In 2024, Lancaster Medicaid providers submitted $31,479,764 in claims for services classified under the National Codes Established for State Medicaid Agencies category, according to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents an increase of 1.7% compared with 2023, during which providers reported $30,952,988 in claims for the same service type.
Medicaid is a statewide public health insurance program funded through a partnership between federal and state governments. It provides coverage for low-income families and individuals, seniors, children, and people with disabilities, making it one of the most significant components of the U.S. health care system.
As Medicaid funding comes from public sources, shifts in local billing figures highlight how community health care funding is allocated.
The “National Codes Established for State Medicaid Agencies” category includes a range of Medicaid services defined by care type, using standardized HCPCS and CPT code groupings. For this report, each billing code was placed into a single service category based on code prefixes and numerical ranges, which allowed for a consistent review of related services without duplicating counts or misrepresenting their rankings over time.
National Codes Established for State Medicaid Agencies was the leading Medicaid payment category in Lancaster in 2024 by total dollars spent, outpacing all other service categories.
Statewide in Pennsylvania, this category ranked second in total Medicaid spending for 2024.
From 2019 through 2024, Lancaster’s Medicaid payments associated with this category rose by $26,789,594, or 571.2%. Some years saw faster growth, most notably in 2021 and 2023.
Spending tied to the National Codes Established for State Medicaid Agencies category was distributed throughout Lancaster, but payment amounts were heavily concentrated in a select number of ZIP codes. In 2024, the highest Medicaid payments in this category were in ZIP codes 17601 at $13,523,457, 17603 with $11,523,444, and 17602 totaling $6,432,861. Together, these 3 ZIP codes made up 100% of category payments in Lancaster for the year.
Within this service category, Medicaid spending also focused on a limited group of billing codes.
Comparison of year-over-year changes shows that Medicaid payments in Lancaster linked to National Codes Established for State Medicaid Agencies increased by 1.7% between 2024 and 2023—the same rate as the overall Medicaid claim categories in the city over the same span.
According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid expenditures reached approximately $871.7 billion in fiscal year 2023, accounting for about 18% of the country’s total health spending—up significantly from $613.5 billion in 2019 before the COVID-19 pandemic.
This rise marks an increase of about 40% over several years, much of which resulted from higher enrollment and increased service use during and after the pandemic.
Recent federal budget legislation signed under the Trump administration included major proposals to curb federal Medicaid funding and restructure the program. For instance, the “One Big Beautiful Bill Act,” passed in 2025, is expected to reduce federal Medicaid spending by more than $1 trillion over the next decade, while adding work requirements and greater cost-sharing—changes likely to reduce both coverage and funding for some recipients. These adjustments are anticipated to shift more expenses to states and restrain the federal Medicaid support growth, even as the program continues to serve tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $4,690,169 | 113.5% |
| 2021 | $12,290,748 | 162.1% |
| 2022 | $12,567,178 | 2.2% |
| 2023 | $30,952,988 | 146.3% |
| 2024 | $31,479,763 | 1.7% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $31,479,763 | 31.6% |
| 2 | Alcohol and Drug Abuse Treatment | $22,705,929 | 22.8% |
| 3 | Medicine Services and Procedures | $19,019,849 | 19.1% |
| 4 | Evaluation and Management | $14,646,923 | 14.7% |
| 5 | Procedures / Professional Services | $4,999,732 | 5% |
| 6 | Dental Services | $1,964,963 | 2% |
| 7 | Temporary National Codes (Non-Medicare) | $1,503,094 | 1.5% |
| 8 | Radiology Procedures | $1,079,159 | 1.1% |
| 9 | Pathology and Laboratory Procedures | $770,650 | 0.8% |
| 10 | Vision Services | $448,171 | 0.4% |
| 11 | Durable Medical Equipment | $407,861 | 0.4% |
| 12 | Ambulance and Other Transport Services and Supplies | $183,227 | 0.2% |
| 13 | Surgery | $166,492 | 0.2% |
| 14 | Medical And Surgical Supplies | $138,031 | 0.1% |
| 15 | Enteral and Parenteral Therapy | $76,748 | 0.1% |
| 16 | Orthotic Procedures and services | $5,892 | <0.1% |
| 17 | Drugs Administered Other than Oral Method | $4 | <0.1% |
| 18 | Chemotherapy Drugs | $0 | <0.1% |
| 18 | Outpatient PPS | $0 | <0.1% |
| 18 | Temporary Codes | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1015 | Clinic service | $16,044,572 | 643 |
| T1003 | Lpn/lvn services up to 15min | $11,293,881 | 48 |
| T1002 | Rn services up to 15 minutes | $1,510,041 | 61 |
| T1017 | Targeted case management | $1,181,821 | 20 |
| T1016 | Case management | $1,050,663 | 20 |
| T2024 | Serv asmnt/care plan waiver | $206,800 | 12 |
| T1000 | Private duty/independent nsg | $131,592 | 1 |
| T2023 | Targeted case mgmt per month | $37,400 | 7 |
| T1028 | Home environment assessment | $22,990 | 12 |
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.
