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Jefferson County is basically Louisville, and it's a major transportation nexus in a particularly fucked-up bit of geography, so it's not surprising for it to be a bit higher, plus I think there's a couple big companies like Humana that show up under Louisville but aren't really spent in or on that location. Even with that, these numbers look jank, as does the extent it's all set as "multiple recipients" under mostly HHS funding -- there's reasons to suspect older and unhealthier populace there, but not that unusually so.
Sorting awards by Direct Payment in Jefferson County for FY2023 and 2024 shows a lot of Medicaid awards in the 1b-9.5b range, nearly 90b of them. By place of performance, Jefferson County (112.2b) is literally orders of magnitude higher than any other county (and an order of magnitude higher by congressional district), in the state. The only nearby comparable countries in total spending are Marion County Illinois (ok, Chicago I can believe), Cumberland County, Pennsylvania (wtf?), and Richmond County, South Carolina (Prisma and Blue Cross / Blue Shield), which points away from a particularly sick local population.
My guess is that there's a number of companies headquartered or having technical place-of-performance in those counties, but with the effects of that spending (and likely the actual anything-but-paper spending) occurring in a far more distributed manner.
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