New Mexico Medicaid Spend Reconciliation

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

31%Moderate coverage

These claims represent 31.0% of New Mexico’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

82% 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

$7,923,702,120

CMS-64 Total Net Expenditures, as New Mexico filed it

Visible in claims

$2,458,251,178

31.0% of the program

Published per-enrollee spending

$893PMPM

CMS-64 total ÷ 739,628 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$1,404,758,537

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 New Mexico 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	$740,082,235	$509,047,642	69%
Hospital (Inpatient & Outpatient)	$187,233,122	$40,544,502	22%
Home Health	$121,090,040	$301,659,829	249%
School-Based Services	$78,466,874	$0	0%
Non-Emergency Transportation	$70,310,353	$140,176,826	199%
Other Practitioners	$63,496,821	$0	0%
Intermediate Care Facility (IID)	$38,914,154	$0	0%
Other Care Services	$28,973,756	$72,538,110	250%
Prescribed Drugs	$22,589,471	$24,998,239	111%
Physician & Surgical	$21,485,506	$544,698,674	2535%
FQHC & Rural Health Clinic	$7,483,833	$932,590	12%
Dental	$6,894,806	$85,282,249	1237%
Laboratory & Radiology	$4,746,694	$196,407,124	4138%
Behavioral Health	$4,730,066	$312,753,869	6612%
Clinic Services	$3,248,985	$17,057,660	525%
Screening & Preventive	$1,902,300	$29,566,749	1554%
DME & Supplies	$1,183,489	$42,814,854	3618%
Nursing Facility	$943,317	$6,657,793	706%
Therapy Services	$851,993	$49,838,660	5850%
Hospice	$79,105	$10,669,541	9999%
Family Planning	$51,462	$82,458	160%
Targeted Case Management	$155	$72,523,810	9999%

Categories no claims dataset can see$6,518,943,583

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	$6,365,550,566
Supplemental & DSH Payments	$278,983,550
Medicare Premiums (Duals)	$222,377,241
Drug Rebates & Collections	-$347,967,774

The table adds up. The categories above sum to $7,923,702,120, which is New Mexico’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.