IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 09/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 09/28/24 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) 179,911 233,519 388,332 154,611,030.60 859.38 662.09 FEDERAL ONLY, PRESUMP IH(881) 2 4 21 1,652.50 826.25 413.13 FEDERAL ONLY, PRESUMP(886) 1 1 2 36.93 36.93 36.93 TOTAL FEDERAL ONLY - MONEY PAYMENT 179,914 233,524 388,355 154,612,720.03 859.37 662.08 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 85 165 276 74,533.56 876.87 451.72 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 85 165 276 74,533.56 876.87 451.72 TOTAL FEDERAL ONLY 179,999 233,689 388,631 154,687,253.59 859.38 661.94 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 7,729 8,550 18,693 8,952,341.77 1,158.28 1,047.06 SSI DISABLED 38,325 42,614 86,879 70,489,320.97 1,839.25 1,654.14 FOSTER CARE 912 1,269 2,185 570,068.28 625.07 449.23 SUBSIDIZED ADOPTION 9,283 9,826 20,504 5,941,597.68 640.05 604.68 SSA RCF IHHRC 7,564 8,945 15,785 37,496,491.38 4,957.23 4,191.89 SUBSIDIZED ADOPTION-INTERSTATE 77 91 169 62,766.99 815.16 689.75 TOTAL FEDERAL-STATE - MONEY PAYMENT 63,890 71,295 144,215 123,512,587.07 1,933.21 1,732.42 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 9,646 11,848 22,947 51,659,865.84 5,355.57 4,360.22 NON-INTERMEDIATE CARE FACILITY 45,086 68,769 117,631 45,661,132.84 1,012.76 663.98 CMAP 1,076 1,474 2,752 580,205.29 539.22 393.63 SUBSIDIZED ADOPTIONS 1,552 1,628 3,457 1,230,428.56 792.80 755.79 NO MONEY - ADC - VOLUNTARY 120,721 134,288 246,541 52,752,097.70 436.98 392.83 NO MONEY - SSI-SSA - VOLUNTARY 4,424 5,456 8,761 2,660,122.34 601.29 487.56 MED NEEDY - NO SPEND - CHILDRN 113 92 194 36,045.54 318.99 391.80 MED NEEDY - WI SPEND - CHILDRN 0 2 9 2,246.43 0.00 1,123.22 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 09/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 09/28/24 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 5 2 2 156.38 31.28 78.19 MED NEEDY - NO SPEND - DISABLE 2 3 9 521.01 260.51 173.67 MED NEEDY - WITH SPEND - AGED 0 3 1 127.78 0.00 42.59 MED NEEDY - WITH SPEND - DISAB 0 1 2 1,791.13 0.00 1,791.13 MED NEEDY - WITH SPEND - CRTKR 1 1 13 7,923.16 7,923.16 7,923.16 MAC SOBRA - PREGNANT WOMEN 8,453 11,475 14,521 6,825,020.17 807.41 594.77 MAC SOBRA - INFANTS 26,674 36,833 65,735 19,182,441.63 719.14 520.79 MAC SOBRA - CHILDREN 99,635 108,067 181,145 25,874,876.14 259.70 239.43 QUALIFIED MEDICARE BENE - AGED 7,088 2,904 9,475 574,444.18 81.04 197.81 QUALIFIED MEDICARE BENE - DISA 4,270 1,687 5,514 328,430.48 76.92 194.68 MAC (SOBRA/TXXI) CHILD 18,449 15,167 24,578 3,803,706.22 206.17 250.79 BREAST CERVICAL CANCER 86 93 164 349,818.14 4,067.65 3,761.49 ICARE PMIC MHI 300% 837 713 1,844 2,190,236.55 2,616.77 3,071.86 STATE ONLY - NO MONEY PAYMENT 1 1 2 451.62 451.62 451.62 BLENDED FAMP PME PREG WOMEN 6 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 7,353 8,871 16,137 2,139,861.05 291.02 241.22 LEGAL PERMANENT RESIDENT TXXI 1,020 814 1,233 163,901.11 160.69 201.35 FEDERAL ST, EX MIYA (375) 947 942 1,649 374,392.85 395.35 397.44 TOTAL FEDERAL-STATE - NO MONEY PYMT 357,445 411,134 724,316 216,400,244.14 605.41 526.35 TOTAL FEDERAL-STATE 421,335 482,429 868,531 339,912,831.21 806.75 704.59 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 264 321 1,486 2,776,866.28 10,518.43 8,650.67 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 264 321 1,486 2,776,866.28 10,518.43 8,650.67 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 12,152 12,638 33,132 96,871,719.83 7,971.67 7,665.11 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 12,152 12,638 33,132 96,871,719.83 7,971.67 7,665.11 TOTAL FEDERAL-COUNTY 12,416 12,959 34,618 99,648,586.11 8,025.82 7,689.53 STATE ONLY STATE ONLY - MONEY PAYMENT IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 09/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 09/28/24 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 6 7 10 2,266.92 377.82 323.85 TOTAL STATE ONLY - MONEY PAYMENT 6 7 10 2,266.92 377.82 323.85 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 4,175 182 258 31,226.24 7.48 171.57 TOTAL STATE ONLY - NO MONEY PAYMENT 4,175 182 258 31,226.24 7.48 171.57 TOTAL STATE ONLY 4,181 189 268 33,493.16 8.01 177.21 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,724 1 0 600.13 0.35 600.13 TOTAL FEDERAL-COUNTY-STATE MONEY 1,724 1 0 600.13 0.35 600.13 FEDERAL-COUNTY-STATE NO MONEY TOTAL FEDERAL-COUNTY-STATE NO MONEY 0 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE 1,724 1 0 600.13 0.35 600.13 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,962 1,833 5,742 289,046,376.67 147,322.31 157,690.33 TOTAL UNDEFINED SUBTOTAL 1,962 1,833 5,742 289,046,376.67 147,322.31 157,690.33 TOTAL UNDEFINED 1,962 1,833 5,742 289,046,376.67 147,322.31 157,690.33 TOTAL S T A T E 621,617 731,100 1,297,790 883,329,140.87 1,421.02 1,208.22 * * * E N D O F R E P O R T * * *