The small peninsula is isolated from the rest of Molokaʻi by cliffs over a quarter-mile high; the only land access is a mule trail.

The quarantine policy was only lifted after effective antibiotic treatments were developed that could be administered on an outpatient basis and patients could be rendered non-contagious.

[10] Tourists 16 years of age and older and personal guests of residents may visit with prior government permission,[11][12] and the general public must be part of an official tour.

Instead, Kalawao County is administered by the Hawaii Department of Health because of the history of the settlement and current patients living there.

Under Hawaiian state law, the Director of the Hawaii Department of Health, who is appointed by the Governor, also serves as the Mayor of Kalawao County.

[19] For the purpose of notarization, the designated venue for the First Judicial Circuit is "State of Hawaii, City and County of Honolulu."

The Kalaupapa Peninsula developed from lava that erupted from the ocean floor near Kauhakō Crater and spread outward, forming a low shield volcano.

This was the most recent volcanic episode on the island and of the larger East Molokaʻi shield volcano, occurring after the formation of the cliffs by erosion.

The population has declined since 1900:[31] Current residents include 16 former patients,[32] 40 federal employees who work on preservation projects, and some state-employed health workers.

It was the only county in the United States where the Republican candidate in the 2016 United States presidential election, Donald Trump, finished in third by only getting one vote; 70% of Kalawao's voters chose Democratic nominee Hillary Clinton, and 25% of Kalawao voters cast their ballots for Green Party candidate Jill Stein, making it Stein's strongest county nationwide in terms of vote percentage.