Oceano Medicaid payments for Evaluation and Management services climb to $6,742 in 2024

In 2024, Medicaid providers in Oceano billed $6,742 for services in the Evaluation and Management category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents a 142.6% increase over 2023, when claims submitted for these services totaled $2,779.

Medicaid, a state-administered program jointly funded by federal and state governments, covers low-income individuals, families, seniors, children, and people with disabilities. It is a significant component of the U.S. health system. More information is available at this explainer.

Since Medicaid funding is sourced from taxpayer dollars, changes in billing patterns in the community reflect shifts in how public health care funds are distributed locally.

The “Evaluation and Management” group includes Medicaid-billed services determined by the kind of care provided. Standardized HCPCS and CPT code ranges were used for this analysis, ensuring each billing code was uniquely assigned and services could be grouped for reporting without overlap or misranking.

Spending on Medicaid rose for several service groups, and Evaluation and Management placed third by total Medicaid payments in Oceano for 2024.

At the state level, Evaluation and Management was the second-largest Medicaid payment category in California for 2024.

Over the last five years ending in 2024, Oceano’s Medicaid payments for Evaluation and Management services grew by $5,529, or 456%. At specific intervals, such as 2022 and 2020, year-over-year increases were notable.

Although these payments were distributed citywide, most of the spending occurred in just a few ZIP codes. In 2024, the highest payments were in ZIP code 93445, totaling $6,741. Together, Oceano’s top ZIP code accounted for 100% of Medicaid payments in this category during the year.

Within Evaluation and Management, Medicaid payments were highly concentrated in a subset of individual billing codes.

Between 2024 and 2023, Medicaid payments for this category in Oceano grew by 142.6%. For comparison, all Medicaid claim categories in the city saw a 17% increase in the same time frame.

According to the Centers for Medicare & Medicaid Services, total federal and state Medicaid expenditures reached close to $871.7 billion in fiscal year 2023, or roughly 18% of all national health spending. This was up sharply from $613.5 billion in 2019, before the start of the COVID-19 pandemic.

This growth represents an increase of about 40% in several years, largely the result of higher enrollment and greater utilization during and following the pandemic.

Recent U.S. federal budget measures under the Trump administration have incorporated significant proposals to reduce federal Medicaid funding and change program structure. One example is the “One Big Beautiful Bill Act,” signed into law in 2025, which could cut federal Medicaid spending by over $1 trillion over 10 years. The law adds requirements such as mandated work, more cost-sharing, and other provisions expected to reduce coverage and federal funding for some recipients. As a result, states may bear more of Medicaid’s cost and see limited increases in federal funds, even as the program continues to serve millions nationwide.

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.