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Medicaid

Seventy-five percent of the states cited the reason for the decreased enrollment as tighter citizenship documentation requirements. The 0.5% decline resulted from a change last year that required Medicaid applicants to submit documentation - a driver's license or birth certificate, for example - proving they are legal citizens of the United States. Before this change, applicants merely had to check a box.

However, the director of the Center for Medicaid and State Operations disputed that information. Instead, they claim a strong economy kept the numbers of people needing to enroll to a minimum.

The spending increase was caused primarily by an increase in reimbursements to care providers in a number of the states, including Connecticut. Officials from Kansas also complained that the documentation changes increased their administrative costs.

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