Medicaid Outpatient PPS payments in Connecticut rise 10.9% to $2,096,018 in 2024

The total Medicaid payments for services under the Outpatient PPS category reached $2,096,018 across Connecticut in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database show. This was a 10.9% uptick from 2023, when providers filed $1,889,652 in claims for the same category.

Medicaid, a joint state and federal public health insurance initiative, covers individuals and families with low incomes, seniors, children, and people with disabilities, ranking among the largest components of the U.S. health system. Funding is provided by both levels of government, as outlined by the Commonwealth Fund.

Shifts in Medicaid billing volumes directly affect how taxpayer-funded health care resources are distributed throughout communities.

The Outpatient PPS category includes a range of Medicaid claims defined by the care type and standardized through HCPCS and CPT code groupings. This analysis ensures that each billing code appears in only one service category using specified code prefixes and number ranges, eliminating overlaps and enabling accurate year-to-year comparisons.

Where relevant, groupings may cover several forms of underlying services. In those circumstances, the category gathers together related Medicaid-billed care types, such as office appointments, diagnostic exams, and therapy procedures.

During the five years before 2024, Medicaid payments related to the Outpatient PPS category within the state increased by $1,439,114, representing 219.1% growth. Certain years saw especially sharp rises, including 2021 and 2022.

Although Outpatient PPS category payments were registered across Connecticut, a small number of ZIP codes accounted for the majority. In 2024, leading ZIP codes included 06504, with $1,161,002 (55.4% of the total); 06105 at $143,253 (6.8%); and 06052, with $142,049 (6.8%).

Together, these top three ZIP codes were responsible for 69% of statewide Medicaid payments in the Outpatient PPS grouping that year.

Statewide, Medicaid disbursements across all claim classes showed an 8.3% increase from 2023 to 2024.

While multiple service categories posted increases, Outpatient PPS ranked within the top 20 statewide Medicaid categories by total payments in 2024.

The Centers for Medicare & Medicaid Services report that overall federal and state Medicaid expenditure reached about $871.7 billion in fiscal 2023, or approximately 18% of total national health expenditure—a sharp increase from about $613.5 billion in 2019, preceding the COVID-19 pandemic.

The growth represents an approximate 40% increase over just a few years, much of it triggered by expanded enrollment and higher usage during and after the pandemic.

Recent federal budget acts enacted during the Trump administration contain substantial measures to reduce federal Medicaid spending and modify the program. The “One Big Beautiful Bill Act,” signed into law in 2025, is forecast to pare federal Medicaid dollars by over $1 trillion in the coming decade and institutes initiatives like work requirements and greater cost-sharing, which may result in decreased coverage and funding for certain enrollees. These adjustments are likely to place more responsibility on states and constrain federal funding growth, even as Medicaid continues to serve many Americans.

Details in this article are sourced from the U.S. Department of Health and Human Services Medicaid Provider Spending database. Additional source data is available here.