IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 11/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/23/24 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) 179,732 171,698 370,921 117,314,969.76 652.72 683.26 FEDERAL ONLY, PRESUMP IH(881) 2 3 11 3,963.71 1,981.86 1,321.24 FEDERAL ONLY, PRESUMP(886) 4 10 21 9,559.23 2,389.81 955.92 TOTAL FEDERAL ONLY - MONEY PAYMENT 179,738 171,711 370,953 117,328,492.70 652.78 683.29 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 98 86 196 51,120.49 521.64 594.42 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 98 86 196 51,120.49 521.64 594.42 TOTAL FEDERAL ONLY 179,836 171,797 371,149 117,379,613.19 652.70 683.25 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 7,831 7,197 14,858 4,407,964.41 562.89 612.47 SSI DISABLED 37,991 35,529 92,277 59,934,149.52 1,577.59 1,686.91 FOSTER CARE 869 835 1,816 365,088.53 420.12 437.23 SUBSIDIZED ADOPTION 9,307 9,292 22,576 5,575,147.91 599.03 599.99 SSA RCF IHHRC 7,708 842 3,586 8,723,212.17 1,131.71 10,360.11 SUBSIDIZED ADOPTION-INTERSTATE 77 77 177 55,198.44 716.86 716.86 TOTAL FEDERAL-STATE - MONEY PAYMENT 63,783 53,772 135,290 79,060,760.98 1,239.53 1,470.30 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 9,711 16,702 35,276 80,294,949.06 8,268.45 4,807.51 NON-INTERMEDIATE CARE FACILITY 45,742 47,481 110,875 45,767,871.94 1,000.57 963.92 CMAP 1,068 1,041 2,525 426,472.07 399.32 409.68 SUBSIDIZED ADOPTIONS 1,530 1,537 3,960 1,085,723.19 709.62 706.39 NO MONEY - ADC - VOLUNTARY 119,591 116,417 257,273 47,079,885.02 393.67 404.41 NO MONEY - SSI-SSA - VOLUNTARY 4,571 4,434 9,451 2,854,578.88 624.50 643.79 MED NEEDY - NO SPEND - CHILDRN 121 118 331 43,544.19 359.87 369.02 MED NEEDY - WI SPEND - CHILDRN 0 1 0 58.51- 0.00 58.51- IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 11/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/23/24 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 5 8 673.47 134.69 134.69 MED NEEDY - NO SPEND - DISABLE 2 4 7 496.45 248.23 124.11 MED NEEDY - WITH SPEND - AGED 0 3 9 1,046.13 0.00 348.71 MED NEEDY - WITH SPEND - DISAB 0 3 51 60,242.23 0.00 20,080.74 MED NEEDY - NO SPEND - CRTKR 2 0 0 0.00 0.00 0.00 MED NEEDY - WITH SPEND - CRTKR 1 8 5 2,802.36 2,802.36 350.30 MAC SOBRA - PREGNANT WOMEN 8,475 7,561 18,544 5,525,723.17 652.00 730.82 MAC SOBRA - INFANTS 27,306 25,852 58,312 18,403,664.15 673.98 711.89 MAC SOBRA - CHILDREN 98,886 96,620 212,834 24,557,778.96 248.34 254.17 QUALIFIED MEDICARE BENE - AGED 7,247 3,247 10,052 478,004.45 65.96 147.21 QUALIFIED MEDICARE BENE - DISA 4,404 1,965 6,197 297,453.07 67.54 151.38 PRESUMPTIVE ELIG - PREG WOMEN 0 5 5 792.34- 0.00 158.47- MAC (SOBRA/TXXI) CHILD 19,325 18,467 41,011 5,026,513.26 260.10 272.19 BREAST CERVICAL CANCER 81 77 160 256,060.88 3,161.25 3,325.47 ICARE PMIC MHI 300% 845 779 3,345 2,797,990.24 3,311.23 3,591.77 STATE ONLY - NO MONEY PAYMENT 1 1 2 281.80 281.80 281.80 BLENDED FAMP PME PREG WOMEN 1 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 7,763 7,346 17,130 2,040,354.24 262.83 277.75 LEGAL PERMANENT RESIDENT TXXI 1,090 1,011 2,299 270,901.19 248.53 267.95 FEDERAL ST, EX MIYA (375) 937 942 1,927 350,052.67 373.59 371.61 TOTAL FEDERAL-STATE - NO MONEY PYMT 358,705 351,627 791,589 237,622,212.22 662.44 675.78 TOTAL FEDERAL-STATE 422,488 405,399 926,879 316,682,973.20 749.57 781.16 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 256 266 1,310 2,411,782.74 9,421.03 9,066.85 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 256 266 1,310 2,411,782.74 9,421.03 9,066.85 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 12,197 13,648 45,599 108,426,409.39 8,889.60 7,944.49 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 12,197 13,648 45,599 108,426,409.39 8,889.60 7,944.49 TOTAL FEDERAL-COUNTY 12,453 13,914 46,909 110,838,192.13 8,900.52 7,965.95 STATE ONLY IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 11/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/23/24 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 7 17 3,224.22 644.84 460.60 TOTAL STATE ONLY - MONEY PAYMENT 5 7 17 3,224.22 644.84 460.60 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 4,226 221 310 31,510.90 7.46 142.58 TOTAL STATE ONLY - NO MONEY PAYMENT 4,226 221 310 31,510.90 7.46 142.58 TOTAL STATE ONLY 4,231 228 327 34,735.12 8.21 152.35 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,737 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE MONEY 1,737 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 1,737 0 0 0.00 0.00 0.00 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,560 3,061 5,470 5,703,781.42 3,656.27 1,863.37 TOTAL UNDEFINED SUBTOTAL 1,560 3,061 5,470 5,703,781.42 3,656.27 1,863.37 TOTAL UNDEFINED 1,560 3,061 5,470 5,703,781.42 3,656.27 1,863.37 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 11/30/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 11/23/24 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 622,305 594,399 1,350,734 550,639,295.06 884.84 926.38 * * * E N D O F R E P O R T * * *