In 2024, Medicaid providers in Mount Vernon billed a total of $1,168,120 for services in the National Codes Established for State Medicaid Agencies category, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represents a 6.8% rise over 2023, when $1,093,352 in claims were recorded for the same service category.
Medicaid, a public health insurance initiative run by the states and financed collaboratively by federal and state governments, covers individuals and families with low income, as well as seniors, children, and people with disabilities, making it a key component of the American health care system.
Because Medicaid funding is sourced from taxpayers, local shifts in billing highlight how health care dollars are distributed within a community.
The “National Codes Established for State Medicaid Agencies” category groups Medicaid services as defined by the care delivered, using standardized HCPCS and CPT coding structures. Each billing code in this analysis has been classified into a single service group through use of code prefixes and number ranges, helping group similar services for accurate yearly ranking and to avoid duplicate counting.
While Medicaid spending rose across multiple service areas, the National Codes Established for State Medicaid Agencies category ranked sixth for total Medicaid payments in Mount Vernon in 2024.
Statewide in Washington, the National Codes Established for State Medicaid Agencies category was ranked first by total payments that year.
During the five years preceding 2024, Medicaid payments for the National Codes Established for State Medicaid Agencies category in Mount Vernon climbed by $124,452, representing 11.9% growth. There were especially significant year-over-year increases in 2021 and 2022.
Although services under the National Codes Established for State Medicaid Agencies category were billed throughout Mount Vernon, payments were concentrated within a few ZIP codes. In 2024, ZIP code 98273 accounted for $1,167,544 in Medicaid payments, while 98274 represented $574. Combined, these 2 ZIP codes made up 100% of the Medicaid payments for this category in Mount Vernon that year.
Within this Medicaid service category, payments were mainly focused on a limited number of specific billing codes.
For context, Medicaid payments linked to the National Codes Established for State Medicaid Agencies category increased by 6.8% from 2023 to 2024 in Mount Vernon, while citywide Medicaid claim categories overall saw a 13.2% change during the same period.
According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid expenditures reached about $871.7 billion in fiscal year 2023, representing approximately 18% of the nation’s health spending. This is a significant increase from the $613.5 billion recorded in 2019, prior to the COVID-19 pandemic.
This growth reflects a roughly 40% jump in just a few years, primarily attributed to increased enrollment and higher utilization during and after the pandemic.
Recent federal budget measures passed under the Trump administration have included major proposals designed to decrease federal Medicaid funding and adjust program structure. The “One Big Beautiful Bill Act,” enacted in 2025, is projected to reduce federal Medicaid expenditures by over $1 trillion over 10 years and implements policies such as work requirements and greater cost-sharing, which may reduce access and funding for some enrollees. These changes are expected to increase state responsibility for Medicaid costs and limit federal support growth, even as the program continues to cover tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $1,043,668 | -60.2% |
| 2021 | $1,328,920 | 27.3% |
| 2022 | $1,193,771 | -10.2% |
| 2023 | $1,093,351 | -8.4% |
| 2024 | $1,168,119 | 6.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Procedures / Professional Services | $6,579,077 | 28.9% |
| 2 | Evaluation and Management | $5,791,911 | 25.4% |
| 3 | Medicine Services and Procedures | $3,167,768 | 13.9% |
| 4 | Alcohol and Drug Abuse Treatment | $1,928,571 | 8.5% |
| 5 | Radiology Procedures | $1,406,955 | 6.2% |
| 6 | National Codes Established for State Medicaid Agencies | $1,168,119 | 5.1% |
| 7 | Surgery | $1,073,382 | 4.7% |
| 8 | Dental Services | $676,433 | 3% |
| 9 | Pathology and Laboratory Procedures | $462,876 | 2% |
| 10 | Drugs Administered Other than Oral Method | $191,668 | 0.8% |
| 11 | Medical And Surgical Supplies | $127,129 | 0.6% |
| 12 | Ambulance and Other Transport Services and Supplies | $98,467 | 0.4% |
| 13 | Durable Medical Equipment | $87,096 | 0.4% |
| 14 | Temporary National Codes (Non-Medicare) | $12,495 | 0.1% |
| 15 | Temporary Codes | $8,078 | <0.1% |
| 16 | Outpatient PPS | $6,478 | <0.1% |
| 17 | Administrative, Miscellaneous and Investigational | $1,385 | <0.1% |
| 18 | Vision Services | $310 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1015 | Clinic service | $1,094,114 | 126 |
| T1017 | Targeted case management | $46,800 | 23 |
| T1002 | Rn services up to 15 minutes | $20,510 | 20 |
| T1027 | Family training & counseling | $5,424 | 12 |
| T1016 | Case management | $695 | 1 |
| T1999 | Noc retail items andsupplies | $574 | 5 |
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.