In 2024, Medicaid providers in Sonora billed a total of $5,678,788 for services categorized under the National Codes Established for State Medicaid Agencies, as reported by the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represented a 4.5% uptick compared with 2023, when $5,436,772 was submitted for the same group of services.
Medicaid is a government health insurance initiative operated by the states with funding from both federal and state governments. It provides coverage for low-income individuals and families, seniors, children, and people with disabilities, making it among the largest segments of the U.S. health care system. More about its funding can be found here.
Since Medicaid is funded by taxpayers, changes in local billing indicate how community health care funds are being used.
The National Codes Established for State Medicaid Agencies category covers Medicaid services defined by the specific type of care, grouped according to standardized HCPCS and CPT codes. For this report, service billing codes were assigned to categories using consistent code prefixes and number ranges, grouping related services together to avoid double counting and maintain accurate comparisons over time.
This category led all Medicaid spending groups in Sonora by total payments in 2024, even as other service categories also saw increases.
Statewide, the National Codes Established for State Medicaid Agencies category also ranked first in California for overall Medicaid payments in 2024.
Between 2020 and 2024, Sonora saw Medicaid payments in this category rise by $1,428,065, which amounts to a 33.6% increase. The pace of growth was particularly strong in some years, notably 2021 and 2020.
Spending in this category was distributed citywide but was highly concentrated in a few ZIP codes. In 2024, ZIP code 95370 accounted for $5,678,788, with the top 1 ZIP code representing 100% of all payments linked to this service category in Sonora for the year.
Additionally, a small number of individual billing codes dominated Medicaid payments within this group.
For context, Sonora’s Medicaid payments for the National Codes Established for State Medicaid Agencies category increased 4.5% from 2023 to 2024, while all Medicaid claim categories combined in the city recorded a 21% change over the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid expenses reached approximately $871.7 billion in fiscal 2023, making up about 18% of all national health spending. This is a substantial jump from roughly $613.5 billion in 2019, before the COVID-19 pandemic.
This growth equals about 40% over just a few years, with enrollment expansions and higher usage during and after the pandemic driving much of the increase.
Recent changes in federal budgeting under the Trump administration have led to notable proposals to reduce Medicaid funding and alter program structures. One example, the “One Big Beautiful Bill Act,” enacted in 2025, is expected to decrease federal Medicaid funding by more than $1 trillion over the next 10 years. It also implements policies such as work requirements and greater cost-sharing, potentially curbing coverage and federal support for some Medicaid recipients. As a result, states may take on more costs, and future federal Medicaid growth could be more constrained even as the program continues to serve millions.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $4,250,722 | 6.4% |
| 2021 | $5,199,840 | 22.3% |
| 2022 | $5,146,280 | -1% |
| 2023 | $5,436,771 | 5.6% |
| 2024 | $5,678,788 | 4.5% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $5,678,788 | 42.5% |
| 2 | Medicine Services and Procedures | $1,770,396 | 13.2% |
| 3 | Evaluation and Management | $1,655,550 | 12.4% |
| 4 | Anesthesia | $858,868 | 6.4% |
| 5 | Alcohol and Drug Abuse Treatment | $797,454 | 6% |
| 6 | Procedures / Professional Services | $726,040 | 5.4% |
| 7 | Pathology and Laboratory Procedures | $584,247 | 4.4% |
| 8 | Radiology Procedures | $517,481 | 3.9% |
| 9 | Ambulance and Other Transport Services and Supplies | $474,677 | 3.6% |
| 10 | Durable Medical Equipment | $110,291 | 0.8% |
| 11 | Drugs Administered Other than Oral Method | $106,121 | 0.8% |
| 12 | Surgery | $35,341 | 0.3% |
| 13 | Medical And Surgical Supplies | $28,085 | 0.2% |
| 14 | Temporary National Codes (Non-Medicare) | $11,163 | 0.1% |
| 15 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $6,451 | <0.1% |
| 16 | Temporary Codes | $5,314 | <0.1% |
| 17 | Administrative, Miscellaneous and Investigational | $591 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1015 | Clinic service | $4,566,876 | 238 |
| T2033 | Res, nos waiver per diem | $849,144 | 7 |
| T1017 | Targeted case management | $163,678 | 8 |
| T2024 | Serv asmnt/care plan waiver | $68,322 | 2 |
| T1019 | Personal care ser per 15 min | $14,642 | 1 |
| T2021 | Day habil waiver per 15 min | $11,472 | 1 |
| T1001 | Nursing assessment/evaluatn | $3,251 | 3 |
| T1999 | Noc retail items andsupplies | $732 | 7 |
| T2003 | N-et; encounter/trip | $667 | 1 |
| T1007 | Treatment plan development | $0 | 6 |
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.
