Medicaid Evaluation and Management service payments jump 54.6% in Schaefferstown in 2024

Data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows Medicaid providers in Schaefferstown billed $688 for services in the Evaluation and Management category in 2024. That total reflects a 54.6% rise compared to 2023, when $445 was billed for the same services.

Medicaid is a public health insurance initiative managed by states and financed by both federal and state governments. The program serves low-income individuals and families, as well as seniors, children, and those with disabilities, making it a cornerstone of the U.S. health care system.

Since Medicaid is taxpayer funded, trends in local billing levels highlight how health care funds are spent within a community.

The “Evaluation and Management” group comprises services determined by the nature of care provided and is categorized by standardized HCPCS and CPT codes. For this analysis, each code was assigned to a single service group using consistent numbering, preventing double counting and helping to clarify long-term rankings and spending trends.

Evaluation and Management services topped all Medicaid service categories by total payments in Schaefferstown for 2024, even as multiple categories saw growth.

Statewide, the Evaluation and Management category was ranked fourth for total Medicaid spending in Pennsylvania for 2024.

During the five-year span before 2024, Schaefferstown saw Medicaid payments attributed to Evaluation and Management rise by $688, a 0% change overall. Spending accelerated at certain periods, with pronounced annual increases in 2023 and 2022.

While these Evaluation and Management payments were dispersed citywide, a handful of ZIP codes held the highest concentrations. In 2024, the 17088 ZIP code accounted for $687 in such payments—the top among all zones and making up 100% of category payments in Schaefferstown that year.

Within this category, Medicaid payments were heavily concentrated among just a few specific billing codes.

For perspective, the 54.6% increase in Schaefferstown’s Evaluation and Management spending from 2023 to 2024 matches the 54.5% increase observed across all Medicaid billing categories in the city in the same period.

According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid outlays reached about $871.7 billion for fiscal 2023, or roughly 18% of the nation’s total health expenditures—up sharply compared with about $613.5 billion back in 2019, before the COVID-19 pandemic.

This marks close to a 40% increase within just a few years, largely due to broader enrollment and greater use during and after the pandemic.

Recent federal budget bills signed during the Trump administration include major proposals to cut federal Medicaid funding and restructure the program. The “One Big Beautiful Bill Act,” passed into law in 2025, is expected to cut federal Medicaid expenditures by more than $1 trillion over the next decade and enacts policies like work requirements and greater cost-sharing. These provisions may decrease access to coverage and lower federal funding for some eligible individuals, likely shifting more costs onto states while federal support grows more slowly, though Medicaid will still 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.