South Dakota Medicaid Spend Reconciliation

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

35%Moderate coverage

These claims represent 34.9% of South Dakota’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

This state reports little or no comprehensive managed care, so a comparatively large share of its spending appears as claims. 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

$1,498,274,373

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

Visible in claims

$523,337,944

34.9% of the program

Published per-enrollee spending

$1,111PMPM

CMS-64 total ÷ 112,413 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$1,525,244,143

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 Dakota 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
Hospital (Inpatient & Outpatient)	$397,786,582	$7,137,836	2%
Home & Community-Based Services	$277,453,171	$220,601,380	80%
Nursing Facility	$229,192,904	$9,699,574	4%
Prescribed Drugs	$211,908,667	$2,261,555	1%
Physician & Surgical	$99,547,806	$110,077,574	111%
Clinic Services	$58,599,990	$0	0%
Other Care Services	$43,161,747	$2,168,083	5%
Intermediate Care Facility (IID)	$41,968,469	$0	0%
Dental	$36,694,967	$27,056,312	74%
Behavioral Health	$36,571,768	$77,047,941	211%
Home Health	$27,866,201	$13,775,519	49%
Laboratory & Radiology	$15,361,387	$12,584,585	82%
Hospice	$14,636,950	$0	0%
FQHC & Rural Health Clinic	$11,938,073	$233,769	2%
Other Practitioners	$9,059,053	$0	0%
Screening & Preventive	$3,124,251	$6,827,379	219%
Targeted Case Management	$2,974,010	$5,190,712	175%
School-Based Services	$2,801,415	$0	0%
DME & Supplies	$2,743,496	$8,140,396	297%
Non-Emergency Transportation	$1,518,366	$14,502,833	955%
Family Planning	$334,870	$0	0%

Categories no claims dataset can see-$26,969,770

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)
Medicare Premiums (Duals)	$47,777,171
Supplemental & DSH Payments	$4,811,087
Drug Rebates & Collections	-$79,558,028

The table adds up. The categories above sum to $1,498,274,373, which is South Dakota’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.