Arizona Medicaid Spend Reconciliation

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

27%Moderate coverage

These claims represent 27.4% of Arizona’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

79% of enrollees are in comprehensive managed care, so most of their care is paid by capitation and never becomes a provider claim. 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

$19,966,362,750

CMS-64 Total Net Expenditures, as Arizona filed it

Visible in claims

$5,470,428,240

27.4% of the program

Published per-enrollee spending

$876PMPM

CMS-64 total ÷ 1,899,856 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$2,340,570,141

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 Arizona 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
Hospital (Inpatient & Outpatient)	$880,772,154	$216,621,848	25%
Prescribed Drugs	$426,203,663	$73,864,137	17%
Other Care Services	$314,090,788	$51,347,987	16%
Behavioral Health	$144,352,539	$749,539,732	519%
Clinic Services	$113,768,879	$46,806	0%
FQHC & Rural Health Clinic	$90,801,987	$505,880,502	557%
Physician & Surgical	$76,080,332	$1,095,958,002	1441%
Non-Emergency Transportation	$73,702,703	$337,043,458	457%
Nursing Facility	$64,094,800	$148,649,208	232%
School-Based Services	$59,875,390	$26,910	0%
Targeted Case Management	$28,266,772	$212,288,758	751%
Laboratory & Radiology	$27,336,866	$299,566,475	1096%
Other Practitioners	$11,294,148	$0	0%
Screening & Preventive	$11,282,848	$44,125,480	391%
Home Health	$5,613,692	$57,208,149	1019%
Dental	$5,606,979	$53,989,224	963%
DME & Supplies	$5,423,759	$77,003,070	1420%
Home & Community-Based Services	$940,644	$1,402,398,357	9999%
Hospice	$679,594	$1,741,964	256%
Therapy Services	$362,131	$140,667,921	9999%
Family Planning	$19,473	$0	0%

Categories no claims dataset can see$17,625,792,609

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)
Managed Care Capitation	$17,864,364,104
Medicare Premiums (Duals)	$546,393,326
Supplemental & DSH Payments	$520,845,830
Drug Rebates & Collections	-$1,305,810,651

The table adds up. The categories above sum to $19,966,362,750, which is Arizona’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.