Wilmington’s Medicaid Evaluation and Management payments reach $29,668,755 in 2024

Wilmington Medicaid providers billed $29,668,755 for services within the Evaluation and Management category in 2024, U.S. Department of Health and Human Services Medicaid Provider Spending data show. This reflects a 2.4% rise from 2023, when $28,972,516 in claims were filed under the same category.

Medicaid, a public health insurance system managed by states and financed by both federal and state governments, provides coverage for low-income families and individuals, seniors, children and those with disabilities. It stands among the largest components of the national health care landscape.

Fluctuations in Medicaid billing at the local level reflect the direction of taxpayer-funded health care resources within affected communities.

The Evaluation and Management classification covers a set of Medicaid services organized by the kind of care delivered, using standard HCPCS and CPT code groupings. Each code in this analysis was placed in a single service category, relying on uniform prefixes and number ranges for accurate categorization, preventing double counting and supporting consistent historic comparisons.

Payments in multiple Medicaid service categories climbed, with Evaluation and Management ranking second in Wilmington by payment amount in 2024.

Statewide in North Carolina, Evaluation and Management was also the second highest Medicaid payment category in 2024.

Between 2020 and 2024, Medicaid payments to Wilmington providers for Evaluation and Management services rose by $13,392,535—or 82.3%. Growth accelerated at several points, with significant annual increases reported in 2021 and 2022.

Although spending on Evaluation and Management care in Wilmington occurred throughout the city, payments were mostly concentrated in a few ZIP codes. Top ZIP codes were 28401 with $22,541,054, 28403 at $5,303,522 and 28412 totaling $1,463,917 in 2024. Combined, those 3 ZIP codes made up 98.8% of all Evaluation and Management Medicaid payments citywide that year.

Medicaid payments in this category were grouped among a select number of specific billing codes.

Looking at the annual change, Medicaid payments in Wilmington’s Evaluation and Management category grew 2.4% from 2023 to 2024, whereas charges across all Medicaid categories in the city rose 7% during the same timeframe.

The Centers for Medicare & Medicaid Services report federal and state Medicaid spending totaled about $871.7 billion in fiscal 2023, about 18% of all health spending nationally, a steep rise from $613.5 billion in 2019, before the COVID-19 pandemic began.

This nearly 40% increase was fueled largely by expanded enrollment and higher use of health care services during and since the pandemic period.

Recently enacted federal budget legislation during the Trump administration involved proposals to significantly decrease federal Medicaid dollars and modify program structure. The “One Big Beautiful Bill Act,” passed in 2025, is forecast to reduce federal Medicaid spending by more than $1 trillion over the coming decade and implements measures such as work requirements and greater cost-sharing, potentially reducing coverage or funding for some participants. States are likely to bear more costs, and growth in federal Medicaid funding is set to slow even as coverage continues for 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.