Shoreham Medicaid payments for Evaluation and Management surge to $904 in 2024

In 2024, Medicaid providers in Shoreham recorded $904 in claims 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, a 68.3% jump from 2023, compares to $537 in reported bills for the same service group during the previous period.

Medicaid, administered by states with both state and federal funding, is a public health coverage program serving low-income individuals and families, as well as seniors, children and people with disabilities, making it a central part of the U.S. health care framework.

Shifts in local Medicaid billing indicate how taxpayer-funded health care dollars are distributed at the community level.

The “Evaluation and Management” section covers groups of Medicaid services categorized by the care given, following standard HCPCS and CPT code formats. Each billing code for this analysis was linked to a specific service type using designated code prefixes and numeric groups, ensuring that related care could be evaluated collectively and that there was no double-counting, allowing continuous accurate category rankings into the future.

Although spending rose across multiple Medicaid service groups, Evaluation and Management placed second among all categories by total provider payments in Shoreham in 2024.

Evaluation and Management ranked as the highest Medicaid service category by total payments throughout Vermont in 2024.

During the five years preceding 2024, Evaluation and Management-related Medicaid payments in Shoreham climbed by $4,803, marking an 84.2% increase. Noteworthy year-over-year rises were especially prevalent in 2023 and 2022 as growth momentum intensified during specific intervals.

The distribution of Evaluation and Management claims spanned the city overall, but most payments were limited to a small set of ZIP codes. In 2024, ZIP code 05770 reported $904—accounting for the full share of Evaluation and Management Medicaid payments across Shoreham that year.

For this service type, a small group of billing codes generated a high proportion of total Medicaid payments.

When comparing rate changes, Evaluation and Management Medicaid payments rose 68.3% between 2024 and 2023, whereas bills from all Medicaid categories combined in Shoreham saw just an 11.5% uptick for that timeframe.

According to the Centers for Medicare & Medicaid Services, federal and state Medicaid spending jointly reached about $871.7 billion in fiscal year 2023, or approximately 18% of national health outlays—up considerably from $613.5 billion in 2019, ahead of the COVID-19 pandemic period.

This expansion represents approximately 40% growth in several years, largely fueled by higher enrollment and greater usage in the pandemic era and its aftermath.

Recent federal budgets initiated under the Trump administration brought substantial proposals to reduce Medicaid funding at the federal level and change program structure. For instance, the “One Big Beautiful Bill Act,” signed in 2025, is expected to decrease federal Medicaid spending by more than $1 trillion during the next decade, bringing forth requirements such as work stipulations and greater cost-sharing measures that could impact coverage and support for certain recipients. These adjustments shift more responsibility to individual states and slow down federal Medicaid funding growth, though the program still covers tens of 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.