Marion Medicaid providers recorded $8,101,418 in claims for services within the National Codes Established for State Medicaid Agencies category in 2024, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This reflects a 16.1% uptick over 2023, when claims in the same category totaled $6,977,692.
Medicaid, funded through both federal and state sources and administered by states, offers health insurance coverage to eligible low-income individuals and families, seniors, children, and people with disabilities. The program is a key component of the larger U.S. health care landscape.
Because funding comes from taxpayers, fluctuations in Marion’s Medicaid billing shed light on how public health spending is directed locally.
The “National Codes Established for State Medicaid Agencies” group includes a set of Medicaid service claims defined by their specific care types, based on standardized HCPCS and CPT code classifications. This analysis categorizes each code under a single service group using uniform code prefixes and numbers, supporting accurate trend tracking and preventing duplicate counts.
Of the various Medicaid service groups, National Codes Established for State Medicaid Agencies topped all other categories for total Medicaid spending in Marion during 2024.
Statewide in Illinois, this same category also held the lead position by total Medicaid payments for 2024.
Over the five years ending in 2024, Marion’s Medicaid payments for the National Codes Established for State Medicaid Agencies group rose $3,531,241, a 77.3% increase. Certain years, such as 2022 and 2021, saw particularly notable year-over-year growth.
While services in this group were billed throughout Marion, payments were heavily concentrated in just a few ZIP codes. In 2024, ZIP code 62959 accounted for $8,101,417 of these Medicaid payments, amounting to 100% of Marion’s total for this category during the year.
Furthermore, payments within the National Codes Established for State Medicaid Agencies group focused on a relatively small subset of billing codes.
For additional context, Marion’s Medicaid payments for this group jumped 16.1% between 2023 and 2024, compared with a 5.8% change across all local Medicaid claim groups in the same timeframe.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid expenditures reached approximately $871.7 billion in fiscal 2023, representing about 18% of total U.S. health spending. This is a sharp rise from $613.5 billion in 2019, before the onset of the COVID-19 pandemic.
This jump marks an increase of nearly 40% in a few years, mostly attributable to expanded enrollment and greater service utilization during and following the pandemic.
Recent federal budget actions during the Trump administration have included major proposals aimed at reducing federal Medicaid dollars and changing program structure. The “One Big Beautiful Bill Act,” enacted in 2025, is set to reduce federal Medicaid funding by more than $1 trillion over the next 10 years while adding requirements such as work conditions and higher cost-sharing for some recipients. These changes may shift greater financial responsibility to states and could limit increases in federal Medicaid support, even as the program continues to serve millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $4,570,176 | -5.2% |
| 2021 | $4,921,639 | 7.7% |
| 2022 | $7,205,282 | 46.4% |
| 2023 | $6,977,691 | -3.2% |
| 2024 | $8,101,417 | 16.1% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $8,101,417 | 73.4% |
| 2 | Alcohol and Drug Abuse Treatment | $1,097,580 | 9.9% |
| 3 | Medicine Services and Procedures | $732,743 | 6.6% |
| 4 | Dental Services | $394,062 | 3.6% |
| 5 | Durable Medical Equipment | $210,861 | 1.9% |
| 6 | Vision Services | $187,001 | 1.7% |
| 7 | Ambulance and Other Transport Services and Supplies | $118,403 | 1.1% |
| 8 | Surgery | $116,267 | 1.1% |
| 9 | Medical And Surgical Supplies | $38,542 | 0.3% |
| 10 | Evaluation and Management | $27,548 | 0.2% |
| 11 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $8,995 | 0.1% |
| 12 | Procedures / Professional Services | $5,927 | 0.1% |
| 13 | Pathology and Laboratory Procedures | $2,365 | <0.1% |
| 14 | Temporary National Codes (Non-Medicare) | $291 | <0.1% |
| 15 | Radiology Procedures | $56 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1015 | Clinic service | $6,112,711 | 89 |
| T1003 | Lpn/lvn services up to 15min | $1,368,561 | 16 |
| T1002 | Rn services up to 15 minutes | $248,898 | 5 |
| T1021 | Hh aide or cn aide per visit | $194,127 | 10 |
| T1040 | Comm bh clinic svc per diem | $108,764 | 27 |
| T4541 | Large disposable underpad | $19,015 | 11 |
| T1016 | Case management | $17,724 | 8 |
| T1502 | Medication admin visit | $10,382 | 10 |
| T2003 | N-et; encounter/trip | $9,107 | 4 |
| T4535 | Disposable liner/shield/pad | $6,394 | 9 |
| T4527 | Adult size pull-on lg | $5,730 | 3 |
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.
