In 2024, providers in Montclair billed $867,975 to Medicaid for services grouped under the National Codes Established for State Medicaid Agencies, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. That represents a 297.9% rise compared with 2023, when providers submitted $218,119 in claims for the same care category.
Medicaid operates as a publicly funded health insurance program managed by states and financed in partnership between federal and state governments. It serves low-income families and individuals, children, seniors, and people with disabilities, making up a substantial portion of the nation’s health care system.
Taxpayer dollars fund Medicaid payments, so shifts in local billing highlight how public health care resources are distributed across communities.
The “National Codes Established for State Medicaid Agencies” category encompasses a defined set of services, classified by standardized HCPCS and CPT code ranges that group like services together. For analysis, each billing code was allocated into a single service category based on code prefixes and number sequences, supporting grouped review, avoiding duplicate counting, and maintaining consistent rankings.
Although spending across different Medicaid categories rose, National Codes Established for State Medicaid Agencies was the highest by total Medicaid payments in Montclair for 2024.
Statewide in Virginia, this service group also ranked first by total Medicaid payments for the year.
From 2020 through 2024, Medicaid payments linked to this category in Montclair grew by $867,975, or 0%. Certain years saw particularly significant increases, especially in the years immediately before 2024.
While Medicaid spending in this category spanned the city, most payments were concentrated within a single ZIP code. In 2024, ZIP code 22025 led with $867,974 billed, accounting for 100% of all payments tied to this group in Montclair for the year.
Within this category, payments were largely focused on a relatively small set of specific billing codes.
To compare, Medicaid payments in Montclair for this service category grew 297.9% from 2023 to 2024, matching the 297.9% increase observed across all Medicaid billed categories in Montclair during the same window.
According to the Centers for Medicare & Medicaid Services, overall federal and state Medicaid spending reached about $871.7 billion in fiscal 2023, making up roughly 18% of the country’s total health expenditures—up sharply from around $613.5 billion in 2019, before the COVID-19 pandemic.
This surge reflects growth of nearly 40% over a few years, primarily fueled by rising enrollment and greater medical usage during and after the pandemic.
Recent federal budget measures under the Trump administration have included sizable proposals to cut federal Medicaid funding and reform the program. For instance, the “One Big Beautiful Bill Act,” enacted in 2025, is anticipated to reduce federal Medicaid spending by over $1 trillion in the next decade and adds policies such as work requirements and expanded cost-sharing. These changes may reduce coverage and funding for some recipients and shift more expenses to the states.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2023 | $218,118 | – |
| 2024 | $867,974 | 297.9% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $867,974 | 10<0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1019 | Personal care ser per 15 min | $855,962 | 11 |
| T1005 | Respite care service 15 min | $12,012 | 1 |
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.
