This is the accessible text file for GAO report number GAO-13-454R entitled 'Medicaid: Additional Enrollment and Expenditure Data for the Transitional Medical Assistance Program' which was released on March 15, 2013. This text file was formatted by the U.S. Government Accountability Office (GAO) to be accessible to users with visual impairments, as part of a longer term project to improve GAO products' accessibility. Every attempt has been made to maintain the structural and data integrity of the original printed product. Accessibility features, such as text descriptions of tables, consecutively numbered footnotes placed at the end of the file, and the text of agency comment letters, are provided but may not exactly duplicate the presentation or format of the printed version. The portable document format (PDF) file is an exact electronic replica of the printed version. We welcome your feedback. Please E-mail your comments regarding the contents or accessibility features of this document to Webmaster@gao.gov. This is a work of the U.S. government and is not subject to copyright protection in the United States. It may be reproduced and distributed in its entirety without further permission from GAO. Because this work may contain copyrighted images or other material, permission from the copyright holder may be necessary if you wish to reproduce this material separately. GAO-13-454R: United States Government Accountability Office: Washington, DC 20548: March 15, 2013: The Honorable Orrin G. Hatch: Ranking Member: Committee on Finance: United States Senate: The Honorable Joseph R. Pitts: Chairman: Subcommittee on Health: Committee on Energy and Commerce: House of Representatives: Subject: Medicaid: Additional Enrollment and Expenditure Data for the Transitional Medical Assistance Program: Transitional Medical Assistance (TMA) is a Medicaid program that offers up to 1 year of additional Medicaid health insurance benefits for certain low-income families who would otherwise lose coverage. Specifically, under TMA provisions that are subject to reauthorization, families who would otherwise lose Medicaid eligibility because of earned income or hours of employment, or the loss of a time-limited earnings disregard, receive at least 6 months and up to 12 months of Medicaid coverage.[Footnote 1] However, because little is known about TMA enrollment and expenditures within each state, you had asked us to provide more information to inform deliberations on reauthorization.[Footnote 2] To this end, we issued a report in December 2012, which included information about states' TMA program policies, enrollment, and expenditures beginning in 2006 through the most recent year available.[Footnote 3] To obtain the information for our December 2012 report, we sent an electronic survey to the Medicaid Director, or his or her designated staff, in all 50 states and the District of Columbia to obtain key information about their respective TMA programs.[Footnote 4] While 45 states responded to at least a portion of the survey, some states were not able to provide the information we requested, or were not able to provide the information within the time frames of our work.[Footnote 5] However, our December report noted that for 2011, 41 states reported TMA enrollment of over 3.5 million individuals, and 32 states reported TMA total expenditures of about $3.9 billion. After we completed the analysis for the December 2012 report, four states that had responded to our survey provided additional information. Specifically, two states (Virginia and Washington) provided TMA enrollment data, and four states (Arkansas, North Dakota, Virginia, and Washington) provided TMA expenditure data. You asked us to update the survey results to include these data. With these states included, TMA enrollment in 2011 totaled over 3.7 million in the 43 states that provided enrollment data, and TMA expenditures in 2011 totaled about $4.1 billion in the 36 states that provided expenditure data, which is about $241 million higher than what we originally reported. Enclosure I provides updated state-reported information on TMA enrollment and expenditures. This update is based on our work for the December 2012 report and our analysis of the subsequent survey responses, and was conducted in accordance with generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to provide a reasonable basis for our findings and conclusions based on our audit objectives. The prior work and this update were conducted from October 2012 through March 2013. For further information regarding this report, please contact me at (202) 512-7114 or yocomc@gao.gov. Copies of this report will be sent to the Administrator of CMS and other interested parties. In addition, the report will be available at no charge on the GAO website at [hyperlink, http://www.gao.gov]. Contact points for our Offices of Congressional Relations and Public Affairs may be found on the last page of this report. Major contributors to this report were Susan Anthony, Assistant Director; Hannah Locke; JoAnn Martinez-Shriver; and Samantha Poppe. Signed by: Carolyn L. Yocom: Director, Health Care: [End of section] Enclosure: Transitional Medical Assistance (TMA): Updated State Survey Responses: The following tables on Transitional Medical Assistance (TMA) enrollment and expenditures include states that provided additional data subsequent to our December 2012 report.[Footnote 6] Table 1: Reported Enrollment in the Transitional Medical Assistance (TMA) Program by State, 2006 through 2011: Number of individuals: State: Alabama; 2006: 3,170; 2007: 2,408; 2008: 1,928; 2009: 2,103; 2010: 2,370; 2011: 1,927. State: Alaska[A]; 2006: 1,740; 2007: 1,811; 2008: 1,833; 2009: 1,902; 2010: 2,168; 2011: 2,889. State: Arizona[B]; 2006: [Empty]; 2007: [Empty]; 2008: 45,445; 2009: 43,836; 2010: 42,843; 2011: 45,562. State: Arkansas; 2006: 5,288; 2007: 4,818; 2008: 4,524; 2009: 3,793; 2010: 3,133; 2011: 3,235. State: California; 2006: 227,419; 2007: 297,103; 2008: 316,787; 2009: 312,139; 2010: 323,300; 2011: 336,635. State: Colorado; 2006: [Empty]; 2007: [Empty]; 2008: 58,817; 2009: 60,152; 2010: 54,697; 2011: 64,643. State: Connecticut; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Delaware; 2006: 35,061; 2007: 13,168; 2008: 14,940; 2009: 14,179; 2010: 14,351; 2011: 17,585. State: District of Columbia; 2006: 2,917; 2007: 2,342; 2008: 1,762; 2009: 1,287; 2010: 1,140; 2011: 1,332. State: Florida; 2006: 328,912; 2007: 277,890; 2008: 280,906; 2009: 324,094; 2010: 384,227; 2011: 424,312. State: Georgia; 2006: 148,259; 2007: 106,472; 2008: 127,110; 2009: 118,149; 2010: 110,933; 2011: 111,554. State: Hawaii; 2006: 6,151; 2007: 4,850; 2008: 4,808; 2009: 4,536; 2010: 4,892; 2011: 6,271. State: Idaho; 2006: 29,160; 2007: 16,131; 2008: 4,654; 2009: 4,070; 2010: 4,280; 2011: 7,089. State: Illinois; 2006: [Empty]; 2007: 358,910; 2008: 374,673; 2009: 382,085; 2010: 399,244; 2011: 445,481. State: Indiana; 2006: 113,527; 2007: 113,095; 2008: 109,547; 2009: 99,217; 2010: 99,173; 2011: 109,114. State: Iowa; 2006: [Empty]; 2007: 49,961; 2008: 46,569; 2009: 44,342; 2010: 44,358; 2011: 41,180. State: Kansas; 2006: 25,739; 2007: 22,061; 2008: 18,020; 2009: 14,521; 2010: 10,910; 2011: 15,632. State: Kentucky; 2006: 58,574; 2007: 59,821; 2008: 56,374; 2009: 52,162; 2010: 48,590; 2011: 54,119. State: Louisiana; 2006: 23,391; 2007: 27,689; 2008: 29,262; 2009: 28,575; 2010: 25,830; 2011: 24,893. State: Maine; 2006: 22,400; 2007: 23,661; 2008: 23,940; 2009: 21,440; 2010: 20,269; 2011: 23,427. State: Maryland; 2006: 19,424; 2007: 15,744; 2008: 14,186; 2009: 32,412; 2010: 69,080; 2011: 96,945. State: Massachusetts; 2006: 63,376; 2007: 65,120; 2008: 70,208; 2009: 73,528; 2010: 69,696; 2011: 64,886. State: Michigan; 2006: 155,329; 2007: 140,315; 2008: 130,920; 2009: 142,853; 2010: 135,214; 2011: 166,496. State: Minnesota; 2006: 27,607; 2007: 28,846; 2008: 30,108; 2009: 29,121; 2010: 30,036; 2011: 35,359. State: Mississippi; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: 12,356; 2010: 35,946; 2011: 37,348. State: Missouri; 2006: 238,727; 2007: 84,676; 2008: 104,803; 2009: 117,594; 2010: 112,421; 2011: 109,357. State: Montana; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Nebraska; 2006: 31,335; 2007: 28,060; 2008: 18,443; 2009: 23,928; 2010: 35,448; 2011: 40,903. State: Nevada; 2006: 13,782; 2007: 10,092; 2008: 3,102; 2009: 2,814; 2010: 8,156; 2011: 10,297. State: New Hampshire; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: New Jersey; 2006: 23,066; 2007: 26,084; 2008: 30,889; 2009: 32,973; 2010: 32,739; 2011: 35,627. State: New Mexico; 