Spending AnalysisFebruary 16, 2026·5 min read
Where Does $1 Trillion in Medicaid Money Actually Go?
We broke down $1.09 trillion in Medicaid spending by provider specialty. The results reveal stunning concentration — a handful of specialties receive the lion's share of spending.
Home Health
$70.96B
from only 264 providers
$268.8M avg per provider
Acute Care Hospitals
$35.06B
154 providers
Supports Brokerage
$10.79B
from only 15 providers
$719.3M avg each
When people ask "where does Medicaid money go?" they usually think of doctor visits and hospital stays. The reality is more surprising. The single largest known spending category is Home Health at $70.96B — but that money goes to just 264 providers, averaging $268.8M each.
15 providers, $10.8 billion
Perhaps the most striking finding: Supports Brokerage providers — just 15 of them — received $10.79B in total payments. That averages to $719.3M per provider. These are intermediaries that help Medicaid beneficiaries manage their self-directed care benefits.
Community and Behavioral Health received $31.5B across 166 providers. Case Management received $23.8B from 103 providers. The pattern is clear: massive sums flowing through relatively few organizational entities, each handling enormous volumes of claims on behalf of thousands of beneficiaries.
The "Unknown" category: $749.13B
The largest single category is "Unknown" — $749.13B across 616K providers. This represents providers whose specialty classification is not recorded in the NPI database, including many state agencies, tribal health facilities, and government entities that register under non-standard categories.
Top 25 Specialties by Spending
1Home Health
264 providers$70.96B
$268.8M/ea
2General Acute Care Hospital
154 providers$35.06B
$227.7M/ea
3Community/Behavioral Health
166 providers$31.52B
$189.9M/ea
4Case Management
103 providers$23.76B
$230.7M/ea
5Clinical Medical Laboratory
100 providers$15.33B
$153.3M/ea
6Supports Brokerage
15 providers$10.79B
$719.3M/ea
7Voluntary or Charitable
14 providers$7.92B
$565.7M/ea
8Clinic/Center, Mental Health (Including Community Mental Health Center)
8 providers$7.82B
$977.0M/ea
9Public Health or Welfare
13 providers$7.77B
$597.6M/ea
10Clinic/Center Mental Health (Including Community Mental Health Center)
63 providers$7.03B
$111.6M/ea
11In Home Supportive Care
39 providers$6.96B
$178.5M/ea
12Transportation Broker
12 providers$5.77B
$480.5M/ea
13Durable Medical Equipment & Medical Supplies
26 providers$5.59B
$215.1M/ea
14Clinic/Center Federally Qualified Health Center (FQHC)
52 providers$5.09B
$97.9M/ea
15Day Training Developmentally Disabled Services
67 providers$4.66B
$69.5M/ea
16Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
22 providers$4.17B
$189.5M/ea
17Day Training, Developmentally Disabled Services
18 providers$3.65B
$202.9M/ea
18General Acute Care Hospital Children
17 providers$3.60B
$212.0M/ea
19Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities
42 providers$3.51B
$83.6M/ea
20Ambulance
9 providers$2.48B
$275.9M/ea
21Clinic/Center Developmental Disabilities
23 providers$2.35B
$102.3M/ea
22Clinic/Center, Federally Qualified Health Center (FQHC)
12 providers$2.16B
$180.4M/ea
23Internal Medicine
15 providers$1.84B
$122.9M/ea
24Clinic/Center Rehabilitation Substance Use Disorder
11 providers$1.77B
$161.2M/ea
25Residential Treatment Facility Intellectual and/or Developmental Disabilities
22 providers$1.64B
$74.7M/ea
Full Specialty Breakdown
| # | Specialty | Total Paid | Providers | Claims | Avg/Provider |
|---|---|---|---|---|---|
| 1 | Unknown | $749.13B | 616K | 14.2B | $1.2M |
| 2 | Home Health | $70.96B | 264 | 500.6M | $268.8M |
| 3 | General Acute Care Hospital | $35.06B | 154 | 604.3M | $227.7M |
| 4 | Community/Behavioral Health | $31.52B | 166 | 257.1M | $189.9M |
