District of Columbia 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 26.9% of District of Columbia’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

87% 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

$4,137,819,497

CMS-64 Total Net Expenditures, as District of Columbia filed it

Visible in claims

$1,113,198,346

26.9% of the program

Published per-enrollee spending

$1,367PMPM

CMS-64 total ÷ 252,333 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$2,232,634,311

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 District of Columbia 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
Home & Community-Based Services	$700,887,666	$308,045,097	44%
Clinic Services	$351,829,294	$37,800,467	11%
Nursing Facility	$299,988,975	$17,636,963	6%
Hospital (Inpatient & Outpatient)	$192,798,933	$40,347,503	21%
Prescribed Drugs	$172,428,611	$532,524	0%
Other Care Services	$120,435,933	$1,811,550	2%
Behavioral Health	$113,085,697	$326,912,140	289%
Intermediate Care Facility (IID)	$93,261,305	$0	0%
Home Health	$54,332,049	$36,862,381	68%
School-Based Services	$42,007,074	$0	0%
Physician & Surgical	$29,968,406	$188,436,017	629%
Non-Emergency Transportation	$20,058,965	$58,344,530	291%
Other Practitioners	$10,089,614	$0	0%
FQHC & Rural Health Clinic	$9,850,422	$548	0%
Laboratory & Radiology	$8,676,026	$20,554,630	237%
Dental	$5,638,169	$24,712,514	438%
Hospice	$4,964,780	$511,424	10%
DME & Supplies	$1,583,469	$11,846,065	748%
Screening & Preventive	$545,286	$7,787,985	1428%
Therapy Services	$192,884	$18,268,914	9471%
Family Planning	$10,753	$0	0%

Categories no claims dataset can see$1,905,185,186

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	$1,866,101,109
Supplemental & DSH Payments	$115,499,623
Medicare Premiums (Duals)	$85,747,740
Drug Rebates & Collections	-$162,163,286

The table adds up. The categories above sum to $4,137,819,497, which is District of Columbia’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.