“„Although Medicaid enrollment growth may have peaked in the first half of 2009, enrollment increases during the recession continue to place additional strain on state budgets. This growth would likely have been much smaller, and many more Americans would likely have become uninsured, without the added federal support and maintenance of effort requirements provided through the 2009 fiscal stimulus, the financing portion of which has been extended to June 30, 2011. Financing and maintaining the program will continue to be a challenge for state and federal policymakers as they prepare for the Medicaid eligibility expansions beginning in 2014 under health reform and the 16 million new enrollees estimated to gain Medicaid coverage.