Maine Medicaid Evaluation and Management service spending totals $88.2 million in 2024

Maine spent $88,176,999 in Medicaid funds on services categorized under Evaluation and Management in 2024, data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows. This figure represents a 1% rise compared with 2023, when providers reported $87,304,979 in claims.

Medicaid is a jointly funded program delivered by each state and the federal government, as explained by the Commonwealth Fund. It insures low-income individuals and families, senior citizens, children, and those living with disabilities, forming a major part of the country’s health system.

Since Medicaid expenditures consist of taxpayer dollars, fluctuations in local billing levels help illustrate the allocation of public funds in community health care delivery.

The Evaluation and Management category consists of services billed to Medicaid that are grouped by care type, using standard HCPCS and CPT coding structures. In this analysis, codes were consistently grouped based on numerical prefix and range, supporting comparative study over time and reducing double counting.

In instances where categories contain more than one service type, such groupings span related types of care commonly billed together within Medicaid, including office visits, diagnostic assessments and therapeutic interventions.

Between 2019 and 2024, evaluation and Management Medicaid payments statewide increased $35,916,259, amounting to a 68.7% rise. Growth in payment activity accelerated during some periods—particularly in 2021 and 2022.

Although Evaluation and Management services were reimbursed across the state, payment levels were concentrated within certain ZIP codes. The highest recipients in 2024 were ZIP Code 04102 with $15,123,340 (17.2% of total), ZIP Code 04240 at $13,494,883 (15.3% of total), and ZIP Code 04401 with $12,599,995 (14.3% of total).

Together, these three ZIP codes made up 46.7% of all Medicaid Evaluation and Management payments statewide in 2024.

For perspective, across all claim types, Medicaid payments in Maine increased 1.3% from 2023 to 2024.

Overall, while Medicaid spending grew across numerous types of services, the Evaluation and Management category was among the top five categories statewide by overall payments in 2024.

Data from the Centers for Medicare & Medicaid Services show combined state and federal Medicaid outlays totaled close to $871.7 billion during the 2023 fiscal year, making up approximately 18% of U.S. health spending, which is a significant increase from $613.5 billion in 2019 before the COVID-19 pandemic.

This jump equates to roughly 40% growth in just a few years, fueled mainly by greater enrollment and increased service use during and after the pandemic.

Recent significant budget proposals under the Trump administration included efforts to reduce federal Medicaid funding and reorganize program operations. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to cut federal Medicaid funding by over $1 trillion over the next 10 years. The law also introduces changes like work requirements and higher cost-sharing, factors likely to impact coverage for some recipients and shift more Medicaid costs to states, likely constraining federal funding growth as the program continues to insure tens of millions across the United States.

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.