IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 02/29/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 02/26/24 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) 190,940 246,363 412,587 172,077,367.04 901.21 698.47 FEDERAL ONLY, PRESUMP IH(881) 2 3 4 4,710.50 2,355.25 1,570.17 FEDERAL ONLY, PRESUMP(886) 1 1 4 805.48 805.48 805.48 TOTAL FEDERAL ONLY - MONEY PAYMENT 190,943 246,367 412,595 172,082,883.02 901.23 698.48 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 145 168 340 84,600.47 583.45 503.57 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 145 168 340 84,600.47 583.45 503.57 TOTAL FEDERAL ONLY 191,088 246,535 412,935 172,167,483.49 900.99 698.35 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 7,654 7,698 15,138 5,938,892.46 775.92 771.49 SSI DISABLED 38,282 41,726 98,615 93,258,553.61 2,436.09 2,235.02 FOSTER CARE 854 1,139 2,144 998,852.53 1,169.62 876.96 SUBSIDIZED ADOPTION 9,288 9,763 23,106 6,254,150.61 673.36 640.60 SSA RCF IHHRC 7,779 8,686 16,097 35,282,007.43 4,535.55 4,061.94 SUBSIDIZED ADOPTION-INTERSTATE 79 97 196 80,635.99 1,020.71 831.30 FOSTER CARE - INTERSTATE 0 1 2 5,342.02 0.00 5,342.02 TOTAL FEDERAL-STATE - MONEY PAYMENT 63,936 69,110 155,298 141,818,434.65 2,218.13 2,052.07 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 9,578 11,808 23,679 51,291,344.34 5,355.12 4,343.78 NON-INTERMEDIATE CARE FACILITY 49,399 79,062 139,391 54,818,669.74 1,109.71 693.36 CMAP 1,036 1,337 2,782 845,236.59 815.87 632.19 SUBSIDIZED ADOPTIONS 1,605 1,714 4,386 1,256,509.65 782.87 733.09 NO MONEY - ADC - VOLUNTARY 124,362 140,662 265,873 61,212,064.68 492.21 435.17 NO MONEY - SSI-SSA - VOLUNTARY 5,202 5,982 9,517 4,567,722.44 878.07 763.58 MED NEEDY - NO SPEND - CHILDRN 107 80 173 20,997.60 196.24 262.47 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 02/29/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 02/26/24 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 3 3 358.38 0.00 119.46 MED NEEDY - NO SPEND - AGED 14 16 52 1,207.13 86.22 75.45 MED NEEDY - NO SPEND - DISABLE 4 3 5 91.77 22.94 30.59 MED NEEDY - WITH SPEND - AGED 0 2 2 595.53 0.00 297.77 MED NEEDY - WITH SPEND - DISAB 0 1 1 79.29 0.00 79.29 MED NEEDY - NO SPEND - CRTKR 1 1 8 1,120.77 1,120.77 1,120.77 MED NEEDY - WITH SPEND - CRTKR 0 3 6 1,022.04 0.00 340.68 MAC SOBRA - PREGNANT WOMEN 11,801 12,366 21,393 7,210,042.51 610.97 583.05 MAC SOBRA - INFANTS 30,088 36,036 68,348 34,905,390.65 1,160.11 968.63 MAC SOBRA - CHILDREN 103,811 120,447 203,616 29,328,637.55 282.52 243.50 QUALIFIED MEDICARE BENE - AGED 6,872 2,461 6,816 494,489.31 71.96 200.93 QUALIFIED MEDICARE BENE - DISA 4,063 1,545 4,222 304,745.85 75.01 197.25 MAC (SOBRA/TXXI) CHILD 16,416 14,422 24,130 3,756,926.35 228.86 260.50 BREAST CERVICAL CANCER 89 94 181 246,426.97 2,768.84 2,621.56 ICARE PMIC MHI 300% 896 793 2,851 2,790,388.63 3,114.27 3,518.78 STATE ONLY - NO MONEY PAYMENT 2 2 4 446.06 223.03 223.03 BLENDED FAMP PME PREG WOMEN 3 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 6,683 8,626 15,193 2,706,471.12 404.98 313.76 LEGAL PERMANENT RESIDENT TXXI 824 726 1,112 191,154.09 231.98 263.30 FEDERAL ST, EX MIYA (375) 1,014 992 1,809 325,865.56 321.37 328.49 TOTAL FEDERAL-STATE - NO MONEY PYMT 373,870 439,184 795,553 256,278,004.60 685.47 583.53 TOTAL FEDERAL-STATE 437,806 508,294 950,851 398,096,439.25 909.30 783.20 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 286 307 1,286 2,853,869.44 9,978.56 9,295.99 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 286 307 1,286 2,853,869.44 9,978.56 9,295.99 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 11,525 12,305 39,735 95,442,625.15 8,281.36 7,756.41 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 11,525 12,305 39,735 95,442,625.15 8,281.36 7,756.41 TOTAL FEDERAL-COUNTY 11,811 12,612 41,021 98,296,494.59 8,322.45 7,793.89 STATE ONLY IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 02/29/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 02/26/24 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 7 7 12 1,539.47 219.92 219.92 TOTAL STATE ONLY - MONEY PAYMENT 7 7 12 1,539.47 219.92 219.92 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 2,562 141 209 17,659.17 6.89 125.24 TOTAL STATE ONLY - NO MONEY PAYMENT 2,562 141 209 17,659.17 6.89 125.24 TOTAL STATE ONLY 2,569 148 221 19,198.64 7.47 129.72 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,729 1 1 2.41 0.00 2.41 TOTAL FEDERAL-COUNTY-STATE MONEY 1,729 1 1 2.41 0.00 2.41 FEDERAL-COUNTY-STATE NO MONEY EXTENDED SLMB - BLIND 0 1 6 1,940.82 0.00 1,940.82 TOTAL FEDERAL-COUNTY-STATE NO MONEY 0 1 6 1,940.82 0.00 1,940.82 TOTAL FEDERAL-COUNTY-STATE 1,729 2 7 1,943.23 1.12 971.62 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,919 1,884 4,658 23,651,450.94 12,324.88 12,553.85 TOTAL UNDEFINED SUBTOTAL 1,919 1,884 4,658 23,651,450.94 12,324.88 12,553.85 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 02/29/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 02/26/24 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 646,922 769,475 1,409,693 692,233,010.14 1,070.04 899.62 * * * E N D O F R E P O R T * * *