Fairfield Medicaid providers submitted $12,825,726 in claims in 2024 for services grouped under the National Codes Established for State Medicaid Agencies, based on information from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This was a 9.6% increase from 2023, when claims for these services totaled $11,702,111.
Medicaid is a publicly funded health insurance program managed by states and supported by both federal and state governments. It provides coverage to low-income families and individuals, the elderly, children and people with disabilities, making it one of the country’s largest health care programs.
Because Medicaid is funded with taxpayer dollars, fluctuations in local billing reflect the way public resources for health care are distributed within a community.
The “National Codes Established for State Medicaid Agencies” category represents a set of Medicaid services identified by the type of care delivered, using standardized HCPCS and CPT code groups. Each code was mapped to a single service category by applying uniform code prefixes and numeric ranges, allowing for the grouping of similar services without double counting, and ensuring reliable year-to-year comparisons.
While Fairfield saw higher Medicaid spending in several service categories, National Codes Established for State Medicaid Agencies was third by total Medicaid payments in 2024.
Statewide, National Codes Established for State Medicaid Agencies claimed the top spot for total Medicaid payments in California in 2024.
Over the five years ending in 2024, Fairfield’s Medicaid payments for this category rose by $5,605,150, or 77.6%. Growth in spending was especially strong in select years, such as 2023 and 2021, which saw sharp increases.
Although payments were made throughout Fairfield, funds in this service category were concentrated in just a few ZIP codes. In 2024, ZIP code 94534 reported $7,547,771 in Medicaid payments, and 94533 saw $5,277,954. Combined, these top 2 ZIP codes accounted for 100% of all Fairfield Medicaid payments for this category.
Within this category, most Medicaid dollars were also focused on a small subset of individual billing codes.
Between 2023 and 2024, Fairfield experienced a 9.6% increase in Medicaid payments in this category, compared to a 10.1% change across all city Medicaid claim categories during that time frame.
According to the Centers for Medicare & Medicaid Services, combined state and federal Medicaid spending reached approximately $871.7 billion in fiscal 2023, about 18% of total national health expenditures, and up from $613.5 billion in 2019, before COVID-19.
This nearly 40% jump over several years was mainly due to expanded enrollment and increased medical utilization during and following the pandemic.
Federal budget laws under the Trump administration have included major initiatives to decrease federal Medicaid contributions and overhaul the system. The “One Big Beautiful Bill Act,” signed in 2025, is expected to reduce federal Medicaid outlays by more than $1 trillion over the next decade, and sets provisions for work requirements and higher cost-sharing, which could impact coverage and funding for certain groups. Such changes are likely to place greater financial responsibility on states and curb the future growth of federal Medicaid resources, even as the program continues to cover tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $7,220,575 | 1.8% |
| 2021 | $8,805,739 | 22% |
| 2022 | $7,368,760 | -16.3% |
| 2023 | $11,702,111 | 58.8% |
| 2024 | $12,825,725 | 9.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $18,437,785 | 25.4% |
| 2 | Alcohol and Drug Abuse Treatment | $14,532,059 | 2<0.1% |
| 3 | National Codes Established for State Medicaid Agencies | $12,825,725 | 17.7% |
| 4 | Medicine Services and Procedures | $12,580,040 | 17.3% |
| 5 | Radiology Procedures | $2,615,359 | 3.6% |
| 6 | Ambulance and Other Transport Services and Supplies | $2,606,489 | 3.6% |
| 7 | Procedures / Professional Services | $2,152,104 | 3% |
| 8 | Pathology and Laboratory Procedures | $1,540,822 | 2.1% |
| 9 | Temporary National Codes (Non-Medicare) | $1,463,678 | 2% |
| 10 | Anesthesia | $1,457,848 | 2% |
| 11 | Surgery | $600,762 | 0.8% |
| 12 | Drugs Administered Other than Oral Method | $563,536 | 0.8% |
| 13 | Dental Services | $514,194 | 0.7% |
| 14 | Hearing Services | $228,693 | 0.3% |
| 15 | Durable Medical Equipment | $224,672 | 0.3% |
| 16 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $93,132 | 0.1% |
| 17 | Medical And Surgical Supplies | $31,703 | <0.1% |
| 18 | Temporary Codes | $30,630 | <0.1% |
| 19 | Vision Services | $5,319 | <0.1% |
| 20 | Enteral and Parenteral Therapy | $2,037 | <0.1% |
| 21 | Outpatient PPS | $1,503 | <0.1% |
| 22 | Administrative, Miscellaneous and Investigational | $62 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1015 | Clinic service | $9,706,863 | 425 |
| T1017 | Targeted case management | $2,293,793 | 171 |
| T2024 | Serv asmnt/care plan waiver | $468,952 | 14 |
| T2021 | Day habil waiver per 15 min | $224,041 | 12 |
| T2007 | Non-emer transport wait time | $93,237 | 12 |
| T1001 | Nursing assessment/evaluatn | $19,031 | 12 |
| T1014 | Telehealth transmit, per min | $9,240 | 28 |
| T1004 | Nsg aide service up to 15min | $8,287 | 3 |
| T1007 | Treatment plan development | $2,278 | 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.
