California Medicaid Spend Reconciliation

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

17%Low coverage

These claims represent 16.7% of California’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

96% 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

$148,772,636,090

CMS-64 Total Net Expenditures, as California filed it

Visible in claims

$24,803,227,997

16.7% of the program

Published per-enrollee spending

$993PMPM

CMS-64 total ÷ 12,487,478 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$79,170,182,262

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 California 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 categoryCMS-64 (state total)Seen in claimsCoverage
Home & Community-Based Services$31,565,196,020$906,686,548
3%
Prescribed Drugs$15,021,230,200$262,486,651
2%
Other Care Services$12,342,580,665$469,336,235
4%
Hospital (Inpatient & Outpatient)$5,125,113,340$1,762,678,175
34%
FQHC & Rural Health Clinic$4,717,408,428$4,151,099,032
88%
Dental$2,007,869,115$1,587,521,289
79%
School-Based Services$1,689,689,223$11,693,167
1%
Behavioral Health$1,347,323,394$4,605,899,708
342%
Targeted Case Management$1,243,214,795$855,990,800
69%
Physician & Surgical$1,236,106,237$4,289,162,694
347%
Clinic Services$1,134,805,477$3,666,077
0%
Nursing Facility$840,227,684$570,102,496
68%
Intermediate Care Facility (IID)$232,928,664$0
0%
Hospice$202,939,072$19,720,620
10%
Other Practitioners$198,088,596$0
0%
Screening & Preventive$151,287,895$113,055,833
75%
Laboratory & Radiology$66,299,730$1,644,777,181
2481%
DME & Supplies$29,511,203$783,539,154
2655%
Home Health$10,939,736$491,598,952
4494%
Non-Emergency Transportation$4,325,150$844,831,949
9999%
Therapy Services$2,372,378$289,787,951
9999%
Family Planning$725,260$7,036,484
970%
Categories no claims dataset can see$69,602,453,828

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 categoryCMS-64 (state total)
Managed Care Capitation$67,786,680,913
Supplemental & DSH Payments$6,863,801,553
Medicare Premiums (Duals)$3,697,904,929
Other CMS-64 Lines$19,900,369
Drug Rebates & Collections-$8,765,833,936
The table adds up. The categories above sum to $148,772,636,090, which is California’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.