Taxpayers might soon get a clearer picture of how one of the country’s costly welfare programs has been utilizing their funds, thanks to the Trump administration’s release of new Medicaid claims data.
(This map utilizes federal data published by the Department of Health and Human Services, detailing monthly claims-level payments to Medicaid providers from 2018 to 2024. The data is combined with the National Provider Index to provide a comprehensive view of the business associated with each claims record set. The index measures fraud risk using standard metrics employed by fraud investigators.)
Maine spending trajectory (2018–2024)
| year | Total amount spent | claim | Provider (based in Maine) | Average cost/charge |
|---|---|---|---|---|
| 2018 | $1.077 billion | 11.9 million | 1,570 | $90.78 |
| 2019 | $1.2 billion | 12.9 million | 1,567 | $92.85 |
| 2020 | $1.186 billion | 11.8M | 1,616 | $100.45 |
| 2021 | $1.299 billion | 13.8M | 1,657 | $94.45 |
| 2022 | $1.388 billion | 13.8M | 1,601 | $100.20 |
| 2023 | $1.658 billion | 14.4M | 1,641 | $115.33 |
| 2024 | $1.679 billion | 13.1M | 1,605 | $128.21 |
From 2018 to 2024, Maine’s total Medicaid spending reached $9.49 billion for local providers. The cost per claim rose by 41% ($90.78 to $128.21), which is significantly higher than the inflation rate. Meanwhile, the total number of claims only grew by 10%. This hints that the increases in costs stem largely from higher prices per service instead of greater demand for services—something that raises concerns. It suggests that providers are charging more for the same care, rather than more people needing care.
Maine vs. Nationwide: Outliers in cost per claim
The data paints a concerning picture. Maine spends 5.4 times more on certain substance abuse treatment medications like methadone and Suboxone compared to other states. Essentially, the same treatment under the same program costs over five times more in Maine. A similar discrepancy is seen in Maine’s residential care program for individuals with disabilities. The average bill here is $1,671, compared to $482.04 nationally. Below are Maine’s costs per claim in contrast to the national average (excluding Maine from the benchmarks):
| service code | explanation | Maine Costs/Bills | Nationwide (excluding ME) | ratio | maine spending |
|---|---|---|---|---|---|
| H0020 | Methadone/Drug Abuse | $106.80 | $19.68 | 5.4 times | $129 million |
| S5140 | adult foster care | $527.15 | $149.01 | 3.5 times | $421 million |
| T2016 | residential rehabilitation | $1,671.26 | $482.04 | 3.5 times | $2.3 billion |
| G0299 | Home medical care skilled nurse | $151.85 | $53.33 | 2.8 times | $143 million |
| H2036 | Mental rehabilitation – concentration | $735.77 | $256.97 | 2.9 times | $33 million |
| S5125 | attendant care | $160.76 | $78.54 | 2.0 times | $149 million |
| H0019 | behavioral health housing | $564.68 | $277.07 | 2.0 times | $670 million |
| T1019 | personal care services | $223.01 | $111.29 | 2.0 times | $513 million |
| Since 2012 | Day Treatment – Action | $232.06 | $122.73 | 1.9 times | $212 million |
| From 2021 onwards | community support | $294.49 | $170.23 | 1.7 times | $534 million |
Next, we examine spending growth and claims related to services marked as Suboxone or Methadone in the Medicaid data.
| year | my spending | ME Cost/Billing | Nationwide (excluding ME) |
|---|---|---|---|
| 2018 | $7.6 million | $62.33 | ~$20 |
| 2021 | $16.5 million | $105.12 | ~$20 |
| 2024 | $28.7 million | $154.70 | ~$20 |
realization…
