Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64)

(CMS-10529) Quarterly Medicaid and CHIP Budget and Expenditure Reporting for the Medical Assistance Program, Administration and CHIP (MBES/CBES Forms CMS-21 and -21B, -37, and -64)

OMB: 0938-1265

IC ID: 213568

Documents and Forms

Document Name Document Type
Form CMS-64 Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program (CMS-64) Form
CMS-64 Medical Assistance Expenditures by Type of Service For t 64 Summary.pdf mbescbesval0.medicaid.gov/MBESCBES/Default.aspx Form
CMS-64 Medical Assistance Expenditures by Type of Service For t 64 Summary.pdf mbescbesval0.medicaid.gov/MBESCBES/Default.aspx Form
CMS-64 Unfilled Form 64 Blank Forms.pdf Form
CMS-64 Unfilled Form 64 Blank Forms.pdf Form