North Carolina Medicaid payments reach $1.4 billion for services under national code standards in 2024

In 2024, Medicaid payments for services grouped under the National Codes Established for State Medicaid Agencies totaled $1,404,076,859 across North Carolina, according to figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. That amount represents a 3% rise from the prior year, when claims reached $1,363,745,090.

Medicaid, a public health insurance initiative overseen by states and funded through both federal and state contributions, serves low-income families and individuals, seniors, children, and people with disabilities. It is one of the most significant parts of the United States’ health care system.

Given that Medicaid expenditures come from taxpayer funding, fluctuations in local billing offer insight into how these public health resources are distributed in individual communities.

The “National Codes Established for State Medicaid Agencies” service category encompasses a selection of services defined according to type of care and based on standardized HCPCS and CPT coding structures. For this report, every billing code was sorted into a single service group by matching code prefixes and number ranges. This method supports consistency in comparing related services and avoids double counting, ensuring accurate performance rankings over time.

In some cases, these categories cover multiple underlying service types, grouping together related forms of care that are frequently billed at the same time in Medicaid—for instance, routine office visits, diagnostic procedures, or therapeutic services.

From 2019 to 2024, Medicaid payments associated with the National Codes Established for State Medicaid Agencies category in North Carolina rose by $527,353,146, or 60.2%. Some periods within that span experienced particularly sharp year-over-year growth, notably in 2020 and 2023.

Although these payments were spread throughout the state, they were concentrated in specific ZIP codes. In 2024, ZIP Code 28227 posted Medicaid payments totaling $136,720,362 (9.7% of the statewide total), with ZIP Code 28704 at $104,849,891 (7.5%) and ZIP Code 28054 at $45,745,962 (3.3%).

Altogether, the top 3 ZIP codes represented 20.5% of Medicaid expenditures under this service category across North Carolina for the year.

In comparison, Medicaid spending across all claim types in North Carolina increased by 3.2% from 2023 to 2024.

Spending climbed in several service groups, yet the National Codes Established for State Medicaid Agencies category remained among the highest statewide in 2024 by overall dollars paid.

The Centers for Medicare & Medicaid Services reported that combined state and federal Medicaid costs neared $871.7 billion in fiscal year 2023. This expenditure made up about 18% of all national health spending, a significant increase from $613.5 billion in 2019 prior to COVID-19.

This change marks a roughly 40% jump in just a few years, mainly due to expanded program enrollment and increased service use during and following the pandemic.

The Trump administration approved federal budget legislation bringing major changes to Medicaid funding and program structure. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce more than $1 trillion in federal Medicaid outlays over 10 years and enacts new provisions, such as work requirements and expanded cost-sharing. Such policies could lower federal coverage and funding for some beneficiaries and place a greater financial burden on states while the program continues serving tens of millions of Americans.