Nearly 30% of the population of Guam relies on the local Medicaid program for healthcare coverage. Due to a high prevalence of non-communicable disease, access to affordable chronic care management is crucial to sustaining the island territory’s healthcare system. With nearly $130 million in federal match funding, understanding the spending trends of Guam’s Medicaid program may yield insight to how these funds are being accessed by the patient population. Data was obtained from the Medicaid section of the Medicaid and MIP Expenditure and Demographic End of 4th Quarter Report available on the Guam Department of Health and Human Services Bureau of Health Care Financing Administration web page. A data set was constructed from reports published for fiscal years 2014-2023. Categories for expenditure were titled “Type of Service” on the report and all services provided in the report were included in the data set. Regression analysis was performed to determine average change in expenses over time. Between 2014 and 2023, total expenses increased from $57.9 million to $115.3 million (R2=0.84). 16 out of 24 services had an average increase in expenses. Amongst services, the greatest average increase was observed in Inpatient Hospital services with $6,601,156 (p=0.00005; R2=0.8). The greatest average annual decrease was observed in Dental services with -$897,347 (p=0.003; R2=0.6) Increases in Emergency Room services (p=0.004; R2=0.6), Outpatient Hospital services (p=0.001; R2=0.8), and Home Health services (p=0.02; R2=0.7) were also observed. No statistically significant increase was seen in FQHC with an annual average decrease of -$75,170 (p=0.2; R2=0.1) Although there has been a dramatic increase in total spending by the Guam Medicaid program, there is disparity in how this increase has been distributed across available services. Between 2014 and 2023, there have been increases in spending observed in Hospital services (Inpatient, Outpatient, and Emergency Room) with no increase in spending for primary care services (FQHC) during this time of overall spending growth. Publicly funded Dental services have observed dramatically decreased reimbursement. Information regarding disease prevalence and healthcare infrastructure must be considered to fully contextualize these findings. Local and federal policy makers should acknowledge these trends and ensure that distribution of the territorial Medicaid resources aligns with the needs of the island community.