Wyoming 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 19.5% of Wyoming’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

$758,941,018

CMS-64 Total Net Expenditures, as Wyoming filed it

Visible in claims

$147,733,790

19.5% of the program

Published per-enrollee spending

$965PMPM

CMS-64 total ÷ 65,567 avg enrollees. Both figures published by CMS — not derived from these claims.

Categories this dataset can see$663,568,559

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 Wyoming 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	$180,513,818	$43,096,217	24%
Hospital (Inpatient & Outpatient)	$103,824,803	$255,384	0%
Nursing Facility	$95,094,139	$6,932,701	7%
Prescribed Drugs	$90,989,806	$96,239	0%
Clinic Services	$43,668,274	$33,320,778	76%
Physician & Surgical	$41,375,924	$16,055,602	39%
Intermediate Care Facility (IID)	$16,232,521	$0	0%
Dental	$14,281,253	$8,600,727	60%
FQHC & Rural Health Clinic	$13,495,425	$49,398	0%
Laboratory & Radiology	$13,020,182	$1,240,990	10%
Home Health	$12,093,815	$5,953,533	49%
Behavioral Health	$11,344,268	$8,881,581	78%
Other Practitioners	$8,495,230	$0	0%
Therapy Services	$6,241,955	$2,391,658	38%
Targeted Case Management	$3,589,686	$15,164,768	422%
Hospice	$2,332,276	$0	0%
DME & Supplies	$2,176,331	$3,517,022	162%
Screening & Preventive	$2,174,732	$917,087	42%
Family Planning	$1,653,101	$0	0%
Other Care Services	$956,728	$9,804	1%
School-Based Services	$14,292	$690	5%

Categories no claims dataset can see$95,372,459

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)
Supplemental & DSH Payments	$118,635,985
Medicare Premiums (Duals)	$23,919,881
Managed Care Capitation	$1,936,328
Other CMS-64 Lines	$48,290
Drug Rebates & Collections	-$49,168,025

The table adds up. The categories above sum to $758,941,018, which is Wyoming’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.