Idaho Medicaid Spend Reconciliation

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

15%Low coverage

These claims represent 15.3% of Idaho’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

6% 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

$3,893,210,477

CMS-64 Total Net Expenditures, as Idaho filed it

Visible in claims

$594,267,439

15.3% of the program

Published per-enrollee spending

$1,056PMPM

CMS-64 total ÷ 307,358 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$2,890,912,212

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 Idaho 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)	$813,836,073	$382,103	0%
Home & Community-Based Services	$718,850,439	$112,764,625	16%
Prescribed Drugs	$586,287,421	$2,361,603	0%
Physician & Surgical	$179,506,555	$81,505,449	45%
Other Care Services	$98,795,141	$1,047,498	1%
Nursing Facility	$85,896,792	$10,607,346	12%
FQHC & Rural Health Clinic	$61,506,138	$420,334	1%
Other Practitioners	$56,521,224	$0	0%
School-Based Services	$55,078,689	$3,858,211	7%
DME & Supplies	$48,954,334	$11,623,992	24%
Intermediate Care Facility (IID)	$38,115,273	$0	0%
Targeted Case Management	$37,500,756	$18,660,635	50%
Non-Emergency Transportation	$33,275,606	$9,767,582	29%
Screening & Preventive	$32,759,177	$6,515,512	20%
Laboratory & Radiology	$17,992,223	$6,954,216	39%
Home Health	$15,668,235	$3,657,306	23%
Behavioral Health	$5,753,727	$194,008,246	3372%
Hospice	$4,184,443	$0	0%
Family Planning	$392,791	$0	0%
Clinic Services	$36,745	$61,943,038	9999%
Dental	$430	$34,178,204	9999%

Categories no claims dataset can see$1,002,298,265

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	$765,500,010
Supplemental & DSH Payments	$498,235,219
Medicare Premiums (Duals)	$101,826,982
Drug Rebates & Collections	-$363,263,946

The table adds up. The categories above sum to $3,893,210,477, which is Idaho’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.