Antioch Medicaid providers see 108.2% increase in Evaluation and Management payments in 2024

In 2024, Medicaid providers in Antioch billed $11,045,125 for services grouped under the Evaluation and Management category, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This represented a 108.2% increase over 2023, when $5,305,703 in claims were submitted for the same service type.

Medicaid, a public health insurance program administered by states and funded by both federal and state governments, provides coverage for low-income individuals, families, seniors, children, and those with disabilities—making it a major component of the U.S. health system.

Since Medicaid payments are taxpayer funded, shifts in local billing reflect how communities allocate public health care resources.

The Evaluation and Management category comprises a set of Medicaid-billed services based on the nature of care and defined by standardized HCPCS and CPT code groupings. In this analysis, each code was classified into one service category using regular code prefixes and ranges, ensuring related services could be evaluated together while maintaining accurate rankings and avoiding duplicate counts.

Evaluation and Management represented the top category for total Medicaid payments in Antioch for 2024, even as increases were seen across other service types.

Statewide, Evaluation and Management ranked as the second-largest category by Medicaid payments in California for 2024.

Over the five-year period leading up to 2024, Medicaid payments for Evaluation and Management in Antioch increased by $8,315,649, translating to a 304.7% growth. There were notable year-over-year spikes, especially during 2021 and 2023.

Spending for Evaluation and Management services was seen throughout Antioch, though payments were concentrated in select ZIP codes. In 2024, ZIP code 94531 accounted for $7,578,743 and ZIP code 94509 for $3,466,380—together making up 100% of Evaluation and Management Medicaid payments in the city for the year.

Payments within the Evaluation and Management category were largely attributed to a limited group of individual billing codes.

When compared to all Medicaid claim categories in Antioch, the 108.2% increase for Evaluation and Management services between 2024 and 2023 was significantly higher than the citywide change of 32.7% over the same period.

The Centers for Medicare & Medicaid Services report that combined federal and state Medicaid spending reached about $871.7 billion in fiscal year 2023. This amount represented roughly 18% of all U.S. health expenditures and marked a sizable jump from $613.5 billion in 2019, prior to the COVID-19 pandemic.

This growth—nearly 40% in several years—was primarily fueled by higher enrollment and increased use of services during and after the pandemic.

Federal budget measures during the Trump administration have proposed major reductions to Medicaid funding and changes to the program’s structure. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to cut over $1 trillion in federal Medicaid spending over 10 years and adds measures like work requirements and higher cost-sharing, potentially impacting funding and coverage for some groups. These adjustments may shift more financial responsibility to states and slow federal funding growth, even as Medicaid continues to provide coverage for 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 sourced from the U.S. Department of Health and Human Services Medicaid Provider Spending database. The source data is available here.