Commercial enrollment in North Carolina and South Carolina increased slightly between January 2010 and January 2010. However, a lagging economy continues to make increased market share a difficult prospect for managed care organizations in both states. Meanwhile, employers in the market are showing increased interest in high-deductible health plans and other products that shift more of the healthcare benefit cost to employees. MCOs could find enrollment growth through health plans that offer employers greater flexibility in plan design. Budget woes in North Carolina and South Carolina are driving deeper cuts to the Medicaid programs in both states. In North Carolina, the legislature cut $350 million from the state’s $12.8 billion Medicaid budget in 2011. In July 2011, South Carolina lawmakers implemented another round of Medicaid provider reimbursement cuts. Given the reimbursement cuts implemented in April 2011, some providers will see a total reimbursement cut of 7 percent for 2011.