Santa Monica Medicaid providers reported $5,435,165 in billed services under the National Codes Established for State Medicaid Agencies category for 2024, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This was a 43.3% rise from 2023, during which providers recorded $3,791,828 in claims for this service type.
Medicaid, administered by the states and funded jointly by federal and state governments, offers public health insurance coverage to low-income people, families, seniors, children, and those with disabilities. It remains a major component of the U.S. health care landscape.
Because taxpayer funds support Medicaid payments, shifts in local billing levels reflect the allocation of public health dollars around the community.
The “National Codes Established for State Medicaid Agencies” group represents a variety of Medicaid-billed services defined by standardized HCPCS and CPT code groupings. For this review, billing codes were categorized into a single service category based on consistent prefixes and number ranges, which made it possible to analyze related services as one set without overlap and to track payment rankings across different years accurately.
Among all service types, National Codes Established for State Medicaid Agencies received the highest total Medicaid payments in Santa Monica for 2024.
Statewide, this service category also led others in total Medicaid payments in California in 2024.
From 2019 through 2024, Medicaid payments for the National Codes Established for State Medicaid Agencies group in Santa Monica grew by $2,227,866, or 69.5%. Certain periods, including 2020 and 2023, exhibited particularly strong year-over-year increases.
While Medicaid payments for this category occurred citywide, the majority originated in a small number of ZIP codes. In 2024, ZIP code 90405 accounted for $3,839,939 and 90404 logged $1,595,226 in related payments. Together, these top 2 ZIP codes represented 100% of local Medicaid payments in this category for the year.
A limited set of individual billing codes also captured the bulk of Medicaid payments within this service category.
To compare, Santa Monica posted a 43.3% rise in Medicaid payments under this category between 2024 and 2023, while all claim categories together in the city increased by 11.6% over the same period.
Centers for Medicare & Medicaid Services data indicate combined federal and state Medicaid spending totaled approximately $871.7 billion in fiscal year 2023, making up about 18% of all U.S. health expenditures. This figure rose from $613.5 billion in 2019, prior to the COVID-19 pandemic.
This nearly 40% rise over just several years stems mainly from higher enrollment and increased use of services during and after the pandemic.
Recent funding proposals and budget actions at the federal level during the Trump administration have called for significant changes to Medicaid’s structure and federal financial commitment. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to enforce over $1 trillion in federal Medicaid funding reductions over 10 years and add policies including work requirements and higher participant cost-sharing. These provisions could cut federal coverage and funding for certain recipients, while shifting more responsibility to states, even as enrollment remains high.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $3,207,298 | 36.2% |
| 2021 | $3,509,921 | 9.4% |
| 2022 | $2,819,793 | -19.7% |
| 2023 | $3,791,828 | 34.5% |
| 2024 | $5,435,165 | 43.3% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $5,435,165 | 36.8% |
| 2 | Evaluation and Management | $3,142,938 | 21.3% |
| 3 | Pathology and Laboratory Procedures | $2,554,707 | 17.3% |
| 4 | Medicine Services and Procedures | $1,453,986 | 9.8% |
| 5 | Anesthesia | $892,186 | 6% |
| 6 | Temporary National Codes (Non-Medicare) | $489,134 | 3.3% |
| 7 | Radiology Procedures | $485,766 | 3.3% |
| 8 | Dental Services | $176,316 | 1.2% |
| 9 | Drugs Administered Other than Oral Method | $102,325 | 0.7% |
| 10 | Temporary Codes | $11,121 | 0.1% |
| 11 | Procedures / Professional Services | $10,512 | 0.1% |
| 12 | Surgery | $8,132 | 0.1% |
| 13 | Medical And Surgical Supplies | $2,618 | <0.1% |
| 14 | Vision Services | $1,885 | <0.1% |
| 15 | Administrative, Miscellaneous and Investigational | $250 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1015 | Clinic service | $3,839,939 | 263 |
| T2031 | Assist living waiver/diem | $1,592,924 | 11 |
| T1001 | Nursing assessment/evaluatn | $2,301 | 2 |
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.
