Kentucky 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 23.5% of Kentucky’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

90% 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

$17,878,704,523

CMS-64 Total Net Expenditures, as Kentucky filed it

Visible in claims

$4,196,487,265

23.5% of the program

Published per-enrollee spending

$1,111PMPM

CMS-64 total ÷ 1,341,218 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$4,932,343,533

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 Kentucky 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	$1,685,415,773	$864,810,248	51%
Nursing Facility	$1,554,918,125	$24,117,458	2%
FQHC & Rural Health Clinic	$429,043,760	$4,294,878	1%
Hospital (Inpatient & Outpatient)	$252,925,248	$168,749,743	67%
Intermediate Care Facility (IID)	$168,122,143	$0	0%
Other Care Services	$157,254,537	$46,821,669	30%
Non-Emergency Transportation	$155,765,356	$28,198,093	18%
Prescribed Drugs	$148,466,215	$50,469,910	34%
Behavioral Health	$86,224,894	$809,804,720	939%
Home Health	$62,160,283	$20,660,634	33%
Hospice	$48,651,477	$7,111,202	15%
Targeted Case Management	$41,632,100	$163,190,063	392%
Physician & Surgical	$37,791,611	$977,850,061	2587%
School-Based Services	$35,266,758	$0	0%
Screening & Preventive	$33,719,675	$36,390,121	108%
Clinic Services	$15,054,604	$4,952,405	33%
Therapy Services	$8,451,731	$261,853,850	3098%
Dental	$4,191,425	$140,054,575	3341%
Laboratory & Radiology	$3,783,290	$473,262,441	9999%
DME & Supplies	$1,991,828	$113,878,578	5717%
Other Practitioners	$1,476,090	$0	0%
Family Planning	$36,610	$492	1%

Categories no claims dataset can see$12,946,360,990

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	$13,893,254,456
Medicare Premiums (Duals)	$340,964,420
Supplemental & DSH Payments	$151,386,048
Drug Rebates & Collections	-$1,439,243,934

The table adds up. The categories above sum to $17,878,704,523, which is Kentucky’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.