Data from the U.S. Department of Health and Human Services Medicaid Provider Spending database shows Medicaid providers in Kapaa submitted $177,940 in claims for Medicine Services and Procedures in 2024. That total represents a 287.1% rise from 2023, when providers filed $45,973 in claims in the same category.
Medicaid is operated by states and funded in partnership with federal and state governments. The program covers low-income populations, seniors, children and individuals with disabilities, making it a crucial component of the U.S. health care system.
Since Medicaid payments are taxpayer-funded, fluctuations in local billing levels provide insight into public health care funding within communities.
The “Medicine Services and Procedures” category includes services defined by care type, grouped by consistent HCPCS and CPT codes. For this reporting, individual billing codes were placed into one category using standard prefixes and numeric ranges, ensuring related services were grouped together without duplicated counts and permitting accurate rankings.
Though Medicaid spending climbed in several categories, Medicine Services and Procedures secured the second place in total payments for Kapaa in 2024.
Statewide, Medicine Services and Procedures also ranked second by total Medicaid expenditures in Hawaii for 2024.
Analyzing a five-year span ending in 2024, Medicaid claims in Kapaa for Medicine Services and Procedures grew by $151,339, an increase of 568.9%. Some periods witnessed accelerated growth, with especially sharp annual increases in both 2021 and 2023.
Medicaid payments for this service category in Kapaa were broadly distributed, but the majority were concentrated within a small set of ZIP codes. In 2024, ZIP code 96746 accounted for $177,940 in Medicaid claims. This single ZIP code represented 100% of Kapaa Medicaid spending for Medicine Services and Procedures that year.
Within the Medicine Services and Procedures category, billing activity remained concentrated among a few specific Medicaid billing codes.
Comparing categories, Medicaid claims for Medicine Services and Procedures in Kapaa rose 287.1% from 2023 to 2024, whereas citywide Medicaid payments across all claim types posted an 11% change in that period.
According to the Centers for Medicare & Medicaid Services, federal and state Medicaid expenditures reached about $871.7 billion in the 2023 fiscal year, which made up roughly 18% of national health costs. This marks a significant rise from approximately $613.5 billion in 2019 before the global pandemic.
This growth is roughly a 40% rise over several years, largely due to an expansion in enrollees and higher service utilization during and post-pandemic.
Federal budget actions under the Trump administration have put forward major proposals to shrink federal Medicaid funding and alter its structure. For example, the “One Big Beautiful Bill Act,” enacted in 2025, aims to decrease federal Medicaid spending by over $1 trillion during the next 10 years. This law also implements work requirements and higher cost-sharing, potentially reducing coverage and federal support for certain beneficiaries. These changes may shift more costs to states and limit federal Medicaid expansion, even as millions remain covered.
| Year | Total Medicaid Payments | % Change From Previous Year |
|---|---|---|
| 2020 | $26,601 | -76.2% |
| 2021 | $50,318 | 89.2% |
| 2022 | $38,445 | -23.6% |
| 2023 | $45,973 | 19.6% |
| 2024 | $177,940 | 287% |
| Rank | Category | Medicaid Payments | Share of City Total |
|---|---|---|---|
| 1 | Evaluation and Management | $1,264,504 | 77.4% |
| 2 | Medicine Services and Procedures | $177,940 | 10.9% |
| 3 | Dental Services | $137,300 | 8.4% |
| 4 | Radiology Procedures | $24,748 | 1.5% |
| 5 | Temporary National Codes (Non-Medicare) | $24,680 | 1.5% |
| 6 | Pathology and Laboratory Procedures | $3,285 | 0.2% |
| 7 | Surgery | $750 | <0.1% |
| 8 | Vision Services | $332 | <0.1% |
| 9 | Temporary Codes | $81 | <0.1% |
| 10 | Drugs Administered Other than Oral Method | $8 | <0.1% |
| 11 | Outpatient PPS | $0 | <0.1% |
| 11 | Procedures / Professional Services | $0 | <0.1% |
| HCPCS Code | Description | Medicaid Payments | Claims |
|---|---|---|---|
| 90837 | Psytx w pt 60 minutes | $94,892 | 20 |
| 97110 | Therapeutic exercises | $30,778 | 15 |
| 97032 | Appl modality 1+estim ea 15 | $22,050 | 7 |
| 97530 | Therapeutic activities | $9,642 | 6 |
| 97140 | Manual therapy 1/> regions | $7,915 | 7 |
| 90833 | Psytx w pt w e/m 30 min | $5,381 | 6 |
| 97112 | Neuromuscular reeducation | $5,114 | 5 |
| 92004 | Compre oph exam new pt 1/> | $1,139 | 4 |
| 92015 | Determine refractive state | $554 | 6 |
| 90471 | Immunization admin | $160 | 1 |
| 93005 | Electrocardiogram tracing | $117 | 10 |
| 96127 | Brief emotional/behav assmt | $70 | 1 |
| 96375 | Tx/pro/dx inj new drug addon | $52 | 4 |
| 96374 | Ther/proph/diag inj iv push | $33 | 7 |
| 96361 | Hydrate iv infusion add-on | $30 | 5 |
| 96110 | Developmental screen w/score | $7 | 11 |
| 96365 | Ther/proph/diag iv inf init | $0 | 1 |
| 96372 | Ther/proph/diag inj sc/im | $0 | 11 |
Note: HCPCS codes are provided as reference within the category. Category totals and rankings in this article are based on standardized service groupings, not individual billing codes.
The information presented in this report comes from the U.S. Department of Health and Human Services Medicaid Provider Spending database. Access to the underlying data is available here.