In 2024, Medicaid providers in Holyoke billed a total of $35,602,799 for services categorized under the National Codes Established for State Medicaid Agencies, according to figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represents a 53.4% increase from 2023, when providers recorded $23,211,508 in claims for the same services.
Medicaid is a government health insurance program operated by individual states and funded through federal and state contributions. The program provides coverage for low-income people and families, seniors, children, and those with disabilities, making it a key component of the U.S. health care landscape.
Since Medicaid payments are financed by taxpayers, fluctuations in local billing amounts illustrate how public health funding is distributed within a community.
The “National Codes Established for State Medicaid Agencies” classification includes a set of Medicaid-billed services defined by type of care, organized according to standardized HCPCS and CPT code groupings. This analysis assigned individual billing codes to a single service category using consistent code prefixes and numerical ranges, which enabled related services to be grouped for review while preventing double counting and ensuring accurate trend analysis over time.
National Codes Established for State Medicaid Agencies led all Medicaid service categories in Holyoke for total provider payments in 2024, amid broader increases in spending across numerous categories.
Across Massachusetts, the National Codes Established for State Medicaid Agencies category also ranked first by payment totals in 2024.
In the five years ending with 2024, Holyoke’s Medicaid payments for this service category grew by $8,816,571, an increase of 19.8%. Certain years, such as 2020 and 2021, saw especially strong year-over-year growth in these payments.
Although service spending in this category was distributed citywide, payments were concentrated in a small number of ZIP codes. In 2024, ZIP code 01040 accounted for all $35,602,799 in Medicaid payments within this category, representing 100% of the city’s total reported for these services.
Payments tied to the National Codes Established for State Medicaid Agencies category were further concentrated among a limited set of billing codes.
For context, between 2024 and 2023, Holyoke saw a 53.4% jump in Medicaid payments within this service category. By comparison, across all Medicaid claim categories citywide, the increase over the same period was 2.7%.
According to the Centers for Medicare & Medicaid Services, national Medicaid spending from federal and state sources reached approximately $871.7 billion in fiscal 2023, or about 18% of all U.S. health expenditures. This is up from roughly $613.5 billion in 2019, prior to the COVID-19 pandemic.
The change reflects an increase of around 40% during this period, with the bulk of growth attributed to enrollment expansion and higher service use during and after the pandemic.
Recent federal budget measures under the Trump administration have included major proposals to decrease federal Medicaid funding and revise the program structure. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid expenditures by more than $1 trillion over 10 years, introducing provisions like work requirements and greater cost-sharing that could impact some beneficiaries’ coverage and funding. These policy changes may shift more financial responsibility to states and limit annual federal Medicaid growth, even as the program continues to cover tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $44,419,370 | 6.4% |
| 2021 | $47,023,337 | 5.9% |
| 2022 | $29,542,948 | -37.2% |
| 2023 | $23,211,507 | -21.4% |
| 2024 | $35,602,799 | 53.4% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $35,602,799 | 34.3% |
| 2 | Temporary National Codes (Non-Medicare) | $14,240,318 | 13.7% |
| 3 | Medicine Services and Procedures | $12,552,485 | 12.1% |
| 4 | Pathology and Laboratory Procedures | $11,790,231 | 11.4% |
| 5 | Evaluation and Management | $11,108,929 | 10.7% |
| 6 | Alcohol and Drug Abuse Treatment | $7,992,047 | 7.7% |
| 7 | Procedures / Professional Services | $6,141,674 | 5.9% |
| 8 | Dental Services | $1,410,991 | 1.4% |
| 9 | Radiology Procedures | $1,358,759 | 1.3% |
| 10 | Surgery | $846,144 | 0.8% |
| 11 | Drugs Administered Other than Oral Method | $645,470 | 0.6% |
| 12 | Durable Medical Equipment | $25,889 | <0.1% |
| 13 | Hearing Services | $25,001 | <0.1% |
| 14 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $10,989 | <0.1% |
| 15 | Medical And Surgical Supplies | $6,416 | <0.1% |
| 16 | Temporary Codes | $5,850 | <0.1% |
| 17 | Administrative, Miscellaneous and Investigational | $2,643 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T2016 | Habil res waiver per diem | $28,754,789 | 10 |
| T2023 | Targeted case mgmt per month | $1,780,474 | 14 |
| T2003 | N-et; encounter/trip | $1,571,372 | 22 |
| T1027 | Family training & counseling | $1,159,730 | 21 |
| T2022 | Case management, per month | $878,101 | 22 |
| T2019 | Habil sup empl waiver 15min | $839,043 | 10 |
| T1015 | Clinic service | $226,172 | 12 |
| T1019 | Personal care ser per 15 min | $219,549 | 15 |
| T1005 | Respite care service 15 min | $84,917 | 10 |
| T1023 | Program intake assessment | $68,507 | 17 |
| T1040 | Comm bh clinic svc per diem | $13,300 | 2 |
| T1020 | Personal care ser per diem | $6,840 | 8 |
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.
