IAMM3800-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 11/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/23/24 ICF & ICF-ID VENDOR PAYMENTS BY COUNTY ICF ICF-ID TOTAL COUNTY RECIPIENT UNITS OF TOTAL RECIPIENT UNITS OF TOTAL RECIPIENT UNITS OF TOTAL SERVED SERVICE PAYMENTS SERVED SERVICE PAYMENTS SERVED SERVICE PAYMENTS ADAIR 5 154 $56,120 1 29 $14,037 6 183 $70,158 ALLAMAKEE 1 5 $1,195 0 0 $00 1 5 $1,195 AUDUBON 1 31 $11,779 0 0 $00 1 31 $11,779 BENTON 2 61 $18,482 1 31 $14,991 3 92 $33,474 BLACK HAWK 3 121 $34,321 1 31 $13,537 4 152 $47,858 BOONE 0 0 $00 1 0 $4,578 1 0 $4,578 BUENA VISTA 1 31 $8,969 0 0 $00 1 31 $8,969 BUTLER 1 31 $7,079 0 0 $00 1 31 $7,079 CALHOUN 0 0 $00 1 30 $14,566 1 30 $14,566 CERRO GORDO 1 92 $19,149 0 0 $00 1 92 $19,149 CHICKASAW 1 91 $21,927 0 0 $00 1 91 $21,927 CLINTON 1 91 $22,886 0 0 $00 1 91 $22,886 CRAWFORD 1 31 $6,613 0 0 $00 1 31 $6,613 DALLAS 0 0 $00 2 240 $111,609 2 240 $111,609 DELAWARE 1 31 $13,395 0 0 $00 1 31 $13,395 EMMET 1 31 $6,963 0 0 $00 1 31 $6,963 FREMONT 1 30 $7,148 0 0 $00 1 30 $7,148 GRUNDY 0 0 $00 1 31 $14,588 1 31 $14,588 HANCOCK 1 31 $8,775 0 0 $00 1 31 $8,775 HARRISON 1 31 $9,308 0 0 $00 1 31 $9,308 HENRY 2 31 $14,759 0 0 $00 2 31 $14,759 IOWA 4 124 $52,024 0 0 $00 4 124 $52,024 JASPER 1 27 $14,563 0 0 $00 1 27 $14,563 JEFFERSON 1 90 $21,828 0 0 $00 1 90 $21,828 JOHNSON 2 62 $16,990 0 0 $00 2 62 $16,990 LEE 2 123 $33,374 0 0 $00 2 123 $33,374 LINN 1 30 $4,896 0 0 $00 1 30 $4,896 LUCAS 1 31 $7,546 0 0 $00 1 31 $7,546 LYON 1 31 $5,963 0 0 $00 1 31 $5,963 MAHASKA 3 44 $9,581 0 0 $00 3 44 $9,581 MARION 1 7 $1,785 0 0 $00 1 7 $1,785 MARSHALL 162 5,832 $2,413,825 0 0 $00 162 5,832 $2,413,825 MILLS 1 16 $4,185 0 0 $00 1 16 $4,185 MONTGOMERY 2 182 $27,873 0 0 $00 2 182 $27,873 MUSCATINE 1 0 $00 0 0 $00 1 0 $00 O BRIEN 0 0 $00 1 31 $14,711 1 31 $14,711 OSCEOLA 1 33 $5,588 0 0 $00 1 33 $5,588 PLYMOUTH 1 62 $15,701 0 0 $00 1 62 $15,701 POLK 10 394 $126,703 3 74 $59,546 13 468 $186,250 POTTAWATTAMIE 16 559 $202,744 0 0 $00 16 559 $202,744 POWESHIEK 1 30 $8,138 0 0 $00 1 30 $8,138 SCOTT 4 161 $41,385 1 27 $14,568 5 188 $55,953 SIOUX 1 38 $8,418 0 0 $00 1 38 $8,418 IAMM3800-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 11/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/23/24 ICF & ICF-ID VENDOR PAYMENTS BY COUNTY ICF ICF-ID TOTAL COUNTY RECIPIENT UNITS OF TOTAL RECIPIENT UNITS OF TOTAL RECIPIENT UNITS OF TOTAL SERVED SERVICE PAYMENTS SERVED SERVICE PAYMENTS SERVED SERVICE PAYMENTS STORY 1 4 $707 1 242 $116,106 2 246 $116,814 TAMA 1 31 $8,905 0 0 $00 1 31 $8,905 UNION 1 31 $8,374 0 0 $00 1 31 $8,374 WAPELLO 2 92 $35,990 0 0 $00 2 92 $35,990 WARREN 1 55 $16,474 0 0 $00 1 55 $16,474 WEBSTER 2 58 $14,821 0 0 $00 2 58 $14,821 WINNEBAGO 1 25 $5,999 0 0 $00 1 25 $5,999 WOODBURY 5 232 $60,723 0 0 $00 5 232 $60,723 WRIGHT 1 38 $7,724 0 0 $00 1 38 $7,724 IAMM3800-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 11/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/23/24 ICF & ICF-ID VENDOR PAYMENTS BY COUNTY ICF ICF-ID TOTAL COUNTY RECIPIENT UNITS OF TOTAL RECIPIENT UNITS OF TOTAL RECIPIENT UNITS OF TOTAL SERVED SERVICE PAYMENTS SERVED SERVICE PAYMENTS SERVED SERVICE PAYMENTS STATE TOTAL 257 9,366 $3,451,718 14 766 $392,842 271 10,132 $3,844,560 *** END OF REPORT ***