Medicaid providers in Amherst billed $10,103,966 for services falling under the National Codes Established for State Medicaid Agencies category in 2024, according to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents a 7.4% increase from 2023, when providers submitted $9,406,242 in claims for the same group of services.
Medicaid, a public health insurance program overseen by states and funded through both federal and state contributions, serves low-income individuals, families, seniors, children, and people with disabilities. It remains a cornerstone of the U.S. health care system.
Taxpayer funding of Medicaid means local shifts in billing levels reflect the allocation of public health care resources in a community.
The “National Codes Established for State Medicaid Agencies” group represents a collection of Medicaid-billed services defined by specific care types, based on standardized HCPCS and CPT code groupings. For this review, each code was associated with a single service category using systematic code prefixes and number ranges. This method allows analysis of related services, avoids double counting, and maintains consistent rankings across different time periods.
Medicaid expenditures rose in several service categories, but the National Codes Established for State Medicaid Agencies category received the highest total Medicaid payments in Amherst in 2024.
Statewide in New York, this category also led in total Medicaid payments in 2024.
Over the five years ending in 2024, Medicaid payments tied to the National Codes Established for State Medicaid Agencies category in Amherst rose by $3,269,184, an increase of 24.4%. Certain timeframes saw significant jumps in spending, notably in 2020 and 2023.
Spending under this category was distributed throughout Amherst, but a few ZIP codes saw the bulk of payments. In 2024, ZIP code 14221 had $8,934,184 in Medicaid payments, while ZIP code 14226 recorded $1,169,780. Together, these top 2 ZIP codes accounted for 100% of all Medicaid payments in this category across Amherst for the year.
A small group of individual billing codes within the National Codes Established for State Medicaid Agencies category accounted for most of the Medicaid payments.
Comparatively, Medicaid payments tied to this category in Amherst increased 7.4% from 2023 to 2024, whereas all Medicaid claim categories in the city collectively saw an 11.8% change in the same time span.
According to the Centers for Medicare & Medicaid Services, total state and federal Medicaid spending reached approximately $871.7 billion in fiscal 2023, about 18% of national health expenditures, jumping significantly from roughly $613.5 billion in 2019 prior to the COVID-19 pandemic.
This growth—about 40% in a few years—was largely fueled by expanded enrollment and higher utilization during and after the pandemic period.
Recent federal budget measures under the Trump administration featured major proposals to reduce federal Medicaid funding and make program changes. The “One Big Beautiful Bill Act,” signed into law in 2025, is expected to reduce federal Medicaid spending by more than $1 trillion over the coming decade, introducing policies such as work requirements and increased cost-sharing. These measures could cut coverage and funding for some enrollees, with states bearing a greater share of costs and federal Medicaid growth limited, even as millions of Americans continue relying on the program.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $13,373,150 | 19.7% |
| 2021 | $10,236,653 | -23.5% |
| 2022 | $8,070,024 | -21.2% |
| 2023 | $9,406,242 | 16.6% |
| 2024 | $10,103,965 | 7.4% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $10,103,965 | 38.4% |
| 2 | Evaluation and Management | $4,608,565 | 17.5% |
| 3 | Procedures / Professional Services | $2,831,547 | 10.8% |
| 4 | Ambulance and Other Transport Services and Supplies | $2,341,463 | 8.9% |
| 5 | Medicine Services and Procedures | $2,302,986 | 8.8% |
| 6 | Alcohol and Drug Abuse Treatment | $2,034,873 | 7.7% |
| 7 | Pathology and Laboratory Procedures | $613,412 | 2.3% |
| 8 | Radiology Procedures | $543,336 | 2.1% |
| 9 | Surgery | $280,117 | 1.1% |
| 10 | Dental Services | $223,292 | 0.8% |
| 11 | Outpatient PPS | $156,660 | 0.6% |
| 12 | Durable Medical Equipment | $98,418 | 0.4% |
| 13 | Temporary National Codes (Non-Medicare) | $48,528 | 0.2% |
| 14 | Medical And Surgical Supplies | $35,904 | 0.1% |
| 15 | Orthotic Procedures and services | $26,637 | 0.1% |
| 16 | Vision Services | $18,608 | 0.1% |
| 17 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $9,143 | <0.1% |
| 18 | Drugs Administered Other than Oral Method | $6,923 | <0.1% |
| 19 | Chemotherapy Drugs | $5,697 | <0.1% |
| 20 | Administrative, Miscellaneous and Investigational | $3,418 | <0.1% |
| 21 | Anesthesia | $2,567 | <0.1% |
| 22 | Temporary Codes | $859 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1019 | Personal care ser per 15 min | $10,081,538 | 25 |
| T1022 | Contracted services per day | $12,657 | 5 |
| T4522 | Adult size brief/diaper med | $3,749 | 4 |
| T4523 | Adult size brief/diaper lg | $3,566 | 3 |
| T4524 | Adult size brief/diaper xl | $2,455 | 2 |
Note: HCPCS codes are provided for context within the category. Category totals and rankings in this article are based on standardized service groupings, not individual billing codes.
This article is based on information from the U.S. Department of Health and Human Services Medicaid Provider Spending database. Source data is available here.
