Koloa Medicaid providers submitted $231,081 in claims for Evaluation and Management services in 2024, based on figures from the U.S. Department of Health and Human Services Medicaid Provider Spending database. This was a 44.9% increase from 2023, when claims for these services totaled $159,464.
Medicaid operates as a state-managed health insurance program, financed through a combination of federal and state funding. It provides coverage for people with low incomes, seniors, children, and those with disabilities, making it a key component of the U.S. health system.
As Medicaid spending is funded by taxpayers, shifts in community billing can indicate how public resources for healthcare are being distributed locally.
The “Evaluation and Management” section includes Medicaid-billed care identified by various HCPCS and CPT code groups. For this report, billing codes fell into single, distinct service categories using consistent code prefixes and number ranges, helping to group similar services, prevent double counting, and maintain accurate orderings across periods.
Evaluation and Management accounted for the highest Medicaid payment total in Koloa among all service categories in 2024.
For Hawaii, Evaluation and Management also led all categories statewide in Medicaid payments for 2024.
Koloa reported an increase of $216,835, or 1522.1%, in Medicaid payments for Evaluation and Management over the five years up to 2024. Rates of spending growth accelerated during select years, with significant jumps in 2021 and 2020.
Payments for Evaluation and Management services were spread locally but concentrated within only a few ZIP codes. In 2024, the highest Medicaid payments in this category originated from ZIP code 96756, accounting for $231,080. This top ZIP code represented 100% of all Medicaid payments for these services in Koloa for the year.
Spending within the Evaluation and Management category was also mainly driven by just a few specific billing codes.
Compared with a citywide average across all Medicaid claims, Evaluation and Management payments in Koloa increased 44.9% from 2023 to 2024, while all categories together rose by 47.2% during that period.
The Centers for Medicare & Medicaid Services reports that federal and state Medicaid expenditures climbed to about $871.7 billion in fiscal year 2023. That accounts for roughly 18% of total national health spending, a significant rise from about $613.5 billion in 2019, the year before the COVID-19 pandemic.
This almost 40% increase in only a few years stems from higher enrollment numbers and greater usage during and after the pandemic.
Federal budget measures passed under the Trump administration proposed major reductions in federal support for Medicaid, aiming to restructure the funding approach. The “One Big Beautiful Bill Act,” enacted in 2025, is expected to trim federal Medicaid expenditure by more than $1 trillion over the coming decade. The law implements new policies such as work requirements and increased cost-sharing, which may decrease coverage and federal funding for certain participants. As a result, states could bear a greater share of costs and experience slowed federal Medicaid growth, during a time when Medicaid remains vital to millions in the U.S.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $14,245 | 181.4% |
| 2021 | $42,208 | 196.3% |
| 2022 | $94,724 | 124.4% |
| 2023 | $159,463 | 68.3% |
| 2024 | $231,080 | 44.9% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $231,080 | 82.1% |
| 2 | Medicine Services and Procedures | $44,107 | 15.7% |
| 3 | Pathology and Laboratory Procedures | $6,001 | 2.1% |
| 4 | Procedures / Professional Services | $298 | 0.1% |
| 5 | Drugs Administered Other than Oral Method | $62 | <0.1% |
| 6 | Temporary National Codes (Non-Medicare) | $12 | <0.1% |
| 7 | Medical And Surgical Supplies | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 99214 | Office o/p est mod 30 min | $174,195 | 49 |
| 99213 | Office o/p est low 20 min | $38,197 | 30 |
| 99203 | Office o/p new low 30 min | $18,530 | 8 |
| 99417 | Prolng op e/m each 15 min | $157 | 1 |
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.