a. Recipient payment levels for Iowa

Federal Code State OS Code Category FBR State Supplement Level Total Payment Levels A A Blind 994.00 22.00 1016.00 C Aged 994.00 518.00 1512.00 Blind 994.00 540.00 1534.00 Disabled 994.00 518.00 1512.00 D Aged 994.00 142.00 1136.00 Blind 994.00 164.00 1158.00 Disabled 994.00 142.00 1136.00 Z All 994.00 0.00 994.00 B B Blind 662.67 1 22.00 684.67 H Aged 662.67 1 518.00 1180.67 Blind 662.67 1 540.00 1202.67 Disabled 662.67 1 518.00 1180.67 I Aged 662.67 1 142.00 804.67 I Disabled 662.67 1 142.00 804.67 I Blind 662.67 1 164.00 826.67 Z All 662.67 1 0.00 662.67 C A Blind 994.00 22.00 1016.00 C Blind 994.00 540.00 1534.00 Disabled 994.00 518.00 1512.00 Z Disabled 994.00 0.00 994.00 D Z All 30.00 2 0.00 30.00

1 Not the FBR; the amount represents the FBR less VTR.

2 Not the FBR; the amount represents a payment cap to recipients in a Title XIX institution.

NOTE: State-administered programs include recipients receiving:

• “Residential Care” and a payment based on a per diem rate plus a monthly personal allowance;

• “In-Home Health Care” and a payment based on actual cost of in-home health care plus basic Federal benefits; or

• a supplement for Medicare and Medicaid and a $1 monthly payment.