90 $27,327 0 0 $00 2 90 $27,327 CASS 1 39 $9,430 0 0 $00 1 39 $9,430 CEDAR 1 30 $6,713 0 0 $00 1 30 $6,713 CERRO GORDO 1 31 $14,838 0 0 $00 1 31 $14,838 CHEROKEE 1 43 $3,413 0 0 $00 1 43 $3,413 CHICKASAW 3 154 $51,556 0 0 $00 3 154 $51,556 DALLAS 1 0 $275 0 0 $00 1 0 $275 DUBUQUE 2 59 $18,366 4 119 $51,893 6 178 $70,260 GREENE 1 31 $7,655 0 0 $00 1 31 $7,655 GRUNDY 1 31 $6,775 1 31 $14,423 2 62 $21,199 GUTHRIE 2 93 $29,917 0 0 $00 2 93 $29,917 HENRY 1 31 $10,318 0 0 $00 1 31 $10,318 IOWA 1 31 $14,071 0 0 $00 1 31 $14,071 JASPER 2 62 $29,106 2 41 $27,533 4 103 $56,640 JOHNSON 1 28 $5,116 0 0 $00 1 28 $5,116 LINN 1 31 $15,635 0 0 $00 1 31 $15,635 LYON 2 96 $18,331 0 0 $00 2 96 $18,331 MAHASKA 2 47 $17,492 0 0 $00 2 47 $17,492 MARION 3 92 $24,474 0 0 $00 3 92 $24,474 MARSHALL 154 4,917 $2,027,403 0 0 $00 154 4,917 $2,027,403 MONONA 1 31 $13,479 0 0 $00 1 31 $13,479 O BRIEN 0 0 $00 1 31 $15,034 1 31 $15,034 PALO ALTO 1 10 $2,116 0 0 $00 1 10 $2,116 PLYMOUTH 0 0 $00 1 31 $12,995 1 31 $12,995 POLK 5 213 $72,599 5 154 $77,403 10 367 $150,003 POTTAWATTAMIE 3 121 $33,419 0 0 $00 3 121 $33,419 STORY 2 62 $28,584 2 54 $26,271 4 116 $54,856 TAMA 1 31 $11,366 0 0 $00 1 31 $11,366 WAPELLO 1 31 $15,198 0 0 $00 1 31 $15,198 WARREN 1 31 $7,774 0 0 $00 1 31 $7,774 WOODBURY 2 61 $12,433 4 124 $47,835 6 185 $60,269 IAMM3800-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 11/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/25/23 ICF & ICF-ID VENDOR PAYMENTS BY COUNTY ICF ICF-ID TOTAL COUNTY RECIPIENT UNITS OF TOTAL RECIPIENT UNITS OF TOTAL RECIPIENT UNITS OF TOTAL SERVED SERVICE PAYMENTS SERVED SERVICE PAYMENTS SERVED SERVICE PAYMENTS STATE TOTAL 208 6,717 $2,611,311 22 647 $330,711 230 7,364 $2,942,022 *** END OF REPORT ***