Alabama Medicaid Spend Reconciliation

Every CMS-64 service category for FY2024, and how much of each appears in this claims dataset.

21%Low coverage

These claims represent 21.1% of Alabama’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

This state reports little or no comprehensive managed care, so a comparatively large share of its spending appears as claims. The remainder is capitation, supplemental and DSH payments, Medicare premiums for dual eligibles, drug rebates and administration — none of which are claim-level. See the full reconciliation.

Total Medicaid spending, FY2024

$8,109,366,769

CMS-64 Total Net Expenditures, as Alabama filed it

Visible in claims

$1,713,167,931

21.1% of the program

Published per-enrollee spending

$798PMPM

CMS-64 total ÷ 846,805 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$6,089,072,473

Services paid as provider claims. Coverage below 100% typically means part of the category is delivered through managed care, or billed with codes this dataset does not carry.

Read the category rows as indicative, not exact. The state total above is a like-for-like comparison and is sound. Individual rows are not, because the two columns are attributed differently: claims are categorised by billing code, while the CMS-64 is categorised by the authority the state pays under. A home visit billed under a 1915(c) waiver and the same visit billed under the state plan carry identical codes, so this dataset cannot tell them apart while Alabama books them on different lines. That is why some rows exceed 100% while their neighbours sit near zero — it reflects where the state books the spending, not a discrepancy in the amount.

Service category	CMS-64 (state total)	Seen in claims	Coverage
Nursing Facility	$1,242,799,454	$32,196	0%
Hospital (Inpatient & Outpatient)	$1,196,115,959	$33,043,016	3%
Prescribed Drugs	$1,018,489,352	$6,678,829	1%
Home & Community-Based Services	$764,238,355	$574,116,364	75%
Physician & Surgical	$620,402,912	$285,746,199	46%
Behavioral Health	$222,985,953	$149,662,603	67%
Laboratory & Radiology	$182,393,139	$199,493,380	109%
Hospice	$125,433,224	$33,205,812	26%
Home Health	$120,606,717	$7,446,607	6%
Targeted Case Management	$110,521,686	$51,390,118	47%
FQHC & Rural Health Clinic	$94,279,192	$117,315,542	124%
Dental	$89,196,946	$85,717,866	96%
Screening & Preventive	$75,745,687	$30,071,892	40%
Other Care Services	$71,229,910	$2,926,720	4%
Therapy Services	$65,666,581	$26,585,210	40%
Clinic Services	$36,873,316	$1,059,627	3%
Other Practitioners	$35,518,477	$0	0%
DME & Supplies	$9,892,198	$36,228,806	366%
Intermediate Care Facility (IID)	$2,768,909	$0	0%
Non-Emergency Transportation	$2,576,293	$72,306,657	2807%
Family Planning	$1,338,213	$140,486	11%

Categories no claims dataset can see$2,020,294,296

These are real spending — they are simply not paid as claims to providers, so no claims-based analysis will ever contain them. This is the bulk of the difference between the two figures above.

Service category	CMS-64 (state total)
Supplemental & DSH Payments	$2,059,022,431
Medicare Premiums (Duals)	$467,052,126
Other CMS-64 Lines	$102,173,760
Managed Care Capitation	$3,880,021
Drug Rebates & Collections	-$611,834,042

The table adds up. The categories above sum to $8,109,366,769, which is Alabama’s CMS-64 Total Net Expenditures for FY2024 exactly. Every line the state filed is accounted for in one of the two tables — nothing is dropped or double-counted.

Sources: CMS-64 net expenditures from the CMS MBES/CBES quarterly expenditure reports (FY2024); enrollment from the CMS Medicaid and CHIP applications, eligibility determinations and enrollment data; managed-care share from the CMS managed care enrollment reports. Claims figures are from the public T-MSIS provider extract. Methodology.