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Medicaid Per Capita Expenditures


VISIT THE PILLAR: National Context

State per capita expenditures provide information about each state’s Medicaid program and all the populations they serve. The following estimates provide average annual Medicaid expenditures per enrollee for calendar years 2017 and 2018 by state for five eligibility groups:

  1. Children
  2. Adults: non-expansion, non-disabled, under age 65
  3. Aged
  4. People with disabilities
  5. Adults: ACA Medicaid expansion

The estimates rely on total spending reported by states to the Medicaid Budget and Expenditure System (MBES) and the number of enrollees and their expenditures reported by states in the Transformed Medicaid Statistical Information System (T-MSIS). The calculations exclude all Children’s Health Insurance Program (CHIP) spending and enrollment through both Medicaid CHIP and separate CHIP programs.

The validity of the results presented here is directly related to the accuracy of state-reported data. For this reason, four data usability assessments are included to evaluate the usability of each state’s data to produce the per capita expenditure estimates. These data quality assessments are largely similar to the approach used in the 2019 Scorecard, with some exceptions, most notably a broader assessment of expenditure data was used compared to the previous year and the addition of three levels of data usability. The criteria for assigning states to a data usability level are:

High level of data usability: States met all minimum data usability thresholds

  • The number of Medicaid enrollees in state-reported T-MSIS files was within 5 percent of enrollment numbers in other state-reported data, indicated by a check (✔) in the first column of Table 4.
  • 5 percent or less of all Medicaid enrollees were missing eligibility group information, indicated by a ✔ in the second column of Table 4.
  • The volume of state reported claims data met acceptable thresholds for all file types, indicated by a ✔ in the third column of Table 4.
  • Total claim expenditures (fee-for service plus capitated managed care and other monthly payments) were within 5 percent of CMS-64 expenditures states reported in MBES, indicated by a ✔ in the fourth column of Table 4.

Moderate level of data usability: States met all moderate data usability thresholds

  • The state met the first three thresholds described in the high level of data usability, but total Medicaid claim expenditures (fee-for service plus capitated managed care and other monthly payments) were between 5 percent to 10 percent different than CMS-64 expenditures states reported in MBES, indicated by a ✔* in the fourth column of Table 4.

Low level of data usability: States did not meet all data usability thresholds

  • State-reported T-MSIS data did not meet one or more of the conditions in the moderate level of data usability, indicated by a blank in any of the columns of Table 4.

Multiple factors drive variation in state Medicaid spending. Some of these factors include, for example, differences in:

  • Enrollee characteristics and health status
  • Eligibility rules that determine who qualifies for Medicaid
  • Scope of benefits covered
  • Mix of delivery systems, such as managed care and fee-for-service
  • Payment levels and arrangements for providers and health plans
  • Local health care costs and market features

In addition, an array of factors beyond T-MSIS data quality and completeness may impact state performance on the data usability assessments, some of which may be outside of the control of Medicaid agencies, for example, differences in:

  • Organization of the data sources being compared, e.g. T-MSIS expenditures for each calendar year are grouped primarily based on service date, while CMS-64 expenditures are reported based on payment date
  • Guidance to states for reporting information to each data source

The following estimates do not adjust for these differences (Tables 1-3). See the data usability section and Table 4 for more detail about the assessment of state T-MSIS data usability.

Table 1. Per Capita expenditure estimates for states with a high level of data usability (2017)

State Total Children Adult: non-expansion, non-disabled, under age 65 Aged People with disabilities Adult: ACA Medicaid expansion
Alabama $5,336 $2,339 $2,904 $11,637 $10,587 -
Arizona $5,962 $3,145 $4,004 $9,945 $19,546 $5,916
Connecticut $7,960 $3,211 $4,588 $16,544 $27,657 $5,962
Delaware $9,339 $4,438 $7,962 $21,278 $23,153 $8,302
Louisiana $6,422 $3,091 $5,967 $10,964 $12,689 $6,514
Maryland $8,739 $3,521 $6,702 $19,511 $23,600 $8,227
Massachusetts $9,561 $4,258 $3,145 $23,952 $18,402 $6,325
Mississippi $7,250 $4,045 $5,229 $13,086 $12,260 -
Nevada $5,573 $2,815 $5,321 $8,600 $14,654 $5,942
Ohio $7,091 $3,109 $5,417 $21,070 $14,514 $7,053
Puerto Rico $1,714 $2,209 $2,022 $607 $798 $2,100
South Dakota $7,962 $3,072 $6,528 $18,274 $19,580 -
West Virginia $7,171 $2,956 $4,309 $23,426 $13,906 $4,949
Min $1,714 $2,209 $2,022 $607 $798 $2,100
Median $7,171 $3,109 $5,229 $16,544 $14,654 $6,144
Max $9,561 $4,438 $7,962 $23,952 $27,657 $8,302

Source: CMS calculations using calendar years 2017 and 2018 MBES expenditure data and T-MSIS data on enrollees and expenditures.