2006: 59,151; 2007: 56,436; 2008: 52,923; 2009: 53,100; 2010: 52,949; 2011: 50,532. State: New York; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: North Carolina; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: North Dakota[C]; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Ohio; 2006: 360,876; 2007: 369,752; 2008: 352,192; 2009: 328,838; 2010: 320,639; 2011: 371,193. State: Oklahoma; 2006: 14; 2007: 125; 2008: 469; 2009: 48; 2010: 20; 2011: 86. State: Oregon; 2006: 80,614; 2007: 63,517; 2008: 52,328; 2009: 48,218; 2010: 55,021; 2011: 70,197. State: Pennsylvania; 2006: 223,732; 2007: 277,879; 2008: 294,864; 2009: 251,688; 2010: 233,278; 2011: 240,330. State: Rhode Island; 2006: 19,165; 2007: 15,763; 2008: 12,162; 2009: 9,718; 2010: 9,776; 2011: 8,128. State: South Carolina; 2006: 52,840; 2007: 47,658; 2008: 55,520; 2009: 53,583; 2010: 53,876; 2011: 62,190. State: South Dakota; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Tennessee; 2006: [Empty]; 2007: 178,188; 2008: 95,687; 2009: 46,018; 2010: 50,559; 2011: 55,669. State: Texas; 2006: 214,713; 2007: 174,581; 2008: 152,595; 2009: 130,002; 2010: 129,332; 2011: 135,068. State: Utah; 2006: 12,180; 2007: 15,155; 2008: 20,808; 2009: 21,807; 2010: 21,486; 2011: 22,846. State: Vermont; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Virginia; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: 20,042. State: Washington; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: 145,992. State: West Virginia; 2006: 7,789; 2007: 6,060; 2008: 4,322; 2009: 4,046; 2010: 4,415; 2011: 3,135. State: Wisconsin; 2006: 140,313; 2007: 138,053; 2008: 131,371; 2009: 131,424; 2010: 158,621; 2011: 187,016. State: Wyoming; 2006: 3,944; 2007: 4,081; 2008: 4,005; 2009: 3,691; 2010: 3,760; 2011: 4,013. Total states providing enrollment data: 2006: 35; 2007: 38; 2008: 40; 2009: 41; 2010: 41; 2011: 43. Total for states reporting enrollment: 2006: 2,779,685; 2007: 3,128,376; 2008: 3,153,804; 2009: 3,082,342; 2010: 3,219,176; 2011: 3,710,535. Source: GAO analysis of state data. Notes: State data are as of March 2013. State officials were asked to provide an unduplicated enrollment number for each year. Alaska and Arizona could not provide unduplicated enrollment data. Officials in 22 states reported enrollment data by state fiscal year, 6 reported by federal fiscal year, 13 reported by calendar year, and 2 reported average monthly enrollments. Some states do not separate data based on the provisions under which Medicaid coverage is extended. However, the states that were able to break out the number of enrollees based on the provisions under which Medicaid coverage is extended generally reported over 90 percent of enrollees were eligible for TMA due to earnings. [Empty] indicates that data were not available from the state. [A] For a number of reasons, Alaska does not determine annual, unduplicated enrollment for TMA. Instead, the state tracks monthly TMA enrollment and provided us with the average monthly TMA enrollment for state fiscal years 2006 through 2012. However, a state Medicaid official noted that these data have limitations. For example, the enrollment data have not been adjusted for retroactive eligibility determinations, and for state fiscal years 2006 through 2010, TMA enrollment may be overstated because of the potential overlap between eligibility categories that existed during that time. [B] Arizona Medicaid officials told us that they were not able to provide an unduplicated count. [C] Officials in North Dakota were not able to provide TMA enrollment data for all years; however, they were able to produce a point-in-time enrollment of 6,066 individuals as of September 30, 2012. [End of table] Table 2: Reported Expenditures for the Transitional Medical Assistance (TMA) Program by State, 2006 through 2011: State: Alabama; 2006: $2,102,000; 2007: $1,795,000; 2008: $1,596,000; 2009: $1,599,000; 2010: $1,676,000; 2011: $2,283,000. State: Alaska; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Arizona; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Arkansas; 2006: $13,031,000; 2007: $12,301,000; 2008: $10,369,000; 2009: $8,466,000; 2010: $7,697,000; 2011: $6,711,000. State: California; 2006: $140,258,000; 2007: $161,731,000; 2008: $180,819,000; 2009: $139,563,000; 2010: $138,335,000; 