South Portland Medicaid providers billed a total of $49,881,958 for services within the National Codes Established for State Medicaid Agencies category in 2024, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 43.5% rise from 2023, when these providers submitted $34,751,065 in claims for similar services.
Medicaid is administered by individual states and funded through a partnership between federal and state governments. The program covers low-income groups, seniors, children, and people with disabilities, making it a major part of the U.S. health system.
Since Medicaid funding comes from taxpayers, changes in local billing help illustrate how communities allocate public health care funds.
The “National Codes Established for State Medicaid Agencies” service group refers to categories of Medicaid-billed care defined by specific HCPCS and CPT codes. For this review, each billing code was assigned to a single service group by analyzing code prefixes and ranges, allowing for accurate year-over-year comparisons without double counting.
Among all Medicaid service categories, National Codes Established for State Medicaid Agencies recorded the highest total payments in South Portland for 2024.
Statewide in Maine, the National Codes Established for State Medicaid Agencies category also took the top position for total Medicaid payments in 2024.
From 2019 through 2024, Medicaid payments linked to the National Codes Established for State Medicaid Agencies in South Portland were up by $23,680,171, an increase of 90.4%. Some of the most significant annual growth occurred in 2020 and 2023.
Although spending under this category was distributed citywide, payments were largely concentrated in a small set of ZIP codes. During 2024, ZIP code 04106 led with $49,881,957 in Medicaid payments, representing 100% of the city’s total for this category during the year.
Within the National Codes Established for State Medicaid Agencies grouping, payments were centered on only a handful of billing codes.
For context, the 43.5% rise in Medicaid payments for the National Codes Established for State Medicaid Agencies category between 2024 and 2023 outpaced the 20.5% increase observed across all Medicaid claim categories in South Portland during the same span.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending climbed to approximately $871.7 billion in fiscal year 2023, about 18% of total national health expenditures. This was a notable jump from $613.5 billion in 2019, prior to the COVID-19 pandemic.
This nearly 40% growth over several years has been driven mainly by an increase in enrollment and greater service use in the aftermath of the pandemic.
Recent federal budget actions under the Trump administration contained proposals to reduce Medicaid funding and modify the program’s structure. The “One Big Beautiful Bill Act,” enacted in 2025, is estimated to cut more than $1 trillion in federal Medicaid funding in the coming decade, establishing new policies such as work requirements and higher cost-sharing that may reduce coverage and payments for some enrollees. These adjustments are forecast to transfer more responsibility to state budgets and restrain federal Medicaid growth even as the program remains vital for tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $26,201,786 | 24.7% |
| 2021 | $28,153,300 | 7.4% |
| 2022 | $30,283,647 | 7.6% |
| 2023 | $34,751,064 | 14.8% |
| 2024 | $49,881,957 | 43.5% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $49,881,957 | 56.4% |
| 2 | Temporary National Codes (Non-Medicare) | $24,310,753 | 27.5% |
| 3 | Alcohol and Drug Abuse Treatment | $10,971,538 | 12.4% |
| 4 | Procedures / Professional Services | $1,569,671 | 1.8% |
| 5 | Evaluation and Management | $554,492 | 0.6% |
| 6 | Ambulance and Other Transport Services and Supplies | $487,846 | 0.6% |
| 7 | Medicine Services and Procedures | $308,492 | 0.3% |
| 8 | Durable Medical Equipment | $225,119 | 0.3% |
| 9 | Dental Services | $45,403 | 0.1% |
| 10 | Medical And Surgical Supplies | $17,941 | <0.1% |
| 11 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $14,048 | <0.1% |
| 12 | Pathology and Laboratory Procedures | $1,884 | <0.1% |
| 13 | Surgery | $41 | <0.1% |
| 14 | Temporary Codes | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T2016 | Habil res waiver per diem | $30,939,603 | 48 |
| T1019 | Personal care ser per 15 min | $12,132,641 | 48 |
| T2022 | Case management, per month | $2,316,146 | 22 |
| T1020 | Personal care ser per diem | $1,568,622 | 10 |
| T1015 | Clinic service | $925,233 | 34 |
| T1005 | Respite care service 15 min | $844,540 | 23 |
| T1017 | Targeted case management | $431,490 | 22 |
| T2040 | Financial mgt waiver/15min | $355,868 | 11 |
| T2021 | Day habil waiver per 15 min | $204,174 | 12 |
| T2042 | Hospice routine home care | $105,213 | 2 |
| T2017 | Habil res waiver 15 min | $47,316 | 3 |
| T1013 | Sign lang/oral interpreter | $11,107 | 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.
