Maine Medicaid Spend Reconciliation

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

38%High coverage

These claims represent 38.4% of Maine’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

This state reports little or no comprehensive managed care, so a comparatively large share of its spending appears as claims. 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

$4,526,919,083

CMS-64 Total Net Expenditures, as Maine filed it

Visible in claims

$1,739,392,174

38.4% of the program

Published per-enrollee spending

$1,080PMPM

CMS-64 total ÷ 349,275 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$4,428,302,369

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 Maine 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	$1,071,276,674	$789,702,780	74%
Hospital (Inpatient & Outpatient)	$913,872,090	$158,423,943	17%
Prescribed Drugs	$528,278,756	$9,431,522	2%
Nursing Facility	$454,646,275	$0	0%
Other Care Services	$291,780,732	$3,600,713	1%
Behavioral Health	$203,803,575	$406,694,373	200%
Physician & Surgical	$183,600,428	$70,586,319	38%
Clinic Services	$159,249,480	$0	0%
FQHC & Rural Health Clinic	$102,058,538	$116,009,964	114%
Other Practitioners	$100,547,744	$0	0%
School-Based Services	$84,778,008	$3,589,418	4%
Targeted Case Management	$79,548,892	$50,311,654	63%
Intermediate Care Facility (IID)	$65,806,542	$0	0%
Non-Emergency Transportation	$58,690,095	$25,604,954	44%
Dental	$40,722,922	$30,785,932	76%
Home Health	$36,085,070	$24,241,394	67%
Therapy Services	$22,830,106	$12,515,141	55%
Laboratory & Radiology	$14,740,183	$13,476,095	91%
DME & Supplies	$10,010,534	$19,295,355	193%
Hospice	$4,844,210	$594,343	12%
Screening & Preventive	$1,130,697	$4,502,098	398%
Family Planning	$818	$26,176	3200%

Categories no claims dataset can see$98,616,714

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)
Medicare Premiums (Duals)	$300,939,550
Supplemental & DSH Payments	$192,487,331
Drug Rebates & Collections	-$394,810,167

The table adds up. The categories above sum to $4,526,919,083, which is Maine’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.