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Spending Concentration

Visuals in this post: EyePic Case Per-Enrollee Spending Concentration Top Providers Outlier Screen Provider Lookup Random Sample Methodology
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Medicaid July 2026

1% of New York billers collect 74 cents of every Medicaid dollar

Ranking every billing organization by its 2018 to 2024 Medicaid payments shows how top-heavy each state's program is. New York is by far the most concentrated of the three, driven by its home-care system routing billions through a handful of fiscal intermediaries.

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The top 1% of New York billers collect 74% of the dollars, far above Texas and California
Cumulative share of 2018 to 2024 Medicaid paid amounts, providers ranked from smallest to largest biller. A perfectly even distribution would follow the dotted diagonal.
Created by Tal Roded · NYCuriosity · Source: HHS Open Data, Medicaid Provider Spending by HCPCS

New York's Medicaid dollars are strikingly concentrated. Its top 1% of billing organizations, about 580 of 57,967, collect 74.1% of all attributable dollars. The same slice collects 48.1% in California and 42.3% in Texas.

Concentration is a structure, not an accusation. New York routes enormous home-care and personal-assistance payments through fiscal intermediaries and large agencies, which pulls dollars into few billing organizations. But concentration also means oversight of a handful of billers covers most of the money.

Method: billing organizations in each state ranked by total 2018 to 2024 paid amounts; the curve shows each percentile's cumulative share of state dollars. Providers are assigned to states by NPPES practice location. Only providers with positive totals are included (NY 57,967; CA 49,567; TX 29,539).

Sources: HHS Open Data, Medicaid Provider Spending by HCPCS; CMS NPPES. Author's analysis; replication steps in the methodology.