Lancaster Medicaid payments for National Codes Established for State Medicaid Agencies climb to $507,645 in 2024

Providers in Lancaster billed Medicaid a total of $507,645 for services grouped under the National Codes Established for State Medicaid Agencies category in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This amount represents a 58.7% rise over 2023, when providers submitted $319,881 in claims for these services.

Medicaid is a state-administered, jointly funded health insurance program that covers low-income people, seniors, children, and individuals with disabilities—making it one of the largest parts of the U.S. health system. It is supported by both federal and state governments.

Because taxpayer money supports Medicaid payments, variations in local billing show how health care funding is distributed within a community.

The “National Codes Established for State Medicaid Agencies” category includes a range of Medicaid-billed services determined by the type of care provided, using HCPCS and CPT code groupings. Each billing code was placed into a single service category for this analysis, based on code prefixes and numerical series, which allowed similar services to be compared as a group, avoided double counting, and ensured consistent rankings year to year.

While Medicaid payments went up in several service categories, National Codes Established for State Medicaid Agencies was the top category in Lancaster by total Medicaid spending in 2024.

Statewide in Wisconsin, the National Codes Established for State Medicaid Agencies category also led all categories by total payments in 2024.

Between 2019 and 2024, Medicaid payments related to the National Codes Established for State Medicaid Agencies group in Lancaster increased by $338,294, or 199.8%. Some years, including 2021 and 2023, saw especially rapid growth.

Although spending for National Codes Established for State Medicaid Agencies services was reported citywide, the payments were concentrated in a small number of ZIP codes. In 2024, ZIP code 53813 accounted for $507,644 in Medicaid payments, representing 100% of the category’s total for Lancaster that year.

Within this service category, Medicaid payments also focused on a small subset of individual billing codes.

For reference, Medicaid payments linked to this category in Lancaster grew by 58.7% from 2023 to 2024, while overall Medicaid claim spending across all categories in the city grew 10.2% over the same time frame.

According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending totaled roughly $871.7 billion in fiscal 2023, which was about 18% of all national health expenditures. That figure was up significantly from about $613.5 billion in 2019, before the COVID-19 pandemic.

This growth reflects an increase of close to 40% in several years, largely due to more enrollees and increased service use during and after the pandemic.

Recent federal budget measures under the Trump administration have proposed major cuts to federal Medicaid funding and program restructuring. The “One Big Beautiful Bill Act,” passed in 2025, is expected to reduce federal Medicaid funding by more than $1 trillion over 10 years. It introduces policies such as work requirements and higher cost-sharing, which may limit both coverage and funding for certain groups. The measures are anticipated to shift greater responsibility to states and restrict growth in federal Medicaid support, while coverage continues for tens of millions nationwide.

Note: HCPCS codes are shown for context within the category. Category totals and rankings in this article are based on standardized service groupings rather than individual billing codes.

Information in this article was obtained from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The source data can be found here.