IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 05/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 05/24/25 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) 179,396 189,098 375,450 179,521,831.70 1,000.70 949.36 FEDERAL ONLY, PRESUMP IH(881) 1 3 6 380.65 380.65 126.88 FEDERAL ONLY, PRESUMP(886) 2 4 19 1,814.84 907.42 453.71 TOTAL FEDERAL ONLY - MONEY PAYMENT 179,399 189,105 375,475 179,524,027.19 1,000.70 949.34 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 4 10 14 9,243.46 2,310.87 924.35 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 4 10 14 9,243.46 2,310.87 924.35 TOTAL FEDERAL ONLY 179,403 189,115 375,489 179,533,270.65 1,000.73 949.33 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 7,936 8,251 16,556 8,866,932.85 1,117.31 1,074.65 SSI DISABLED 36,315 37,790 99,942 90,384,609.62 2,488.91 2,391.76 FOSTER CARE 806 963 2,263 879,722.93 1,091.47 913.52 SUBSIDIZED ADOPTION 9,306 9,410 24,744 7,436,206.74 799.08 790.25 SSA RCF IHHRC 8,080 8,202 17,140 42,091,306.27 5,209.32 5,131.83 SUBSIDIZED ADOPTION-INTERSTATE 77 76 271 97,922.34 1,271.72 1,288.45 TOTAL FEDERAL-STATE - MONEY PAYMENT 62,520 64,692 160,916 149,756,700.75 2,395.34 2,314.92 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 9,671 9,784 20,728 50,246,900.27 5,195.63 5,135.62 NON-INTERMEDIATE CARE FACILITY 44,954 51,379 113,903 53,985,309.37 1,200.90 1,050.73 CMAP 1,139 1,182 2,712 654,307.89 574.46 553.56 SUBSIDIZED ADOPTIONS 1,520 1,527 4,334 1,403,708.45 923.49 919.26 NO MONEY - ADC - VOLUNTARY 117,271 119,838 251,875 66,392,163.12 566.14 554.02 NO MONEY - SSI-SSA - VOLUNTARY 5,639 4,925 10,163 4,053,248.86 718.79 822.99 MED NEEDY - NO SPEND - CHILDRN 138 121 280 42,401.56 307.26 350.43 MED NEEDY - WI SPEND - CHILDRN 0 2 12 23,605.73 0.00 11,802.87 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 05/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 05/24/25 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 15 866.05 108.26 123.72 MED NEEDY - WITH SPEND - AGED 1 3 31 32,499.92 32,499.92 10,833.31 MED NEEDY - WITH SPEND - DISAB 0 3 8 5,551.18 0.00 1,850.39 MED NEEDY - WITH SPEND - CRTKR 0 11 30 6,100.42 0.00 554.58 MAC SOBRA - PREGNANT WOMEN 10,862 8,259 18,184 8,682,787.51 799.37 1,051.31 MAC SOBRA - INFANTS 20,987 23,087 47,729 31,897,191.32 1,519.85 1,381.61 MAC SOBRA - CHILDREN 101,047 101,296 212,148 33,896,627.22 335.45 334.63 QUALIFIED MEDICARE BENE - AGED 7,963 3,503 10,505 639,136.44 80.26 182.45 QUALIFIED MEDICARE BENE - DISA 4,516 2,066 6,108 373,215.53 82.64 180.65 PRESUMPTIVE ELIG - PREG WOMEN 0 1 1 19.03 0.00 19.03 MAC (SOBRA/TXXI) CHILD 19,527 18,335 37,647 6,353,539.30 325.37 346.53 BREAST CERVICAL CANCER 62 63 120 225,684.32 3,640.07 3,582.29 ICARE PMIC MHI 300% 865 801 3,799 3,237,101.44 3,742.31 4,041.33 STATE ONLY - NO MONEY PAYMENT 1 1 2 314.23 314.23 314.23 BLENDED FAMP PME PREG WOMEN 2 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 8,021 8,429 17,368 2,886,334.44 359.85 342.43 LEGAL PERMANENT RESIDENT TXXI 1,201 1,125 2,246 436,778.47 363.68 388.25 FEDERAL ST, EX MIYA (375) 850 874 1,659 353,194.38 415.52 404.11 TOTAL FEDERAL-STATE - NO MONEY PYMT 356,245 356,622 761,607 265,828,586.45 746.20 745.41 TOTAL FEDERAL-STATE 418,765 421,314 922,523 415,585,287.20 992.41 986.40 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 246 251 855 2,483,045.71 10,093.68 9,892.61 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 246 251 855 2,483,045.71 10,093.68 9,892.61 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 12,024 13,822 50,835 116,944,766.03 9,725.95 8,460.77 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 12,024 13,822 50,835 116,944,766.03 9,725.95 8,460.77 TOTAL FEDERAL-COUNTY 12,270 14,073 51,690 119,427,811.74 9,733.32 8,486.31 STATE ONLY STATE ONLY - MONEY PAYMENT IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 05/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 05/24/25 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 5 5 10 1,697.69 339.54 339.54 TOTAL STATE ONLY - MONEY PAYMENT 5 5 10 1,697.69 339.54 339.54 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 4,401 215 322 33,049.45 7.51 153.72 TOTAL STATE ONLY - NO MONEY PAYMENT 4,401 215 322 33,049.45 7.51 153.72 TOTAL STATE ONLY 4,406 220 332 34,747.14 7.89 157.94 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,982 0 0 0.00 0.00 0.00 TOTAL FEDERAL-COUNTY-STATE MONEY 1,982 0 0 0.00 0.00 0.00 FEDERAL-COUNTY-STATE NO MONEY SLMB - AGED 35 0 0 0.00 0.00 0.00 EXTENDED SLMB - BLIND 14 2 3 294.35 21.03 147.18 TOTAL FEDERAL-COUNTY-STATE NO MONEY 49 2 3 294.35 6.01 147.18 TOTAL FEDERAL-COUNTY-STATE 2,031 2 3 294.35 0.14 147.18 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 1,023 1,262 3,168 21,383,914.38 20,903.14 16,944.46 TOTAL UNDEFINED SUBTOTAL 1,023 1,262 3,168 21,383,914.38 20,903.14 16,944.46 TOTAL UNDEFINED 1,023 1,262 3,168 21,383,914.38 20,903.14 16,944.46 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 05/31/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 05/24/25 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 TOTAL S T A T E 617,898 625,986 1,353,205 735,965,325.46 1,191.08 1,175.69 * * * E N D O F R E P O R T * * *