IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 11/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/26/23 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) 195,941 188,908 403,059 166,040,854.85 847.40 878.95 FEDERAL ONLY, PRESUMP IH(881) 2 1 4 1,922.34 961.17 1,922.34 FEDERAL ONLY, PRESUMP(886) 1 6 23 4,493.29 4,493.29 748.88 TOTAL FEDERAL ONLY - MONEY PAYMENT 195,944 188,915 403,086 166,047,270.48 847.42 878.95 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 127 113 272 55,502.36 437.03 491.17 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 127 113 272 55,502.36 437.03 491.17 TOTAL FEDERAL ONLY 196,071 189,028 403,358 166,102,772.84 847.16 878.72 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 6,821 6,421 13,111 3,673,902.40 538.62 572.17 SSI DISABLED 40,170 36,611 85,882 77,462,499.29 1,928.37 2,115.83 FOSTER CARE 868 870 1,859 1,221,854.56 1,407.67 1,404.43 SUBSIDIZED ADOPTION 9,275 9,278 21,277 5,179,103.92 558.39 558.21 SSA RCF IHHRC 8,018 771 3,035 7,723,974.92 963.33 10,018.13 SUBSIDIZED ADOPTION-INTERSTATE 84 84 270 86,736.79 1,032.58 1,032.58 TOTAL FEDERAL-STATE - MONEY PAYMENT 65,236 54,035 125,434 95,348,071.88 1,461.59 1,764.56 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 10,382 17,529 37,007 80,004,794.63 7,706.11 4,564.14 NON-INTERMEDIATE CARE FACILITY 54,915 59,113 130,910 57,737,370.99 1,051.40 976.73 CMAP 1,060 1,040 2,296 782,319.75 738.04 752.23 SUBSIDIZED ADOPTIONS 1,643 1,635 3,893 1,275,523.37 776.34 780.14 NO MONEY - ADC - VOLUNTARY 126,511 122,548 268,095 60,595,805.09 478.98 494.47 NO MONEY - SSI-SSA - VOLUNTARY 6,033 5,862 12,316 5,133,984.65 850.98 875.81 MED NEEDY - NO SPEND - CHILDRN 93 90 184 19,458.78 209.23 216.21 MED NEEDY - WI SPEND - CHILDRN 0 5 21 13,563.20 0.00 2,712.64 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 11/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/26/23 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 - AGED 15 14 68 6,539.48 435.97 467.11 MED NEEDY - NO SPEND - DISABLE 2 2 28 8,395.35 4,197.68 4,197.68 MED NEEDY - WITH SPEND - AGED 1 5 44 3,623.60 3,623.60 724.72 MED NEEDY - WITH SPEND - DISAB 1 2 34 26,067.46 26,067.46 13,033.73 MED NEEDY - NO SPEND - CRTKR 1 1 6 2.31 2.31 2.31 MED NEEDY - WITH SPEND - CRTKR 0 7 26 6,556.05 0.00 936.58 MAC SOBRA - PREGNANT WOMEN 12,075 10,730 24,003 7,674,673.52 635.58 715.25 MAC SOBRA - INFANTS 29,418 28,604 62,584 32,284,957.23 1,097.46 1,128.69 MAC SOBRA - CHILDREN 104,688 101,839 221,872 29,571,197.24 282.47 290.37 QUALIFIED MEDICARE BENE - AGED 6,770 2,923 8,622 449,835.28 66.45 153.90 QUALIFIED MEDICARE BENE - DISA 4,190 1,971 5,787 387,916.86 92.58 196.81 PRESUMPTIVE ELIG - PREG WOMEN 0 5 12 454.37 0.00 90.87 MAC (SOBRA/TXXI) CHILD 15,758 14,674 32,585 6,160,789.96 390.96 419.84 BREAST CERVICAL CANCER 93 91 184 278,322.28 2,992.71 3,058.49 ICARE PMIC MHI 300% 885 853 2,732 2,632,665.91 2,974.76 3,086.36 STATE ONLY - NO MONEY PAYMENT 2 2 4 436.38 218.19 218.19 BLENDED FAMP PME PREG WOMEN 4 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 6,539 6,345 14,355 2,133,626.53 326.29 336.27 LEGAL PERMANENT RESIDENT TXXI 780 714 1,693 216,120.91 277.08 302.69 FEDERAL ST, EX MIYA (375) 1,040 1,030 2,057 400,247.15 384.85 388.59 TOTAL FEDERAL-STATE - NO MONEY PYMT 382,899 377,634 831,418 287,805,248.33 751.65 762.13 TOTAL FEDERAL-STATE 448,135 431,669 956,852 383,153,320.21 855.00 887.61 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 281 290 814 2,545,562.37 9,058.94 8,777.80 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 281 290 814 2,545,562.37 9,058.94 8,777.80 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 11,331 12,759 37,771 99,361,436.04 8,768.99 7,787.56 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 11,331 12,759 37,771 99,361,436.04 8,768.99 7,787.56 TOTAL FEDERAL-COUNTY 11,612 13,049 38,585 101,906,998.41 8,776.01 7,809.56 STATE ONLY IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 11/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/26/23 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 STATE ONLY - MONEY PAYMENT 5 6 12 1,515.40 303.08 252.57 TOTAL STATE ONLY - MONEY PAYMENT 5 6 12 1,515.40 303.08 252.57 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 2,277 176 262 31,048.35 13.64 176.41 TOTAL STATE ONLY - NO MONEY PAYMENT 2,277 176 262 31,048.35 13.64 176.41 TOTAL STATE ONLY 2,282 182 274 32,563.75 14.27 178.92 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,626 1 1 15,662.75 9.63 15,662.75 TOTAL FEDERAL-COUNTY-STATE MONEY 1,626 1 1 15,662.75 9.63 15,662.75 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 1,629 1 1 15,662.75 9.61 15,662.75 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,812 1,888 5,479 10,753,108.01 5,934.39 5,695.50 TOTAL UNDEFINED SUBTOTAL 1,812 1,888 5,479 10,753,108.01 5,934.39 5,695.50 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 11/30/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/26/23 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 661,541 635,817 1,404,549 661,964,425.97 1,000.64 1,041.12 * * * E N D O F R E P O R T * * *