2011: $186,278,000. State: Colorado; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Connecticut; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Delaware; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: District of Columbia; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Florida; 2006: [Empty]; 2007: $195,949,000; 2008: $173,440,000; 2009: $194,094,000; 2010: $251,171,000; 2011: $296,136,000. State: Georgia; 2006: $132,323,000; 2007: $25,673,000; 2008: $94,009,000; 2009: $114,709,000; 2010: $97,227,000; 2011: $75,333,000. State: Hawaii; 2006: $8,778,000; 2007: $8,645,000; 2008: $4,568,000; 2009: $9,257,000; 2010: $9,738,000; 2011: $11,217,000. State: Idaho; 2006: $34,349,000; 2007: $21,305,000; 2008: $8,994,000; 2009: $7,820,000; 2010: $10,455,000; 2011: $15,735,000. State: Illinois; 2006: [Empty]; 2007: $336,931,000; 2008: $389,190,000; 2009: $439,819,000; 2010: $504,305,000; 2011: $563,039,000. State: Indiana; 2006: $92,055,000; 2007: $99,702,000; 2008: $98,091,000; 2009: $94,301,000; 2010: $92,932,000; 2011: $91,440,000. State: Iowa; 2006: $48,644,000; 2007: $45,857,000; 2008: $45,474,000; 2009: $44,487,000; 2010: $42,130,000; 2011: $45,025,000. State: Kansas; 2006: $23,430,000; 2007: $23,833,000; 2008: $18,823,000; 2009: $16,204,000; 2010: $12,772,000; 2011: $21,785,000. State: Kentucky; 2006: $60,571,000; 2007: $66,954,000; 2008: $70,800,000; 2009: $71,606,000; 2010: $66,000,000; 2011: $74,405,000. State: Louisiana; 2006: $16,059,000; 2007: $18,325,000; 2008: $22,478,000; 2009: $26,285,000; 2010: $24,603,000; 2011: $21,197,000. State: Maine; 2006: $50,593,000; 2007: $57,440,000; 2008: $56,365,000; 2009: $53,855,000; 2010: $51,289,000; 2011: $58,173,000. State: Maryland; 2006: $25,049,000; 2007: $21,517,000; 2008: $19,451,000; 2009: $53,845,000; 2010: $138,587,000; 2011: $193,185,000. State: Massachusetts; 2006: $77,683,000; 2007: $85,291,000; 2008: $101,443,000; 2009: $109,969,000; 2010: $105,848,000; 2011: $100,472,000. State: Michigan; 2006: [Empty]; 2007: $307,621,000; 2008: $151,110,000; 2009: [Empty]; 2010: $251,771,000; 2011: $313,474,000. State: Minnesota; 2006: $39,354,000; 2007: $47,180,000; 2008: $54,867,000; 2009: $57,040,000; 2010: $58,358,000; 2011: $66,827,000. State: Mississippi; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Missouri; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Montana; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Nebraska; 2006: $29,613,000; 2007: $31,556,000; 2008: $28,918,000; 2009: $27,438,000; 2010: $39,823,000; 2011: $50,893,000. State: Nevada; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: New Hampshire; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: New Jersey; 2006: $16,645,000; 2007: $24,851,000; 2008: $33,728,000; 2009: $37,250,000; 2010: $40,074,000; 2011: $43,894,000. State: New Mexico; 2006: $87,946,000; 2007: $95,415,000; 2008: $96,049,000; 2009: $97,414,000; 2010: $93,521,000; 2011: $82,437,000. State: New York; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: North Carolina; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: North Dakota; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: $18,627,000; 2010: $20,603,000; 2011: $20,561,000. State: Ohio; 2006: $314,746,000; 2007: $384,472,000; 2008: $339,743,000; 2009: $390,330,000; 2010: $365,884,000; 2011: $525,133,000. State: Oklahoma; 2006: $25,000; 2007: $27,000; 2008: $373,000; 2009: $47,000; 2010: $2,000; 2011: $53,000. State: Oregon; 2006: $93,012,000; 2007: $64,796,000; 2008: $59,659,000; 2009: $58,105,000; 2010: $76,398,000; 2011: $103,688,000. State: Pennsylvania; 2006: $241,658,000; 2007: $323,900,000; 2008: $352,511,000; 2009: $323,874,000; 2010: $299,649,000; 2011: $319,087,000. State: Rhode Island; 2006: $24,865,000; 2007: $22,021,000; 2008: $18,526,000; 2009: $13,407,000; 2010: $12,211,000; 2011: $10,977,000. State: South Carolina; 2006: [Empty]; 2007: $78,952,000; 2008: $83,914,000; 2009: $97,815,000; 2010: $94,104,000; 2011: $117,013,000. State: South Dakota; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Tennessee; 2006: [Empty]; 2007: $302,074,000; 2008: $160,141,000; 2009: $100,932,000; 2010: $118,499,000; 2011: $139,625,000. State: Texas; 2006: $72,008,000; 2007: $73,745,000; 2008: $82,661,000; 2009: $105,498,000; 2010: $107,592,000; 2011: $125,559,000. State: