IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 10/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 10/26/24 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) 179,287 221,525 382,254 178,811,849.55 997.35 807.19 FEDERAL ONLY, PRESUMP IH(881) 3 1 4 695.15 231.72 695.15 FEDERAL ONLY, PRESUMP(886) 1 1 4 208.94 208.94 208.94 TOTAL FEDERAL ONLY - MONEY PAYMENT 179,291 221,527 382,262 178,812,753.64 997.33 807.18 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 93 148 238 60,254.50 647.90 407.13 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 93 148 238 60,254.50 647.90 407.13 TOTAL FEDERAL ONLY 179,384 221,675 382,500 178,873,008.14 997.15 806.92 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 7,929 8,782 16,985 9,568,626.89 1,206.79 1,089.57 SSI DISABLED 38,008 40,560 87,781 86,004,810.13 2,262.81 2,120.43 FOSTER CARE 895 1,218 2,225 1,029,777.29 1,150.59 845.47 SUBSIDIZED ADOPTION 9,287 9,665 21,640 6,484,886.98 698.28 670.97 SSA RCF IHHRC 7,736 8,948 16,149 39,115,452.53 5,056.29 4,371.42 SUBSIDIZED ADOPTION-INTERSTATE 78 88 218 77,990.03 999.87 886.25 TOTAL FEDERAL-STATE - MONEY PAYMENT 63,933 69,261 144,998 142,281,543.85 2,225.48 2,054.28 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 9,616 10,614 21,116 47,748,836.55 4,965.56 4,498.67 NON-INTERMEDIATE CARE FACILITY 45,292 64,469 117,412 52,080,418.12 1,149.88 807.84 CMAP 1,064 1,401 2,660 592,780.10 557.12 423.11 SUBSIDIZED ADOPTIONS 1,543 1,590 3,830 1,219,776.77 790.52 767.16 NO MONEY - ADC - VOLUNTARY 120,199 131,720 248,848 61,686,159.98 513.20 468.31 NO MONEY - SSI-SSA - VOLUNTARY 4,527 5,036 7,942 2,774,515.82 612.88 550.94 MED NEEDY - NO SPEND - CHILDRN 116 102 251 47,308.82 407.83 463.81 MED NEEDY - WI SPEND - CHILDRN 0 1 1 298.52 0.00 298.52 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 10/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 10/26/24 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 - NO SPEND - AGED 6 7 16 969.82 161.64 138.55 MED NEEDY - NO SPEND - DISABLE 2 2 6 484.98 242.49 242.49 MED NEEDY - WITH SPEND - AGED 0 2 5 675.54 0.00 337.77 MED NEEDY - NO SPEND - CRTKR 0 1 0 41.06- 0.00 41.06- MED NEEDY - WITH SPEND - CRTKR 0 3 21 22,281.50 0.00 7,427.17 MAC SOBRA - PREGNANT WOMEN 8,422 10,627 14,814 6,975,006.38 828.19 656.35 MAC SOBRA - INFANTS 27,002 34,359 63,871 31,670,439.31 1,172.89 921.75 MAC SOBRA - CHILDREN 98,889 108,407 189,447 30,021,292.18 303.59 276.93 QUALIFIED MEDICARE BENE - AGED 7,176 2,909 8,919 371,404.49 51.76 127.67 QUALIFIED MEDICARE BENE - DISA 4,341 1,696 5,195 251,470.51 57.93 148.27 PRESUMPTIVE ELIG - PREG WOMEN 0 3 7 629.52 0.00 209.84 MAC (SOBRA/TXXI) CHILD 18,793 15,750 26,149 4,756,675.70 253.11 302.01 BREAST CERVICAL CANCER 82 88 156 338,563.92 4,128.83 3,847.32 ICARE PMIC MHI 300% 834 718 2,415 2,512,535.13 3,012.63 3,499.35 STATE ONLY - NO MONEY PAYMENT 1 1 2 341.17 341.17 341.17 BLENDED FAMP PME PREG WOMEN 4 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 7,580 8,859 16,572 3,006,894.15 396.69 339.42 LEGAL PERMANENT RESIDENT TXXI 1,062 851 1,412 211,871.60 199.50 248.97 FEDERAL ST, EX MIYA (375) 942 923 1,660 334,904.10 355.52 362.84 TOTAL FEDERAL-STATE - NO MONEY PYMT 357,493 400,139 732,727 246,626,493.62 689.88 616.35 TOTAL FEDERAL-STATE 421,426 469,400 877,725 388,908,037.47 922.84 828.52 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 262 321 988 3,689,492.98 14,082.03 11,493.75 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 262 321 988 3,689,492.98 14,082.03 11,493.75 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 12,183 12,988 36,908 101,470,517.59 8,328.86 7,812.64 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 12,183 12,988 36,908 101,470,517.59 8,328.86 7,812.64 TOTAL FEDERAL-COUNTY 12,445 13,309 37,896 105,160,010.57 8,449.98 7,901.42 STATE ONLY IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 10/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 10/26/24 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 6 6 10 1,707.81 284.64 284.64 TOTAL STATE ONLY - MONEY PAYMENT 6 6 10 1,707.81 284.64 284.64 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 4,154 174 267 25,474.47 6.13 146.41 TOTAL STATE ONLY - NO MONEY PAYMENT 4,154 174 267 25,474.47 6.13 146.41 TOTAL STATE ONLY 4,160 180 277 27,182.28 6.53 151.01 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,728 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE MONEY 1,728 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 1,728 0 0 0.00 0.00 0.00 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,873 1,709 4,848 386,833,047.16 206,531.26 226,350.52 TOTAL UNDEFINED SUBTOTAL 1,873 1,709 4,848 386,833,047.16 206,531.26 226,350.52 TOTAL UNDEFINED 1,873 1,709 4,848 386,833,047.16 206,531.26 226,350.52 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 10/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 10/26/24 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 621,016 706,273 1,303,246 1,059,801,285.62 1,706.56 1,500.55 * * * E N D O F R E P O R T * * *