San Rafael saw 112.1% jump in Medicaid Evaluation and Management payments in 2024

In 2024, Medicaid providers in San Rafael billed $2,335,117 for services under the Evaluation and Management category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This figure reflects a 112.1% rise over the previous year, when claims totaled $1,100,894 for these services.

Medicaid is a state-administered public health insurance program funded through a federal-state partnership. Covering low-income individuals, families, seniors, children, and people with disabilities, it is among the largest components of health care nationally.

Because taxpayers fund Medicaid payments, local shifts in billing patterns highlight how public health resources are distributed at the community level.

The “Evaluation and Management” category comprises Medicaid services defined by care type and identified using standardized HCPCS and CPT coding groupings. This analysis assigned each billing code to one service category using uniform code prefixes and ranges, enabling clear tracking of related services without double counting and supporting precise rankings over time.

While multiple service categories saw spending growth, Evaluation and Management represented the third-largest share of total Medicaid payments in San Rafael for 2024.

At the state level, Evaluation and Management ranked as the second-highest Medicaid payment category in California in 2024.

Over the five years ending in 2024, Medicaid payments connected to Evaluation and Management services in San Rafael increased by $1,713,263, an overall rise of 275.5%. Significant annual growth appeared during select periods, with the steepest year-to-year surges observed in 2023 and 2021.

Service-related spending within this category occurred throughout San Rafael, but reporting shows payments were concentrated primarily in a few ZIP codes. For 2024, ZIP code 94903 accounted for $1,589,309 and 94901 for $745,807 in Medicaid payments linked to Evaluation and Management, together representing 100% of the category’s citywide total.

Medicaid reimbursement was also densely distributed among a small set of individual billing codes within the Evaluation and Management category.

During the same period, the 112.1% increase in locally tied Evaluation and Management Medicaid payments contrasted with a 37.4% growth across all Medicaid claim categories in San Rafael.

The Centers for Medicare & Medicaid Services reports that total federal and state Medicaid outlays reached around $871.7 billion for fiscal year 2023. This made up roughly 18% of national health spending, a steep increase from the $613.5 billion figure reported for 2019, the year before the COVID-19 pandemic.

This rise amounts to about 40% over several years, propelled by a larger beneficiary pool and increased usage during and following the pandemic period.

Recent federal budget actions under the Trump administration have proposed notable reductions to Medicaid funding and structural revisions to the program. Notably, the “One Big Beautiful Bill Act,” enacted in 2025, is projected to reduce federal Medicaid spending by over $1 trillion over the next decade while implementing work requirements and raising cost-sharing that may impact access and funding for certain beneficiaries. These reforms could place more cost responsibility on states and restrain future federal financial support, even as millions continue to rely on 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.