IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 12/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 12/28/24 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) 180,284 203,584 377,268 145,815,732.30 808.81 716.24 FEDERAL ONLY, PRESUMP IH(881) 5 6 17 2,259.31 451.86 376.55 FEDERAL ONLY, PRESUMP(886) 3 9 42 5,858.49 1,952.83 650.94 TOTAL FEDERAL ONLY - MONEY PAYMENT 180,292 203,599 377,327 145,823,850.10 808.82 716.23 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 66 106 177 55,013.59 833.54 519.00 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 66 106 177 55,013.59 833.54 519.00 TOTAL FEDERAL ONLY 180,358 203,705 377,504 145,878,863.69 808.83 716.13 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 7,778 8,443 16,328 9,520,594.71 1,224.04 1,127.63 SSI DISABLED 37,974 39,567 96,163 76,549,443.07 2,015.84 1,934.68 FOSTER CARE 891 1,118 2,280 595,139.68 667.95 532.33 SUBSIDIZED ADOPTION 9,318 9,563 24,026 6,620,358.01 710.49 692.29 SSA RCF IHHRC 7,792 8,301 16,064 38,498,340.57 4,940.75 4,637.80 SUBSIDIZED ADOPTION-INTERSTATE 75 84 243 108,659.03 1,448.79 1,293.56 FOSTER CARE - INTERSTATE 0 1 12 1,250.34 0.00 1,250.34 TOTAL FEDERAL-STATE - MONEY PAYMENT 63,828 67,077 155,116 131,893,785.41 2,066.39 1,966.30 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 9,747 10,421 20,934 49,966,223.32 5,126.32 4,794.76 NON-INTERMEDIATE CARE FACILITY 45,741 56,791 116,687 51,809,463.07 1,132.67 912.28 CMAP 1,041 1,305 2,564 508,031.59 488.02 389.30 SUBSIDIZED ADOPTIONS 1,534 1,558 4,191 1,241,865.47 809.56 797.09 NO MONEY - ADC - VOLUNTARY 118,860 126,719 253,005 54,424,600.73 457.89 429.49 NO MONEY - SSI-SSA - VOLUNTARY 4,615 4,532 8,714 3,906,341.72 846.44 861.95 MED NEEDY - NO SPEND - CHILDRN 121 114 254 41,349.45 341.73 362.71 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 12/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 12/28/24 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 - WI SPEND - CHILDRN 0 1 0 266.92- 0.00 266.92- MED NEEDY - NO SPEND - AGED 6 6 15 589.52 98.25 98.25 MED NEEDY - WITH SPEND - AGED 0 3 47 8,951.92 0.00 2,983.97 MED NEEDY - WITH SPEND - DISAB 0 1 0 81.75 0.00 81.75 MED NEEDY - NO SPEND - CRTKR 0 2 2 94.36 0.00 47.18 MED NEEDY - WITH SPEND - CRTKR 1 8 12 26,815.25 26,815.25 3,351.91 MAC SOBRA - PREGNANT WOMEN 8,493 9,048 16,483 6,505,463.07 765.98 718.99 MAC SOBRA - INFANTS 27,651 30,444 61,916 19,326,905.16 698.96 634.83 MAC SOBRA - CHILDREN 99,126 105,116 203,404 29,543,547.33 298.04 281.06 QUALIFIED MEDICARE BENE - AGED 7,310 4,548 10,125 271,083.30 37.08 59.60 QUALIFIED MEDICARE BENE - DISA 4,426 2,696 6,427 207,526.29 46.89 76.98 PRESUMPTIVE ELIG - PREG WOMEN 0 1 2 4.76 0.00 4.76 MAC (SOBRA/TXXI) CHILD 19,538 17,044 31,458 4,986,186.18 255.20 292.55 BREAST CERVICAL CANCER 61 75 98 180,999.87 2,967.21 2,413.33 ICARE PMIC MHI 300% 845 750 3,314 2,826,003.37 3,344.38 3,768.00 STATE ONLY - NO MONEY PAYMENT 1 1 2 289.39 289.39 289.39 BLENDED FAMP PME PREG WOMEN 4 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 7,907 8,734 17,553 2,574,607.38 325.61 294.78 LEGAL PERMANENT RESIDENT TXXI 1,129 956 1,755 259,034.80 229.44 270.96 FEDERAL ST, EX MIYA (375) 936 904 1,741 347,920.99 371.71 384.87 TOTAL FEDERAL-STATE - NO MONEY PYMT 359,093 381,778 760,703 228,963,713.12 637.62 599.73 TOTAL FEDERAL-STATE 422,921 448,855 915,819 360,857,498.53 853.25 803.95 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 252 281 1,115 2,585,508.22 10,259.95 9,201.10 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 252 281 1,115 2,585,508.22 10,259.95 9,201.10 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 12,232 13,580 45,927 110,900,885.94 9,066.46 8,166.49 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 12,232 13,580 45,927 110,900,885.94 9,066.46 8,166.49 TOTAL FEDERAL-COUNTY 12,484 13,861 47,042 113,486,394.16 9,090.55 8,187.46 STATE ONLY IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 12/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 12/28/24 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 STATE ONLY - MONEY PAYMENT 5 6 10 1,913.16 382.63 318.86 TOTAL STATE ONLY - MONEY PAYMENT 5 6 10 1,913.16 382.63 318.86 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 4,273 377 275 25,081.47 5.87 66.53 TOTAL STATE ONLY - NO MONEY PAYMENT 4,273 377 275 25,081.47 5.87 66.53 TOTAL STATE ONLY 4,278 383 285 26,994.63 6.31 70.48 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,727 2 0 1,317.90 0.76 658.95 TOTAL FEDERAL-COUNTY-STATE MONEY 1,727 2 0 1,317.90 0.76 658.95 FEDERAL-COUNTY-STATE NO MONEY TOTAL FEDERAL-COUNTY-STATE NO MONEY 0 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE 1,727 2 0 1,317.90 0.76 658.95 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,557 2,167 4,737 42,076,978.31 27,024.39 19,417.16 TOTAL UNDEFINED SUBTOTAL 1,557 2,167 4,737 42,076,978.31 27,024.39 19,417.16 TOTAL UNDEFINED 1,557 2,167 4,737 42,076,978.31 27,024.39 19,417.16 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 12/31/24 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 12/28/24 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 TOTAL S T A T E 623,325 668,973 1,345,387 662,328,047.22 1,062.57 990.07 * * * E N D O F R E P O R T * * *