| 5 | Case Management | $23.76B | 103 | 116.1M | $230.7M |
| 6 | Clinical Medical Laboratory | $15.33B | 100 | 1.2B | $153.3M |
| 7 | Supports Brokerage | $10.79B | 15 | 120.4M | $719.3M |
| 8 | Voluntary or Charitable | $7.92B | 14 | 88.6M | $565.7M |
| 9 | Clinic/Center, Mental Health (Including Community Mental Health Center) | $7.82B | 8 | 38.6M | $977.0M |
| 10 | Public Health or Welfare | $7.77B | 13 | 51.0M | $597.6M |
| 11 | Clinic/Center Mental Health (Including Community Mental Health Center) | $7.03B | 63 | 60.5M | $111.6M |
| 12 | In Home Supportive Care | $6.96B | 39 | 49.4M | $178.5M |
| 13 | Transportation Broker | $5.77B | 12 | 197.9M | $480.5M |
| 14 | Durable Medical Equipment & Medical Supplies | $5.59B | 26 | 72.1M | $215.1M |
| 15 | Clinic/Center Federally Qualified Health Center (FQHC) | $5.09B | 52 | 44.8M | $97.9M |
| 16 | Day Training Developmentally Disabled Services | $4.66B | 67 | 25.7M | $69.5M |
| 17 | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | $4.17B | 22 | 16.3M | $189.5M |
| 18 | Day Training, Developmentally Disabled Services | $3.65B | 18 | 20.4M | $202.9M |
| 19 | General Acute Care Hospital Children | $3.60B | 17 | 28.0M | $212.0M |
| 20 | Community Based Residential Treatment Facility Intellectual and/or Developmental Disabilities | $3.51B | 42 | 8.9M | $83.6M |
| 21 | Ambulance | $2.48B | 9 | 16.2M | $275.9M |
| 22 | Clinic/Center Developmental Disabilities | $2.35B | 23 | 10.6M | $102.3M |
| 23 | Clinic/Center, Federally Qualified Health Center (FQHC) | $2.16B | 12 | 37.6M | $180.4M |
| 24 | Internal Medicine | $1.84B | 15 | 44.8M | $122.9M |
| 25 | Clinic/Center Rehabilitation Substance Use Disorder | $1.77B | 11 | 11.0M | $161.2M |
| 26 | Residential Treatment Facility Intellectual and/or Developmental Disabilities | $1.64B | 22 | 3.6M | $74.7M |
| 27 | Pediatrics | $1.59B | 10 | 43.6M | $159.3M |
| 28 | Early Intervention Provider Agency | $1.56B | 17 | 9.9M | $91.9M |
| 29 | Nursing Care | $1.48B | 13 | 9.6M | $113.6M |
| 30 | Local Education Agency (LEA) | $1.47B | 15 | 41.2M | $98.3M |
| 31 | Counselor, Addiction (Substance Use Disorder) | $1.31B | 5 | 21.8M | $261.9M |
| 32 | Anesthesiology | $1.30B | 7 | 26.7M | $185.0M |
| 33 | Clinic/Center Adult Mental Health | $1.24B | 7 | 7.2M | $176.7M |
| 34 | Ambulance, Land Transport | $1.22B | 7 | 17.3M | $174.1M |
| 35 | Specialist | $1.18B | 2 | 4.2M | $591.5M |
| 36 | Psychologist Intellectual & Developmental Disabilities | $1.16B | 8 | 3.8M | $145.6M |
| 37 | Clinic/Center | $1.16B | 9 | 12.6M | $128.5M |
| 38 | Substance Abuse Rehabilitation Facility | $1.13B | 19 | 7.5M | $59.4M |
| 39 | Case Manager/Care Coordinator | $1.12B | 9 | 13.8M | $124.6M |
| 40 | Psychiatric Unit | $1.12B | 7 | 14.8M | $159.7M |
| 41 | Psychiatric Hospital | $1.07B | 8 | 12.7M | $133.7M |
| 42 | Clinic/Center, Developmental Disabilities | $1.05B | 7 | 8.0M | $150.5M |
| 43 | Respite Care | $1.01B | 8 | 2.4M | $126.1M |
| 44 | Non-emergency Medical Transport (VAN) | $980.3M | 7 | 38.7M | $140.0M |
| 45 | Clinic/Center Urgent Care | $928.8M | 5 | 11.5M | $185.8M |
| 46 | Home Delivered Meals | $910.6M | 1 | 51.0M | $910.6M |
| 47 | Prosthetic/Orthotic Supplier | $910.4M | 4 | 15.3M | $227.6M |
| 48 | Technician Personal Care Attendant | $846.7M | 5 | 12.6M | $169.3M |
| 49 | Respite Care Respite Care Intellectual and/or Developmental Disabilities Child | $841.7M | 4 | 2.8M | $210.4M |
| 50 | Family Medicine | $810.0M | 7 | 10.7M | $115.7M |
| 51 | Clinic/Center Rehabilitation | $807.8M | 8 | 6.0M | $101.0M |
| 52 | Psychiatry & Neurology Psychiatry | $771.7M | 4 | 4.9M | $192.9M |
| 53 | Exclusive Provider Organization | $770.9M | 6 | 13.3M | $128.5M |
| 54 | Emergency Medicine | $736.1M | 6 | 14.1M | $122.7M |
| 55 | Clinic/Center, Multi-Specialty | $734.8M | 4 | 19.3M | $183.7M |
