Oklahoma Medicaid Spend Reconciliation

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

20%Low coverage

These claims represent 19.5% of Oklahoma’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

55% 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

$9,039,451,464

CMS-64 Total Net Expenditures, as Oklahoma filed it

Visible in claims

$1,766,391,692

19.5% of the program

Published per-enrollee spending

$821PMPM

CMS-64 total ÷ 917,671 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$7,392,743,609

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 Oklahoma 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
Prescribed Drugs	$1,622,907,020	$13,330,944	1%
Hospital (Inpatient & Outpatient)	$1,615,816,922	$71,432,670	4%
Nursing Facility	$866,943,461	$1,784,346	0%
Home & Community-Based Services	$813,626,155	$38,424,038	5%
Physician & Surgical	$647,274,748	$587,497,281	91%
Clinic Services	$539,301,677	$33,491	0%
Behavioral Health	$390,263,538	$362,984,329	93%
Other Care Services	$222,959,203	$5,658,816	3%
FQHC & Rural Health Clinic	$130,862,419	$126,632,187	97%
Dental	$113,226,440	$122,059,335	108%
Intermediate Care Facility (IID)	$104,007,173	$0	0%
Laboratory & Radiology	$101,604,052	$68,775,923	68%
Targeted Case Management	$87,340,882	$125,335,949	144%
Non-Emergency Transportation	$35,059,216	$55,172,013	157%
Home Health	$30,091,110	$48,439,608	161%
Other Practitioners	$28,184,999	$0	0%
Screening & Preventive	$23,218,751	$24,689,050	106%
Family Planning	$9,575,588	$1,451	0%
School-Based Services	$4,876,483	$0	0%
DME & Supplies	$4,274,337	$72,817,797	1704%
Hospice	$687,003	$0	0%
Therapy Services	$642,432	$41,322,464	6432%

Categories no claims dataset can see$1,646,707,855

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	$1,902,375,877
Supplemental & DSH Payments	$1,019,922,917
Medicare Premiums (Duals)	$242,610,388
Drug Rebates & Collections	-$1,518,201,327

The table adds up. The categories above sum to $9,039,451,464, which is Oklahoma’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.