Providers in Downey submitted $18,783,490 in Medicaid claims for services under the National Codes Established for State Medicaid Agencies category in 2024, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents an 11% rise over 2023, when claims in this category totaled $16,922,671.
Medicaid, managed by states with joint federal and state funding, insures low-income individuals, families, older adults, children and those with disabilities, making it a key component of the U.S. health care structure. For more information on Medicaid funding, view resources from the Commonwealth Fund.
Because taxpayer dollars fund Medicaid, shifts in local billing levels illustrate how public health care funds are distributed within each community.
The “National Codes Established for State Medicaid Agencies” category groups Medicaid claims by type of care, based on standard HCPCS and CPT code sets. In this report, billing codes were mapped to service categories using consistent code prefixes and numerical ranges. This allows for clear service analysis, avoids overlapping claims, and maintains accurate category rankings over time.
Total Medicaid spending increased across several categories, but National Codes Established for State Medicaid Agencies led all categories in Downey for 2024 by total dollar amount.
For California overall, this category was also the top recipient of Medicaid payments in 2024.
Between 2019 and 2024, Medicaid claims in Downey for the National Codes Established for State Medicaid Agencies category climbed by $10,234,486, or 119.7%. Periods of accelerated growth occurred, with year-over-year gains recorded in 2023 and 2021.
Spending on these services was spread citywide, yet the highest payments came from a few ZIP codes: 90241 reported $10,569,841 and 90242 $8,213,647 in 2024. These two ZIP codes together made up 100% of Downey’s Medicaid payments for this category that year.
Payments tied to National Codes Established for State Medicaid Agencies were also focused among a few specific billing codes in 2024.
From 2023 to 2024, Medicaid payments related to this category in Downey grew 11%, outpacing the 2.2% change observed for all Medicaid claim categories citywide in the same period.
According to the Centers for Medicare & Medicaid Services, state and federal Medicaid spending reached about $871.7 billion in fiscal year 2023, accounting for approximately 18% of national health expenditures—up significantly from $613.5 billion in 2019, prior to the COVID-19 pandemic.
The increase of around 40% in just a few years stemmed in large part from increased enrollment and usage during and after the pandemic.
Federal budget laws under the Trump administration have led to proposals that reduce federal Medicaid funding and change the program structure. The “One Big Beautiful Bill Act,” enacted in 2025, is estimated to cut more than $1 trillion in federal Medicaid support over the coming decade and introduces work requirements and greater cost sharing that could reduce payments and coverage for some participants. Such policy shifts are expected to move additional costs to states and slow growth in federal Medicaid support, while the program continues to cover tens of millions nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $8,549,003 | 3.3% |
| 2021 | $11,478,471 | 34.3% |
| 2022 | $10,234,036 | -10.8% |
| 2023 | $16,922,670 | 65.4% |
| 2024 | $18,783,489 | 11% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $18,783,489 | 22.4% |
| 2 | Evaluation and Management | $17,161,143 | 20.4% |
| 3 | Alcohol and Drug Abuse Treatment | $15,715,608 | 18.7% |
| 4 | Medicine Services and Procedures | $15,415,072 | 18.4% |
| 5 | Radiology Procedures | $7,003,366 | 8.3% |
| 6 | Pathology and Laboratory Procedures | $2,166,291 | 2.6% |
| 7 | Anesthesia | $1,623,519 | 1.9% |
| 8 | Temporary National Codes (Non-Medicare) | $1,183,275 | 1.4% |
| 9 | Medical And Surgical Supplies | $1,128,866 | 1.3% |
| 10 | Dental Services | $825,590 | 1% |
| 11 | Procedures / Professional Services | $729,529 | 0.9% |
| 12 | Drugs Administered Other than Oral Method | $638,704 | 0.8% |
| 13 | Surgery | $550,210 | 0.7% |
| 14 | Ambulance and Other Transport Services and Supplies | $468,210 | 0.6% |
| 15 | Chemotherapy Drugs | $161,068 | 0.2% |
| 16 | Orthotic Procedures and services | $141,679 | 0.2% |
| 17 | Durable Medical Equipment | $83,951 | 0.1% |
| 18 | Administrative, Miscellaneous and Investigational | $66,392 | 0.1% |
| 19 | Prosthetic Procedures | $54,927 | 0.1% |
| 20 | Temporary Codes | $54,703 | 0.1% |
| 21 | Vision Services | $18,565 | <0.1% |
| 22 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $14,554 | <0.1% |
| 23 | Pathology and Laboratory Services | $8,046 | <0.1% |
| 24 | Hearing Services | $1,141 | <0.1% |
| 25 | Coronavirus Diagnostic Panel | $625 | <0.1% |
| 26 | Outpatient PPS | $541 | <0.1% |
| 27 | EOM (Enhancing Oncology Model) Enhanced Services | $98 | <0.1% |
| 28 | Components, Accessories and Supplies | $0 | <0.1% |
| 28 | Miscellaneous Medical Services | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T2031 | Assist living waiver/diem | $14,026,605 | 55 |
| T1015 | Clinic service | $4,406,965 | 268 |
| T4541 | Large disposable underpad | $155,239 | 23 |
| T4527 | Adult size pull-on lg | $42,765 | 23 |
| T4523 | Adult size brief/diaper lg | $30,798 | 20 |
| T4522 | Adult size brief/diaper med | $24,908 | 19 |
| T4534 | Youth size pull-on | $22,173 | 6 |
| T4524 | Adult size brief/diaper xl | $21,139 | 16 |
| T4535 | Disposable liner/shield/pad | $20,495 | 19 |
| T4526 | Adult size pull-on med | $16,437 | 15 |
| T4528 | Adult size pull-on xl | $13,051 | 11 |
| T4525 | Adult size pull-on sm | $1,639 | 3 |
| T4530 | Ped size brief/diaper lg | $1,270 | 1 |
| T1014 | Telehealth transmit, per min | $0 | 1 |
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.