In 2024, Medicaid providers in Coral Gables billed $15,471,342 for services categorized under National Codes Established for State Medicaid Agencies, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This figure reflects a 38.5% increase over 2023, when $11,166,951 in claims were submitted for the same services.
Medicaid, jointly funded by federal and state governments, operates as a public health insurance program across states. It serves low-income individuals and families, seniors, children, and those with disabilities, making it a key component of the U.S. health care system. More information about funding is available from the Commonwealth Fund.
Since Medicaid uses taxpayer resources, shifts in local billing data reveal how public health care funding is distributed within the community.
The “National Codes Established for State Medicaid Agencies” grouping includes particular Medicaid-billed services identified by the care provided, based on standardized HCPCS and CPT code sets. Analysts assigned each billing code to a service category using defined code prefixes and numeric ranges. This approach enabled cohesive analysis across services, avoided counting services multiple times, and supported precise annual rankings.
While Medicaid expenditures climbed in several groups, the National Codes Established for State Medicaid Agencies category led all Medicaid service categories in total payment volume in Coral Gables for 2024.
On the state level, this category ranked second overall in total Medicaid payments throughout Florida in 2024.
Over the five years before 2024, Medicaid payments connected to the National Codes Established for State Medicaid Agencies category in Coral Gables increased by $11,336,689—a growth of 274.2%. The pace of spending growth accelerated at key times, with marked year-over-year gains noted in both 2023 and 2021.
Although care spending in the National Codes Established for State Medicaid Agencies category occurred throughout the city, a few ZIP codes saw the bulk of 2024’s Medicaid payments. Within Coral Gables, codes 33134 drove $14,458,491 in Medicaid payments, 33145 saw $767,780, and 33146 registered $245,069. In combination, these 3 ZIP codes represented 100% of the Medicaid outlays in this category for the city during the year.
This service category also saw payments distributed mostly across a small portion of specific billing codes in 2024.
To illustrate, Medicaid payments related to this category in Coral Gables rose 38.5% from 2023 to 2024, while payments across all local Medicaid claim categories grew at a rate of 7.8% in the same time frame.
Centers for Medicare & Medicaid Services data shows total federal and state Medicaid spending climbed to approximately $871.7 billion in fiscal year 2023. Medicaid represented around 18% of total national health expenditures then, rising sharply from an estimated $613.5 billion in 2019, before the onset of the COVID-19 pandemic.
This jump signifies an increase of nearly 40% within a few years, due mainly to higher enrollment and greater service use during and following the pandemic’s impacts.
Recent federal budget actions under the Trump administration have introduced key proposals to scale back and change federal Medicaid funding. For instance, the “One Big Beautiful Bill Act,” enacted in 2025, is forecast to lower federal Medicaid spending by more than $1 trillion for the next decade. It introduces elements like work requirements and higher cost-sharing, which could limit coverage and resources for certain enrollees. As a result, more Medicaid expenses may shift to state governments, reducing the rate of federal Medicaid fund increases, but the program continues covering tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $4,134,653 | -14.2% |
| 2021 | $5,406,082 | 30.8% |
| 2022 | $4,795,453 | -11.3% |
| 2023 | $11,166,950 | 132.9% |
| 2024 | $15,471,342 | 38.5% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $15,471,342 | 32.7% |
| 2 | Evaluation and Management | $11,203,271 | 23.7% |
| 3 | Temporary National Codes (Non-Medicare) | $9,245,947 | 19.5% |
| 4 | Alcohol and Drug Abuse Treatment | $7,439,569 | 15.7% |
| 5 | Medicine Services and Procedures | $2,275,805 | 4.8% |
| 6 | Surgery | $578,183 | 1.2% |
| 7 | Enteral and Parenteral Therapy | $306,944 | 0.6% |
| 8 | Radiology Procedures | $267,937 | 0.6% |
| 9 | Administrative, Miscellaneous and Investigational | $161,999 | 0.3% |
| 10 | Pathology and Laboratory Procedures | $159,495 | 0.3% |
| 11 | Procedures / Professional Services | $54,140 | 0.1% |
| 12 | Anesthesia | $53,548 | 0.1% |
| 13 | Medical And Surgical Supplies | $26,515 | 0.1% |
| 14 | Ambulance and Other Transport Services and Supplies | $19,955 | <0.1% |
| 15 | Dental Services | $19,013 | <0.1% |
| 16 | Vision Services | $9,736 | <0.1% |
| 17 | Drugs Administered Other than Oral Method | $2,721 | <0.1% |
| 18 | Coronavirus Diagnostic Panel | $380 | <0.1% |
| 19 | Temporary Codes | $4 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1019 | Personal care ser per 15 min | $9,414,442 | 59 |
| T1017 | Targeted case management | $2,742,249 | 85 |
| T1025 | Ped compr care pkg, per diem | $2,217,237 | 12 |
| T1004 | Nsg aide service up to 15min | $692,680 | 14 |
| T1027 | Family training & counseling | $130,581 | 35 |
| T1015 | Clinic service | $105,240 | 85 |
| T2002 | N-et; per diem | $91,695 | 19 |
| T4534 | Youth size pull-on | $77,214 | 12 |
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 sourced from the U.S. Department of Health and Human Services Medicaid Provider Spending database. Source data is available here.
