In 2024, Medicaid providers in East Palo Alto billed $1,680,218 for services grouped under the Evaluation and Management category, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database show. This was a 122% increase compared to 2023, when providers billed $756,767 for similar services.
Medicaid is a public health insurance program managed by the states and financed by both federal and state governments. It serves low-income people and families, seniors, children, and individuals with disabilities, making it one of the largest U.S. health care programs.
Since Medicaid funding comes from taxpayers, shifts in local billing illustrate how public health care resources are distributed throughout a community.
The “Evaluation and Management” category encompasses Medicaid-billed services identified by the type of care given, using recognized HCPCS and CPT code groups. For this report, each billing code was mapped to a specific service category with consistent code prefixes and number ranges, which allowed related services to be tracked together while preventing double counting and ensuring reliable rankings over time.
Although increases occurred in several service groupings, Evaluation and Management was the second-largest Medicaid spending category in East Palo Alto in 2024.
Statewide, Evaluation and Management also placed second in total Medicaid payments in California in 2024.
Between 2020 and 2024, East Palo Alto Medicaid payments for the Evaluation and Management category grew by $1,465,983—or 684.3%. Some periods saw faster growth, with major year-over-year boosts in 2023 and 2021.
Spending for Evaluation and Management was spread across East Palo Alto but mostly concentrated in a few ZIP codes. In 2024, ZIP code 94303 accounted for $1,680,218 in Medicaid payments related to Evaluation and Management, representing 100% of such payments across the city for the year.
Most payments within Evaluation and Management were clustered in a relatively small number of billing codes.
In comparison, Evaluation and Management payments in East Palo Alto rose 122% between 2024 and 2023, while the overall increase across all Medicaid claim types in the city during the same period was 0.9%.
According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid expenditures reached about $871.7 billion in fiscal year 2023, making up roughly 18% of all U.S. health spending, a significant increase from about $613.5 billion in 2019 prior to the COVID-19 pandemic.
This reflects an increase of about 40% over several years, driven mainly by expanded coverage and higher service use during and after the pandemic.
Recent federal budget measures during the Trump administration have included major proposals to reduce federal Medicaid spending and adjust the program’s structure. One example, the “One Big Beautiful Bill Act,” signed into law in 2025, is set to reduce federal Medicaid spending by more than $1 trillion over the next decade. It introduces policies such as work requirements and higher cost sharing, which may cut coverage and funding for some recipients. Such changes are projected to push more costs onto states and restrict the growth of federal Medicaid support, even as the program continues serving tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $214,235 | -1.9% |
| 2021 | $255,764 | 19.4% |
| 2022 | $250,978 | -1.9% |
| 2023 | $756,767 | 201.5% |
| 2024 | $1,680,218 | 122% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $17,933,953 | 81.9% |
| 2 | Evaluation and Management | $1,680,218 | 7.7% |
| 3 | Medicine Services and Procedures | $1,097,928 | 5% |
| 4 | Alcohol and Drug Abuse Treatment | $492,997 | 2.3% |
| 5 | Procedures / Professional Services | $392,112 | 1.8% |
| 6 | Dental Services | $258,732 | 1.2% |
| 7 | Pathology and Laboratory Procedures | $17,958 | 0.1% |
| 8 | Drugs Administered Other than Oral Method | $11,777 | 0.1% |
| 9 | Temporary National Codes (Non-Medicare) | $8,463 | <0.1% |
| 10 | Radiology Procedures | $3,430 | <0.1% |
| 11 | Surgery | $830 | <0.1% |
| 12 | Temporary Codes | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $687,231 | 378 |
| 99215 | Office o/p est hi 40 min | $449,901 | 10 |
| 99214 | Office o/p est mod 30 min | $346,920 | 159 |
| 99212 | Office o/p est sf 10 min | $71,702 | 42 |
| 98941 | Chiropract manj 3-4 regions | $32,660 | 15 |
| 99401 | Prev med cnsl indiv apprx 15 | $24,001 | 22 |
| 99211 | Off/op est may x req phy/qhp | $16,877 | 52 |
| 99391 | Per pm reeval est pat infant | $11,220 | 54 |
| 99396 | Prev visit est age 40-64 | $8,717 | 26 |
| 99392 | Prev visit est age 1-4 | $8,606 | 51 |
| 99393 | Prev visit est age 5-11 | $6,758 | 32 |
| 99395 | Prev visit est age 18-39 | $6,329 | 18 |
| 99394 | Prev visit est age 12-17 | $3,013 | 11 |
| 99188 | App topical fluoride varnish | $2,975 | 14 |
| 99000 | Specimen handling office-lab | $2,080 | 205 |
| 99385 | Prev visit new age 18-39 | $992 | 2 |
| 99203 | Office o/p new low 30 min | $211 | 1 |
| 99173 | Visual acuity screen | $18 | 53 |
| 99174 | Ocular instrumnt screen bil | $0 | 2 |
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.