Florida 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 16.5% of Florida’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

70% 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

$34,969,221,636

CMS-64 Total Net Expenditures, as Florida filed it

Visible in claims

$5,783,769,224

16.5% of the program

Published per-enrollee spending

$758PMPM

CMS-64 total ÷ 3,845,364 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$7,192,849,091

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 Florida 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	$2,136,265,646	$1,339,506,286	63%
Behavioral Health	$2,037,244,721	$581,986,373	29%
Hospital (Inpatient & Outpatient)	$709,796,273	$48,639,237	7%
Intermediate Care Facility (IID)	$586,319,075	$0	0%
Other Care Services	$367,654,492	$178,387,840	49%
Dental	$302,374,079	$206,850,414	68%
Prescribed Drugs	$259,428,994	$55,137,109	21%
Nursing Facility	$249,329,321	$193,795,913	78%
FQHC & Rural Health Clinic	$247,865,761	$2,297,028	1%
Physician & Surgical	$126,616,246	$1,091,955,788	862%
Home Health	$42,671,039	$845,112,965	1981%
Hospice	$42,405,415	$22,053,979	52%
Laboratory & Radiology	$25,969,601	$208,860,947	804%
Non-Emergency Transportation	$13,469,942	$118,732,222	881%
Therapy Services	$13,368,559	$235,993,469	1765%
Other Practitioners	$10,357,559	$0	0%
Targeted Case Management	$7,966,241	$242,244,233	3041%
Clinic Services	$7,031,731	$42,517,047	605%
Screening & Preventive	$6,492,809	$122,338,080	1884%
School-Based Services	$221,587	$1,435	1%

Categories no claims dataset can see$27,776,372,545

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	$25,100,885,816
Supplemental & DSH Payments	$2,937,127,615
Medicare Premiums (Duals)	$2,537,080,776
Drug Rebates & Collections	-$2,798,721,662

The table adds up. The categories above sum to $34,969,221,636, which is Florida’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.