Johnstown Medicaid providers submitted claims totaling $4,695,615 for services within the National Codes Established for State Medicaid Agencies category in 2024, reporting from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represents a 0.5% increase compared to 2023, when providers billed $4,674,370 for similar services.
Medicaid is a state-run public health insurance program, jointly financed by federal and state governments. Covering low-income individuals, families, seniors, children, and people with disabilities, it remains one of the nation’s major health care programs.
Since Medicaid is funded by taxpayers, shifts in local billing illustrate how public dollars for health care are distributed within the community.
The “National Codes Established for State Medicaid Agencies” category includes a set of Medicaid-billed services defined by care type using standardized HCPCS and CPT code groupings. For this report, each billing code was assigned exclusively to one service group by tracking consistent code prefixes and ranges, enabling analysts to examine related services together without double counting or distorting rankings over time.
Spending rose in several service categories, but National Codes Established for State Medicaid Agencies ranked third for total Medicaid payments within Johnstown in 2024.
Statewide in Pennsylvania, the National Codes Established for State Medicaid Agencies held the second-highest total among Medicaid payment categories in 2024.
From 2019 to 2024, Medicaid payments in Johnstown linked to the National Codes Established for State Medicaid Agencies category increased by $4,251,878, or 958.2%. Certain years, such as 2021 and 2020, saw particularly large annual increases.
Medicaid payments for care in the National Codes Established for State Medicaid Agencies category were distributed throughout the city but heavily concentrated in a few ZIP codes. In 2024, ZIP code 15905 reported $2,212,876; ZIP code 15904 recorded $1,922,059; and ZIP code 15901 had $560,678. Collectively, these 3 ZIP codes represented 100% of the Medicaid payments in this category for Johnstown that year.
Within this category, a relatively small number of individual billing codes accounted for the bulk of Medicaid payments.
To compare, Medicaid payments in Johnstown tied to the National Codes Established for State Medicaid Agencies category increased by 0.5% between 2024 and 2023, while the change across all Medicaid claim categories in Johnstown for the same period was 2.3%.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending amounted to about $871.7 billion in fiscal year 2023. This made up roughly 18% of total U.S. health expenditures, up sharply from the approximately $613.5 billion spent in 2019, prior to the COVID-19 pandemic.
This rise reflects growth of around 40% in just a few years, prompted mainly by expanded program enrollment and greater service use during and after the pandemic period.
Recent federal budget measures enacted during the Trump administration have featured proposals to significantly reduce federal Medicaid funding and modify the program’s structure. For instance, the “One Big Beautiful Bill Act,” signed into law in 2025, is expected to lower federal Medicaid spending by more than $1 trillion in the next decade and introduces work requirements and additional cost-sharing, potentially reducing both coverage and funding for certain beneficiaries. The projected result is greater cost responsibility for states and slower federal Medicaid spending growth, even as millions continue to rely on the program.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $443,736 | 204.9% |
| 2021 | $2,206,096 | 397.2% |
| 2022 | $3,378,623 | 53.1% |
| 2023 | $4,674,370 | 38.4% |
| 2024 | $4,695,614 | 0.5% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Alcohol and Drug Abuse Treatment | $21,306,924 | 38.1% |
| 2 | Medicine Services and Procedures | $20,463,201 | 36.6% |
| 3 | National Codes Established for State Medicaid Agencies | $4,695,614 | 8.4% |
| 4 | Evaluation and Management | $4,048,371 | 7.2% |
| 5 | Procedures / Professional Services | $2,586,252 | 4.6% |
| 6 | Ambulance and Other Transport Services and Supplies | $1,151,727 | 2.1% |
| 7 | Pathology and Laboratory Procedures | $391,064 | 0.7% |
| 8 | Durable Medical Equipment | $348,479 | 0.6% |
| 9 | Radiology Procedures | $316,701 | 0.6% |
| 10 | Vision Services | $206,196 | 0.4% |
| 11 | Medical And Surgical Supplies | $180,977 | 0.3% |
| 12 | Surgery | $84,887 | 0.2% |
| 13 | Temporary National Codes (Non-Medicare) | $39,766 | 0.1% |
| 14 | Dental Services | $39,605 | 0.1% |
| 15 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $10,367 | <0.1% |
| 16 | Outpatient PPS | $75 | <0.1% |
| 17 | Administrative, Miscellaneous and Investigational | $0 | <0.1% |
| 17 | Drugs Administered Other than Oral Method | $0 | <0.1% |
| 17 | Temporary Codes | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1017 | Targeted case management | $2,325,239 | 41 |
| T1003 | Lpn/lvn services up to 15min | $2,212,876 | 11 |
| T1016 | Case management | $102,216 | 19 |
| T1015 | Clinic service | $54,345 | 12 |
| T4535 | Disposable liner/shield/pad | $936 | 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.
