Expenditure Reports from MBES/CBES
The automated Medicaid Budget and Expenditure System/State Children's Health Insurance Program Budget and Expenditure System (MBES/CBES) allows states to electronically submit their Form CMS-64 directly to the CMS Data Center and the Medicaid data base. Summary state-by-state total expenditures by program for the Medicaid Program, Medicaid Administration and CHIP programs are available as well as summary state-specific data from the CMS-64 and the CMS-21:
- Financial Management Report for FY1997 through FY 2001
- Financial Management Report for FY 2002 through FY 2011
- Financial Management Report for FY 2012 through FY 2013
Each zip file contains spreadsheet files containing the financial data for the Federal Fiscal Year specified. The unzipped file can be identified as follows:
- on the left-side of the spreadsheet at the top is the regular Title XIX Medicaid expenditures
- half way down the left-side of the spreadsheet is a C- in front of the service category this denotes Medicaid CHIP expansion population
- on the right side of the spreadsheet at the top is Title XIX Medicaid Administration expenditures
- one half way down the right-side of the spreadsheet is regular Title XXI CHIP expenditures.
Medicaid CMS-64 New Adult Group Expenditures Data Collected through MBES
The Affordable Care Act established a new adult eligibility group (VIII Group) to cover certain low-income individuals who are not otherwise eligible for coverage. An increased Federal Medical Assistance Percentage (FMAP) is available for medical services provided to people defined as “newly eligible” who are enrolled in the VIII Group. An increased FMAP rate is also available for certain “not newly eligible” expenditures for qualifying states that expanded coverage to the adult group prior to enactment of the Affordable Care Act. Recently, states began reporting Medicaid new adult group expenditures to CMS through the Medicaid Budget and Expenditure System (MBES) on the Form CMS-64.
January 1, 2014 was the earliest that states could elect to cover individuals under the new adult group. Accordingly, some states began reporting new adult group expenditures on the Form CMS-64 for the quarter ended March 31, 2014.
CMS has summary level expenditure data available for the March 31, 2014 Medicaid expenditures associated with the new adult group, including a breakout for individuals that are newly eligible (100% FMAP). This expenditure data, however, is not representative of the total amount of FFP associated with services provided to individuals in the new adult group from January 1, 2014 through March 31, 2014. Specifically:
- States generally report expenditures based on date of payment, not date of service. Please note that the date expenditures are incurred or reported is not entirely determinative of the applicable federal matching rate available for such expenditures.
- States may report additional expenditures applicable to this service period up to two years (possibly more) after the date of original service payment.
- States may increase or decrease reported expenditures through prior period adjustments.
- Some states have not certified expenditure reports for this period.
- CMS is in the process of conducting oversight activities relating to these expenditures
On a quarterly basis, states report summarized Medicaid expenditures on the Form CMS-64 which serve as the basis for the amount of Federal Financial Participation (FFP) paid to states to fund the Medicaid program. As part of their submission, states certify that their reported expenditures are actual expenditures allowable under federal requirements. States have up to two years, and occasionally longer, to report expenditures on the Form CMS-64. CMS performs various financial management oversight activities to ensure that reported expenditures are allowable under federal requirements. CMS has the authority to defer questionable expenditures or disallow improper expenditures as a result of its oversight activities.
CMS has provided significant training and guidance to ensure that states have mechanisms and systems in place so as to be able to track and report expenditures appropriately new adult group. States must separately report expenditures for newly eligible individuals (which are currently 100% FMAP) and not newly eligible individuals (varying FMAP rates). Additionally, CMS has placed special emphasis on ensuring that FFP paid to states for the new adult group is accurate, including conducting enhanced reviews of new adult group expenditures.