Wayne sees 20.4% rise in Medicaid Evaluation and Management payments in 2024

Wayne’s Medicaid providers billed $17,283 for Evaluation and Management services in 2024, based on the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount reflects a 20.4% jump over 2023, when $14,350 in claims were submitted for the same service type.

Medicaid, a state-administered health insurance program funded by both federal and state governments, provides coverage for low-income individuals and families, seniors, children, and people with disabilities. It remains one of the largest segments of the U.S. health care system.

Since Medicaid is financed by taxpayers, any fluctuation in local billing offers a view into how public health care funding is distributed throughout a community.

The Evaluation and Management category represents a set of services billed to Medicaid according to the nature of care provided, using set HCPCS and CPT code ranges. This analysis grouped each billing code under a single service category by using consistent code prefixes and ranges, ensuring related services could be analyzed together without double counting or misranking over time.

The Evaluation and Management group was fourth by total Medicaid payments in Wayne for 2024, even as Medicaid allocations increased across multiple categories.

Around West Virginia, Evaluation and Management services placed second statewide for total Medicaid payments in 2024.

Looking at the five years up to 2024, Medicaid payments for Evaluation and Management in Wayne rose by $16,727, or 3005.8%. Notable growth occurred in certain periods, with marked year-over-year rises in 2022 and 2021.

Despite citywide distribution of Evaluation and Management service payments, the highest amounts were concentrated in select ZIP codes. In 2024, the primary ZIP code, 25570, accounted for all $17,283 in Medicaid payments in this category, meaning the top ZIP code represented 100% of these payments in Wayne for the year.

Spending within the Evaluation and Management group also clustered among just a few specific billing codes.

For additional context, Medicaid payments for the Evaluation and Management category in Wayne increased by 20.4% from 2023 to 2024, compared with a 21.3% rise across all Medicaid claim categories locally during the same interval.

Centers for Medicare & Medicaid Services data shows combined federal and state Medicaid spending reached about $871.7 billion in fiscal 2023, making up about 18% of nationwide health expenditures. This was a substantial rise from roughly $613.5 billion in 2019, before the COVID-19 pandemic.

This rise represents an approximately 40% increase within a few years, primarily due to higher enrollment and increased service utilization during and after the pandemic.

Recent congressional budget actions under the Trump administration have included major proposals to cut federal Medicaid funding and modify how the program operates. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to reduce federal Medicaid spending by over $1 trillion over the next decade and establish policies such as work requirements and higher cost-sharing, which could impact coverage and funding for some enrollees. These adjustments would increase state financial responsibility and curb federal Medicaid expansion, even as the program continues to cover tens of millions of Americans.

Note: HCPCS codes are shown for context within the category. Category totals and rankings in this article are based on standardized service groupings rather than individual billing codes.

Information in this article was obtained from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The source data can be found here.