The eighth annual budget survey of state officials was conducted by researchers from the Kaiser Foundation and Health Management Associates. The researchers also gathered state-level data about fiscal year 2008 restorations, enhancements, and expansions to state Medicaid programs, which were also factors in the enrollment and spending increases. These include changes in provider reimbursement levels, Medicaid eligibility requirements and enrollment processes, benefits, and home- and community-based services for long-term care. The changes reflect efforts that began during the favorable economic climate in 2007, as states prepared their fiscal year 2008 budgets. Most states covered similar efforts in their fiscal year 2009 budgets, but expansions were fewer and smaller in scope.