In 2024, Ephrata Medicaid providers filed $504,752 in claims for Alcohol and Drug Abuse Treatment services, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. That amount is up 9.4% compared with 2023, when $461,179 was billed for the same category.
Medicaid is a state-administered public health insurance program, funded jointly by state and federal governments. It covers people and families with low incomes, children, seniors, and those living with disabilities, making it a major part of the U.S. health care system.
Because Medicaid spending comes from taxpayer dollars, variations in local billing demonstrate how health care funds are distributed within communities.
The “Alcohol and Drug Abuse Treatment” category is composed of a set of Medicaid-paid services organized by care type, mapped according to standardized HCPCS and CPT codes. For this report, billing codes were sorted into individual service categories using shared code prefixes and numeric patterns, enabling examination of related services without overlap and maintaining precise trend comparisons.
Alcohol and Drug Abuse Treatment was second among all Medicaid spending categories in Ephrata by total expenditures in 2024, while overall Medicaid spending also increased in several categories.
Statewide, Alcohol and Drug Abuse Treatment was the leading category for Medicaid payments in Pennsylvania in 2024.
Between 2019 and 2024, Ephrata Medicaid payments for Alcohol and Drug Abuse Treatment rose by $490,294, or 3391.3%. The largest jumps were noted year over year in 2021 and 2022.
Although payments for Alcohol and Drug Abuse Treatment spanned the city, most were concentrated in a few ZIP codes. In 2024, ZIP code 17522 alone recorded $504,752 in Medicaid payments for these services, representing the full 100% share of Ephrata’s total in this category.
Within Alcohol and Drug Abuse Treatment, spending was further condensed across select billing codes.
Between 2023 and 2024, Ephrata Medicaid payments for Alcohol and Drug Abuse Treatment grew 9.4%, compared to a 2.4% overall increase in citywide Medicaid categories for the period.
The Centers for Medicare & Medicaid Services report combined federal and state Medicaid spending reached around $871.7 billion in fiscal year 2023, making up close to 18% of the nation’s total health costs, a steep climb from about $613.5 billion in 2019 before the COVID-19 pandemic.
This rise equals approximately 40% over several years, mainly due to greater use of services and higher enrollment during and after the pandemic.
Federal budget measures enacted during the Trump administration brought major proposals to reduce federal Medicaid contributions and change the program’s structure. Notably, the “One Big Beautiful Bill Act,” became law in 2025 and is projected to cut more than $1 trillion in federal Medicaid spending over 10 years. Provisions include work requirements and increased cost-sharing, which could shrink both coverage and funding for select groups. These reforms are expected to add cost pressures to states and slow federal Medicaid support growth, as the program continues to provide health care for millions.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $14,457 | – |
| 2021 | $216,361 | 1396.5% |
| 2022 | $514,710 | 137.9% |
| 2023 | $461,178 | -10.4% |
| 2024 | $504,752 | 9.4% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $1,902,406 | 40.8% |
| 2 | Alcohol and Drug Abuse Treatment | $504,752 | 10.8% |
| 3 | Temporary National Codes (Non-Medicare) | $455,466 | 9.8% |
| 4 | Durable Medical Equipment | $412,127 | 8.8% |
| 5 | National Codes Established for State Medicaid Agencies | $396,162 | 8.5% |
| 6 | Medical And Surgical Supplies | $363,306 | 7.8% |
| 7 | Medicine Services and Procedures | $191,075 | 4.1% |
| 8 | Ambulance and Other Transport Services and Supplies | $117,001 | 2.5% |
| 9 | Surgery | $108,825 | 2.3% |
| 10 | Pathology and Laboratory Procedures | $95,119 | 2% |
| 11 | Vision Services | $89,784 | 1.9% |
| 12 | Radiology Procedures | $19,906 | 0.4% |
| 13 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $11,047 | 0.2% |
| 14 | Procedures / Professional Services | $198 | <0.1% |
| 15 | Administrative, Miscellaneous and Investigational | $0 | <0.1% |
| 15 | Drugs Administered Other than Oral Method | $0 | <0.1% |
| 15 | Temporary Codes | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| H0020 | Alcohol and/or drug services | $408,276 | 12 |
| H0004 | Alcohol and/or drug services | $87,510 | 13 |
| H0015 | Alcohol and/or drug services | $8,965 | 1 |
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.
