Medicaid payments for state agency code services up 9.1% in Caribou in 2024

In Caribou, Medicaid providers billed a total of $4,841,523 in 2024 for services designated under the National Codes Established for State Medicaid Agencies category, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This figure represents a 9.1% rise compared to 2023, when claims under the same category amounted to $4,439,173.

Medicaid, a state-run public health insurance program with joint federal and state funding, serves low-income families and individuals, seniors, children, and those with disabilities. It is a major component of the U.S. health care system.

Given that Medicaid funding derives from public sources, local billing fluctuations indicate how taxpayer health dollars are distributed within a community.

The “National Codes Established for State Medicaid Agencies” classification includes a set of Medicaid services organized by standardized HCPCS and CPT code groupings. For the purposes of this analysis, each billing code was categorized into a single service group using set code prefixes and numerical ranges, enabling a comprehensive look at related services, with steps taken to prevent overlap and maintain precise rankings over the years.

Among all Medicaid service categories, National Codes Established for State Medicaid Agencies led in Caribou for total payments in 2024.

Statewide in Maine, National Codes Established for State Medicaid Agencies also ranked first by payments in 2024.

Looking at the period spanning five years before 2024, Caribou’s Medicaid payments for this category rose by $2,806,848, a gain of 138%. Increases accelerated in certain years, notably in 2023 and 2022, as indicated by consistent year-over-year growth.

While these Medicaid expenditures spread across Caribou, the bulk was concentrated in a small number of ZIP codes. In 2024, ZIP code 04736 accounted for $4,841,522 of the payments tied to National Codes Established for State Medicaid Agencies, representing 100% of such Medicaid spending for the city that year.

Medicaid payments in this service category were largely linked to a handful of billing codes.

For context, Medicaid payments for these state-level agency codes in Caribou increased by 9.1% from 2023 to 2024, compared with an 8.9% rise for all Medicaid claim types locally during the same period.

According to the Centers for Medicare & Medicaid Services, total state and federal Medicaid spending reached approximately $871.7 billion in fiscal year 2023, representing about 18% of total U.S. health expenditures, a notable rise from $613.5 billion in 2019, ahead of the COVID-19 pandemic.

This reflects an increase of about 40% over several years, mainly driven by more enrollees and greater use of services both during and after the pandemic.

Legislation approved during the Trump administration contained significant proposals to scale back federal Medicaid funding and reform the program. For instance, the “One Big Beautiful Bill Act,” which became law in 2025, is expected to reduce federal Medicaid contributions by over $1 trillion in the next decade and puts in place measures such as work requirements and increased cost-sharing. These provisions could limit coverage for some beneficiaries and shift additional financial responsibility to states, potentially restricting future federal Medicaid funding growth even as the program continues to serve millions across the country.

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.