Washington Medicaid Spend Reconciliation

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

14%Minimal coverage

These claims represent 14.1% of Washington’s total Medicaid spending in FY2024, measured against the state’s own CMS-64 filing.

84% 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

$20,038,047,659

CMS-64 Total Net Expenditures, as Washington filed it

Visible in claims

$2,831,383,657

14.1% of the program

Published per-enrollee spending

$913PMPM

CMS-64 total ÷ 1,829,758 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$12,605,221,780

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 Washington 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	$5,381,075,047	$14,348,555	0%
Hospital (Inpatient & Outpatient)	$1,851,706,480	$308,386,779	17%
Other Care Services	$1,843,714,802	$53,279,389	3%
FQHC & Rural Health Clinic	$1,190,428,115	$1,474,889	0%
Nursing Facility	$984,643,161	$268,579	0%
Intermediate Care Facility (IID)	$334,576,217	$0	0%
Prescribed Drugs	$317,005,367	$69,386,526	22%
Dental	$256,511,844	$256,875,663	100%
Non-Emergency Transportation	$123,271,103	$106,352,578	86%
Clinic Services	$113,260,127	$626,478,944	553%
Home Health	$48,101,886	$31,835,631	66%
Physician & Surgical	$45,180,531	$562,005,722	1244%
Screening & Preventive	$32,516,662	$26,965,743	83%
Hospice	$28,892,342	$4,004,208	14%
Targeted Case Management	$19,410,645	$3,878,590	20%
School-Based Services	$13,794,286	$18,162,340	132%
Behavioral Health	$8,952,588	$396,402,070	4428%
Other Practitioners	$4,894,138	$0	0%
DME & Supplies	$3,612,839	$108,479,025	3003%
Laboratory & Radiology	$3,116,284	$185,364,447	5948%
Family Planning	$557,316	$728,117	131%

Categories no claims dataset can see$7,432,825,879

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	$8,933,874,051
Medicare Premiums (Duals)	$611,734,990
Supplemental & DSH Payments	$439,861,172
Other CMS-64 Lines	$20,313,498
Drug Rebates & Collections	-$2,572,957,832

The table adds up. The categories above sum to $20,038,047,659, which is Washington’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.