| 56 | Clinic/Center, Adult Mental Health | $728.6M | 3 | 9.3M | $242.9M |
| 57 | Clinic/Center, Community Health | $721.3M | 4 | 9.7M | $180.3M |
| 58 | Behavior Analyst | $714.7M | 12 | 6.0M | $59.6M |
| 59 | Health Maintenance Organization | $709.5M | 9 | 19.8M | $78.8M |
| 60 | Community Based Residential Treatment Facility Mental Illness | $676.3M | 10 | 1.9M | $67.6M |
| 61 | Counselor Mental Health | $659.9M | 11 | 9.2M | $60.0M |
| 62 | Clinic/Center, Ambulatory Surgical | $642.6M | 4 | 16.9M | $160.6M |
| 63 | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | $593.3M | 3 | 2.8M | $197.8M |
| 64 | Durable Medical Equipment & Medical Supplies, Customized Equipment | $590.0M | 4 | 6.1M | $147.5M |
| 65 | Social Worker, Clinical | $586.2M | 3 | 9.0M | $195.4M |
| 66 | Counselor | $574.3M | 5 | 8.7M | $114.9M |
| 67 | Pharmacy | $573.0M | 4 | 3.0M | $143.3M |
| 68 | Surgery | $559.6M | 5 | 17.4M | $111.9M |
| 69 | General Acute Care Hospital, Children | $539.6M | 2 | 5.5M | $269.8M |
| 70 | Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition | $533.3M | 3 | 11.5M | $177.8M |
| 71 | Ambulance Land Transport | $533.0M | 5 | 1.9M | $106.6M |
| 72 | Internal Medicine Addiction Medicine | $526.3M | 2 | 8.5M | $263.2M |
| 73 | Clinic/Center, Primary Care | $520.4M | 2 | 7.8M | $260.2M |
| 74 | Clinic/Center Methadone Clinic | $502.8M | 5 | 5.0M | $100.6M |
| 75 | General Practice | $501.6M | 4 | 6.6M | $125.4M |
| 76 | Psychologist, Rehabilitation | $493.6M | 1 | 3.3M | $493.6M |
| 77 | Pediatrics Pediatric Hematology-Oncology | $493.4M | 1 | 3.6M | $493.4M |
| 78 | Psychiatry & Neurology, Child & Adolescent Psychiatry | $480.9M | 2 | 4.4M | $240.4M |
| 79 | Residential Treatment Facility Emotionally Disturbed Children | $480.2M | 7 | 649K | $68.6M |
| 80 | Community Based Residential Treatment Facility, Mental Illness | $473.4M | 2 | 3.2M | $236.7M |
| 81 | Hospice Care, Community Based | $462.9M | 3 | 4.6M | $154.3M |
| 82 | Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | $445.0M | 3 | 2.5M | $148.3M |
| 83 | Ambulance Air Transport | $422.7M | 1 | 3.7M | $422.7M |
| 84 | Orthotic Fitter | $422.3M | 1 | 6.7M | $422.3M |
| 85 | Secured Medical Transport (VAN) | $416.8M | 1 | 20.3M | $416.8M |
| 86 | Counselor, Mental Health | $413.9M | 2 | 4.2M | $206.9M |
| 87 | General Acute Care Hospital Rural | $410.3M | 3 | 3.3M | $136.8M |
| 88 | Nursing Facility/Intermediate Care Facility | $403.3M | 2 | 1.5M | $201.6M |
| 89 | Emergency Response System Companies | $401.8M | 2 | 14.4M | $200.9M |
| 90 | Pharmacy Specialty Pharmacy | $394.5M | 3 | 147K | $131.5M |
| 91 | Urology | $387.7M | 1 | 5.3M | $387.7M |
| 92 | Foster Care Agency | $374.2M | 5 | 1.4M | $74.8M |
| 93 | Radiology, Diagnostic Radiology | $371.8M | 2 | 4.8M | $185.9M |
| 94 | Clinic/Center, Rehabilitation, Substance Use Disorder | $364.1M | 2 | 10.3M | $182.0M |
| 95 | Clinic/Center Primary Care | $363.9M | 6 | 4.5M | $60.7M |
| 96 | Clinic/Center, Rural Health | $361.4M | 2 | 7.9M | $180.7M |
| 97 | Clinic/Center, Ambulatory Family Planning Facility | $361.3M | 2 | 6.0M | $180.6M |
| 98 | Pharmacy, Community/Retail Pharmacy | $358.2M | 2 | 234K | $179.1M |
| 99 | Clinic/Center, Dental | $350.7M | 2 | 8.6M | $175.4M |
| 100 | Contractor | $321.4M | 3 | 4.2M | $107.1M |
Key Takeaways
- ▸Home Health dominates with $70.96B from only 264 providers.
- ▸15 Supports Brokerage providers received $10.79B — averaging $719.3M each.
- ▸Medicaid spending is highly concentrated: a few hundred large organizations in each specialty handle billions in billing.
- ▸The "Unknown" category is the largest ($749.13B) — mostly state agencies and tribal facilities without standard specialty codes.
Source: HHS Medicaid Provider Spending Data (2018–2024) · 227M records