States, caught between the approaching expiration of American Recovery and Reinvestment Act (ARRA) funding and implementation of the Patient Protection and Affordable Care Act (PPACA), are balancing cost-cutting and cost-containment strategies with healthcare reform initiatives, according to a survey by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured. The 11th annual survey provides a snapshot of Medicaid spending, enrollment and policy initiatives in each state based on data for fiscal year (FY) 2011 and FY 2012.