IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 01/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 01/28/24 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) 191,855 257,582 406,985 124,047,569.60 646.57 481.58 FEDERAL ONLY, PRESUMP IH(881) 4 2 13 284.78 71.20 142.39 FEDERAL ONLY, PRESUMP(886) 2 7 18 8,873.97 4,436.99 1,267.71 TOTAL FEDERAL ONLY - MONEY PAYMENT 191,861 257,591 407,016 124,056,728.35 646.60 481.60 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 149 167 397 72,405.09 485.94 433.56 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 149 167 397 72,405.09 485.94 433.56 TOTAL FEDERAL ONLY 192,010 257,758 407,413 124,129,133.44 646.47 481.57 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 7,620 7,653 15,107 5,333,255.49 699.90 696.88 SSI DISABLED 39,304 41,140 97,597 65,351,377.25 1,662.72 1,588.51 FOSTER CARE 841 1,134 2,270 497,285.15 591.30 438.52 SUBSIDIZED ADOPTION 9,266 9,741 22,942 5,114,531.90 551.97 525.05 SSA RCF IHHRC 7,817 8,679 15,879 33,719,464.75 4,313.61 3,885.18 SUBSIDIZED ADOPTION-INTERSTATE 79 102 247 73,878.13 935.17 724.30 FOSTER CARE - INTERSTATE 0 1 2 178.90 0.00 178.90 TOTAL FEDERAL-STATE - MONEY PAYMENT 64,927 68,450 154,044 110,089,971.57 1,695.60 1,608.33 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 9,840 11,913 24,386 50,034,589.75 5,084.82 4,200.00 NON-INTERMEDIATE CARE FACILITY 49,636 83,064 140,078 43,892,084.75 884.28 528.41 CMAP 1,029 1,354 2,706 483,955.66 470.32 357.43 SUBSIDIZED ADOPTIONS 1,606 1,694 4,411 1,219,499.05 759.34 719.89 NO MONEY - ADC - VOLUNTARY 124,091 143,176 260,390 43,224,602.35 348.33 301.90 NO MONEY - SSI-SSA - VOLUNTARY 5,361 6,150 9,695 3,540,019.22 660.33 575.61 MED NEEDY - NO SPEND - CHILDRN 101 79 158 24,690.49 244.46 312.54 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 01/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 01/28/24 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 - WI SPEND - CHILDRN 0 1 2 1,346.86 0.00 1,346.86 MED NEEDY - NO SPEND - AGED 14 13 39 2,588.10 184.86 199.08 MED NEEDY - NO SPEND - DISABLE 4 3 7 653.61 163.40 217.87 MED NEEDY - WITH SPEND - AGED 0 2 4 2,716.50 0.00 1,358.25 MED NEEDY - WITH SPEND - DISAB 0 1 0 24.00- 0.00 24.00- MED NEEDY - NO SPEND - CRTKR 1 1 11 126.31 126.31 126.31 MED NEEDY - WITH SPEND - CRTKR 0 3 4 2,086.03 0.00 695.34 MAC SOBRA - PREGNANT WOMEN 11,947 13,045 20,768 4,811,551.85 402.74 368.84 MAC SOBRA - INFANTS 29,519 37,384 66,992 17,579,108.73 595.52 470.23 MAC SOBRA - CHILDREN 103,388 123,237 199,256 21,684,580.15 209.74 175.96 QUALIFIED MEDICARE BENE - AGED 6,864 2,851 8,810 471,492.03 68.69 165.38 QUALIFIED MEDICARE BENE - DISA 4,128 1,802 5,727 259,724.28 62.92 144.13 MAC (SOBRA/TXXI) CHILD 16,203 14,353 22,904 2,647,674.23 163.41 184.47 BREAST CERVICAL CANCER 90 97 172 236,919.61 2,632.44 2,442.47 ICARE PMIC MHI 300% 903 784 3,182 2,730,848.32 3,024.20 3,483.22 STATE ONLY - NO MONEY PAYMENT 2 2 4 446.20 223.10 223.10 BLENDED FAMP PME PREG WOMEN 1 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 6,527 8,728 14,467 1,629,285.45 249.62 186.67 LEGAL PERMANENT RESIDENT TXXI 824 774 1,115 121,472.18 147.42 156.94 FEDERAL ST, EX MIYA (375) 1,028 984 1,720 292,916.55 284.94 297.68 TOTAL FEDERAL-STATE - NO MONEY PYMT 373,107 451,495 787,008 194,894,954.26 522.36 431.67 TOTAL FEDERAL-STATE 438,034 519,945 941,052 304,984,925.83 696.26 586.57 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 284 307 1,056 2,519,784.93 8,872.48 8,207.77 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 284 307 1,056 2,519,784.93 8,872.48 8,207.77 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 11,340 12,252 41,880 92,890,411.69 8,191.39 7,581.65 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 11,340 12,252 41,880 92,890,411.69 8,191.39 7,581.65 TOTAL FEDERAL-COUNTY 11,624 12,559 42,936 95,410,196.62 8,208.03 7,596.96 STATE ONLY IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 01/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 01/28/24 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 7 8 1,005.20 201.04 143.60 TOTAL STATE ONLY - MONEY PAYMENT 5 7 8 1,005.20 201.04 143.60 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 2,435 187 292 27,416.26 11.26 146.61 TOTAL STATE ONLY - NO MONEY PAYMENT 2,435 187 292 27,416.26 11.26 146.61 TOTAL STATE ONLY 2,440 194 300 28,421.46 11.65 146.50 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,809 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE MONEY 1,809 0 0 0.00 0.00 0.00 FEDERAL-COUNTY-STATE NO MONEY EXTENDED SLMB - BLIND 3 3 0 4.26 1.42 1.42 TOTAL FEDERAL-COUNTY-STATE NO MONEY 3 3 0 4.26 1.42 1.42 TOTAL FEDERAL-COUNTY-STATE 1,812 3 0 4.26 0.00 1.42 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,860 1,990 4,911 12,973,491.95 6,975.00 6,519.34 TOTAL UNDEFINED SUBTOTAL 1,860 1,990 4,911 12,973,491.95 6,975.00 6,519.34 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 01/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 01/28/24 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 647,780 792,449 1,396,612 537,526,173.56 829.80 678.31 * * * E N D O F R E P O R T * * *