Atherton Medicaid payments for National Codes Established for State Medicaid Agencies reach $2,645,572 in 2024

In 2024, Medicaid providers in Atherton submitted $2,645,572 in claims for services classified under the National Codes Established for State Medicaid Agencies category, according to data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 1% growth from 2023, when providers billed $2,618,468 for the same set of services.

Medicaid, a public health insurance program managed at the state level and jointly funded by state and federal governments, provides coverage for low-income people and families, children, seniors, and those with disabilities, making it a core part of America’s health care infrastructure.

As Medicaid funding is supported by public dollars, shifts in local billing activity reflect how communities dedicate resources to health care needs.

The “National Codes Established for State Medicaid Agencies” group includes Medicaid-billed services designated by standardized HCPCS and CPT code ranges tied to specific types of care. For analysis, billing codes were grouped under a single service category using unified code prefixes and numeric sequences. This grouping helps track related services accurately and prevents duplication in reported figures or rankings over multiple years.

Though several Medicaid service categories saw spending increases, in 2024 the National Codes Established for State Medicaid Agencies category accounted for the highest total Medicaid payments in Atherton.

Statewide, this category also led all others in California by total payments in the same year.

Between 2019 and 2024, Medicaid payments for the National Codes Established for State Medicaid Agencies category in Atherton climbed by $664,462, or 33.5%. There were particularly strong year-over-year increases noted during 2021 and 2023.

Although payments related to this category were distributed across Atherton, most funds were paid out in a few ZIP codes. In 2024, ZIP code 94027 alone represented $2,645,571 of such payments, with the top 1 ZIP codes comprising 100% of the Medicaid spending under this category citywide for the year.

Within this group, Medicaid dollars were heavily focused on a select set of billing codes.

For context, Medicaid payments for the National Codes Established for State Medicaid Agencies category in Atherton rose by 1% from 2023 to 2024, while payments for all Medicaid claim categories across the city changed by 3.4% over the same time period.

According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending rose to approximately $871.7 billion in fiscal 2023, making up about 18% of national health expenditures, sharply up from $613.5 billion in 2019, prior to the onset of COVID-19.

This increase reflects roughly a 40% jump in a few years, fueled in part by broader enrollment and higher service use during and after the pandemic.

The federal budget passed during the Trump administration included proposals to decrease federal Medicaid spending and restructure the program. The “One Big Beautiful Bill Act,” signed in 2025, is expected to trim over $1 trillion from Medicaid at the federal level in the next decade and introduces provisions such as work requirements and increased recipient cost-sharing, potentially scaling back access and funding for parts of the Medicaid population. This will likely result in a larger share of program costs being assumed by states even as Medicaid continues serving tens of millions of Americans.

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.