Riverside Medicaid Evaluation and Management spending climbs to $82.1 million in 2024

Medicaid providers in Riverside billed a total of $82,124,833 for services within the Evaluation and Management category in 2024, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represented a 19.7% uptick from the previous year, when Riverside providers submitted $68,600,296 in claims for these services.

Medicaid, a health insurance program managed by the states with funding shared between federal and state governments, covers seniors, low-income families and individuals, children, and people with disabilities, making it a major component of the U.S. health system.

Since Medicaid spending is financed by taxpayers, shifts in local billing demonstrate how public health resources are distributed throughout a community.

The term “Evaluation and Management” refers to a collection of Medicaid services grouped by care type, as identified through standardized HCPCS and CPT code ranges and prefixes. A single billing code was designated for each service group in the analysis to enable accurate trend assessments and prevent overlap or duplication in reporting.

In 2024, the Evaluation and Management category was the fourth-highest among Medicaid service types by total payments in Riverside, following growth across several medical service categories.

At the state level, Evaluation and Management was second by payment amount among Medicaid service groupings in California in 2024.

Riverside’s Medicaid payments for the Evaluation and Management category rose by $59,160,742 over the past five years, a 257.6% increase, with notable annual surges in 2022 and 2023 accelerating this trend.

Though these services were provided citywide, Medicaid payments in the Evaluation and Management category were mostly concentrated in a few ZIP codes. In 2024, ZIP codes 92503 ($27,498,124), 92501 ($18,818,758), and 92505 ($18,704,120) generated the highest totals, together making up 79.2% of the local category’s Medicaid payment volume.

Within this service group, the majority of Medicaid payments were attributed to a small subset of billing codes.

Between 2024 and 2023, payments for the Evaluation and Management category in Riverside increased 19.7%, compared to a 4.5% overall rise for all Medicaid billed categories in the city in the same period.

According to the Centers for Medicare & Medicaid Services, total Medicaid spending at both the federal and state levels reached about $871.7 billion in fiscal year 2023. This accounted for approximately 18% of national health expenditures, a significant jump from $613.5 billion in 2019, prior to the COVID-19 pandemic.

This change reflects an approximate 40% increase in just a few years, largely due to broader enrollment and greater service use during and after the pandemic period.

Recent federal budget actions from the Trump administration included significant initiatives that aim to cut federal Medicaid funds and reshape how the program operates. The “One Big Beautiful Bill Act,” enacted in 2025, is anticipated to reduce federal Medicaid funding by over $1 trillion over 10 years, introducing policy changes such as work requirements and increased cost-sharing that have potential to limit both coverage and funding for certain Medicaid recipients. As a result, more costs could shift to the states and the growth in federal Medicaid support could slow despite sustained demand for the program.

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.