Minnesota Medicaid Spend Reconciliation

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

24%Low coverage

These claims represent 23.7% of Minnesota’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

83% 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

$18,407,749,783

CMS-64 Total Net Expenditures, as Minnesota filed it

Visible in claims

$4,354,905,966

23.7% of the program

Published per-enrollee spending

$1,232PMPM

CMS-64 total ÷ 1,244,912 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$10,337,830,606

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 Minnesota 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	$6,267,644,941	$1,013,159,438	16%
Nursing Facility	$1,185,819,579	$343,471,802	29%
Hospital (Inpatient & Outpatient)	$475,899,197	$191,752,383	40%
Targeted Case Management	$372,735,413	$293,326,378	79%
Other Practitioners	$368,023,310	$0	0%
Home Health	$243,596,998	$29,827,141	12%
Behavioral Health	$218,847,978	$1,102,032,767	504%
Prescribed Drugs	$215,062,742	$37,111,560	17%
Physician & Surgical	$182,313,343	$411,876,644	226%
School-Based Services	$153,874,574	$43,883,605	29%
Other Care Services	$153,082,969	$34,177,030	22%
FQHC & Rural Health Clinic	$152,809,170	$1,044,972	1%
Hospice	$125,910,927	$3,384,847	3%
Intermediate Care Facility (IID)	$121,520,611	$0	0%
Dental	$25,193,387	$215,200,038	854%
Therapy Services	$19,880,902	$58,280,770	293%
Clinic Services	$17,086,357	$3,745,122	22%
Laboratory & Radiology	$14,331,452	$96,446,378	673%
DME & Supplies	$12,239,788	$255,706,022	2089%
Screening & Preventive	$11,893,058	$20,372,439	171%
Family Planning	$63,910	$587,511	919%

Categories no claims dataset can see$8,069,919,177

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	$8,750,080,362
Medicare Premiums (Duals)	$280,217,906
Supplemental & DSH Payments	$148,478,955
Other CMS-64 Lines	$45,400,633
Drug Rebates & Collections	-$1,154,258,679

The table adds up. The categories above sum to $18,407,749,783, which is Minnesota’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.