If you're looking for a snapshot of the hard times states are going through in this Great Recession, look no further than new numbers from a recent survey on the state of state Medicaid.

Going into fiscal 2009, state Medicaid officials estimated that enrollment in the health insurance program for the poor would grow by 3.6 percent. That wasn't even close. It ballooned by 5.4 percent, the highest rate in six years.

Fiscal 2009 predictions on spending growth for the program were 5.8 percent. The reality: It went up by 7.9 percent, the highest growth rate in five years.

So what have states projected for 2010? Medicaid directors expect spending to ratchet up by an average of at least 6.3 percent. But here's the kicker: Three-quarters of the states don't think an appropriation to cover that growth will be enough. That means there will be budget shortfalls and continued pressure to trim services and spending.

All this despite the $87 billion in federal American Recovery and Reinvestment Act monies targeted for Medicaid relief. And despite the fact that nearly every state implemented at least one new Medicaid policy to control spending in fiscal 2009 and 2010.

This snapshot comes from Kaiser Family Foundation's 9th annual survey of Medicaid directors. The survey was conducted in July and August 2009. More details from the report, "The Credit Crunch Continues" are at http://www.kff.org/