IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 06/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/22/24 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) 181,957 239,257 391,186 127,169,689.83 698.90 531.52 FEDERAL ONLY, PRESUMP IH(881) 3 5 12 1,701.72 567.24 340.34 FEDERAL ONLY, PRESUMP(886) 3 6 26 11,977.31 3,992.44 1,996.22 TOTAL FEDERAL ONLY - MONEY PAYMENT 181,963 239,268 391,224 127,183,368.86 698.95 531.55 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 102 154 240 61,714.42 605.04 400.74 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 102 154 240 61,714.42 605.04 400.74 TOTAL FEDERAL ONLY 182,065 239,422 391,464 127,245,083.28 698.90 531.47 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 6,999 8,050 15,602 6,636,817.77 948.25 824.45 SSI DISABLED 35,799 42,212 116,040 71,398,926.36 1,994.44 1,691.44 FOSTER CARE 847 1,187 2,301 507,625.03 599.32 427.65 SUBSIDIZED ADOPTION 9,270 9,818 27,156 6,311,938.92 680.90 642.89 SSA RCF IHHRC 133 8,613 14,961 34,280,312.03 257,746.71 3,980.07 SUBSIDIZED ADOPTION-INTERSTATE 77 96 207 67,823.35 880.82 706.49 TOTAL FEDERAL-STATE - MONEY PAYMENT 53,125 69,976 176,267 119,203,443.46 2,243.83 1,703.49 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 17,040 12,237 24,974 53,323,522.80 3,129.31 4,357.56 NON-INTERMEDIATE CARE FACILITY 47,865 75,346 141,049 46,914,129.30 980.13 622.65 CMAP 1,079 1,391 3,283 543,746.57 503.94 390.90 SUBSIDIZED ADOPTIONS 1,562 1,675 4,866 1,264,746.24 809.70 755.07 NO MONEY - ADC - VOLUNTARY 121,148 135,904 260,302 46,722,715.61 385.67 343.79 NO MONEY - SSI-SSA - VOLUNTARY 4,242 5,718 7,897 2,366,699.27 557.92 413.90 MED NEEDY - NO SPEND - CHILDRN 113 91 202 26,806.68 237.23 294.58 MED NEEDY - WI SPEND - CHILDRN 0 2 1 11,673.25 0.00 5,836.63 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 06/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/22/24 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 2 3 9 206.80 103.40 68.93 MED NEEDY - NO SPEND - DISABLE 3 1 1 2.51 0.84 2.51 MED NEEDY - WITH SPEND - AGED 0 4 28 3,154.88 0.00 788.72 MED NEEDY - WITH SPEND - DISAB 0 2 1 3,157.96- 0.00 1,578.98- MED NEEDY - NO SPEND - CRTKR 0 1 1 8.70 0.00 8.70 MED NEEDY - WITH SPEND - CRTKR 0 3 39 53,429.64 0.00 17,809.88 MAC SOBRA - PREGNANT WOMEN 8,500 11,497 14,617 4,834,704.49 568.79 420.52 MAC SOBRA - INFANTS 25,341 36,297 63,626 18,131,647.12 715.51 499.54 MAC SOBRA - CHILDREN 101,845 113,125 196,675 23,362,983.78 229.40 206.52 QUALIFIED MEDICARE BENE - AGED 6,988 2,891 7,818 425,180.21 60.84 147.07 QUALIFIED MEDICARE BENE - DISA 4,181 1,713 4,487 286,362.67 68.49 167.17 PRESUMPTIVE ELIG - PREG WOMEN 0 1 3 24.52 0.00 24.52 MAC (SOBRA/TXXI) CHILD 17,000 14,540 24,190 3,047,334.75 179.25 209.58 BREAST CERVICAL CANCER 88 92 156 247,290.61 2,810.12 2,687.94 ICARE PMIC MHI 300% 857 722 3,579 2,630,998.03 3,070.01 3,644.04 STATE ONLY - NO MONEY PAYMENT 1 2 2 281.16 281.16 140.58 BLENDED FAMP PME PREG WOMEN 4 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 6,963 8,813 15,915 1,878,460.74 269.78 213.15 LEGAL PERMANENT RESIDENT TXXI 895 786 1,218 138,746.55 155.02 176.52 FEDERAL ST, EX MIYA (375) 959 967 1,724 302,475.90 315.41 312.80 TOTAL FEDERAL-STATE - NO MONEY PYMT 366,676 423,824 776,663 206,514,174.82 563.21 487.26 TOTAL FEDERAL-STATE 419,801 493,800 952,930 325,717,618.28 775.89 659.61 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 274 312 1,897 2,669,376.14 9,742.25 8,555.69 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 274 312 1,897 2,669,376.14 9,742.25 8,555.69 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 13,632 12,504 52,474 97,881,496.51 7,180.27 7,828.01 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 13,632 12,504 52,474 97,881,496.51 7,180.27 7,828.01 TOTAL FEDERAL-COUNTY 13,906 12,816 54,371 100,550,872.65 7,230.75 7,845.73 STATE ONLY IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 06/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/22/24 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 6 4 8 1,125.97 187.66 281.49 TOTAL STATE ONLY - MONEY PAYMENT 6 4 8 1,125.97 187.66 281.49 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 3,888 117 145 13,532.53 3.48 115.66 TOTAL STATE ONLY - NO MONEY PAYMENT 3,888 117 145 13,532.53 3.48 115.66 TOTAL STATE ONLY 3,894 121 153 14,658.50 3.76 121.14 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY TOTAL FEDERAL-COUNTY-STATE MONEY 0 0 0 0.00 0.00 0.00 FEDERAL-COUNTY-STATE NO MONEY EXTENDED SLMB - BLIND 0 1 0 1.63 0.00 1.63 TOTAL FEDERAL-COUNTY-STATE NO MONEY 0 1 0 1.63 0.00 1.63 TOTAL FEDERAL-COUNTY-STATE 0 1 0 1.63 0.00 1.63 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,596 2,133 4,198 333,252,184.07 208,804.63 156,236.37 TOTAL UNDEFINED SUBTOTAL 1,596 2,133 4,198 333,252,184.07 208,804.63 156,236.37 TOTAL UNDEFINED 1,596 2,133 4,198 333,252,184.07 208,804.63 156,236.37 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 06/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/22/24 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 621,262 748,293 1,403,116 886,780,418.41 1,427.39 1,185.07 * * * E N D O F R E P O R T * * *