Monaca Medicaid spending for Evaluation and Management services rises to $143,106 in 2024

Providers in Monaca billed Medicaid $143,106 for services within the Evaluation and Management category in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database show. This represented an increase of 185.6% from 2023, when $50,106 was billed for the same category of care.

Medicaid serves as a state-administered health insurance program financed jointly by the federal and state governments. The program covers low-income families and individuals, seniors, children, and those with disabilities, remaining a major component of the U.S. health care system.

Because Medicaid is taxpayer funded, fluctuations in billing at the community level help demonstrate how public health care resources are distributed locally.

The Evaluation and Management category encompasses a set of Medicaid-billed services defined by the style of care provided under standardized HCPCS and CPT coding. This reporting categorized each billing code into a dedicated service type based on consistent code prefixes and ranges, which allowed grouping similar services accurately, preventing repeated counts, and enabling reliable tracking over time.

Despite overall Medicaid spending growth among several service types, Evaluation and Management placed third in total Medicaid reimbursements in Monaca for 2024.

Across Pennsylvania, Evaluation and Management services came in fourth for total Medicaid payments in 2024.

Over the five years through 2024, Medicaid payments for Evaluation and Management services in Monaca rose by $141,812, or 10963.2%. Some intervals saw faster rate increases, with notable jumps year over year in 2021 and 2023.

Although services covered in the Evaluation and Management category were disbursed throughout Monaca, payment levels were concentrated within a small number of ZIP codes. The highest total paid—a full $143,106—occurred in ZIP code 15061, which alone made up 100% of Medicaid payments for Evaluation and Management services locally in 2024.

Within this service group, Medicaid disbursements focused on a limited set of billing codes.

Medicaid payments tied to Evaluation and Management in Monaca were up 185.6% from 2023 to 2024, while payment growth across all Medicaid claim categories in the city was 3% over that period.

Figures from the Centers for Medicare & Medicaid Services show that combined federal and state Medicaid expenditures reached approximately $871.7 billion for fiscal year 2023, representing about 18% of total national health care outlays—up from $613.5 billion in 2019, pre-pandemic.

This shift marks roughly 40% program growth over a few years, propelled mainly by increased enrollment and utilization during and after the COVID-19 pandemic period.

Congressional budget legislation under the Trump administration has put forth several key proposals impacting federal Medicaid funding. The “One Big Beautiful Bill Act,” signed into law in 2025, is expected to cut more than $1 trillion from federal Medicaid spending over the decade ahead, introducing requirements like mandatory employment and higher patient cost sharing, which could reduce both total benefits and fund allocation for certain recipients. These measures are anticipated to shift more expenses to the states and place limits on future federal investment in the program, despite the program’s large national enrollee population.

Note: HCPCS codes are presented for category context. Rankings and totals discussed in this report reflect standardized service category grouping rather than individual billing codes.

All figures in this article are drawn from the U.S. Department of Health and Human Services Medicaid Provider Spending database, accessible here.