Table 2. Per Capita expenditure estimates for states with a moderate level of data usability (2017)

State Total Children Adult: non-expansion, non-disabled, under age 65 Aged People with disabilities Adult: ACA Medicaid expansion
Alaska $10,410 $6,195 $7,043 $24,211 $32,300 $9,674
California $5,775 $2,387 $2,465 $14,541 $20,508 $4,966
District of Columbia $10,997 $4,854 $6,767 $23,554 $29,766 $6,259
Hawaii $6,835 $3,068 $4,902 $14,537 $23,653 $6,076
Iowa $6,578 $2,401 $5,462 $19,810 $18,496 $4,506
Michigan $6,431 $2,482 $5,082 $16,170 $14,216 $6,014
Minnesota $10,502 $2,414 $3,863 $40,641 $48,179 $3,389
New Hampshire $9,425 $4,075 $5,883 $24,937 $21,354 $7,831
New Mexico $5,581 $3,259 $3,166 $9,666 $19,618 $4,971
North Dakota $13,772 $6,163 $7,030 $54,864 $48,265 $835
South Carolina $4,772 $2,708 $2,925 $10,599 $12,717 -
Tennessee $5,873 $3,012 $4,235 $13,877 $12,756 -
Utah $8,080 $3,619 $6,416 $17,974 $24,794 -
Min $4,772 $2,387 $2,465 $9,666 $12,717 $835
Median $6,835 $3,068 $5,082 $17,974 $21,354 $5,492
Max $13,772 $6,195 $7,043 $54,864 $48,265 $9,674

Source: CMS calculations using calendar years 2017 and 2018 MBES expenditure data and T-MSIS data on enrollees and expenditures.

Table 3. Per Capita expenditure estimates for states with a low level of data usability (2017)

State Total Children Adult: non-expansion, non-disabled, under age 65 Aged People with disabilities Adult: ACA Medicaid expansion
Arkansas $6,731 $4,408 $3,108 $26,630 $16,577 $1,210
Colorado $6,387 $2,518 $4,101 $45,190 $37,276 $4,235
Florida $5,340 $825 $2,416 $15,593 $15,030 -
Georgia $5,335 $744 $1,962 $15,286 $16,475 -
Idaho $6,529 $2,509 $6,047 $13,263 $17,777 -
Illinois $6,362 $2,720 $5,070 $18,422 $18,053 $3,331
Indiana $7,854 $3,743 $7,373 $12,407 $13,210 $10,267
Kansas $8,479 $2,241 $4,095 $32,321 $19,307 -
Kentucky $6,732 $3,561 $6,029 $12,505 $12,306 $5,928
Maine $10,221 $4,326 $4,679 $13,446 $20,333 -
Missouri $9,006 $3,955 $5,870 $20,700 $23,632 -
Montana $7,571 $4,565 $6,120 $18,673 $16,501 $6,745
Nebraska $16,487 $8,446 $12,142 $32,623 $30,127 -
New Jersey $9,246 $3,128 $8,338 $25,035 $29,054 $6,533
New York $11,796 $3,954 $7,356 $29,677 $31,530 $7,424
North Carolina $6,624 $2,862 $3,209 $14,919 $17,162 -
Oklahoma $6,945 $3,884 $4,432 $15,706 $16,729 -
Oregon $9,567 $5,578 $9,620 $24,732 $28,313 $9,722
Pennsylvania $9,966 $2,184 $3,440 $38,039 $21,795 $3,196
Rhode Island $8,145 $3,781 $5,675 $17,495 $16,044 $6,905
Texas $8,550 $3,595 $5,666 $25,178 $25,943 -
Vermont $8,710 $5,824 $5,415 $13,978 $11,624 -
Virgin Islands $4,104 $2,797 $3,593 $3,997 $7,125 $4,083
Virginia $8,447 $3,198 $4,857 $20,207 $20,858 -
Washington $6,424 $2,516 $6,418 $17,400 $18,567 $5,814
Wisconsin $7,668 $3,148 $5,164 $13,346 $19,365 -
Wyoming $8,679 $3,624 $6,082 $22,281 $23,021 -
Min $4,104 $744 $1,962 $3,997 $7,125 $1,210
Median $7,854 $3,561 $5,415 $18,422 $18,567 $5,928
Max $16,487 $8,446 $12,142 $45,190 $37,276 $10,267
Source: CMS calculations using calendar years 2017 and 2018 MBES expenditure data and T-MSIS data on enrollees and expenditures.

