In 2024, Medicaid providers in Enterprise billed $153,673 for services under the Evaluation and Management category, based on data from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 6.8% uptick from the prior year, when providers submitted $143,950 in claims for the same services.
Medicaid is a public health insurance initiative funded by both federal and state governments and administered by states. It serves low-income families and individuals, children, seniors, and people with disabilities, making it a significant component of the United States health care system.
Fluctuations in Medicaid spending reflect the allocation of taxpayer-funded health care resources across local communities.
The “Evaluation and Management” designation comprises a range of Medicaid-billed services grouped by care type, determined by established HCPCS and CPT code sets. This analysis assigned each code to a single service category using strict code prefixes and ranges, ensuring accurate grouping, ranking, and avoiding any double counting over time.
Evaluation and Management placed second among all Medicaid service categories in Enterprise for total payments in 2024, though spending increased across multiple categories.
Statewide in Oregon, Evaluation and Management ranked first for total Medicaid payments in 2024.
Over the five years before 2024, Medicaid payments associated with Evaluation and Management in Enterprise grew by $35,541, or 30.1%. Certain years, such as 2021 and 2022, saw especially notable growth compared with other years in this period.
Although services in the Evaluation and Management category were provided citywide, a small number of ZIP codes accounted for most of the spending. In 2024, ZIP code 97828 was responsible for $153,673, representing 100% of all Medicaid payments in this service category for Enterprise that year.
Within this category, a limited selection of individual billing codes accounted for the bulk of Medicaid payments.
Medicaid payments in Enterprise linked to Evaluation and Management rose 6.8% from 2023 to 2024, exceeding the 0.3% gain for all Medicaid claim categories in the city during the same period.
The Centers for Medicare & Medicaid Services report that joint federal and state Medicaid spending was approximately $871.7 billion in fiscal year 2023, making up about 18% of total national health expenditures and rising sharply from $613.5 billion in 2019, before the COVID-19 pandemic.
This growth of nearly 40% over several years was largely due to increased enrollment and higher service utilization during and after the pandemic.
Recent federal budget measures under the Trump administration have included proposals to decrease federal Medicaid funding and restructure aspects of the program. For instance, the “One Big Beautiful Bill Act,” signed in 2025, is projected to reduce federal Medicaid spending by over $1 trillion over the next decade. The legislation introduces policies such as work requirements and added cost-sharing, which may reduce coverage and funding for certain beneficiaries. These policies are expected to shift more financial responsibility to states and limit future federal Medicaid support, though the program will still serve tens of millions of Americans.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $118,132 | -38.9% |
| 2021 | $180,852 | 53.1% |
| 2022 | $209,466 | 15.8% |
| 2023 | $143,949 | -31.3% |
| 2024 | $153,673 | 6.8% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | National Codes Established for State Medicaid Agencies | $4,067,968 | 92.6% |
| 2 | Evaluation and Management | $153,673 | 3.5% |
| 3 | Alcohol and Drug Abuse Treatment | $80,978 | 1.8% |
| 4 | Medicine Services and Procedures | $80,437 | 1.8% |
| 5 | Surgery | $4,011 | 0.1% |
| 6 | Pathology and Laboratory Procedures | $2,879 | 0.1% |
| 7 | Procedures / Professional Services | $1,376 | <0.1% |
| 8 | Drugs Administered Other than Oral Method | $414 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99213 | Office o/p est low 20 min | $47,118 | 119 |
| 99214 | Office o/p est mod 30 min | $37,518 | 83 |
| 99285 | Emergency dept visit hi mdm | $36,466 | 3 |
| 98941 | Chiropract manj 3-4 regions | $23,531 | 11 |
| 99215 | Office o/p est hi 40 min | $7,904 | 4 |
| 99348 | Home/res vst est low mdm 30 | $1,133 | 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.