In 2024, Winter Garden Medicaid providers reported $852,438 in billings within the National Codes Established for State Medicaid Agencies category, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount was 7.2% higher than in 2023, when $795,453 in claims were filed for the same services.
Medicaid is a publicly funded health insurance initiative, managed by individual states and financed in partnership by federal and state governments. The program serves low-income populations, including seniors, children, individuals with disabilities, and families, making it a key element of the U.S. health care system.
Because Medicaid payments are funded by taxpayers, fluctuations in local billing levels provide insights into how public health care resources are used within a community.
The “National Codes Established for State Medicaid Agencies” category covers a set of Medicaid-billed services defined according to the particular type of care, organized using standardized HCPCS and CPT code classifications. Each billing code was placed in a single service category for this analysis by applying consistent code prefixes and numerical ranges, supporting accurate comparison of related services and ensuring no double counting in rankings over time.
Despite broader increases in Medicaid spending across multiple categories, National Codes Established for State Medicaid Agencies held the third position among Winter Garden service categories by total Medicaid payments in 2024.
Statewide in Florida, this service category ranked second overall in Medicaid payments for 2024.
Across the five years preceding 2024, Medicaid payments linked to the National Codes Established for State Medicaid Agencies category in Winter Garden rose by $377,286, or 79.4%. Noteworthy periods of faster growth occurred in 2021 and 2023, with significant year-over-year increases.
Although care in the National Codes Established for State Medicaid Agencies category was provided throughout the city, payment data indicate a concentration in a few ZIP codes. In 2024, ZIP code 34787 accounted for the full $852,438 in Medicaid claims under the category. Thus, the top ZIP code represented 100% of related Medicaid payments in Winter Garden that year.
Payments within the National Codes Established for State Medicaid Agencies category were also concentrated among a small number of specific billing codes.
By comparison, the 7.2% increase in Winter Garden Medicaid payments for this service group between 2024 and 2023 was outpaced by a 17.3% rise across all Medicaid claim categories in the city over the same period.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid spending totaled about $871.7 billion in fiscal 2023, making up roughly 18% of all national health expenditures, a significant increase from $613.5 billion in 2019, before the COVID-19 pandemic.
This rise amounts to nearly 40% growth over several years, primarily driven by increased enrollment and higher utilization during and after the pandemic.
Legislation passed under the Trump administration has included major proposals to scale back federal Medicaid funding and restructure the program. For example, the “One Big Beautiful Bill Act,” enacted in 2025, is projected to reduce federal Medicaid spending by more than $1 trillion in the coming decade and introduces measures such as work requirements and enhanced cost-sharing. These changes are expected to reduce federal support, possibly affecting coverage for some participants and increasing states’ financial responsibilities, even as Medicaid continues to cover tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $475,151 | -34% |
| 2021 | $757,070 | 59.3% |
| 2022 | $612,370 | -19.1% |
| 2023 | $795,453 | 29.9% |
| 2024 | $852,438 | 7.2% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $1,902,209 | 41.7% |
| 2 | Medicine Services and Procedures | $1,139,749 | 25% |
| 3 | National Codes Established for State Medicaid Agencies | $852,438 | 18.7% |
| 4 | Temporary National Codes (Non-Medicare) | $220,852 | 4.8% |
| 5 | Alcohol and Drug Abuse Treatment | $176,644 | 3.9% |
| 6 | Ambulance and Other Transport Services and Supplies | $88,448 | 1.9% |
| 7 | Durable Medical Equipment | $79,364 | 1.7% |
| 8 | Dental Services | $61,696 | 1.4% |
| 9 | Pathology and Laboratory Procedures | $17,948 | 0.4% |
| 10 | Surgery | $15,264 | 0.3% |
| 11 | Drugs Administered Other than Oral Method | $2,420 | 0.1% |
| 12 | Medical And Surgical Supplies | $998 | <0.1% |
| 13 | Procedures / Professional Services | $647 | <0.1% |
| 14 | Durable medical equipment (DME) Medicare administrative contractors (MACs) | $191 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| T1025 | Ped compr care pkg, per diem | $852,438 | 12 |
Note: HCPCS codes are included for context within the category. The category totals and rankings discussed are based on standardized groupings of services rather than individual billing codes.
Information for this article is sourced from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The original data can be accessed here.