Notes

To conduct this analysis, CMS used two data sources: (1) MBES expenditure data and (2) T-MSIS data. MBES expenditure data (reported by states on CMS-64 forms) are at the state level and do not include expenditures at the enrollee or at the eligibility group levels; therefore CMS used T-MSIS data to classify enrollees, allocate expenditures into eligibility groups, and construct the denominator (number of enrollee years) for each eligibility group.

To compute the denominator, CMS first mapped the 75 eligibility categories in T-MSIS to the five eligibility groups and then determined the count of enrollee months by eligibility group in each state. As the last step, total months were converted to total years.

To compute the numerator (total spending for each eligibility group) for each state, the calculation used total state-level expenditure information from MBES. To distribute MBES expenditures across the five eligibility groups, the calculation used T-MSIS data to determine the percentage of total Medicaid expenditures accounted for by each eligibility group, then applied that percentage to the total net Medicaid expenditures for medical assistance services that each state reports to MBES. For each state, these total net expenditures excluded spending categories not linked to individual enrollees, such as administrative expenses and disproportionate share hospital payments. This methodology largely aligns with methods that CMS’s Office of the Actuary employs to estimate national-level Medicaid spending per enrollee.

The approach used to calculate the per capita expenditure estimates is almost entirely the same as that used in the 2019 Scorecard. One notable exception is how we distributed certain CMS-64 expenditures not typically reported to T-MSIS. In addition, we modified how we identified capitation and monthly payments to be more inclusive. Per capita expenditures for 2017 in this version of the Scorecard will differ from 2017 values displayed in the 2019 Scorecard because the data have been updated and because the per capita expenditures methodology has changed. See the methodology document for further details.

Data usability assessment

To determine whether states’ T-MSIS data met minimum criteria for completeness and accuracy, CMS conducted four data usability assessments of key data elements for calculating per capita expenditures. For some states that did not meet the data usability requirements, differences between their T-MSIS data and other CMS data sources may be due to a number of factors, including reporting issues that are not currently captured in the methodology and may be outside the control of states. In addition to the methodology, there are a range of state-specific factors and external reasons why a state may not have met the usability requirements. Table 4 summarizes the results of the data usability assessments for 2017 and 2018.

Table 4. Assessing state T-MSIS data usability (2017)

State Met enrollment requirementsa Met eligibility information requirementsb Met claims volume requirementsc Met expenditure requirementsd
Alabama
Alaska ✔*
Arizona
Arkansas
California ✔*
Colorado
Connecticut
Delaware
District of Columbia ✔*
Florida
Georgia
Hawaii ✔*
Idaho ✔*
Illinois
Indiana
Iowa ✔*
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan ✔*
Minnesota ✔*
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire ✔*
New Jersey
New Mexico ✔*
New York
North Carolina
North Dakota ✔*
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina ✔*
South Dakota
Tennessee ✔*
Texas
Utah ✔*
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
  1. Enrollment. To ensure a reasonably accurate number of enrollees, we required the difference between T-MSIS Analytic Files (TAF)-based enrollment counts and Eligibility and Enrollment Performance Indicator (PI) enrollment counts to be 5 percent or less, averaged across all months of the year. If the state’s TAF data did not match PI enrollment within 5%, we required states to have a 5 percent or less difference between TAF and MBES/CMS-64 enrollment, averaged across all months of the year.
  2. Eligibility code. To assign expenditures to the appropriate eligibility category, we required states to have 5 percent or less of enrollees with missing eligibility information. This assessment also required states to have reported T-MSIS enrollment and expenditures in all applicable eligibility groups included in the per capita expenditures analysis.
  3. Claims volume. To ensure CMS based spending estimates on a comparatively complete set of claims, claims volume must have been at least 20 percent of the national median of claims per 1,000 enrollee months for each claim type.
  4. Expenditures. Since fee-for-service and capitated managed care and other monthly per beneficiary payments (MBP1) make up a large share of spending, CMS compared these amounts captured in the TAF to the amounts reported by states in the CMS-64 forms. A ✔ in the table means that the difference between the sum of fee-for-service plus monthly payments in TAF and CMS-64 is less than or equal to 5 percent. A ✔* in the table means that the difference between the sum of fee-for-service plus monthly payments in TAF and CMS-64 is between 5 and 10 percent.

