Illinois Medicaid Spend Reconciliation

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

11%Minimal coverage

These claims represent 11.2% of Illinois’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

76% 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

$32,464,090,021

CMS-64 Total Net Expenditures, as Illinois filed it

Visible in claims

$3,630,019,061

11.2% of the program

Published per-enrollee spending

$853PMPM

CMS-64 total ÷ 3,170,754 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$7,810,985,816

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 Illinois 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	$2,470,461,617	$41,393,825	2%
Hospital (Inpatient & Outpatient)	$1,719,222,548	$3,112,535	0%
Other Care Services	$1,134,886,730	$19,806,934	2%
Intermediate Care Facility (IID)	$838,368,457	$0	0%
Nursing Facility	$543,587,316	$2,489,642	0%
Physician & Surgical	$269,044,829	$669,481,794	249%
Prescribed Drugs	$187,618,866	$97,347,338	52%
School-Based Services	$174,572,376	$80	0%
Home Health	$88,895,459	$68,919,240	78%
Behavioral Health	$72,424,701	$548,516,010	757%
FQHC & Rural Health Clinic	$54,334,909	$564,196,170	1038%
Hospice	$50,071,330	$555	0%
Non-Emergency Transportation	$45,178,794	$731,194,531	1618%
Therapy Services	$43,246,673	$26,092,899	60%
Laboratory & Radiology	$27,973,575	$341,815,983	1222%
Targeted Case Management	$23,146,305	$70,183,606	303%
Dental	$21,488,142	$204,814,296	953%
Screening & Preventive	$19,519,595	$42,330,391	217%
Clinic Services	$12,092,831	$5,306	0%
Other Practitioners	$9,034,596	$0	0%
DME & Supplies	$5,767,159	$198,300,282	3438%
Family Planning	$49,008	$17,645	36%

Categories no claims dataset can see$24,653,104,205

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	$23,983,344,198
Supplemental & DSH Payments	$1,605,646,599
Medicare Premiums (Duals)	$817,311,448
Drug Rebates & Collections	-$1,753,198,040

The table adds up. The categories above sum to $32,464,090,021, which is Illinois’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.