Iowa Medicaid Spend Reconciliation

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

23%Low coverage

These claims represent 23.4% of Iowa’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

93% 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

$8,689,318,601

CMS-64 Total Net Expenditures, as Iowa filed it

Visible in claims

$2,031,533,755

23.4% of the program

Published per-enrollee spending

$1,175PMPM

CMS-64 total ÷ 616,488 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$395,592,702

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 Iowa 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
School-Based Services	$103,006,297	$495,707	0%
Home & Community-Based Services	$84,141,292	$573,864,216	682%
FQHC & Rural Health Clinic	$55,248,044	$187,219,036	339%
Hospital (Inpatient & Outpatient)	$45,280,758	$61,163,840	135%
Nursing Facility	$38,720,388	$3,834,112	10%
Prescribed Drugs	$20,346,242	$11,157,065	55%
Other Care Services	$11,437,321	$14,326,388	125%
Home Health	$10,471,676	$26,856,160	256%
Physician & Surgical	$9,944,139	$204,053,045	2052%
Intermediate Care Facility (IID)	$3,934,172	$0	0%
Targeted Case Management	$3,877,809	$5,640,622	145%
Screening & Preventive	$3,523,257	$12,067,526	343%
Laboratory & Radiology	$1,366,212	$28,644,162	2097%
Behavioral Health	$1,343,999	$742,479,087	9999%
Therapy Services	$851,580	$13,099,598	1538%
Clinic Services	$607,889	$0	0%
DME & Supplies	$403,608	$45,915,169	9999%
Hospice	$344,257	$207,383	60%
Other Practitioners	$267,709	$0	0%
Non-Emergency Transportation	$267,115	$40,043,174	9999%
Dental	$143,676	$47,217,458	9999%
Family Planning	$65,262	$66,316	102%

Categories no claims dataset can see$8,293,725,899

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	$8,602,721,884
Medicare Premiums (Duals)	$193,612,907
Supplemental & DSH Payments	$79,229,669
Drug Rebates & Collections	-$581,838,561

The table adds up. The categories above sum to $8,689,318,601, which is Iowa’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.