IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 04/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 04/27/24 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) 183,664 254,775 394,306 139,690,679.04 760.58 548.29 FEDERAL ONLY, PRESUMP IH(881) 6 4 8 490.62 81.77 122.66 FEDERAL ONLY, PRESUMP(886) 2 3 5 2,823.58 1,411.79 941.19 TOTAL FEDERAL ONLY - MONEY PAYMENT 183,672 254,782 394,319 139,693,993.24 760.56 548.29 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 112 159 292 68,505.63 611.66 430.85 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 112 159 292 68,505.63 611.66 430.85 TOTAL FEDERAL ONLY 183,784 254,941 394,611 139,762,498.87 760.47 548.22 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 7,761 7,986 15,750 6,790,759.94 874.99 850.33 SSI DISABLED 38,304 42,277 105,252 72,622,042.91 1,895.94 1,717.77 FOSTER CARE 882 1,227 2,378 481,466.88 545.88 392.39 SUBSIDIZED ADOPTION 9,281 9,867 24,664 6,177,866.06 665.65 626.11 SSA RCF IHHRC 7,685 8,840 15,420 36,667,608.12 4,771.32 4,147.92 SUBSIDIZED ADOPTION-INTERSTATE 78 100 240 79,435.33 1,018.40 794.35 TOTAL FEDERAL-STATE - MONEY PAYMENT 63,991 70,297 163,704 122,819,179.24 1,919.32 1,747.15 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 9,487 12,215 24,845 54,491,648.59 5,743.82 4,461.04 NON-INTERMEDIATE CARE FACILITY 45,089 82,899 136,351 47,838,434.99 1,060.98 577.07 CMAP 1,059 1,367 2,836 560,294.30 529.08 409.87 SUBSIDIZED ADOPTIONS 1,579 1,702 4,485 1,285,079.15 813.86 755.04 NO MONEY - ADC - VOLUNTARY 121,940 142,069 255,118 47,772,024.19 391.77 336.26 NO MONEY - SSI-SSA - VOLUNTARY 4,530 5,946 8,184 2,647,994.72 584.55 445.34 MED NEEDY - NO SPEND - CHILDRN 109 78 163 21,570.99 197.90 276.55 MED NEEDY - WI SPEND - CHILDRN 0 2 3 1,955.18 0.00 977.59 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 04/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 04/27/24 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 - NO SPEND - AGED 4 12 15 991.44 247.86 82.62 MED NEEDY - NO SPEND - DISABLE 4 2 13 1,332.66 333.17 666.33 MED NEEDY - WITH SPEND - AGED 0 1 1 0.00 0.00 0.00 MED NEEDY - NO SPEND - CRTKR 0 1 0 0.26 0.00 0.26 MED NEEDY - WITH SPEND - CRTKR 0 1 3 10,088.84 0.00 10,088.84 MAC SOBRA - PREGNANT WOMEN 8,966 12,273 14,840 4,931,530.50 550.03 401.82 MAC SOBRA - INFANTS 25,399 37,156 62,001 18,068,128.39 711.37 486.28 MAC SOBRA - CHILDREN 102,306 120,120 189,068 24,455,811.76 239.05 203.59 QUALIFIED MEDICARE BENE - AGED 6,926 2,743 8,734 511,992.10 73.92 186.65 QUALIFIED MEDICARE BENE - DISA 4,130 1,554 4,949 297,993.75 72.15 191.76 PRESUMPTIVE ELIG - PREG WOMEN 0 1 2 101.12 0.00 101.12 MAC (SOBRA/TXXI) CHILD 16,510 13,840 21,143 2,945,582.05 178.41 212.83 BREAST CERVICAL CANCER 88 95 170 297,736.18 3,383.37 3,134.07 ICARE PMIC MHI 300% 881 748 3,337 2,944,022.84 3,341.68 3,935.86 STATE ONLY - NO MONEY PAYMENT 2 2 4 628.76 314.38 314.38 BLENDED FAMP PME PREG WOMEN 3 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 6,771 9,032 14,382 1,804,959.51 266.57 199.84 LEGAL PERMANENT RESIDENT TXXI 826 728 985 131,818.31 159.59 181.07 FEDERAL ST, EX MIYA (375) 977 951 1,673 323,709.36 331.33 340.39 TOTAL FEDERAL-STATE - NO MONEY PYMT 357,586 445,538 753,305 211,345,429.94 591.03 474.36 TOTAL FEDERAL-STATE 421,577 515,835 917,009 334,164,609.18 792.65 647.81 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 281 309 1,882 2,743,570.31 9,763.60 8,878.87 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 281 309 1,882 2,743,570.31 9,763.60 8,878.87 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 11,809 12,275 45,660 95,796,970.36 8,112.20 7,804.23 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 11,809 12,275 45,660 95,796,970.36 8,112.20 7,804.23 TOTAL FEDERAL-COUNTY 12,090 12,584 47,542 98,540,540.67 8,150.58 7,830.62 STATE ONLY IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 04/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 04/27/24 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 5 6 10 1,492.76 298.55 248.79 TOTAL STATE ONLY - MONEY PAYMENT 5 6 10 1,492.76 298.55 248.79 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 3,877 148 227 22,726.35 5.86 153.56 TOTAL STATE ONLY - NO MONEY PAYMENT 3,877 148 227 22,726.35 5.86 153.56 TOTAL STATE ONLY 3,882 154 237 24,219.11 6.24 157.27 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,726 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE MONEY 1,726 0 0 0.00 0.00 0.00 FEDERAL-COUNTY-STATE NO MONEY TOTAL FEDERAL-COUNTY-STATE NO MONEY 0 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE 1,726 0 0 0.00 0.00 0.00 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,941 1,816 4,471 328,495,900.54 169,240.55 180,889.81 TOTAL UNDEFINED SUBTOTAL 1,941 1,816 4,471 328,495,900.54 169,240.55 180,889.81 TOTAL UNDEFINED 1,941 1,816 4,471 328,495,900.54 169,240.55 180,889.81 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 04/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 04/27/24 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 625,000 785,330 1,363,870 900,987,768.37 1,441.58 1,147.27 * * * E N D O F R E P O R T * * *