Clayton Medicaid spending on Evaluation and Management soars to $20,986 in 2024

In 2024, Medicaid providers in Clayton submitted $20,986 in claims for Evaluation and Management services, as reported by the U.S. Department of Health and Human Services Medicaid Provider Spending database. This amount represented a 3859.6% increase from 2023, when providers filed just $530 in claims for these services.

Medicaid, a public health insurance program administered by individual states and financed in partnership by the federal and state governments, provides coverage for low-income individuals and families, seniors, children, and those with disabilities, making it one of the nation’s largest health care systems.

Since Medicaid is funded by taxpayers, shifts in local billing levels provide a view into how public health care money is distributed within a community.

The term “Evaluation and Management” covers a set of Medicaid-billed services, grouped according to type of care by standardized HCPCS and CPT coding systems. For the purposes of this analysis, each billing code is assigned to one service category using uniform code prefixes and numbers, enabling similar services to be reviewed as a group while avoiding any double counting and ensuring consistent rankings over time.

Spending under Medicaid increased in several service areas; however, Evaluation and Management had the highest Medicaid payments in Clayton in 2024.

Statewide in Delaware, the Evaluation and Management group ranked third in terms of total Medicaid spending for 2024.

Across the five-year period ending in 2024, Medicaid claims for Evaluation and Management services in Clayton rose by $20,986, or 0%. The pace of spending increases was faster in select years, with significant annual growth seen in 2021 and 2022.

While Evaluation and Management care costs were spread citywide, the majority of Medicaid payments were clustered in a few ZIP codes. In 2024, ZIP code 19938 posted the highest Medicaid payments for Evaluation and Management, totaling $20,985. This top ZIP code made up 100% of all Medicaid claims in this category for Clayton that year.

Within the broader Evaluation and Management group, a small subset of billing codes accounted for most Medicaid payments.

Looking at changes across all categories, Medicaid spending for Evaluation and Management bumped up 3859.6% between 2024 and 2023, outpacing the 2669.5% shift across all claim categories in Clayton during the same period.

Data from the Centers for Medicare & Medicaid Services show that total federal and state Medicaid spending reached approximately $871.7 billion in fiscal 2023. This represented about 18% of total national health expenditures, a jump from about $613.5 billion in 2019, the year before the COVID-19 pandemic.

This 40% increase was primarily driven by higher enrollment and increased use during and following the pandemic.

Recent federal budget laws enacted during the Trump administration included major initiatives to cut federal Medicaid funding and adjust program structure. For instance, the “One Big Beautiful Bill Act,” signed in 2025, is expected to decrease federal Medicaid outlays by over $1 trillion throughout the next decade. The legislation also introduced requirements for work and higher cost-sharing, which could limit coverage or funding for some recipients. States are anticipated to shoulder more financial responsibility as federal Medicaid funding growth slows, though the program remains critical for 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.