Utah; 2006: $20,663,000; 2007: $18,291,000; 2008: $18,694,000; 2009: $22,993,000; 2010: $23,868,000; 2011: $18,411,000. State: Vermont; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: [Empty]. State: Virginia; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: $33,292,000. State: Washington; 2006: [Empty]; 2007: [Empty]; 2008: [Empty]; 2009: [Empty]; 2010: [Empty]; 2011: $180,417,000. State: West Virginia; 2006: $9,505,000; 2007: $9,589,000; 2008: $13,337,000; 2009: $10,990,000; 2010: $10,826,000; 2011: $11,368,000. State: Wisconsin; 2006: $128,524,000; 2007: $123,186,000; 2008: $121,724,000; 2009: $121,964,000; 2010: $137,355,000; 2011: $160,679,000. State: Wyoming; 2006: $13,017,000; 2007: $14,519,000; 2008: $12,636,000; 2009: $12,817,000; 2010: $12,743,000; 2011: $12,406,000. Total states reporting expenditure data: 2006: $28,000; 2007: $33,000; 2008: $33,000; 2009: $33,000; 2010: $34,000; 2011: $36,000. Total for states reporting expenditures: 2006: $1,816,503,000; 2007: $3,105,443,000; 2008: $2,924,499,000; 2009: $2,882,421,000; 2010: $3,318,046,000; 2011: $4,098,208,000. Source: GAO analysis of state data. Notes: State data are as of March 2013. State officials were asked to provide total expenditures, including federal and state portions, for TMA; these data can include expenditures for some or all provisions under which Medicaid coverage is extended. Unless noted, states returned expenditure information for a 12-month period. The boundaries of this period varied, with 23 reporting expenditure data by state fiscal year, 5 reporting by federal fiscal year, 7 reporting by calendar year, and for 1 state, the period covered was unclear. [Empty] indicates that data were not available from the state. In addition, our prior report noted that 23 states reported implementing an option to provide continued Medicaid coverage under TMA by paying enrollees' costs associated with employer-sponsored insurance. We have updated this information to identify the 23 states that indicated use of this option: Alabama, Colorado, the District of Columbia, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Massachusetts, Minnesota, Missouri, Nevada, New Jersey, New York, North Dakota, Oregon, Pennsylvania, Rhode Island, South Carolina, Texas, Washington, and Wyoming. [End of table] Footnotes: [1] Social Security Act (SSA) §1925, codified at 42 U.S.C. § 1396r-6. Under permanent provisions of the SSA, Medicaid coverage continues for 4 months for families who would otherwise lose coverage because of an increase in earned income or hours of employment or increased child or spousal support. See SSA §§ 1902(e)(1)(A), 1931(c), 406(h) (as in effect on July 16, 1996), (codified at 42 U.S.C. §§ 1396a(e)(1)(A), 1396u-1(c)). Section 1925 preempts section 1902(e)(1)(A) through December 31, 2013, for families with earned income. SSA § 1902(e)(1)(B) (codified at 42 U.S.C. § 1396a(e)(1)(B)). [2] These TMA provisions were reauthorized most recently through December 31, 2013, by the American Taxpayer Relief Act of 2012, Pub. L. No.112-240, § 622, 126 Stat. 2313 (2013). [3] See GAO, Medicaid: Enrollment and Expenditures for Qualified Individual and Transitional Medical Assistance Programs, [hyperlink, http://www.gao.gov/products/GAO-13-177R] (Washington, D.C.: Dec. 12, 2012). [4] In this report, we use the term "states" to refer to the 50 states and the District of Columbia. [5] We did not independently verify information reported by states. [6] See GAO, Medicaid: Enrollment and Expenditures for Qualified Individual and Transitional Medical Assistance Programs, [hyperlink, http://www.gao.gov/products/GAO-13-177R] (Washington, D.C.: Dec. 12, 2012). The states that provided additional data are Arkansas, North Dakota, Virginia, and Washington. Ultimately, 45 states responded to the survey. The 6 states that did not respond to our survey were Connecticut, Montana, New Hampshire, North Carolina, South Dakota, and Vermont. [End of section] GAO’s Mission: The Government Accountability Office, the audit, evaluation, and investigative arm of Congress, exists to support Congress in meeting its constitutional responsibilities and to help improve the performance and accountability of the federal government for the American people. 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