Medicaid enrollment growth slowed to 2.7% in fiscal year 2017 due to slower enrollment related to the Affordable Care Act, a stable economy and states’ processing of delayed eligibility determinations, according to the latest annual Kaiser Family Foundation survey of state Medicaid directors. In addition, the survey found that total Medicaid spending grew by 3.9% in FY 2017, which was similar to last year, with higher costs of prescription drug costs and long-term care services and supports, among the major drivers. States project a 5.2% increase in total Medicaid spending in FY 2018. Almost all Medicaid directors surveyed expressed concerns that federal Medicaid reform proposals that limited federal spending would likely lead to budget shortfalls and negative fiscal consequences. Key findings from a companion report found that, despite uncertainty about federal legislative changes, many states were continuing efforts to expand managed care, move ahead with payment and delivery system reforms, and expand benefits. The report also discussed emerging trends on proposals to restrict eligibility and impose premiums through Section 1115 waivers, movement to include value-based purchasing requirements in managed care organization contracts and efforts to combat the growing opioid epidemic.