East Providence Medicaid providers billed $5,511,331 in 2024 for services within the National Codes Established for State Medicaid Agencies category, as indicated by data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This reflects a rise of 18.5% from the previous year, when claims in this category totaled $4,650,814.
Medicaid, covering low-income individuals, families, seniors, children, and people with disabilities, is a public health insurance program managed by states and co-financed by federal and state governments. It accounts for a major component of the national health care system.
Because Medicaid funds are provided by taxpayers, fluctuations in city billing reflect the allocation of public health dollars at the community level.
The “National Codes Established for State Medicaid Agencies” classification encompasses Medicaid-billed services grouped by care type, using standard HCPCS and CPT code groupings. In this assessment, billing codes were allocated to a single service category aligned by code prefixes and corresponding numeric spans to consistently group related services while avoiding both overlap and rank inflation through double counting.
Medicaid spending rose across a range of categories, making National Codes Established for State Medicaid Agencies the second highest category for Medicaid payments in East Providence in 2024.
Statewide, National Codes Established for State Medicaid Agencies was the top-ranking Medicaid service category by total payments in Rhode Island during 2024.
Between 2019 and 2024, Medicaid payments in East Providence for the National Codes Established for State Medicaid Agencies category grew by $1,035,798, representing a 15.8% increase. This growth accelerated at several points, with strong annual gains in both 2023 and 2022.
Spending in the National Codes Established for State Medicaid Agencies category was distributed throughout East Providence, though payments were concentrated within just a few ZIP codes. In 2024, ZIP code 02914 accounted for all Medicaid payments in the category, totaling $5,511,331, and represented 100% of the city’s Medicaid payments in this grouping for the year.
A small set of billing codes drove most Medicaid expenditures within this category.
By comparison, the 18.5% growth in payments for this Medicaid category between 2024 and 2023 outpaced the 1.9% increase observed across all Medicaid service categories in East Providence in the same time frame.
Centers for Medicare & Medicaid Services data show combined federal and state Medicaid spending reached around $871.7 billion in fiscal 2023, making up an estimated 18% of total national health expenditures—an increase from about $613.5 billion in 2019, before the COVID-19 pandemic.
This 40% expansion over several years stems largely from expanded enrollments and increased health care utilization both during and following the pandemic.
Recent federal legislation enacted during the Trump administration features notable proposals for reducing federal Medicaid dollars and adjusting the program’s structure. The “One Big Beautiful Bill Act,” signed in 2025, is expected to shrink federal Medicaid outlays by more than $1 trillion over the next 10 years and bring policy changes such as work requirements and higher cost-sharing measures that could lower coverage and funds for certain groups. These changes aim to shift greater expenses toward states and contain the federal Medicaid funding growth while the program remains a vital source for millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $6,547,129 | -60.3% |
| 2021 | $5,065,688 | -22.6% |
| 2022 | $4,837,281 | -4.5% |
| 2023 | $4,650,813 | -3.9% |
| 2024 | $5,511,331 | 18.5% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Pathology and Laboratory Procedures | $6,179,238 | 33.7% |
| 2 | National Codes Established for State Medicaid Agencies | $5,511,331 | 3<0.1% |
| 3 | Temporary National Codes (Non-Medicare) | $2,047,950 | 11.2% |
| 4 | Alcohol and Drug Abuse Treatment | $1,487,600 | 8.1% |
| 5 | Evaluation and Management | $1,181,803 | 6.4% |
| 6 | Ambulance and Other Transport Services and Supplies | $631,419 | 3.4% |
| 7 | Medicine Services and Procedures | $462,438 | 2.5% |
| 8 | Durable Medical Equipment | $311,119 | 1.7% |
| 9 | Procedures / Professional Services | $144,402 | 0.8% |
| 10 | Surgery | $105,759 | 0.6% |
| 11 | Vision Services | $105,197 | 0.6% |
| 12 | Medical And Surgical Supplies | $87,681 | 0.5% |
| 13 | Pathology and Laboratory Services | $42,915 | 0.2% |
| 14 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $35,038 | 0.2% |
| 15 | Radiology Procedures | $7,176 | <0.1% |
| 16 | Dental Services | $4,779 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T2046 | Hospice long term care, r&b | $1,748,272 | 11 |
| T1024 | Team evaluation & management | $1,566,329 | 12 |
| T2031 | Assist living waiver/diem | $1,282,379 | 14 |
| T4535 | Disposable liner/shield/pad | $202,140 | 12 |
| T4527 | Adult size pull-on lg | $180,892 | 12 |
| T4541 | Large disposable underpad | $160,408 | 12 |
| T4526 | Adult size pull-on med | $147,673 | 12 |
| T4528 | Adult size pull-on xl | $93,850 | 12 |
| T4525 | Adult size pull-on sm | $31,342 | 12 |
| T1001 | Nursing assessment/evaluatn | $27,276 | 11 |
| T4544 | Adlt disp und/pull on abv xl | $22,638 | 11 |
| T4523 | Adult size brief/diaper lg | $20,996 | 11 |
| T1016 | Case management | $20,261 | 6 |
| T4522 | Adult size brief/diaper med | $6,867 | 6 |
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.
