Oregon Medicaid Spend Reconciliation

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

9%Minimal coverage

These claims represent 8.6% of Oregon’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

$16,040,344,828

CMS-64 Total Net Expenditures, as Oregon filed it

Visible in claims

$1,374,089,935

8.6% of the program

Published per-enrollee spending

$1,133PMPM

CMS-64 total ÷ 1,179,922 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$6,409,847,060

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 Oregon 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 categoryCMS-64 (state total)Seen in claimsCoverage
Home & Community-Based Services$4,115,027,264$74,252,972
2%
Nursing Facility$762,488,058$2,350,931
0%
FQHC & Rural Health Clinic$463,112,685$6,058,949
1%
Targeted Case Management$362,482,518$15,656,202
4%
Prescribed Drugs$196,091,868$31,464,383
16%
Hospital (Inpatient & Outpatient)$189,388,519$28,949,309
15%
Clinic Services$73,279,141$2,498,457
3%
Behavioral Health$55,758,782$389,528,439
699%
Hospice$51,530,439$6,249,845
12%
Other Care Services$31,433,610$15,722,478
50%
Physician & Surgical$30,698,550$459,288,385
1496%
Home Health$24,163,833$6,765,961
28%
Other Practitioners$11,728,801$0
0%
Non-Emergency Transportation$8,577,590$63,544,317
741%
Screening & Preventive$8,116,132$12,958,623
160%
Laboratory & Radiology$7,051,314$82,184,313
1166%
DME & Supplies$6,663,218$70,855,285
1063%
Dental$6,108,168$64,920,344
1063%
School-Based Services$4,750,959$142,337
3%
Therapy Services$1,248,099$39,615,508
3174%
Family Planning$147,512$1,082,897
734%
Categories no claims dataset can see$9,630,497,768

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 categoryCMS-64 (state total)
Managed Care Capitation$8,980,939,325
Medicare Premiums (Duals)$359,740,051
Supplemental & DSH Payments$354,613,679
Drug Rebates & Collections-$64,795,287
The table adds up. The categories above sum to $16,040,344,828, which is Oregon’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.