Wind Gap sees 48.4% surge in Medicaid Evaluation and Management payments in 2024

In 2024, Medicaid providers in Wind Gap billed a total of $90,499 for Evaluation and Management services, according to the U.S. Department of Health and Human Services Medicaid Provider Spending database. This represents a 48.4% rise over the $60,979 reported for the same service type in 2023.

Medicaid, a public health insurance initiative operated by states and funded by both federal and state governments, provides coverage to low-income families, seniors, children, and persons with disabilities. The program is among the largest components of the nation’s health care system.

Because Medicaid payments are sourced from public funds, variations in local billing levels help illustrate how health care resources are distributed within communities.

The “Evaluation and Management” designation refers to a range of Medicaid services defined by care type and grouped using standardized HCPCS and CPT billing codes. This report grouped related codes into single service categories based on standardized criteria, helping prevent overlap and maintain consistent tracking over time.

While Medicaid expenditures rose across several categories, Evaluation and Management led all service types in Wind Gap for total payments in 2024.

Statewide in Pennsylvania, Evaluation and Management placed fourth in terms of total Medicaid payments in 2024.

Across the five years ending in 2024, Medicaid payments associated with Evaluation and Management services in Wind Gap grew by $83,353, or 1166.4%. There were marked increases in spending during select periods, particularly in 2021 and 2022.

Payments for Evaluation and Management care were distributed throughout the city, but most were concentrated in just a few ZIP codes. In 2024, ZIP code 18091 accounted for $90,499 in Medicaid payments for Evaluation and Management, representing 100% of Wind Gap’s total for this category during the year.

Payments within the Evaluation and Management classification were also focused among a small number of billing codes.

To compare, Medicaid payments for Evaluation and Management services in Wind Gap climbed 48.4% from 2023 to 2024, while overall Medicaid claims in the city increased by 21.1% across all service categories during that time frame.

According to the Centers for Medicare & Medicaid Services, combined state and federal Medicaid spending was about $871.7 billion in fiscal 2023, making up around 18% of total U.S. health expenditures—a significant jump from $613.5 billion in 2019, prior to the COVID-19 pandemic.

This shift marks an approximate 40% increase in just a few years, largely attributed to expanded enrollment and increased service use during and following the pandemic.

Federal budget legislation enacted during the Trump administration proposed substantial reductions in federal Medicaid funding and changes to program structure. The “One Big Beautiful Bill Act,” signed into law in 2025, is expected to decrease federal Medicaid outlays by over $1 trillion over the next decade. It introduces policies such as work requirements and higher cost-sharing, which could limit coverage and federal funding for certain groups. These changes are anticipated to increase reliance on state funding and restrict federal Medicaid expansion, despite the program’s ongoing service to millions.

Note: HCPCS codes are included for context within the category. Reported totals and rankings are based on consistent service groupings rather than individual billing codes.

Data for this report comes from the U.S. Department of Health and Human Services Medicaid Provider Spending database. Access the original source data here.