IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 12/31/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 12/25/23 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) 191,400 181,706 390,698 119,528,380.07 624.50 657.81 FEDERAL ONLY, PRESUMP IH(881) 0 2 5 39.26 0.00 19.63 FEDERAL ONLY, PRESUMP(886) 4 2 4 129.45 32.36 64.73 TOTAL FEDERAL ONLY - MONEY PAYMENT 191,404 181,710 390,707 119,528,548.78 624.48 657.80 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 144 129 296 62,051.31 430.91 481.02 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 144 129 296 62,051.31 430.91 481.02 TOTAL FEDERAL ONLY 191,548 181,839 391,003 119,590,600.09 624.34 657.67 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 6,878 6,419 13,016 3,765,776.27 547.51 586.66 SSI DISABLED 40,021 36,425 90,213 57,942,819.08 1,447.81 1,590.74 FOSTER CARE 858 832 1,898 371,311.29 432.76 446.29 SUBSIDIZED ADOPTION 9,266 9,232 22,129 4,778,180.36 515.67 517.57 SSA RCF IHHRC 7,639 658 2,602 6,360,176.29 832.59 9,665.92 SUBSIDIZED ADOPTION-INTERSTATE 81 83 243 68,157.53 841.45 821.18 TOTAL FEDERAL-STATE - MONEY PAYMENT 64,743 53,649 130,101 73,286,420.82 1,131.96 1,366.04 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 10,104 17,135 36,733 78,132,788.63 7,732.86 4,559.84 NON-INTERMEDIATE CARE FACILITY 51,312 54,532 123,843 47,619,864.70 928.05 873.25 CMAP 1,055 1,010 2,329 393,901.23 373.37 390.00 SUBSIDIZED ADOPTIONS 1,614 1,611 3,898 1,032,055.17 639.44 640.63 NO MONEY - ADC - VOLUNTARY 124,063 120,051 264,506 45,737,480.03 368.66 380.98 NO MONEY - SSI-SSA - VOLUNTARY 5,672 5,540 11,573 4,377,561.22 771.78 790.17 MED NEEDY - NO SPEND - CHILDRN 95 95 191 20,154.14 212.15 212.15 MED NEEDY - WI SPEND - CHILDRN 0 2 5 855.19 0.00 427.60 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 12/31/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 12/25/23 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 15 56 1,758.81 117.25 117.25 MED NEEDY - NO SPEND - DISABLE 4 4 13 628.07 157.02 157.02 MED NEEDY - WITH SPEND - AGED 0 2 6 1,655.39 0.00 827.70 MED NEEDY - WITH SPEND - DISAB 0 3 17 3,065.58 0.00 1,021.86 MED NEEDY - NO SPEND - CRTKR 1 1 2 2.31 2.31 2.31 MED NEEDY - WITH SPEND - CRTKR 0 2 3 375.17 0.00 187.59 MAC SOBRA - PREGNANT WOMEN 11,760 10,597 23,919 6,923,526.61 588.74 653.35 MAC SOBRA - INFANTS 28,627 27,204 60,229 16,770,610.06 585.83 616.48 MAC SOBRA - CHILDREN 102,297 99,278 219,899 23,680,293.68 231.49 238.53 QUALIFIED MEDICARE BENE - AGED 6,800 2,827 7,794 354,684.99 52.16 125.46 QUALIFIED MEDICARE BENE - DISA 4,203 1,854 5,174 322,882.56 76.82 174.15 PRESUMPTIVE ELIG - PREG WOMEN 0 4 9 478.59 0.00 119.65 MAC (SOBRA/TXXI) CHILD 15,843 14,992 33,595 3,672,804.49 231.83 244.98 BREAST CERVICAL CANCER 91 90 187 259,166.97 2,847.99 2,879.63 ICARE PMIC MHI 300% 895 853 3,043 3,012,227.77 3,365.62 3,531.33 STATE ONLY - NO MONEY PAYMENT 2 2 4 443.66 221.83 221.83 BLENDED FAMP PME PREG WOMEN 1 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 6,366 6,073 13,510 1,500,006.70 235.63 247.00 LEGAL PERMANENT RESIDENT TXXI 778 704 1,639 175,595.62 225.70 249.43 FEDERAL ST, EX MIYA (375) 1,026 1,021 2,062 351,421.27 342.52 344.19 TOTAL FEDERAL-STATE - NO MONEY PYMT 372,624 365,502 814,239 234,346,288.61 628.91 641.16 TOTAL FEDERAL-STATE 437,367 419,151 944,340 307,632,709.43 703.37 733.94 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 284 284 993 2,364,856.30 8,326.96 8,326.96 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 284 284 993 2,364,856.30 8,326.96 8,326.96 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 11,344 12,767 40,697 98,445,805.96 8,678.23 7,710.96 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 11,344 12,767 40,697 98,445,805.96 8,678.23 7,710.96 TOTAL FEDERAL-COUNTY 11,628 13,051 41,690 100,810,662.26 8,669.65 7,724.36 STATE ONLY IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 12/31/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 12/25/23 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 5 10 1,305.18 261.04 261.04 TOTAL STATE ONLY - MONEY PAYMENT 5 5 10 1,305.18 261.04 261.04 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 2,469 232 338 28,168.75 11.41 121.42 TOTAL STATE ONLY - NO MONEY PAYMENT 2,469 232 338 28,168.75 11.41 121.42 TOTAL STATE ONLY 2,474 237 348 29,473.93 11.91 124.36 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,613 2 2 24,039.60 14.90 12,019.80 TOTAL FEDERAL-COUNTY-STATE MONEY 1,613 2 2 24,039.60 14.90 12,019.80 FEDERAL-COUNTY-STATE NO MONEY TOTAL FEDERAL-COUNTY-STATE NO MONEY 0 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE 1,613 2 2 24,039.60 14.90 12,019.80 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,812 1,945 5,890 126,208,304.44 69,651.38 64,888.59 TOTAL UNDEFINED SUBTOTAL 1,812 1,945 5,890 126,208,304.44 69,651.38 64,888.59 TOTAL UNDEFINED 1,812 1,945 5,890 126,208,304.44 69,651.38 64,888.59 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 12/31/23 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 12/25/23 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 646,442 616,225 1,383,273 654,295,789.75 1,012.15 1,061.78 * * * E N D O F R E P O R T * * *