West Pawlet Medicaid providers receive $501,879 for state agency code services in 2024

In 2024, Medicaid providers in West Pawlet received $501,879 for services 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 amount is up 6.6% from 2023, when providers billed $470,950 for the same services.

Medicaid, a state-managed health insurance program funded by both federal and state governments, insures low-income individuals and families, seniors, children, and people with disabilities. It forms one of the largest areas of the nation’s health care system.

Given that Medicaid payments use taxpayer dollars, shifts in local billing totals reflect how public health care resources are distributed in each community.

The “National Codes Established for State Medicaid Agencies” designation encompasses a set of Medicaid services identified by type of care using standardized HCPCS and CPT codes. To conduct this assessment, each code was classified into one category based on code prefixes and numeric ranges, ensuring related services could be reviewed as a group and that accurate rankings were maintained without double counting.

Though Medicaid spending went up across multiple categories, National Codes Established for State Medicaid Agencies represented the largest payment category in West Pawlet for 2024.

Statewide in Vermont, this category ranked third in terms of total Medicaid payments in 2024.

Between 2019 and 2024, Medicaid funds tied to the National Codes Established for State Medicaid Agencies category in West Pawlet increased by $215,719, which represents a 75.4% gain. Spending grew at a faster pace during certain years, including marked increases noted in both 2021 and 2023.

Although these payments were distributed throughout West Pawlet, a small number of ZIP codes accounted for the bulk of spending. In 2024, ZIP code 05775 was responsible for $501,879, equivalent to 100% of local Medicaid payments tied to the category for that year.

Within the National Codes Established for State Medicaid Agencies classification, most Medicaid payments were focused on a limited group of individual codes.

Medicaid payments in this service group in West Pawlet grew 6.6% from 2023 to 2024, while all Medicaid claims citywide increased by 7.1% in the same period.

Data from the Centers for Medicare & Medicaid Services indicates combined federal and state Medicaid expenditures reached about $871.7 billion in fiscal year 2023, comprising roughly 18% of the total national health care costs, a sizable rise from approximately $613.5 billion in 2019 before the COVID-19 pandemic.

This roughly 40% jump over several years can largely be attributed to higher enrollment and an increase in health care use during and following the pandemic.

Federal budget measures under the Trump administration have introduced considerable proposals to shrink federal Medicaid spending and reform the structure of the program. The “One Big Beautiful Bill Act,” signed into law in 2025, is slated to reduce federal Medicaid spending by over $1 trillion in the next 10 years. Its policies, which include new work requirements and greater cost-sharing, could lower coverage and funding for some enrollees and shift more financial responsibility to the states, potentially restricting further federal growth even as Medicaid remains a substantial national program.

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.