Raleigh Medicaid claims for national state codes total $110 million in 2024

In 2024, Medicaid providers in Raleigh billed $110,465,768 for services within the National Codes Established for State Medicaid Agencies category, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represents a 4.9% rise compared with 2023, when $105,290,030 in Medicaid claims were made for this service group.

Medicaid operates as a public health insurance system, run by individual states but financed through a partnership between state and federal governments. It provides coverage for individuals and families with low incomes, older adults, children, and those with disabilities, positioning itself as a major component of the U.S. health care system.

Since Medicaid is taxpayer-funded, variations in billing in local communities reflect how public health dollars are dispersed.

The National Codes Established for State Medicaid Agencies grouping consists of Medicaid-billed services sorted by care type, utilizing standardized HCPCS and CPT code sets. For the analysis, each billing code was assigned once to a relevant service group by matching code prefixes and numerical ranges, ensuring accurate tabulation and avoiding overlap when reporting payment trends and rankings.

Medicaid spending saw increases across various categories, with National Codes Established for State Medicaid Agencies accounting for the highest total Medicaid payments in Raleigh in 2024.

For North Carolina overall, this category was also ranked number one by Medicaid payments in 2024.

Between 2019 and 2024, Medicaid-related payments for the National Codes Established for State Medicaid Agencies category in Raleigh rose by $42,779,352, a 63.2% increase. Some years, including 2023 and 2020, documented significant year-over-year growth.

Payments for services classified in this category occurred citywide but were mainly focused in a few ZIP codes. In 2024, ZIP code 27609 had Medicaid payments totaling $40,485,881, followed by 27615 with $28,066,643 and 27607 with $21,541,268. Combined, these 3 ZIP codes made up 81.6% of the Medicaid payments linked to this category in Raleigh for the year.

Furthermore, a small share of billing codes accounted for the majority of Medicaid dollars under this category.

To compare, Medicaid spending for the National Codes Established for State Medicaid Agencies in Raleigh went up by 4.9% from 2023 to 2024, while Medicaid payments for all claim categories citywide climbed by just 0.6% during this period.

According to the Centers for Medicare & Medicaid Services, federal and state Medicaid expenditures combined reached about $871.7 billion in fiscal 2023, comprising approximately 18% of U.S. national health spending—up from roughly $613.5 billion in 2019, prior to the COVID-19 pandemic.

This represents growth of about 40% within a few years, fueled mainly by higher enrollment and service utilization during and after the pandemic.

Recent federal budget measures signed under the Trump administration have proposed cuts to federal Medicaid funds and restructuring the program. Notably, the “One Big Beautiful Bill Act,” enacted in 2025, is anticipated to cut federal Medicaid spending by over $1 trillion in the next decade while introducing new requirements, such as work mandates and greater cost-sharing, which may reduce availability and funding for some recipients. These changes will likely shift more costs to states and restrain federal contributions, though Medicaid will continue to support millions nationwide.

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.