In what could end up as a budget buster for the state, Maryland's Medicaid rolls went up by more than 90,000 from July 2008 to October 2009. The recession accounted for some of that rise just as it has done in other states, but Maryland's legislators also passed a law in November 2007 to expand eligibility, and this pushed the numbers over the top. Enrollment in Medicare Advantage continues to grow at a fast pace in Virginia, but much more slowly in Maryland and the District. Medicare special needs needs plans, squeezed by new federal rules and lower-than-expected reimbursements, dropped significantly in the Mid-Atlantic, where enrollment has never been high. E-prescribing began to take off in Virginia and other Mid-Atlantic states though it still accounts for only 3 to 5 percent of the total number of prescriptions written. The H1N1 virus has peaked and insurers are beginning to feel the impact of extra medical claims though the worst will be in the first quarter of 2010. In Virginia, Aetna is offering a Medicare Supplement plan in addition to its Medicare Advantage plans. With this, enrollees will be able to choose their own physicians without the limitations of a network. CIGNA is beginning to offer lean benefit plans with four-tier drug benefits in an effort to provide affordable insurance for the medium to small business markets.