Ohio 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 22.6% of Ohio’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

$33,987,517,237

CMS-64 Total Net Expenditures, as Ohio filed it

Visible in claims

$7,662,859,671

22.6% of the program

Published per-enrollee spending

$1,032PMPM

CMS-64 total ÷ 2,743,174 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$10,643,786,591

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 Ohio 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	$4,983,207,629	$684,696,785	14%
Nursing Facility	$2,045,181,237	$101,111,631	5%
Intermediate Care Facility (IID)	$952,161,965	$0	0%
Hospital (Inpatient & Outpatient)	$948,321,231	$1,557,762,749	164%
Home Health	$327,277,290	$537,472,421	164%
Prescribed Drugs	$206,811,986	$97,125,312	47%
Targeted Case Management	$199,177,051	$57,008,287	29%
Hospice	$187,129,582	$326,853,021	175%
FQHC & Rural Health Clinic	$183,439,002	$104,790,130	57%
School-Based Services	$146,685,123	$0	0%
Behavioral Health	$144,138,259	$1,491,330,962	1035%
Physician & Surgical	$123,851,358	$1,189,567,196	960%
Other Care Services	$95,171,694	$66,271,733	70%
Clinic Services	$31,951,658	$281,129	1%
Non-Emergency Transportation	$23,885,839	$111,467,201	467%
Dental	$16,253,626	$322,371,481	1983%
Laboratory & Radiology	$14,016,928	$463,208,782	3305%
Other Practitioners	$8,205,477	$0	0%
Screening & Preventive	$5,579,425	$85,495,638	1532%
DME & Supplies	$1,129,391	$355,773,395	9999%
Family Planning	$140,863	$9,560	7%
Therapy Services	$69,977	$94,481,107	9999%

Categories no claims dataset can see$23,343,730,646

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	$24,582,555,563
Supplemental & DSH Payments	$1,750,941,296
Medicare Premiums (Duals)	$849,871,929
Other CMS-64 Lines	$7,975,525
Drug Rebates & Collections	-$3,847,613,667

The table adds up. The categories above sum to $33,987,517,237, which is Ohio’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.