South San Francisco Medicaid spending on Evaluation and Management services climbs to $3,644,319 in 2024

Medicaid providers in South San Francisco submitted billings totaling $3,644,319 for Evaluation and Management services in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This figure reflects an increase of 179.2% from 2023, when $1,305,133 in claims were reported for the same category of care.

Medicaid is a government health insurance initiative that is organized by states and funded through federal and state resources. It serves low-income residents, seniors, children, and individuals with disabilities, ranking among the largest health programs in the United States.

Since Medicaid funding is derived from taxpayers, changes in area billing reflect how public health resources are distributed in the local community.

The “Evaluation and Management” group includes Medicaid services classified by the nature of care provided, using specific HCPCS and CPT code ranges. Service categories for this report were determined by assigning each code to a single grouping through matched code prefixes and numeric parameters, enabling related services to be tracked over time and preventing duplicate counts to maintain accurate rankings.

Despite growth in Medicaid spending across different service groups, Evaluation and Management was the third-largest category by Medicaid payments in South San Francisco in 2024.

Statewide, Evaluation and Management ranked second for total Medicaid payments in California during 2024.

Over the five-year stretch leading to 2024, Evaluation and Management Medicaid payments in South San Francisco grew by $3,328,406, or 1,053.6%. Several periods of accelerated growth were seen, with sharp annual increases in 2021 and 2023.

Although Evaluation and Management services were billed for across the city, nearly all Medicaid payments in this category were concentrated in a select group of ZIP codes. In 2024, ZIP code 94080 accounted for $3,644,318 in these payments. This single ZIP code represented 100% of Evaluation and Management Medicaid payments in South San Francisco for the year.

Payments within the Evaluation and Management group also focused on a limited group of individual billing codes.

Comparatively, while Medicaid payments in the Evaluation and Management category increased 179.2% from 2023 to 2024 in South San Francisco, payments for all Medicaid claim categories in the city during that time changed by 3.9%.

Centres for Medicare & Medicaid Services data estimate total federal and state Medicaid spending topped $871.7 billion in fiscal year 2023, making up approximately 18% of the nation’s health expenditures, a substantial increase from $613.5 billion in 2019, before the COVID-19 pandemic.

This rise equates to growth of around 40% in just a few years, mainly attributed to greater enrollment and higher use of services during and after the pandemic.

Recent federal budget legislation signed under the Trump administration has outlined major changes to Medicaid funding. The “One Big Beautiful Bill Act,” which became law in 2025, is set to reduce federal Medicaid expenditures by more than $1 trillion over 10 years, with new elements such as work requirements and larger cost-sharing that may decrease coverage and funding for certain groups. These developments are anticipated to shift a larger financial responsibility to states and potentially slow federal Medicaid growth, despite the program’s coverage of 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.