Wisconsin Medicaid payments for national code services rise to $435 million in 2024

Wisconsin recorded $435,712,647 in Medicaid payments for services within the National Codes Established for State Medicaid Agencies category in 2024, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This is an 87.5% rise over 2023, when state Medicaid providers billed $232,415,451 for these services.

Medicaid serves as a public health insurance program operated by individual states and funded jointly by state and federal governments. It insures low-income groups, seniors, children and people with disabilities, making it a key component of the U.S. health care system.

As Medicaid spending originates from public funds, fluctuations in billing amounts show how local health care dollars are distributed through the community.

The “National Codes Established for State Medicaid Agencies” group covers a set of Medicaid services organized by the nature of care, based on their underlying HCPCS and CPT code classifications. Each billing code is attributed to a single service group for this analysis by applying specific code ranges and prefixes, organizing similar services together while ensuring accurate comparisons and avoiding double counting.

When service categories are broad, they may represent several different service lines. In those circumstances, the grouping incorporates connected care delivered within Medicaid claims, such as outpatient appointments, various tests, and procedures.

Between 2019 and 2024, payments associated with National Codes Established for State Medicaid Agencies in Wisconsin climbed $253,582,306, or 139.2%. Certain years saw sharper spikes in growth, notably in 2021 and in 2023, where payment levels increased more substantially.

Although these payments were spread across the state, a significant share went to a handful of ZIP codes. In 2024, ZIP Code 53005 led the state by accounting for $62,585,320 (14.4% of total), followed by ZIP Code 53203 with $54,657,299 (12.5% of total), and ZIP Code 54937 at $26,044,778 (6% of total).

Together, these three ZIP codes represented 32.9% of all Wisconsin Medicaid payments assigned to National Codes Established for State Medicaid Agencies during the year.

In comparison, total payments for all Medicaid claims rose by 7.5% statewide from 2023 to 2024.

Across service categories, outlays for National Codes Established for State Medicaid Agencies ranked among Wisconsin’s largest by total payments in 2024.

According to the Centers for Medicare & Medicaid Services, federal and state Medicaid spending together reached about $871.7 billion during fiscal year 2023, making up roughly 18% of all national health care expenses. This represents a significant increase from around $613.5 billion in 2019 prior to the COVID-19 pandemic.

This jump equates to approximately 40% growth over several years, influenced largely by increased enrollment and care utilization before, during, and after the pandemic period.

Recent U.S. federal budget packages have put forth major changes to the structure and funding levels for Medicaid. The “One Big Beautiful Bill Act,” enacted in 2025 under the Trump administration, is anticipated to reduce federal Medicaid contributions by over $1 trillion over the next decade and includes new requirements like mandatory work and added cost sharing. These policies may reduce both funding and eligibility for some, likely shifting more financial responsibility to states and constraining future growth of the federal program while Medicaid continues to cover tens of millions nationwide.