IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 1 AS OF 06/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/28/25 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) 179,101 171,825 366,582 128,284,583.21 716.27 746.60 FEDERAL ONLY, PRESUMP IH(881) 0 5 9 1,342.81 0.00 268.56 FEDERAL ONLY, PRESUMP(886) 2 4 22 7,004.24 3,502.12 1,751.06 TOTAL FEDERAL ONLY - MONEY PAYMENT 179,103 171,834 366,613 128,292,930.26 716.31 746.61 FEDERAL ONLY -NO MONEY PAYMENT REFUGEE 2 2 6 1,443.87 721.94 721.94 TOTAL FEDERAL ONLY -NO MONEY PAYMENT 2 2 6 1,443.87 721.94 721.94 TOTAL FEDERAL ONLY 179,105 171,836 366,619 128,294,374.13 716.31 746.61 FEDERAL-STATE FEDERAL-STATE - MONEY PAYMENT SSI AGED 7,956 7,317 15,026 4,963,859.67 623.91 678.40 SSI DISABLED 36,118 33,645 112,413 65,695,815.04 1,818.92 1,952.62 FOSTER CARE 803 770 2,343 508,899.67 633.75 660.91 SUBSIDIZED ADOPTION 9,332 9,304 26,768 6,634,130.77 710.90 713.04 SSA RCF IHHRC 8,041 1,188 4,103 9,677,779.96 1,203.55 8,146.28 SUBSIDIZED ADOPTION-INTERSTATE 72 72 192 78,609.27 1,091.80 1,091.80 TOTAL FEDERAL-STATE - MONEY PAYMENT 62,322 52,296 160,845 87,559,094.38 1,404.95 1,674.30 FEDERAL-STATE - NO MONEY PYMT INTERMEDIATE CARE FACILITY 9,797 16,718 35,439 83,175,913.18 8,489.94 4,975.23 NON-INTERMEDIATE CARE FACILITY 45,073 46,488 117,655 52,005,174.71 1,153.80 1,118.68 CMAP 1,145 1,086 2,583 507,727.91 443.43 467.52 SUBSIDIZED ADOPTIONS 1,519 1,517 4,736 1,235,294.11 813.23 814.30 NO MONEY - ADC - VOLUNTARY 117,022 113,833 256,011 51,198,964.28 437.52 449.77 NO MONEY - SSI-SSA - VOLUNTARY 5,619 5,429 12,135 4,553,879.88 810.44 838.81 MED NEEDY - NO SPEND - CHILDRN 142 142 320 53,677.50 378.01 378.01 MED NEEDY - WI SPEND - CHILDRN 0 1 2 867.88 0.00 867.88 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 2 AS OF 06/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/28/25 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 6 8 28 11,959.50- 1,993.25- 1,494.94- MED NEEDY - WITH SPEND - AGED 2 6 80 10,285.49 5,142.75 1,714.25 MED NEEDY - WITH SPEND - DISAB 0 3 13 5,601.79 0.00 1,867.26 MED NEEDY - WITH SPEND - CRTKR 0 6 31 32,317.28 0.00 5,386.21 MAC SOBRA - PREGNANT WOMEN 11,376 10,523 23,536 7,945,479.88 698.44 755.06 MAC SOBRA - INFANTS 20,842 19,168 44,286 16,573,508.64 795.20 864.64 MAC SOBRA - CHILDREN 101,487 99,355 224,202 28,327,950.71 279.13 285.12 QUALIFIED MEDICARE BENE - AGED 8,014 3,748 12,521 747,345.17 93.25 199.40 QUALIFIED MEDICARE BENE - DISA 4,554 2,288 7,749 437,198.61 96.00 191.08 PRESUMPTIVE ELIG - PREG WOMEN 0 3 14 993.91 0.00 331.30 MAC (SOBRA/TXXI) CHILD 19,617 18,973 43,220 5,775,452.23 