In 2024, Medicaid providers in Laguna Woods billed $696,932 for services under the Evaluation and Management category, according to the U.S. Department of Health and Human Services Medicaid Provider Spending data. This total reflects a 1.5% increase compared with 2023, when $686,314 in claims was submitted for these services.
Medicaid, jointly funded by federal and state governments and administered at the state level, is a major U.S. public health insurance program serving low-income populations, seniors, children, and individuals with disabilities.
Because taxpayer dollars support Medicaid, shifts in community-level billing show how public health care funding is distributed locally.
The Evaluation and Management category consists of grouped Medicaid-billed services determined by care type, based on established HCPCS and CPT coding. For this report, related billing codes were compiled under specific service categories using consistent code prefixes and ranges, allowing for an accurate longitudinal analysis without duplication.
Evaluation and Management services ranked second in Laguna Woods among Medicaid spending categories in 2024, despite a general rise in Medicaid payments for multiple categories.
Statewide, Evaluation and Management also held the second-highest spot by Medicaid payment amount in California in 2024.
Between 2019 and 2024, Medicaid spending for the Evaluation and Management category in Laguna Woods increased by $685,004, or 5743%. Spending growth was especially pronounced in certain years, with notable year-to-year jumps seen in 2021 and 2020.
Payments attributed to Evaluation and Management services may be found throughout Laguna Woods. However, in 2024, services in ZIP code 92637 accounted for the full amount of $696,932, meaning that this ZIP code represented 100% of Medicaid payments reported for Evaluation and Management within the city.
Within the Evaluation and Management grouping, Medicaid spending was focused among a small subset of billing codes.
From 2023 to 2024, Laguna Woods saw a 1.5% increase in Medicaid payments for Evaluation and Management services. By contrast, all Medicaid claim categories in the city grew by 33.4% over the same timeframe.
According to the Centers for Medicare & Medicaid Services, combined federal and state Medicaid expenditures rose to about $871.7 billion in fiscal year 2023, comprising about 18% of U.S. health spending. This is up from approximately $613.5 billion in 2019, before the COVID-19 pandemic.
This shift represents an increase of approximately 40%, spurred largely by increased enrollment and service utilization resulting from the pandemic era.
In recent years, federal budget policies signed under the Trump administration have included notable Medicaid funding cuts and restructuring efforts. The “One Big Beautiful Bill Act,” passed in 2025, is expected to reduce federal Medicaid funding by over $1 trillion in the next decade. The law introduces work requirements and greater cost-sharing, which could decrease access or funding for some Medicaid recipients. With these changes, a greater share of Medicaid costs is anticipated to shift to states, limiting federal growth as the program continues to support tens of millions of people nationwide.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $11,927 | 516.4% |
| 2021 | $869,121 | 7186.6% |
| 2022 | $740,309 | -14.8% |
| 2023 | $686,313 | -7.3% |
| 2024 | $696,932 | 1.5% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Temporary National Codes (Non-Medicare) | $1,943,429 | 62.6% |
| 2 | Evaluation and Management | $696,932 | 22.4% |
| 3 | Surgery | $242,427 | 7.8% |
| 4 | Radiology Procedures | $160,537 | 5.2% |
| 5 | Dental Services | $34,292 | 1.1% |
| 6 | Drugs Administered Other than Oral Method | $26,686 | 0.9% |
| 7 | Medicine Services and Procedures | $1,022 | <0.1% |
| 8 | Medical And Surgical Supplies | $866 | <0.1% |
| 9 | Procedures / Professional Services | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99214 | Office o/p est mod 30 min | $453,867 | 140 |
| 99204 | Office o/p new mod 45 min | $152,486 | 89 |
| 99213 | Office o/p est low 20 min | $54,716 | 140 |
| 99203 | Office o/p new low 30 min | $32,118 | 69 |
| 99215 | Office o/p est hi 40 min | $3,743 | 8 |
| 99202 | Office o/p new sf 15 min | $0 | 2 |
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.
