In 2024, Medicaid providers in West Palm Beach submitted $40,718,480 in claims for services grouped under the National Codes Established for State Medicaid Agencies category, as reported by the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 3.7% rise from 2023, when total claims for the same category reached $39,261,905.
Medicaid is a state-administered public health insurance program, jointly financed by state and federal governments, that covers eligible low-income individuals and families, including seniors, children, and those with disabilities, making it a core element of the U.S. health care system.
Since taxpayer dollars fund Medicaid, shifts in local billing trends indicate how publicly funded health care resources are distributed within local communities.
The “National Codes Established for State Medicaid Agencies” category represents a set of Medicaid-billed services, grouped according to care type and defined by standardized HCPCS and CPT code sets. For this assessment, codes were consistently sorted into a single service category based on prefix and numeric range, which grouped related services, eliminated duplication, and supported consistent comparisons over time.
The National Codes Established for State Medicaid Agencies service group accounted for the highest total Medicaid payments in West Palm Beach in 2024, placing it above all other categories in the city.
Statewide in Florida, this category held the second position among all Medicaid payment categories for 2024.
Over the five-year period ending in 2024, Medicaid payments for this service category in West Palm Beach grew by $17,988,620, a 79.1% increase. Certain periods saw faster growth, notably in 2023 and 2022, when year-over-year payment increases were significant.
Although services in the National Codes Established for State Medicaid Agencies classification were billed throughout West Palm Beach, most payments were concentrated in a small set of ZIP codes. In 2024, the ZIP codes receiving the largest payments in this category were 33407 with $16,901,068, 33401 at $8,553,977, and 33409 with $5,962,402. Combined, these 3 ZIP codes represented 77.2% of Medicaid payments tied to this service group within the city for the year.
Payments in this category also centered around a select number of unique billing codes.
When comparing the growth in payments for this category, West Palm Beach experienced a 3.7% rise between 2023 and 2024, while total Medicaid payments across all service types in the city grew by 13.1% during the same period.
According to the Centers for Medicare & Medicaid Services, Medicaid spending from both federal and state sources reached approximately $871.7 billion in fiscal year 2023, representing about 18% of total national health expenditures—an increase from roughly $613.5 billion in 2019, prior to the COVID-19 pandemic.
This change marks an increase of about 40% over just a few years, largely driven by expanded Medicaid rolls and higher utilization during and after the pandemic.
Recent budget legislation under the Trump administration included major proposals to reduce federal Medicaid funding and overhaul the program. The “One Big Beautiful Bill Act,” enacted in 2025, is projected to cut more than $1 trillion in federal Medicaid expenditures over 10 years, introducing work requirements and greater cost-sharing that may lower coverage and financial support for some enrollees. These policy changes are expected to shift more responsibility to states and curb growth in federal contributions, even as Medicaid continues to cover millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $22,729,859 | -13.8% |
| 2021 | $25,821,941 | 13.6% |
| 2022 | $30,641,883 | 18.7% |
| 2023 | $39,261,905 | 28.1% |
| 2024 | $40,718,480 | 3.7% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $40,718,480 | 42.9% |
| 2 | Temporary National Codes (Non-Medicare) | $28,342,780 | 29.8% |
| 3 | Alcohol and Drug Abuse Treatment | $8,806,634 | 9.3% |
| 4 | Evaluation and Management | $8,162,045 | 8.6% |
| 5 | Medicine Services and Procedures | $4,885,012 | 5.1% |
| 6 | Ambulance and Other Transport Services and Supplies | $1,467,914 | 1.5% |
| 7 | Pathology and Laboratory Procedures | $888,104 | 0.9% |
| 8 | Dental Services | $453,764 | 0.5% |
| 9 | Radiology Procedures | $370,449 | 0.4% |
| 10 | Administrative, Miscellaneous and Investigational | $341,205 | 0.4% |
| 11 | Diagnostic Radiology Services | $155,760 | 0.2% |
| 12 | Procedures / Professional Services | $152,967 | 0.2% |
| 13 | Surgery | $63,705 | 0.1% |
| 14 | Medical And Surgical Supplies | $54,388 | 0.1% |
| 15 | Durable Medical Equipment | $40,675 | <0.1% |
| 16 | Temporary Codes | $39,452 | <0.1% |
| 17 | Vision Services | $14,922 | <0.1% |
| 18 | Drugs Administered Other than Oral Method | $3,262 | <0.1% |
| 19 | Coronavirus Diagnostic Panel | $824 | <0.1% |
| 20 | Anesthesia | $790 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1019 | Personal care ser per 15 min | $17,718,158 | 167 |
| T1004 | Nsg aide service up to 15min | $8,342,018 | 134 |
| T2030 | Assist living waiver/month | $5,711,366 | 57 |
| T1017 | Targeted case management | $4,632,486 | 186 |
| T1025 | Ped compr care pkg, per diem | $2,793,016 | 15 |
| T1015 | Clinic service | $801,659 | 163 |
| T2046 | Hospice long term care, r&b | $419,768 | 6 |
| T1030 | Rn home care per diem | $135,773 | 15 |
| T2003 | N-et; encounter/trip | $128,378 | 11 |
| T1027 | Family training & counseling | $12,900 | 4 |
| T4528 | Adult size pull-on xl | $9,200 | 9 |
| T1024 | Team evaluation & management | $7,738 | 7 |
| T1007 | Treatment plan development | $6,014 | 7 |
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.