294.41 304.40 BREAST CERVICAL CANCER 62 62 128 216,866.11 3,497.84 3,497.84 ICARE PMIC MHI 300% 846 820 5,808 3,504,476.69 4,142.41 4,273.75 STATE ONLY - NO MONEY PAYMENT 1 1 2 299.28 299.28 299.28 BLENDED FAMP PME PREG WOMEN 4 0 0 0.00 0.00 0.00 LEGAL PERMANENT RESIDENT TXIX 8,020 7,710 17,099 2,228,048.79 277.81 288.98 LEGAL PERMANENT RESIDENT TXXI 1,232 1,179 2,556 327,937.51 266.18 278.15 FEDERAL ST, EX MIYA (375) 844 831 1,704 319,230.92 378.24 384.15 TOTAL FEDERAL-STATE - NO MONEY PYMT 357,224 349,898 811,858 259,172,532.96 725.52 740.71 TOTAL FEDERAL-STATE 419,546 402,194 972,703 346,731,627.34 826.44 862.10 FEDERAL-COUNTY FEDERAL-COUNTY - MONEY PAYMENT FED COUNTY ICF ID SSI 235 240 1,465 2,171,190.00 9,239.11 9,046.63 TOTAL FEDERAL-COUNTY - MONEY PAYMENT 235 240 1,465 2,171,190.00 9,239.11 9,046.63 FEDERAL-COUNTY - NO MONEY PYMT INTERMED CARE FAC-INT DISABLED 12,080 13,781 62,950 115,818,621.36 9,587.63 8,404.22 TOTAL FEDERAL-COUNTY - NO MONEY PYMT 12,080 13,781 62,950 115,818,621.36 9,587.63 8,404.22 TOTAL FEDERAL-COUNTY 12,315 14,021 64,415 117,989,811.36 9,580.98 8,415.22 STATE ONLY STATE ONLY - MONEY PAYMENT IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 3 AS OF 06/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/28/25 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 1,646.96 329.39 329.39 TOTAL STATE ONLY - MONEY PAYMENT 5 5 10 1,646.96 329.39 329.39 STATE ONLY - NO MONEY PAYMENT STATE ONLY - NO MONEY PAYMENT 4,023 242 351 31,456.65 7.82 129.99 TOTAL STATE ONLY - NO MONEY PAYMENT 4,023 242 351 31,456.65 7.82 129.99 TOTAL STATE ONLY 4,028 247 361 33,103.61 8.22 134.02 FEDERAL-COUNTY-STATE FEDERAL-COUNTY-STATE MONEY FED STATE COUNTY - MHI SSI 1,943 2 2 3,035.83 1.56 1,517.92 TOTAL FEDERAL-COUNTY-STATE MONEY 1,943 2 2 3,035.83 1.56 1,517.92 FEDERAL-COUNTY-STATE NO MONEY MHI - UNDER 21 1 1 2 301.55 301.55 301.55 SLMB - AGED 30 7 21 1,745.70 58.19 249.39 EXTENDED SLMB - BLIND 16 8 20 1,345.58 84.10 168.20 TOTAL FEDERAL-COUNTY-STATE NO MONEY 47 16 43 3,392.83 72.19 212.05 TOTAL FEDERAL-COUNTY-STATE 1,990 18 45 6,428.66 3.23 357.15 UNDEFINED UNDEFINED SUBTOTAL UNDEFINED CATEGORY 988 1,385 3,667 117,958,269.33 119,390.96 85,168.43 TOTAL UNDEFINED SUBTOTAL 988 1,385 3,667 117,958,269.33 119,390.96 85,168.43 TOTAL UNDEFINED 988 1,385 3,667 117,958,269.33 119,390.96 85,168.43 IAMM4400-R001 IOWA DEPARTMENT OF HUMAN SERVICES PAGE 4 AS OF 06/30/25 MEDICAID MANAGEMENT INFORMATION SYSTEM RUN DATE 06/28/25 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 617,972 589,701 1,407,810 711,013,614.43 1,150.56 1,205.72 * * * E N D O F R E P O R T * * *