For more detail on the per capita expenditure calculations, please see the detailed methodology document. This version of the Medicaid and CHIP Scorecard was released in October 2020. To view the version of the Medicaid and CHIP Scorecard that was published in November 2019, please visit the archived Scorecard page.

Table 1. Per Capita expenditure estimates for states with a high level of data usability (2018)

State Total Children Adult: non-expansion, non-disabled, under age 65 Aged People with disabilities Adult: ACA Medicaid expansion
Alaska $10,019 $6,066 $7,119 $23,047 $32,615 $8,787
Arizona $6,258 $3,171 $4,227 $9,590 $20,939 $6,165
California $6,449 $2,789 $2,812 $14,548 $23,462 $5,545
Connecticut $8,890 $3,715 $5,446 $18,012 $30,321 $6,917
Delaware $9,315 $4,603 $8,645 $21,703 $22,799 $7,476
Georgia $5,356 $2,807 $4,905 $10,333 $10,772 -
Hawaii $6,436 $2,997 $4,558 $13,383 $22,397 $5,630
Idaho $7,349 $2,743 $6,771 $14,468 $19,424 -
Louisiana $6,523 $3,531 $6,187 $10,869 $12,086 $6,326
Maryland $9,132 $3,699 $7,404 $19,733 $24,653 $8,434
Mississippi $7,556 $4,053 $5,212 $13,486 $12,859 -
Nevada $5,854 $2,882 $5,718 $8,472 $14,277 $6,673
New Hampshire $9,905 $4,007 $6,183 $24,451 $21,609 $9,355
New Mexico $6,381 $3,757 $3,693 $10,706 $22,184 $5,637
Ohio $8,248 $3,510 $6,025 $21,536 $16,909 $7,422
South Dakota $8,286 $3,256 $6,228 $18,188 $20,464 -
West Virginia $7,232 $2,869 $4,698 $23,013 $13,983 $5,080
Min $5,356 $2,743 $2,812 $8,472 $10,772 $5,080
Median $7,349 $3,510 $5,718 $14,548 $20,939 $6,673
Max $10,019 $6,066 $8,645 $24,451 $32,615 $9,355

Source: CMS calculations using calendar years 2017 and 2018 MBES expenditure data and T-MSIS data on enrollees and expenditures.

Table 2. Per Capita expenditure estimates for states with a moderate level of data usability (2018)

State Total Children Adult: non-expansion, non-disabled, under age 65 Aged People with disabilities Adult: ACA Medicaid expansion
Arkansas $7,186 $4,894 $3,818 $22,083 $18,411 $1,410
Colorado $7,475 $2,982 $4,779 $22,929 $28,453 $5,162
District of Columbia $11,031 $4,732 $6,172 $23,780 $31,193 $6,428
Iowa $8,355 $3,060 $6,920 $23,217 $23,665 $5,986
Massachusetts $10,386 $3,915 $4,006 $25,688 $20,180 $6,381
Minnesota $11,591 $3,172 $5,580 $39,148 $47,050 $7,329
New York $11,831 $3,838 $7,091 $29,530 $32,447 $7,394
Puerto Rico $1,807 $2,108 $2,162 $726 $955 $2,281
South Carolina $4,983 $2,839 $2,936 $10,742 $13,318 -
Utah $9,566 $4,151 $7,608 $21,147 $28,619 -
Virginia $8,219 $3,140 $4,074 $19,671 $21,323 -
Min $1,807 $2,108 $2,162 $726 $955 $1,410
Median $8,355 $3,172 $4,779 $22,929 $23,665 $6,184
Max $11,831 $4,894 $7,608 $39,148 $47,050 $7,394

Source: CMS calculations using calendar years 2017 and 2018 MBES expenditure data and T-MSIS data on enrollees and expenditures.

