Providence Medicaid providers invoiced $58,725,622 for services designated under the National Codes Established for State Medicaid Agencies in 2024, according to information from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents a 21.4% increase compared to 2023, when claims totaled $48,393,225 for these services.
Medicaid is a state-operated public health insurance program funded by both federal and state governments. The program covers individuals and families with low incomes, as well as seniors, children, and people with disabilities, establishing it as one of the largest components of the U.S. health care system.
Because Medicaid payments use public tax dollars, local billing patterns demonstrate how community health resources are allocated.
The “National Codes Established for State Medicaid Agencies” grouping covers Medicaid service types, defined by standardized HCPCS and CPT code categories. This review assigned each billing code to one unique service group using consistent methods for code prefixes and number ranges, allowing for related services to be analyzed jointly and for rankings across different times to remain accurate and unduplicated.
Although several service categories saw rising Medicaid spending, National Codes Established for State Medicaid Agencies was the second highest in total Medicaid payments for Providence in 2024.
Statewide, the National Codes Established for State Medicaid Agencies category held the top position in Rhode Island by Medicaid payments in 2024.
Between 2019 and 2024, Providence Medicaid payments for this category grew by $28,194,408, or 92.3%, with certain years seeing more rapid escalation, including substantial year-over-year increases in 2023 and 2021.
Within Providence, while spending was distributed, payments were mainly concentrated in a few ZIP codes. In 2024, the highest Medicaid payments in this category came from 02904 at $29,559,275, followed by 02909 with $12,455,733, and 02903 with $6,173,203. Collectively, those 3 ZIP codes comprised 82.1% of Medicaid expenditures linked to the category in Providence that year.
Payments within the National Codes Established for State Medicaid Agencies category in Providence showed pronounced concentration among certain billing codes.
By comparison, the 21.4% increase in this category in Providence from 2023 to 2024 far outpaced the 0.9% growth observed across all Medicaid claims citywide for the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid expenditures totaled about $871.7 billion in fiscal year 2023, representing roughly 18% of the nation’s overall health spending. That is a marked rise from the roughly $613.5 billion spent in 2019, before the onset of the COVID-19 pandemic.
This increase equates to an approximate 40% gain over several years, propelled largely by enrollment growth and higher service use during and after the pandemic phase.
The Trump administration’s recent federal budget acts introduced major proposals to shrink federal Medicaid funding and overhaul the program. The “One Big Beautiful Bill Act,” enacted in 2025, aims to reduce federal Medicaid disbursements by over $1 trillion through the next decade, and implements provisions such as worker requirements and higher cost-sharing. These policies are expected to scale back coverage for certain beneficiaries and transfer further financial responsibility to states, constraining federal Medicaid growth despite continued service to millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $30,531,213 | -32.5% |
| 2021 | $36,669,646 | 20.1% |
| 2022 | $40,088,640 | 9.3% |
| 2023 | $48,393,225 | 20.7% |
| 2024 | $58,725,622 | 21.4% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Temporary National Codes (Non-Medicare) | $83,494,814 | 30.1% |
| 2 | National Codes Established for State Medicaid Agencies | $58,725,622 | 21.2% |
| 3 | Pathology and Laboratory Procedures | $31,277,927 | 11.3% |
| 4 | Alcohol and Drug Abuse Treatment | $30,474,014 | 11% |
| 5 | Evaluation and Management | $23,955,586 | 8.6% |
| 6 | Medicine Services and Procedures | $22,293,868 | 8% |
| 7 | Drugs Administered Other than Oral Method | $7,622,216 | 2.7% |
| 8 | Radiology Procedures | $6,041,181 | 2.2% |
| 9 | Procedures / Professional Services | $4,972,150 | 1.8% |
| 10 | Surgery | $3,095,719 | 1.1% |
| 11 | Ambulance and Other Transport Services and Supplies | $1,666,243 | 0.6% |
| 12 | Temporary Codes | $1,111,563 | 0.4% |
| 13 | Vision Services | $888,813 | 0.3% |
| 14 | Chemotherapy Drugs | $667,204 | 0.2% |
| 15 | Anesthesia | $618,350 | 0.2% |
| 16 | Durable Medical Equipment | $94,701 | <0.1% |
| 17 | Medical And Surgical Supplies | $88,590 | <0.1% |
| 18 | Administrative, Miscellaneous and Investigational | $64,635 | <0.1% |
| 19 | Enteral and Parenteral Therapy | $34,325 | <0.1% |
| 20 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $24,571 | <0.1% |
| 21 | Outpatient PPS | $22,055 | <0.1% |
| 22 | Orthotic Procedures and services | $16,448 | <0.1% |
| 23 | Pathology and Laboratory Services | $12,448 | <0.1% |
| 24 | Dental Services | $3,520 | <0.1% |
| 25 | Diagnostic Radiology Services | $1,012 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T2033 | Res, nos waiver per diem | $18,903,489 | 33 |
| T2017 | Habil res waiver 15 min | $9,188,133 | 53 |
| T1041 | Comm bh clinic svc per month | $6,085,622 | 5 |
| T1005 | Respite care service 15 min | $2,765,694 | 52 |
| T2046 | Hospice long term care, r&b | $2,619,135 | 11 |
| T2025 | Waiver service, nos | $2,567,121 | 21 |
| T1002 | Rn services up to 15 minutes | $2,066,129 | 33 |
| T2031 | Assist living waiver/diem | $1,851,535 | 22 |
| T1027 | Family training & counseling | $1,799,290 | 76 |
| T1000 | Private duty/independent nsg | $1,579,937 | 12 |
| T2003 | N-et; encounter/trip | $1,426,270 | 49 |
| T1024 | Team evaluation & management | $1,311,055 | 79 |
| T1003 | Lpn/lvn services up to 15min | $1,251,553 | 12 |
| T1001 | Nursing assessment/evaluatn | $798,644 | 91 |
| T1015 | Clinic service | $790,733 | 134 |
| T1016 | Case management | $775,131 | 121 |
| T2021 | Day habil waiver per 15 min | $717,830 | 19 |
| T2015 | Habil prevoc waiver per hr | $648,934 | 6 |
| T1030 | Rn home care per diem | $607,562 | 31 |
| T1031 | Lpn home care per diem | $185,301 | 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.
