San Francisco Medicaid spending on evaluation and management services climbs to $58.99 million in 2024

Medicaid providers in San Francisco submitted $58,989,700 in claims for Evaluation and Management services during 2024, as reported in the U.S. Department of Health and Human Services Medicaid Provider Spending database. This total reflected a 15.8% rise from 2023, when area providers billed $50,956,323 for the same services.

Medicaid, a public insurance program co-funded by federal and state governments, insures eligible low-income individuals and families, seniors, children, and people with disabilities. It represents a major segment of the U.S. health care structure.

Since taxpayer funds support Medicaid, local trends in Medicaid billing provide insight into the allocation of public health care resources in specific communities.

The “Evaluation and Management” category includes a group of Medicaid-billed services determined by care type and grouped under standardized HCPCS and CPT codes. For this report, each code was assigned to one service category using consistent code patterns to keep related services grouped, eliminate double counting, and preserve reporting accuracy over time.

Spending increased across several Medicaid service categories, but in San Francisco, Evaluation and Management placed fourth by total Medicaid dollars paid in 2024.

Statewide in California, Evaluation and Management ranked as the second highest category for total Medicaid spending in 2024.

Between 2019 and 2024, Medicaid payments for Evaluation and Management in San Francisco rose by $39,321,153, a 199.9% increase. This growth accelerated at certain points, with significant jumps observed in both 2023 and 2021.

Though payments for Evaluation and Management were made throughout San Francisco, the majority were concentrated within a few ZIP codes. In 2024, ZIP code 94103 accounted for $15,146,559, 94143 received $14,738,557, and 94122 reported $8,351,716. Combined, these top 3 ZIP codes represented 64.8% of all Medicaid dollars paid for Evaluation and Management in the city that year.

Payments within the Evaluation and Management category were also concentrated within a small set of billing codes.

Compared to a citywide 14.5% increase in Medicaid claims across all categories from 2023 to 2024, payments tied specifically to Evaluation and Management services rose by 15.8% during the same period in San Francisco.

Data from the Centers for Medicare & Medicaid Services shows that federal and state Medicaid spending together totaled about $871.7 billion in fiscal 2023, making up around 18% of all national health expenditures—an increase from approximately $613.5 billion in 2019, before the onset of the COVID-19 pandemic.

This represents roughly 40% growth over several years, driven by higher enrollment and service use during and after the pandemic.

Recent federal budget measures enacted during the Trump administration have included major efforts to cut federal Medicaid funding and change the program’s structure. The “One Big Beautiful Bill Act,” approved in 2025, is expected to reduce federal Medicaid spending by more than $1 trillion over the upcoming decade and introduces changes such as work requirements and greater cost-sharing, potentially reducing benefits and shifting costs to states while Medicaid continues to serve 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.