Table 3. Per Capita expenditure estimates for states with a low level of data usability (2018)

State Total Children Adult: non-expansion, non-disabled, under age 65 Aged People with disabilities Adult: ACA Medicaid expansion
Alabama $5,328 $1,914 $2,110 $12,867 $11,375 -
Florida $5,601 $2,072 $2,721 $14,242 $12,566 -
Illinois $6,562 $2,532 $5,586 $17,879 $18,274 $4,027
Indiana $8,605 $4,096 $7,268 $12,344 $12,321 $12,679
Kansas $8,999 $2,137 $4,109 $27,765 $23,633 -
Kentucky $6,813 $3,637 $6,597 $10,383 $11,986 $6,629
Maine $10,673 $4,505 $4,520 $14,031 $21,439 $5,038
Michigan $6,922 $2,787 $4,909 $19,257 $15,912 $5,797
Missouri $9,410 $4,248 $6,129 $20,207 $24,244 -
Montana $7,175 $4,380 $5,661 $19,223 $15,672 $6,341
Nebraska $11,360 $5,580 $8,355 $30,973 $23,327 -
New Jersey $9,420 $3,196 $8,028 $24,595 $31,284 $6,103
North Carolina $6,565 $2,873 $2,716 $15,177 $17,776 -
North Dakota $14,387 $6,847 $6,931 $64,964 $54,325 $828
Oklahoma $6,940 $3,934 $4,430 $14,900 $16,379 -
Oregon $10,920 $6,604 $11,921 $25,176 $23,040 $11,581
Pennsylvania $11,654 $3,356 $5,774 $37,702 $25,852 $3,757
Rhode Island $7,928 $3,482 $5,254 $18,272 $15,406 $6,711
Tennessee $6,509 $3,376 $4,659 $14,473 $14,124 -
Texas $9,247 $3,885 $7,108 $27,168 $27,600 -
Vermont $9,305 $6,241 $5,728 $14,828 $12,450 -
Virgin Islands $3,848 $3,000 $3,849 $3,019 $7,476 $3,823
Washington $6,934 $2,724 $6,876 $19,748 $20,076 $5,928
Wisconsin $8,126 $2,792 $4,013 $16,037 $22,940 -
Wyoming $8,790 $3,735 $6,192 $20,571 $22,683 -
Min $3,848 $1,914 $2,110 $3,019 $7,476 $828
Median $8,126 $3,482 $5,661 $18,272 $18,274 $5,928
Max $14,387 $6,847 $11,921 $64,964 $54,325 $12,679
Source: CMS calculations using calendar years 2017 and 2018 MBES expenditure data and T-MSIS data on enrollees and expenditures.

Notes

To conduct this analysis, CMS used two data sources: (1) MBES expenditure data and (2) T-MSIS data. MBES expenditure data (reported by states on CMS-64 forms) are at the state level and do not include expenditures at the enrollee or at the eligibility group levels; therefore CMS used T-MSIS data to classify enrollees, allocate expenditures into eligibility groups, and construct the denominator (number of enrollee years) for each eligibility group.

To compute the denominator, CMS first mapped the 75 eligibility categories in T-MSIS to the five eligibility groups and then determined the count of enrollee months by eligibility group in each state. As the last step, total months were converted to total years.

To compute the numerator (total spending for each eligibility group) for each state, the calculation used total state-level expenditure information from MBES. To distribute MBES expenditures across the five eligibility groups, the calculation used T-MSIS data to determine the percentage of total Medicaid expenditures accounted for by each eligibility group, then applied that percentage to the total net Medicaid expenditures for medical assistance services that each state reports to MBES. For each state, these total net expenditures excluded spending categories not linked to individual enrollees, such as administrative expenses and disproportionate share hospital payments. This methodology largely aligns with methods that CMS’s Office of the Actuary employs to estimate national-level Medicaid spending per enrollee.

The approach used to calculate the per capita expenditure estimates is almost entirely the same as that used in the 2019 Scorecard. One notable exception is how we distributed certain CMS-64 expenditures not typically reported to T-MSIS. In addition, we modified how we identified capitation and monthly payments to be more inclusive. Per capita expenditures for 2017 in this version of the Scorecard will differ from 2017 values displayed in the 2019 Scorecard because the data have been updated and because the per capita expenditures methodology has changed. See the methodology document for further details.

