Shawano sees 20.5% rise in Medicaid payments for services under state-established codes in 2024

In 2024, Medicaid providers in Shawano billed $848,811 for services within the National Codes Established for State Medicaid Agencies category, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database show. This represents a 20.5% uptick from 2023, when $704,367 was billed for the same services.

Medicaid is a state-administered public health insurance program jointly funded by state and federal governments. It provides coverage for low-income people and families, seniors, children, and individuals with disabilities, making it a significant element of the U.S. health system. For more background, see here.

Because Medicaid payments are taxpayer-funded, shifts in local billing levels indicate how public health care spending is distributed in the area.

The National Codes Established for State Medicaid Agencies category encompasses a range of Medicaid-billed services outlined by standardized HCPCS and CPT code groupings as defined by care type. This analysis allocated each code to one service category using consistent code prefixes and number ranges, which allowed for grouping related services while preventing double counting and keeping rankings accurate over time.

While Medicaid spending climbed in multiple service categories, National Codes Established for State Medicaid Agencies stood as the fifth-largest category in Shawano by total Medicaid payments in 2024.

Across Wisconsin, the National Codes Established for State Medicaid Agencies category took the top spot for Medicaid service payments in 2024.

During the five years before 2024, Shawano’s Medicaid payments for the National Codes Established for State Medicaid Agencies category rose by $540,268, or 175.1%. Higher spending was recorded especially in 2021 and 2022, reflecting faster annual growth in parts of the period.

While service payments within the National Codes Established for State Medicaid Agencies category were spread throughout the city, most dollars flowed to a small set of ZIP codes. For 2024, ZIP code 54166 was responsible for $848,811, covering 100% of the Medicaid payments in this category for Shawano.

Payments in the National Codes Established for State Medicaid Agencies service group centralized significantly in just a few individual billing codes.

To compare, Medicaid payments in this category increased 20.5% from 2023 to 2024, while spending across all Medicaid claim categories in Shawano during that period changed by 9.5%.

According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid expenditures reached about $871.7 billion in fiscal 2023. This made up roughly 18% of all U.S. health spending—an increase from $613.5 billion in 2019, prior to the COVID-19 pandemic period.

This growth marks an approximately 40% increase in several years, largely attributed to expanded Medicaid enrollment and greater service use during and following the pandemic.

Recent federal budget laws enacted under the Trump administration targeted major reductions to federal Medicaid allocations and introduced program restructuring. The “One Big Beautiful Bill Act,” passed in 2025, is estimated to decrease federal Medicaid funding by more than $1 trillion over the coming decade. The law implements new work requirements and higher cost-sharing, which could reduce Medicaid coverage and funding for affected beneficiaries. These shifts are forecast to place more financial responsibility on states and may restrict federal Medicaid expansion, even as the program continues to assist millions nationwide.

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.