Michigan Medicaid Spend Reconciliation

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

28%Moderate coverage

These claims represent 28.1% of Michigan’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

98% 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

$24,459,688,035

CMS-64 Total Net Expenditures, as Michigan filed it

Visible in claims

$6,881,887,939

28.1% of the program

Published per-enrollee spending

$837PMPM

CMS-64 total ÷ 2,436,522 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$7,641,877,446

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 Michigan 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
Nursing Facility	$2,202,027,374	$64,677	0%
Home & Community-Based Services	$1,930,978,557	$974,768,550	50%
Prescribed Drugs	$1,572,495,262	$84,723,704	5%
Hospital (Inpatient & Outpatient)	$559,707,707	$741,580,261	132%
School-Based Services	$414,484,444	$2,016	0%
FQHC & Rural Health Clinic	$301,493,843	$116,217,924	39%
Hospice	$174,044,415	$6,662,679	4%
Physician & Surgical	$147,979,953	$896,030,389	606%
Other Care Services	$77,800,719	$46,224,160	59%
Clinic Services	$74,296,308	$270,891	0%
Behavioral Health	$62,294,738	$2,154,061,125	3458%
Home Health	$36,932,169	$69,444,785	188%
Dental	$28,837,024	$360,849,590	1251%
Screening & Preventive	$13,865,642	$101,497,691	732%
Non-Emergency Transportation	$10,684,233	$157,827,330	1477%
DME & Supplies	$10,185,322	$238,055,688	2337%
Other Practitioners	$9,440,483	$0	0%
Laboratory & Radiology	$9,082,503	$136,585,265	1504%
Therapy Services	$4,427,343	$374,942,349	8469%
Targeted Case Management	$758,145	$421,562,636	9999%
Family Planning	$61,262	$354,453	579%

Categories no claims dataset can see$16,817,810,589

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	$17,760,687,090
Supplemental & DSH Payments	$1,277,250,991
Medicare Premiums (Duals)	$817,750,023
Drug Rebates & Collections	-$3,037,877,515

The table adds up. The categories above sum to $24,459,688,035, which is Michigan’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.