In 2024, Medicaid providers in Dumfries submitted $17,856,062 in claims for services within the National Codes Established for State Medicaid Agencies grouping, according to information from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount was up 22.5% compared with 2023, when billings for the same category reached $14,576,758.
Medicaid serves as a states-managed health insurance option financed through joint federal and state funds. The program extends coverage for people and families with low incomes, seniors, children, and individuals with disabilities, placing it among the largest components of the U.S. healthcare system.
Local variations in Medicaid billing reflect how public funds for healthcare are distributed at the community level.
The category “National Codes Established for State Medicaid Agencies” encompasses a set of Medicaid-billed services distinguished by care type and organized under standardized HCPCS and CPT code groupings. For analytical purposes, each code was aligned with a single service category using set code prefixes and numeration, which supports tracking related services, discourages duplication, and maintains consistent rank comparisons over time.
While Medicaid spending rose across many service types, National Codes Established for State Medicaid Agencies ranked as the second-highest for Dumfries Medicaid payments in 2024.
Across Virginia, the National Codes Established for State Medicaid Agencies grouping held the top spot for Medicaid payments statewide in 2024.
From 2019 through 2024, Dumfries Medicaid payments linked to this category grew by $10,041,076 or 128.5%. Segments of this period saw stronger growth, with especially notable yearly increases logged in 2022 and 2021.
The distribution of Medicaid funding for this category throughout the city mostly centered on select ZIP codes. In 2024, the highest Medicaid disbursements associated with the National Codes Established for State Medicaid Agencies category were found in ZIP codes 22026, with $13,801,116, and 22025, with $4,054,945. Combined, these two ZIP codes represented all of Dumfries’ Medicaid payments to the category that year.
Payments within the National Codes Established for State Medicaid Agencies category primarily went to a small subset of HCPCS billing codes.
Between 2024 and 2023, Dumfries Medicaid payments attributed to National Codes Established for State Medicaid Agencies advanced 22.5%, in comparison to a 24.4% year-over-year increase seen across all Medicaid claim categories in the area over that period.
According to the Centers for Medicare & Medicaid Services, federal and state spending through Medicaid reached about $871.7 billion in fiscal year 2023, making up around 18% of total national healthcare expenditures. This was a notable jump from the roughly $613.5 billion spent in 2019 before the COVID-19 public health emergency.
The increase signals a growth rate of roughly 40% in recent years, mainly connected to a rise in enrollments and increased service use during and following the pandemic.
Major federal budget measures passed during the Trump administration included proposals to limit Medicaid funding at the federal level and reshape the program’s structure. For instance, the “One Big Beautiful Bill Act,” enacted in 2025, is forecast to decrease federal Medicaid spending by more than $1 trillion over 10 years and introduces elements such as work requirements and higher cost-sharing. These changes are forecast to potentially lower coverage levels and federal Medicaid funding for some recipients, leading to larger financial responsibilities for states even while the program covers tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $7,814,985 | 1.7% |
| 2021 | $9,605,226 | 22.9% |
| 2022 | $12,892,462 | 34.2% |
| 2023 | $14,576,758 | 13.1% |
| 2024 | $17,856,061 | 22.5% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Alcohol and Drug Abuse Treatment | $19,951,160 | 44.6% |
| 2 | National Codes Established for State Medicaid Agencies | $17,856,061 | 39.9% |
| 3 | Medicine Services and Procedures | $3,369,728 | 7.5% |
| 4 | Temporary National Codes (Non-Medicare) | $2,624,674 | 5.9% |
| 5 | Evaluation and Management | $841,560 | 1.9% |
| 6 | Pathology and Laboratory Procedures | $32,660 | 0.1% |
| 7 | Procedures / Professional Services | $19,758 | <0.1% |
| 8 | Vision Services | $1,619 | <0.1% |
| 9 | Radiology Procedures | $1,274 | <0.1% |
| 10 | Surgery | $888 | <0.1% |
| 11 | Dental Services | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1019 | Personal care ser per 15 min | $13,879,459 | 72 |
| T2021 | Day habil waiver per 15 min | $2,272,961 | 12 |
| T1005 | Respite care service 15 min | $1,703,641 | 56 |
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.
