In 2024, Medicaid providers in San Luis Obispo submitted $11,273,922 in claims for services within the National Codes Established for State Medicaid Agencies category, figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database show. This amount reflects a 0.6% climb from 2023, when Medicaid providers reported $11,202,418 in such payments.
Medicaid is a government-run health insurance program supported cooperatively by federal and state governments. The program insures low-income people, seniors, minors, and individuals with disabilities, making it a leading player in the structure of U.S. health care.
Since taxpayer funds support Medicaid payments, fluctuations in local billing levels help illustrate the allocation of public health care spending within a community.
The “National Codes Established for State Medicaid Agencies” section tracks a set of Medicaid claims organized by types of care, using groups of standardized HCPCS and CPT codes. Analysts assigned each billing code to a single service category consistently by code structure and frequency, letting them compare relevant services together and prevent double counting across periods.
Spending across service categories rose for Medicaid, with National Codes Established for State Medicaid Agencies reported as the second-highest category in San Luis Obispo by payment volume for 2024.
Statewide throughout California, the National Codes Established for State Medicaid Agencies category earned the highest payment ranking of all Medicaid services in 2024.
Over the five years before 2024, Medicaid payments linked to the National Codes Established for State Medicaid Agencies category in San Luis Obispo climbed by $6,669,869, a 37.2% increase. Growth accelerated in certain intervals, notably during 2020 and 2023 when year-over-year jumps were seen.
Payments were distributed citywide across service providers, but particular ZIP codes concentrated more Medicaid dollars for National Codes Established for State Medicaid Agencies services. In 2024, ZIP code 93401 received $7,505,514 and 93405 received $3,768,406; together, they represented all Medicaid payments for this category in San Luis Obispo for the year.
A narrow range of billing codes dominated payments within the National Codes Established for State Medicaid Agencies category in the city.
Between 2023 and 2024, National Codes Established for State Medicaid Agencies payments in San Luis Obispo increased by 0.6%, while citywide Medicaid payments for all categories recorded a 15.8% change during the same period.
According to the Centers for Medicare & Medicaid Services, total Medicaid spending at the federal and state level reached about $871.7 billion in fiscal year 2023, making up roughly 18% of total U.S. health expenditures—significantly higher than the approximately $613.5 billion spent in 2019 prior to the COVID-19 pandemic.
This growth represents an increase of about 40% over those years, driven primarily by greater program enrollment and higher utilization stemming from the pandemic and its aftermath.
Federal budget reforms signed into law in 2025 under the Trump administration, such as the “One Big Beautiful Bill Act,” are projected to reduce federal Medicaid outlays by more than $1 trillion over the following decade, introducing measures like work requirements and increased cost-sharing which could restrict coverage and decrease funding for certain beneficiaries. Shifting more cost to the states, these changes are expected to curb federal support for Medicaid even as millions continue receiving coverage through the program.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $17,943,790 | 129.7% |
| 2021 | $14,652,016 | -18.3% |
| 2022 | $10,511,450 | -28.3% |
| 2023 | $11,202,417 | 6.6% |
| 2024 | $11,273,921 | 0.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Alcohol and Drug Abuse Treatment | $16,595,014 | 36.2% |
| 2 | National Codes Established for State Medicaid Agencies | $11,273,921 | 24.6% |
| 3 | Evaluation and Management | $4,963,587 | 10.8% |
| 4 | Medicine Services and Procedures | $4,197,113 | 9.1% |
| 5 | Pathology and Laboratory Procedures | $2,756,341 | 6% |
| 6 | Procedures / Professional Services | $2,030,391 | 4.4% |
| 7 | Ambulance and Other Transport Services and Supplies | $1,388,837 | 3% |
| 8 | Dental Services | $723,684 | 1.6% |
| 9 | Temporary National Codes (Non-Medicare) | $646,119 | 1.4% |
| 10 | Durable Medical Equipment | $483,116 | 1.1% |
| 11 | Anesthesia | $457,817 | 1% |
| 12 | Surgery | $219,082 | 0.5% |
| 13 | Radiology Procedures | $40,039 | 0.1% |
| 14 | Medical And Surgical Supplies | $36,784 | 0.1% |
| 15 | Drugs Administered Other than Oral Method | $35,723 | 0.1% |
| 16 | Coronavirus Diagnostic Panel | $19,851 | <0.1% |
| 17 | Vision Services | $5,988 | <0.1% |
| 18 | Chemotherapy Drugs | $3,965 | <0.1% |
| 19 | Temporary Codes | $2,197 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1015 | Clinic service | $7,093,054 | 241 |
| T1017 | Targeted case management | $3,458,322 | 102 |
| T2021 | Day habil waiver per 15 min | $245,063 | 18 |
| T2050 | Financial mgt waiver/diem | $221,121 | 9 |
| T2033 | Res, nos waiver per diem | $144,432 | 3 |
| T2024 | Serv asmnt/care plan waiver | $80,091 | 5 |
| T2007 | Non-emer transport wait time | $14,558 | 11 |
| T1001 | Nursing assessment/evaluatn | $12,767 | 7 |
| T1014 | Telehealth transmit, per min | $4,509 | 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.
