Worcester Medicaid payments for state agency national code services rise to $83.5M in 2024

In 2024, Medicaid providers in Worcester accounted for $83,483,971 in billed services within the National Codes Established for State Medicaid Agencies category, according to data published in the U.S. Department of Health and Human Services Medicaid Provider Spending database. This total represents a 14.8% rise from 2023, when providers submitted $72,690,860 in claims for the same services.

Medicaid, a state-managed public health insurance program jointly funded by federal and state governments, covers individuals and families with low incomes, as well as seniors, children, and people with disabilities. The program remains one of the largest components of the U.S. health care system. For additional details on Medicaid funding see this explainer.

Since taxpayer dollars fund Medicaid, changes in local billing reflect how communities allocate public health care resources.

The “National Codes Established for State Medicaid Agencies” category encompasses Medicaid claims grouped by type of care using standardized HCPCS and CPT code designations. In this analysis, service categories were assigned based on the initial prefixes and ranges of billing codes, making possible an examination of related services over time while ensuring codes were not counted twice and rankings stayed consistent.

While multiple Medicaid service categories posted spending increases, National Codes Established for State Medicaid Agencies held the No. 2 spot in Worcester for total Medicaid payments in 2024.

Statewide in Massachusetts, the National Codes Established for State Medicaid Agencies category recorded the highest total Medicaid payments for 2024.

Over the five years ending in 2024, payments tied to this category in Worcester grew by $17,515,715, or 17.3%. Spending levels rose faster during several periods, with significant increases noted in both 2020 and 2022.

Although Medicaid funds for this care category were spent throughout the city, payment concentrations were highest in certain ZIP codes. In 2024, ZIP 01608 accounted for $41,062,478, ZIP 01606 for $13,859,838, and ZIP 01604 for $10,489,531. Combined, these top 3 ZIP codes represented 78.4% of all Medicaid payments related to the National Codes Established for State Medicaid Agencies category in Worcester.

Payments in this category were further concentrated within a small number of individual billing codes.

Between 2024 and 2023, the 14.8% increase in Worcester Medicaid payments for this category outpaced the 2.4% rise recorded across all Medicaid claim categories in the city during the period.

According to data from the Centers for Medicare & Medicaid Services, combined federal and state expenses on Medicaid reached about $871.7 billion in fiscal year 2023, representing roughly 18% of all national health spending. This marked a sharp increase from approximately $613.5 billion in 2019, prior to the COVID-19 pandemic.

Overall, the national Medicaid spending growth of about 40% over these years stemmed largely from expanded enrollment and increased utilization during and after the pandemic.

Recent federal budget laws signed during the Trump administration have brought forward major plans to reduce federal funding and overhaul Medicaid’s structure. For instance, the “One Big Beautiful Bill Act,” signed in 2025, is projected to slash more than $1 trillion in federal Medicaid spending over the coming decade. It introduces requirements like work mandates and more cost-sharing, policies expected to limit benefits and funding for certain recipients and shift increased responsibility to states while restricting federal Medicaid support across the country.

Note: HCPCS codes are provided for context within the category. Category totals and rankings are based on standardized service grouping methods, not on billing codes individually.

This article is based on information from the U.S. Department of Health and Human Services Medicaid Provider Spending database. Source data can be accessed here.