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State Budget & Expenditure Reporting for Medicaid and CHIP

Medicaid & CHIP Expenditure Tracking System

CMS tracks state expenditures through the automated Medicaid Budget and Expenditure System/State Children's Health Insurance Budget and Expenditure System (MBES/CBES). 

The MBES/CBES is a web-based application system that has been implemented nationwide. The system allows states to report budgeted and actual expenditures for Medicaid and the Children’s Health Insurance Program (CHIP), by electronically submitting their Form CMS-64 directly to the CMS Data Center and the Medicaid data base.  

The system uses the information from each state to compute the amount of Federal Financial Participation (FFP) the Agency will provide to the state to fund program operations. The MBES/CBES also stores the state’s historical budget and expenditure records for data analysis purposes.

Medicaid & CHIP Financial (MACFin) System

The Medicaid and CHIP Financial (MACFin) product's mission is to modernize and streamline the current system and processes used in providing oversight and monitoring for the Medicaid and Children’s Health Insurance Program (CHIP) expenditures. While modernizing and improving the dependability of the older legacy system, we are also adding new reporting functionality, automation of current manual processes, documentation upload and depository capabilities, and a focus on improving the overall user experience. This new system will be a modern, integrated product suite to manage the Medicaid and CHIP financial reporting.

MACFin will increase accuracy, efficiency, transparency and decrease administrative burden for state budget and expenditure reporting, CMS budget and expenditure review, and grant processes through improved features, workflows, and automation. MACFin will provide functionality to support Incurred But Not Reported Survey (IBNRS); Disproportionate Share Hospital (DSH) allotments and audit; and the Upper Payment Limit (UPL) annual reporting.  At this time, the IBNRS reporting has already transitioned and integrated into MACFin. In addition, CMS continues to improve the dependability of MBES, the legacy systems for budget and expenditures reporting, which will be integrated into the new MACFin system.

For assistance with MACFin please email the MACFin Helpdesk at MACFin@dcca.com.

Medicaid Program Expenditure Forms

Two series of forms detail the quarterly anticipated and actual budget for Medicaid and CHIP. The forms distinguish between budget and costs associated with the program’s medical services, and budget and costs associated with program administration. 

  • CMS-37 (PDF, 333.24 KB) form series: identifies anticipated quarterly budgeted costs
  • CMS-64 (PDF, 1.38 MB) form series: identifies actual quarterly expenses form series: identifies anticipated quarterly budgeted costs

States use both series of forms to input budget and expenditure data into the MBES/CBES. Based on the CMS-37 submission, CMS issues a grant award to the state authorizing federal Medicaid funding to the state for the certified quarter. 

For details on the claims process and requirements see Title 42 Part 430.30 of the Code of Federal Regulations.

CMS produces summary state-by-state total expenditures by program for the Medicaid Program, Medicaid Administration and CHIP programs as well as summary state-specific data from the CMS-64 and the CMS-21. Most recently, CMS reports summary level expenditure data associated with the new adult group established under the Affordable Care Act.

See available summary level data and expenditure reports from MBES/CBES.

Expenditures Must Reconcile

The amounts reported on and its attachments must be actual expenditures for which all supporting documentation, in readily reviewable form, has been compiled and is available immediately at the time the claim is filed. Form CMS-64 is a statement of expenditures for which states are entitled to Federal reimbursement under Title XIX and which reconciles the monetary advance made on the basis of Form CMS-37 filed previously for the same quarter. Consequently, the amount claimed on the Form CMS-64 is a summary of expenditures derived from source documents such as invoices, cost reports and eligibility records. All summary statements or descriptions of each claim must identify the claim and source documentation. Claims developed through the use of sampling, projections, or other estimating techniques are considered estimates and are not allowable under any circumstances. Where states are unable to develop and document a claim for expenditures on a current basis, they must withhold it until the actual amount, supported by final documentation, has been determined. The state must report that amount on a future Form CMS-64 as a prior period adjustment.