Understanding the mechanisms of administrative burden through a within-case study of Medicaid expansion implementation

Abstract

The importance of the administrative burden problem in public programs has been apparent during the COVID-19 crisis in the United States as millions of newly unemployed people have had to wait for unemployment checks and public health insurance benefits due to paperwork requirements, agency staff shortages, and outdated information technology systems. The resulting burdens have extended financial hardship, caused the coronavirus to spread, and eroded citizen and agency morale. Administrative burdens have long been known to be costly, yet remain fixtures of public benefit programs across the world. To reduce them, we need to understand their mechanisms. Formal policy solutions per se will not reduce administrative burdens because they do not exist solely by design. This article contributes to behavioral public administration by providing a comprehensive, empirical-driven theoretical framework for understanding the complex processes through which supply-side administrative burdens are instituted, modified, and eliminated. Using a retrospective within-case study method that utilizes participant observation, documentation, and archival records, the article traces the process by which a state eliminated administrative burdens in the process of implementing an initially straightforward expansion of Medicaid eligibility, thereby creating a model for simplifying and streamlining enrollment that was incorporated into the Affordable Care Act.

‘I don’t know nothing about that’: How “learning costs” undermine COVID-related efforts to make SNAP and WIC more accessible

“…Recent scholarship recognizes the need to understand mechanisms of administrative burden (Peeters, 2020), particularly from the perspective of clients as they work to gain information about how to access and use benefits (Masood & Azfar Nisar, 2021). During the COVID-19 pandemic, scholars continue to question the mechanisms that create administrative burdens, demonstrating the relationship between compliance and psychological costs (Baekgaard et al, 2021) and how individuals experience barriers to public assistance programs (Camillo, 2021). In fact, clients must overcome learning hurdles by developing awareness of programs and their rules even before confronting barriers to compliance such as providing documentation (see Camillo, 2021).…”

“…During the COVID-19 pandemic, scholars continue to question the mechanisms that create administrative burdens, demonstrating the relationship between compliance and psychological costs (Baekgaard et al, 2021) and how individuals experience barriers to public assistance programs (Camillo, 2021). In fact, clients must overcome learning hurdles by developing awareness of programs and their rules even before confronting barriers to compliance such as providing documentation (see Camillo, 2021).…”

Assessing Healthcare Pathway through patient experience with Completing Cancer Treatment Incentive (CCTI) Program for Low-Income Populations in Malaysia

“…Additionally, these policies can also create administrative burdens, particularly for vulnerable groups, and are in uenced by political and administrative choices (28). Minimising administrative burdens through streamlining of application processes; eliminating duplicate and redundant processes; and utilising digital solutions that are user-friendly and accessible to individuals with limited digital literacy or internet access; can help to increase the uptake rate of CCTI (29)(30)(31). By doing so, the patients' focus will not be shifted from their treatment and recovery.…”

State Approaches to Simplify Medicaid Eligibility and Implications for Inequality of Infant Health

“…Alternatively, systemic racism could limit the benefits of Medicaid expansion even when coupled with reforms that reduce administrative burdens. Bias by program managers and patient-facing workers can shape how Medicaid policies are implemented (Camillo 2021), allowing unequal encounters with Medicaid and prenatal care to continue despite reforms. Pregnant women of color report disrespectful and stressful encounters with health-care providers (McLemore et al 2018), and Black and Latina women often experience hostility, sur-veillance, and paternalism during prenatal care visits (Bridges 2011;Davis 2019).…”