IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 04/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 04/26/25 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) 182,984 194,135 380,498 138,725,097.89 758.13 714.58 FEDERAL ONLY, PRESUMP IH(881) 1 2 3 621.81 621.81 310.91 FEDERAL ONLY, PRESUMP(886) 1 1 6 4,634.97 4,634.97 4,634.97 TOTAL FEDERAL ONLY - MONEY PAYMENT 182,986 194,138 380,507 138,730,354.67 758.15 714.60 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 7 33 54 14,926.00 2,132.29 452.30 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 7 33 54 14,926.00 2,132.29 452.30 TOTAL FEDERAL ONLY 182,993 194,171 380,561 138,745,280.67 758.20 714.55 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 7,919 8,484 16,721 9,154,220.50 1,155.98 1,079.00 SSI DISABLED 36,602 38,706 95,812 74,068,927.28 2,023.63 1,913.63 FOSTER CARE 853 1,002 2,379 571,015.46 669.42 569.88 SUBSIDIZED ADOPTION 9,313 9,442 23,731 6,660,165.56 715.15 705.38 SSA RCF IHHRC 8,074 8,556 17,317 43,645,227.56 5,405.65 5,101.13 SUBSIDIZED ADOPTION-INTERSTATE 76 79 210 76,835.70 1,011.00 972.60 TOTAL FEDERAL-STATE - MONEY PAYMENT 62,837 66,269 156,170 134,176,392.06 2,135.31 2,024.72 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 9,682 9,836 20,433 49,616,532.78 5,124.62 5,044.38 NON-INTERMEDIATE CARE FACILITY 45,810 52,616 112,058 47,188,547.82 1,030.09 896.85 CMAP 1,127 1,176 2,652 569,804.43 505.59 484.53 SUBSIDIZED ADOPTIONS 1,529 1,535 4,107 1,271,400.99 831.52 828.27 NO MONEY - ADC - VOLUNTARY 118,397 122,501 252,184 52,959,121.56 447.30 432.32 NO MONEY - SSI-SSA - VOLUNTARY 5,401 4,548 9,643 3,410,566.91 631.47 749.90 MED NEEDY - NO SPEND - CHILDRN 137 120 280 42,872.73 312.94 357.27 MED NEEDY - WI SPEND - CHILDRN 0 2 5 173.35 0.00 86.68 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 04/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 04/26/25 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 8 7 13 537.88 67.24 76.84 MED NEEDY - WITH SPEND - AGED 0 3 4 455.04 0.00 151.68 MED NEEDY - WITH SPEND - DISAB 0 3 9 18,795.95 0.00 6,265.32 MED NEEDY - WITH SPEND - CRTKR 4 6 18 8,906.23 2,226.56 1,484.37 MAC SOBRA - PREGNANT WOMEN 7,863 8,926 16,496 6,902,314.81 877.82 773.28 MAC SOBRA - INFANTS 21,632 27,873 53,271 19,076,595.06 881.87 684.41 MAC SOBRA - CHILDREN 100,877 100,539 205,856 26,990,838.48 267.56 268.46 QUALIFIED MEDICARE BENE - AGED 7,852 3,324 9,708 634,438.82 80.80 190.87 QUALIFIED MEDICARE BENE - DISA 4,450 2,039 6,244 358,221.89 80.50 175.69 PRESUMPTIVE ELIG - PREG WOMEN 0 1 3 394.28 0.00 394.28 MAC (SOBRA/TXXI) CHILD 19,522 17,846 36,207 5,123,240.77 262.43 287.08 BREAST CERVICAL CANCER 64 65 134 235,150.00 3,674.22 3,617.69 ICARE PMIC MHI 300% 872 789 3,449 3,077,864.67 3,529.66 3,900.97 STATE ONLY - NO MONEY PAYMENT 1 1 2 329.18 329.18 329.18 BLENDED FAMP PME PREG WOMEN 1 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 8,074 8,557 17,313 2,272,911.82 281.51 265.62 LEGAL PERMANENT RESIDENT TXXI 1,202 1,083 2,112 280,283.75 233.18 258.80 FEDERAL ST, EX MIYA (375) 882 884 1,639 333,652.59 378.29 377.44 TOTAL FEDERAL-STATE - NO MONEY PYMT 355,387 364,280 753,840 220,373,951.79 620.10 604.96 TOTAL FEDERAL-STATE 418,224 430,549 910,010 354,550,343.85 847.75 823.48 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 245 257 786 2,350,556.78 9,594.11 9,146.14 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 245 257 786 2,350,556.78 9,594.11 9,146.14 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 12,014 13,729 47,484 113,879,691.62 9,478.92 8,294.83 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 12,014 13,729 47,484 113,879,691.62 9,478.92 8,294.83 TOTAL FEDERAL-COUNTY 12,259 13,986 48,270 116,230,248.40 9,481.22 8,310.47 STATE ONLY STATE ONLY - MONEY PAYMENT IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 04/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 04/26/25 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 12 2,182.59 363.77 363.77 TOTAL STATE ONLY - MONEY PAYMENT 6 6 12 2,182.59 363.77 363.77 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 4,433 193 269 28,920.19 6.52 149.85 TOTAL STATE ONLY - NO MONEY PAYMENT 4,433 193 269 28,920.19 6.52 149.85 TOTAL STATE ONLY 4,439 199 281 31,102.78 7.01 156.30 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,996 1 0 7.37 0.00 7.37 TOTAL FEDERAL-COUNTY-STATE MONEY 1,996 1 0 7.37 0.00 7.37 FEDERAL-COUNTY-STATE NO MONEY TOTAL FEDERAL-COUNTY-STATE NO MONEY 0 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE 1,996 1 0 7.37 0.00 7.37 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,140 1,468 3,701 379,957,576.37 333,296.12 258,826.69 TOTAL UNDEFINED SUBTOTAL 1,140 1,468 3,701 379,957,576.37 333,296.12 258,826.69 TOTAL UNDEFINED 1,140 1,468 3,701 379,957,576.37 333,296.12 258,826.69 TOTAL S T A T E 621,051 640,374 1,342,823 989,514,559.44 1,593.29 1,545.21 * * * E N D O F R E P O R T * * *