South Carolina Medicaid Spend Reconciliation

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

19%Low coverage

These claims represent 18.9% of South Carolina’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

60% 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

$9,726,541,323

CMS-64 Total Net Expenditures, as South Carolina filed it

Visible in claims

$1,839,837,894

18.9% of the program

Published per-enrollee spending

$765PMPM

CMS-64 total ÷ 1,058,942 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$3,771,996,603

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 South Carolina 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	$1,169,082,182	$517,041,540	44%
Nursing Facility	$872,828,726	$0	0%
Hospital (Inpatient & Outpatient)	$547,935,094	$202,522,280	37%
Prescribed Drugs	$181,089,507	$43,879,389	24%
Intermediate Care Facility (IID)	$158,374,062	$0	0%
Dental	$146,422,968	$115,202,703	79%
Non-Emergency Transportation	$112,777,258	$14,832,565	13%
Physician & Surgical	$99,974,253	$385,688,725	386%
Hospice	$82,034,807	$40,946,244	50%
Clinic Services	$56,825,452	$34,887,669	61%
Behavioral Health	$56,437,922	$156,389,821	277%
DME & Supplies	$54,998,685	$45,429,097	83%
Home Health	$47,229,218	$34,722,415	74%
Targeted Case Management	$46,188,963	$36,333,613	79%
FQHC & Rural Health Clinic	$39,766,900	$250,027	1%
Therapy Services	$30,687,769	$54,743,857	178%
Other Care Services	$19,656,545	$34,405,535	175%
Laboratory & Radiology	$18,714,540	$64,406,836	344%
School-Based Services	$16,411,126	$322	0%
Other Practitioners	$10,800,828	$0	0%
Screening & Preventive	$3,740,207	$56,126,094	1501%
Family Planning	$19,591	$5,435	28%

Categories no claims dataset can see$5,954,544,720

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	$6,041,846,734
Supplemental & DSH Payments	$375,048,548
Medicare Premiums (Duals)	$361,372,518
Drug Rebates & Collections	-$823,723,080

The table adds up. The categories above sum to $9,726,541,323, which is South Carolina’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.