Calais Medicaid spending on national service codes totals $1.6 million in 2024

Calais Medicaid providers billed $1,616,435 for services falling under the National Codes Established for State Medicaid Agencies in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This amount represents an 8.4% increase over 2023, when providers submitted $1,490,666 in claims for the same category of service.

Medicaid, a public health insurance program administered by the states and funded through joint federal and state contributions, covers low-income people, the elderly, children, and individuals with disabilities, making it a significant component of the U.S. health care landscape.

Since taxpayer funds supply Medicaid, changes in local billing figures highlight how public health care resources are distributed within communities.

The “National Codes Established for State Medicaid Agencies” category encompasses a set of Medicaid-billed services defined by service type, using fixed HCPCS and CPT code groups. Each billing code in this analysis was placed into a single service category, using designated prefixes and number ranges, to examine similar services together. This structure helps avoid duplication and maintains accurate rankings over the years.

Although multiple Medicaid service categories saw higher spending, National Codes Established for State Medicaid Agencies was second highest in Calais by Medicaid payments in 2024.

Statewide, this category ranked first in Maine for total Medicaid payments in 2024.

From the five-year period leading to 2024, Medicaid outlays tied to this category in Calais expanded by $876,167, or 118.4%. Spending jumped more rapidly in certain years, with strong annual increases recorded in both 2023 and 2022.

While citywide spending was distributed across Calais, the bulk of Medicaid payments for the National Codes Established for State Medicaid Agencies category came from a small number of ZIP codes. In 2024, ZIP code 04619 accounted for $1,616,434—comprising 100% of all Calais Medicaid payments in this category that year.

Payments within the category were further concentrated in a select few individual HCPCS billing codes.

Compared with all Medicaid claim categories in the city, payments associated with the National Codes Established for State Medicaid Agencies in Calais increased by 8.4% between 2024 and 2023, versus an overall change of 1.1% for all Medicaid claim categories over the same timeframe.

According to the Centers for Medicare & Medicaid Services, combined state and federal Medicaid spending reached around $871.7 billion nationwide in fiscal 2023, making up about 18% of total national health spending, a steep rise from $613.5 billion in 2019, the year before the COVID-19 pandemic.

The increase marks roughly 40% growth over just a few years, fueled by greater enrollment and more service use during and after the pandemic.

Federal budget measures under the Trump administration have featured major proposals to dial back federal Medicaid funding and remake the program’s structure. The “One Big Beautiful Bill Act,” approved in 2025, is expected to trim over $1 trillion in federal Medicaid spending over the next 10 years and introduces requirements such as work mandates and higher cost-sharing, which could impact coverage and funding for some recipients. These changes may shift additional expenses to states while capping federal Medicaid growth, even as the program continues serving tens of millions nationwide.

Note: HCPCS codes are provided to contextualize the category. Totals and rankings in this story use standardized service groupings, not solely individual billing codes.

Information in this article comes from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The underlying data can be accessed here.