IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 05/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 05/25/24 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) 182,478 244,028 392,811 185,435,992.27 1,016.21 759.90 FEDERAL ONLY, PRESUMP IH(881) 5 7 18 11,940.02 2,388.00 1,705.72 FEDERAL ONLY, PRESUMP(886) 3 6 24 20,378.14 6,792.71 3,396.36 TOTAL FEDERAL ONLY - MONEY PAYMENT 182,486 244,041 392,853 185,468,310.43 1,016.34 759.99 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 105 149 248 58,730.57 559.34 394.16 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 105 149 248 58,730.57 559.34 394.16 TOTAL FEDERAL ONLY 182,591 244,190 393,101 185,527,041.00 1,016.08 759.77 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 7,756 7,963 15,461 6,710,578.46 865.21 842.72 SSI DISABLED 38,267 42,072 105,089 91,779,792.65 2,398.41 2,181.49 FOSTER CARE 843 1,190 2,483 995,567.02 1,180.98 836.61 SUBSIDIZED ADOPTION 9,270 9,834 24,389 7,401,679.95 798.46 752.66 SSA RCF IHHRC 7,485 8,654 14,978 36,071,306.97 4,819.15 4,168.17 SUBSIDIZED ADOPTION-INTERSTATE 79 98 253 87,060.74 1,102.03 888.37 TOTAL FEDERAL-STATE - MONEY PAYMENT 63,700 69,811 162,653 143,045,985.79 2,245.62 2,049.05 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 9,148 12,310 24,609 55,931,438.27 6,114.06 4,543.58 NON-INTERMEDIATE CARE FACILITY 45,175 78,891 136,887 58,453,767.81 1,293.94 740.94 CMAP 1,086 1,403 2,841 970,706.18 893.84 691.88 SUBSIDIZED ADOPTIONS 1,575 1,687 4,400 1,423,296.22 903.68 843.68 NO MONEY - ADC - VOLUNTARY 121,388 137,881 256,839 62,654,871.01 516.15 454.41 NO MONEY - SSI-SSA - VOLUNTARY 4,236 5,797 7,889 2,608,365.44 615.76 449.95 MED NEEDY - NO SPEND - CHILDRN 113 84 176 27,550.33 243.81 327.98 MED NEEDY - WI SPEND - CHILDRN 0 1 3 27,931.83 0.00 27,931.83 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 05/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 05/25/24 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 3 7 25 1,235.98 411.99 176.57 MED NEEDY - NO SPEND - DISABLE 4 2 20 524.33 131.08 262.17 MED NEEDY - WITH SPEND - AGED 1 2 9 13,820.18 13,820.18 6,910.09 MED NEEDY - WITH SPEND - DISAB 0 5 16 21,777.69 0.00 4,355.54 MED NEEDY - NO SPEND - CRTKR 0 1 2 0.00 0.00 0.00 MED NEEDY - WITH SPEND - CRTKR 0 3 9 25,926.84 0.00 8,642.28 MAC SOBRA - PREGNANT WOMEN 8,612 11,692 15,144 7,731,328.95 897.74 661.25 MAC SOBRA - INFANTS 25,149 36,085 62,308 35,908,251.60 1,427.82 995.10 MAC SOBRA - CHILDREN 102,187 116,481 192,019 30,028,239.58 293.86 257.80 QUALIFIED MEDICARE BENE - AGED 6,919 2,866 9,543 634,034.27 91.64 221.23 QUALIFIED MEDICARE BENE - DISA 4,130 1,621 5,230 360,227.41 87.22 222.23 PRESUMPTIVE ELIG - PREG WOMEN 0 1 2 43.90 0.00 43.90 MAC (SOBRA/TXXI) CHILD 16,608 14,249 22,402 3,626,712.99 218.37 254.52 BREAST CERVICAL CANCER 88 94 160 277,066.75 3,148.49 2,947.52 ICARE PMIC MHI 300% 865 737 3,591 3,017,776.40 3,488.76 4,094.68 STATE ONLY - NO MONEY PAYMENT 1 2 2 372.38 372.38 186.19 BLENDED FAMP PME PREG WOMEN 7 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 6,861 8,904 15,432 2,355,142.35 343.27 264.50 LEGAL PERMANENT RESIDENT TXXI 839 752 1,066 177,293.67 211.32 235.76 FEDERAL ST, EX MIYA (375) 971 941 1,650 396,963.65 408.82 421.85 TOTAL FEDERAL-STATE - NO MONEY PYMT 355,966 432,499 762,274 266,674,666.01 749.16 616.59 TOTAL FEDERAL-STATE 419,666 502,310 924,927 409,720,651.80 976.30 815.67 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 278 305 1,179 2,794,796.04 10,053.22 9,163.27 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 278 305 1,179 2,794,796.04 10,053.22 9,163.27 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 11,866 12,428 43,956 97,777,009.03 8,240.10 7,867.48 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 11,866 12,428 43,956 97,777,009.03 8,240.10 7,867.48 TOTAL FEDERAL-COUNTY 12,144 12,733 45,135 100,571,805.07 8,281.60 7,898.52 STATE ONLY IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 05/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 05/25/24 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 5 10 1,468.84 293.77 293.77 TOTAL STATE ONLY - MONEY PAYMENT 5 5 10 1,468.84 293.77 293.77 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 3,960 150 205 21,354.75 5.39 142.37 TOTAL STATE ONLY - NO MONEY PAYMENT 3,960 150 205 21,354.75 5.39 142.37 TOTAL STATE ONLY 3,965 155 215 22,823.59 5.76 147.25 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,701 4 7 16,744.51 9.84 4,186.13 TOTAL FEDERAL-COUNTY-STATE MONEY 1,701 4 7 16,744.51 9.84 4,186.13 FEDERAL-COUNTY-STATE NO MONEY EXTENDED SLMB - BLIND 0 3 0 180.77- 0.00 60.26- TOTAL FEDERAL-COUNTY-STATE NO MONEY 0 3 0 180.77- 0.00 60.26- TOTAL FEDERAL-COUNTY-STATE 1,701 7 7 16,563.74 9.74 2,366.25 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,755 1,620 4,481 25,625,552.12 14,601.45 15,818.24 TOTAL UNDEFINED SUBTOTAL 1,755 1,620 4,481 25,625,552.12 14,601.45 15,818.24 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 05/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 05/25/24 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 621,822 761,015 1,367,866 721,484,437.32 1,160.27 948.06 * * * E N D O F R E P O R T * * *