In 2024, Medicaid providers in San Marcos submitted $20,511,256 in claims for services listed in 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 represented a 1.6% increase from 2023, when local providers billed $20,193,471 in the same service category.
Medicaid is a publicly funded health insurance program managed by states and supported by both federal and state governments. It provides coverage to low-income families and individuals, seniors, children, and people with disabilities, and forms a major part of the national health care system.
Since Medicaid is funded by taxpayers, variations in local Medicaid billing levels highlight how public health dollars are distributed within a community.
The “National Codes Established for State Medicaid Agencies” category covers a set of Medicaid services classified by specific care types, based on standardized groupings of HCPCS and CPT codes. Each billing code in this review was assigned exclusively to one service category using consistent numeric patterns and code prefixes. This allowed similar services to be analyzed in one group, while preventing duplicate counts and maintaining clear historical comparisons over time.
National Codes Established for State Medicaid Agencies was the highest-ranking service category in San Marcos in 2024, leading all others by total Medicaid dollars paid out.
Statewide in California, National Codes Established for State Medicaid Agencies also ranked No. 1 for Medicaid spending in 2024.
Over the five-year period ending in 2024, the amount spent on Medicaid services in San Marcos tied to National Codes Established for State Medicaid Agencies increased by $7,755,959, or 60.8%. Periods of rapid growth included year-over-year jumps highlighted in both 2023 and 2020.
Spending was recorded throughout San Marcos, but claims in this Medicaid category were heavily concentrated in just a few ZIP codes. During 2024, ZIP code 92069 accounted for $20,385,004, while ZIP code 92078 had $126,251 in payments. Combined, these 2 ZIP codes represented 100% of all Medicaid claims in this category for the city during the year.
Payments within the National Codes Established for State Medicaid Agencies category were concentrated among select billing codes.
To compare, Medicaid claims associated with this category in San Marcos increased by 1.6% from 2023 to 2024, while total claims for all Medicaid service categories citywide rose 6.2% in the same span.
According to the Centers for Medicare & Medicaid Services, combined state and federal Medicaid outlays totaled about $871.7 billion in fiscal year 2023, roughly 18% of total national health expenses—up significantly from $613.5 billion in 2019, before the onset of COVID-19.
This rise means Medicaid grew about 40% over a few years, driven primarily by increased enrollment and higher usage during and after the pandemic.
Federal budget changes under the Trump administration have included major proposals to decrease federal Medicaid funding and introduce program changes. The “One Big Beautiful Bill Act,” for example, became law in 2025 and is expected to cut more than $1 trillion in federal Medicaid spending across the coming decade. It includes initiatives such as work requirements and increased cost-sharing, which could reduce both services and funding for particular groups of recipients. These measures are expected to shift added financial responsibility to states and limit the expansion of federal Medicaid as enrollment remains high.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $12,755,296 | 1.7% |
| 2021 | $12,566,529 | -1.5% |
| 2022 | $12,702,029 | 1.1% |
| 2023 | $20,193,470 | 59% |
| 2024 | $20,511,256 | 1.6% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $20,511,256 | 48% |
| 2 | Medicine Services and Procedures | $7,253,462 | 17% |
| 3 | Evaluation and Management | $5,771,913 | 13.5% |
| 4 | Dental Services | $2,489,738 | 5.8% |
| 5 | Temporary National Codes (Non-Medicare) | $1,631,743 | 3.8% |
| 6 | Procedures / Professional Services | $1,137,954 | 2.7% |
| 7 | Drugs Administered Other than Oral Method | $1,121,141 | 2.6% |
| 8 | Surgery | $822,696 | 1.9% |
| 9 | Medical And Surgical Supplies | $780,773 | 1.8% |
| 10 | Radiology Procedures | $402,090 | 0.9% |
| 11 | Pathology and Laboratory Procedures | $358,873 | 0.8% |
| 12 | Alcohol and Drug Abuse Treatment | $210,027 | 0.5% |
| 13 | Ambulance and Other Transport Services and Supplies | $166,044 | 0.4% |
| 14 | Anesthesia | $25,544 | 0.1% |
| 15 | Vision Services | $12,047 | <0.1% |
| 16 | Enteral and Parenteral Therapy | $3,991 | <0.1% |
| 17 | Administrative, Miscellaneous and Investigational | $3,864 | <0.1% |
| 18 | Temporary Codes | $787 | <0.1% |
| 19 | Outpatient PPS | $20 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1015 | Clinic service | $20,385,004 | 561 |
| T1014 | Telehealth transmit, per min | $61,227 | 53 |
| T1017 | Targeted case management | $52,903 | 6 |
| T1016 | Case management | $12,121 | 5 |
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.