Data usability assessment

To determine whether states’ T-MSIS data met minimum criteria for completeness and accuracy, CMS conducted four data usability assessments of key data elements for calculating per capita expenditures. For some states that did not meet the data usability requirements, differences between their T-MSIS data and other CMS data sources may be due to a number of factors, including reporting issues that are not currently captured in the methodology and may be outside the control of states. In addition to the methodology, there are a range of state-specific factors and external reasons why a state may not have met the usability requirements. Table 4 summarizes the results of the data usability assessments for 2017 and 2018.

Table 4. Assessing state T-MSIS data usability (2018)

State Met enrollment requirementsa Met eligibility information requirementsb Met claims volume requirementsc Met expenditure requirementsd
Alabama
Alaska
Arizona
Arkansas ✔*
California
Colorado ✔    ✔ ✔*
Connecticut  ✔  ✔  ✔
Delaware  ✔  ✔   ✔  ✔
District of Columbia  ✔  ✔  ✔  ✔*
Florida  ✔  ✔
Georgia  ✔  ✔  ✔
Hawaii  ✔  ✔  ✔
Idaho  ✔  ✔  ✔
Illinois  ✔  ✔
Indiana  ✔  ✔
Iowa  ✔ ✔*
Kansas  ✔
Kentucky  ✔   
Louisiana  ✔ ✔ 
Maine  ✔
Maryland  ✔
Massachusetts  ✔ ✔* 
Michigan  ✔
Minnesota  ✔  ✔  ✔*
Mississippi  ✔  ✔ 
Missouri  ✔
Montana  ✔  ✔
Nebraska  ✔  ✔
Nevada
New Hampshire
New Jersey  ✔   ✔   ✔
New Mexico  ✔
New York  ✔   ✔ ✔* 
North Carolina  ✔
North Dakota   ✔  ✔
Ohio  ✔
Oklahoma
Oregon   
Pennsylvania ✔   ✔
Puerto Rico  ✔  ✔ ✔*
Rhode Island  ✔  ✔
South Carolina ✔*
South Dakota
Tennessee  ✔
Texas
Utah  ✔ ✔*
Vermont   ✔
Virgin Islands
Virginia  ✔  ✔*
Washington  ✔  ✔
West Virginia  ✔
Wisconsin  ✔
Wyoming  ✔  ✔
  1. Enrollment. To ensure a reasonably accurate number of enrollees, we required the difference between T-MSIS Analytic Files (TAF)-based enrollment counts and Eligibility and Enrollment Performance Indicator (PI) enrollment counts to be 5 percent or less, averaged across all months of the year. If the state’s TAF data did not match PI enrollment within 5%, we required states to have a 5 percent or less difference between TAF and MBES/CMS-64 enrollment, averaged across all months of the year.
  2. Eligibility code. To assign expenditures to the appropriate eligibility category, we required states to have 5 percent or less of enrollees with missing eligibility information. This assessment also required states to have reported T-MSIS enrollment and expenditures in all applicable eligibility groups included in the per capita expenditures analysis.
  3. Claims volume. To ensure CMS based spending estimates on a comparatively complete set of claims, claims volume must have been at least 20 percent of the national median of claims per 1,000 enrollee months for each claim type.
  4. Expenditures. Since fee-for-service and capitated managed care and other monthly per beneficiary payments (MBP1) make up a large share of spending, CMS compared these amounts captured in the TAF to the amounts reported by states in the CMS-64 forms. A ✔ in the table means that the difference between the sum of fee-for-service plus monthly payments in TAF and CMS-64 is less than or equal to 5 percent. A ✔* in the table means that the difference between the sum of fee-for-service plus monthly payments in TAF and CMS-64 is between 5 and 10 percent.

For more detail on the per capita expenditure calculations, please see the detailed methodology document. This version of the Medicaid and CHIP Scorecard was released in October 2020. To view the version of the Medicaid and CHIP Scorecard that was published in November 2019, please visit the archived Scorecard page

  1. Monthly beneficiary payments are all monthly payments reported in the TAF Other claims file (OT) which would be claims with claim type = 2: Medicaid or Medicaid-Expansion Capitated Payment. They include: capitated payments to HMOs, HIOs, or PACE plans; capitated payments for primary care case management (PCCM); premium payments for private health insurance; and capitated payments to prepaid health plans (PHPs).
These data present average annual Medicaid expenditures per enrollee by state for five eligibility groups.