Georgia Medicaid Spend Reconciliation

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

5%Minimal coverage

These claims represent 5.3% of Georgia’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

69% 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

$14,870,296,553

CMS-64 Total Net Expenditures, as Georgia filed it

Visible in claims

$788,812,671

5.3% of the program

Published per-enrollee spending

$685PMPM

CMS-64 total ÷ 1,810,150 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$8,070,464,737

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 Georgia 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	$2,173,036,060	$207,035,102	10%
Nursing Facility	$1,718,158,723	$0	0%
Hospital (Inpatient & Outpatient)	$1,688,791,078	$20,885,297	1%
Prescribed Drugs	$892,935,302	$6,850,462	1%
Physician & Surgical	$363,070,316	$255,363,614	70%
Behavioral Health	$348,480,661	$41,907,128	12%
Home Health	$172,629,406	$8,321,765	5%
Hospice	$157,465,731	$0	0%
Non-Emergency Transportation	$131,426,686	$12,438,541	9%
Other Care Services	$105,378,545	$20,009,658	19%
School-Based Services	$72,982,315	$0	0%
Targeted Case Management	$60,022,525	$16,937,389	28%
Other Practitioners	$58,432,215	$0	0%
Laboratory & Radiology	$38,814,716	$100,367,094	259%
Intermediate Care Facility (IID)	$31,155,926	$0	0%
Dental	$16,859,162	$37,755,682	224%
FQHC & Rural Health Clinic	$13,405,981	$123,338	1%
DME & Supplies	$10,831,864	$12,297,693	114%
Screening & Preventive	$10,334,514	$20,898,610	202%
Family Planning	$5,044,505	$0	0%
Clinic Services	$1,208,506	$2,863,835	237%

Categories no claims dataset can see$6,799,831,816

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	$5,834,497,286
Supplemental & DSH Payments	$1,125,896,557
Medicare Premiums (Duals)	$719,628,764
Other CMS-64 Lines	$9,584,066
Drug Rebates & Collections	-$889,774,857

The table adds up. The categories above sum to $14,870,296,553, which is Georgia’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.