In 2024, Medicaid providers in Grand Rapids submitted $30,624,873 in claims for services categorized under the National Codes Established for State Medicaid Agencies, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented an 11.3% increase over totals from 2023, when claims for this category amounted to $27,513,705.
Medicaid operates as a public health insurance program managed by states and jointly financed by federal and state governments. Serving low-income groups, the elderly, children, and people with disabilities, it remains a significant part of the U.S. health care landscape.
Since Medicaid payments are sourced from taxpayer funds, local changes in billing reflect how public health dollars are allocated within communities.
The “National Codes Established for State Medicaid Agencies” classification covers a set of Medicaid-billed services defined by care type, using standard HCPCS and CPT code groupings. For this data review, each billing code was placed into one service category, following consistent code prefixes and ranges, to facilitate tracking related services without duplication and to retain accurate rankings.
While many service categories saw increased Medicaid spending, National Codes Established for State Medicaid Agencies placed fourth among all Medicaid payment categories in Grand Rapids in 2024.
Statewide in Michigan, National Codes Established for State Medicaid Agencies was the second-highest category by Medicaid payments for 2024.
During the five years prior to 2024, Medicaid expenditures for National Codes Established for State Medicaid Agencies in Grand Rapids rose by $11,892,421, representing a 63.5% gain. The rate of growth was faster in some years, especially in 2023 and 2021 when larger year-to-year rises occurred.
Spending for these services in Grand Rapids was found citywide, although the majority was concentrated in specific ZIP codes. In 2024, ZIP codes with the largest Medicaid outlays in this category included 49503 at $12,171,231, 49546 with $9,557,136, and 49512, which contributed $3,163,486. Combined, the top 3 ZIP codes made up 81.3% of Medicaid payments in this category for the city that year.
Within this service category, Medicaid outlays were focused among a small set of individual billing codes.
For further perspective, Medicaid payments for National Codes Established for State Medicaid Agencies services in Grand Rapids went up by 11.3% from 2023 to 2024, compared to a 10.2% rise across all Medicaid claim categories locally for the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid expenditures totaled approximately $871.7 billion in fiscal year 2023, accounting for around 18% of all national health spending—a sharp increase from around $613.5 billion in 2019, before the COVID-19 pandemic.
This growth reflects a roughly 40% increase in just a few years, largely due to expanded enrollment and increased utilization during and after the pandemic period.
Recent federal budget acts passed under the Trump administration have featured prominent proposals to reduce federal Medicaid funding and change the program structure. One example, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to lower federal Medicaid spending by more than $1 trillion over a decade and adds policies such as work requirements and greater cost-sharing, which may decrease coverage and funding for some users. These measures are projected to transfer greater costs to states and limit the growth of federal support for Medicaid, even as the program continues to cover tens of millions of people across the country.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $18,732,452 | -5.7% |
| 2021 | $19,912,536 | 6.3% |
| 2022 | $20,902,893 | 5% |
| 2023 | $27,513,705 | 31.6% |
| 2024 | $30,624,872 | 11.3% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $78,216,119 | 26.5% |
| 2 | Medicine Services and Procedures | $47,966,112 | 16.2% |
| 3 | Alcohol and Drug Abuse Treatment | $47,846,635 | 16.2% |
| 4 | National Codes Established for State Medicaid Agencies | $30,624,872 | 10.4% |
| 5 | Radiology Procedures | $16,429,869 | 5.6% |
| 6 | Procedures / Professional Services | $13,669,762 | 4.6% |
| 7 | Surgery | $13,120,073 | 4.4% |
| 8 | Ambulance and Other Transport Services and Supplies | $7,745,354 | 2.6% |
| 9 | Pathology and Laboratory Procedures | $7,303,858 | 2.5% |
| 10 | Drugs Administered Other than Oral Method | $6,399,496 | 2.2% |
| 11 | Chemotherapy Drugs | $6,121,959 | 2.1% |
| 12 | Temporary National Codes (Non-Medicare) | $4,935,691 | 1.7% |
| 13 | Temporary Codes | $3,232,894 | 1.1% |
| 14 | Dental Services | $2,737,106 | 0.9% |
| 15 | Durable Medical Equipment | $2,240,054 | 0.8% |
| 16 | Anesthesia | $2,230,061 | 0.8% |
| 17 | Enteral and Parenteral Therapy | $1,677,044 | 0.6% |
| 18 | Medical And Surgical Supplies | $1,344,780 | 0.5% |
| 19 | Orthotic Procedures and services | $792,226 | 0.3% |
| 20 | Vision Services | $413,698 | 0.1% |
| 21 | Outpatient PPS | $149,366 | 0.1% |
| 22 | Prosthetic Procedures | $96,184 | <0.1% |
| 23 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $82,706 | <0.1% |
| 24 | Administrative, Miscellaneous and Investigational | $61,678 | <0.1% |
| 25 | Hearing Services | $51,056 | <0.1% |
| 26 | Pathology and Laboratory Services | $21,814 | <0.1% |
| 27 | Components, Accessories and Supplies | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1017 | Targeted case management | $12,727,609 | 68 |
| T2022 | Case management, per month | $5,168,010 | 12 |
| T2033 | Res, nos waiver per diem | $4,831,267 | 22 |
| T1000 | Private duty/independent nsg | $3,163,486 | 12 |
| T1020 | Personal care ser per diem | $2,808,368 | 39 |
| T1023 | Program intake assessment | $1,475,016 | 12 |
| T1005 | Respite care service 15 min | $98,250 | 17 |
| T1001 | Nursing assessment/evaluatn | $87,241 | 10 |
| T1002 | Rn services up to 15 minutes | $74,953 | 13 |
| T1012 | Alcohol/substance abuse skil | $51,172 | 8 |
| T1016 | Case management | $40,805 | 8 |
| T2025 | Waiver service, nos | $38,428 | 10 |
| T4534 | Youth size pull-on | $22,250 | 10 |
| T1003 | Lpn/lvn services up to 15min | $11,982 | 7 |
| T4526 | Adult size pull-on med | $9,536 | 7 |
| T4535 | Disposable liner/shield/pad | $6,397 | 10 |
| T4527 | Adult size pull-on lg | $3,943 | 3 |
| T4541 | Large disposable underpad | $3,515 | 9 |
| T1013 | Sign lang/oral interpreter | $2,016 | 2 |
| T1040 | Comm bh clinic svc per diem | $621 | 11 |
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.
