Connecticut Medicaid Spend Reconciliation

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

41%High coverage

These claims represent 41.1% of Connecticut’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

$10,835,314,555

CMS-64 Total Net Expenditures, as Connecticut filed it

Visible in claims

$4,451,980,841

41.1% of the program

Published per-enrollee spending

$960PMPM

CMS-64 total ÷ 940,152 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$10,595,486,244

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 Connecticut 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)	$2,305,325,089	$524,873,156	23%
Home & Community-Based Services	$2,231,844,203	$15,032,159	1%
Prescribed Drugs	$2,020,697,173	$82,476,886	4%
Nursing Facility	$1,256,353,262	$78,055,078	6%
Physician & Surgical	$494,437,313	$1,184,522,951	240%
Clinic Services	$385,235,608	$556,233,089	144%
Other Practitioners	$366,637,329	$0	0%
Behavioral Health	$311,189,881	$644,446,815	207%
Other Care Services	$244,497,824	$56,500,869	23%
Intermediate Care Facility (IID)	$209,215,021	$0	0%
Home Health	$198,750,325	$363,442,059	183%
Dental	$176,445,190	$214,830,280	122%
Targeted Case Management	$106,475,957	$9,495,438	9%
Screening & Preventive	$103,161,715	$50,938,967	49%
Non-Emergency Transportation	$59,461,201	$162,910,989	274%
Laboratory & Radiology	$59,408,214	$266,477,501	449%
Hospice	$56,719,344	$1,353,790	2%
School-Based Services	$42,032,892	$0	0%
Family Planning	$958,671	$604,065	63%
FQHC & Rural Health Clinic	-$56	$1,922,598	—
Therapy Services	-$33,359,912	$131,591,724	—

Categories no claims dataset can see$239,828,311

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	$906,840,537
Medicare Premiums (Duals)	$697,995,818
Other CMS-64 Lines	$36,396,792
Managed Care Capitation	$16,557
Drug Rebates & Collections	-$1,401,421,393

The table adds up. The categories above sum to $10,835,314,555, which is Connecticut’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.