Policymaking by Other Means

• Author: Elizabeth Ribgy,Donald P. Moynihan,Pamela Herd
• Published date: 01 May 2016
• Date: 01 May 2016
• DOI: http://doi.org/10.1177/0095399713503540
• Subject Matter: Articles

Administration & Society

2016, Vol. 48(4) 497 –524

© The Author(s) 2013

DOI: 10.1177/0095399713503540

aas.sagepub.com

Article

Policymaking by Other

Means: Do States Use

Administrative Barriers

to Limit Access to

Medicaid?

Donald P. Moynihan1, Pamela Herd1, and

Elizabeth Ribgy2

Abstract

While politicians wage legislative battles about welfare benefits, bureaucratic

procedures represent a less visible means to shape access to those benefits.

By constructing complex and time-consuming application procedures,

the state can effectively create administrative barriers that limit access to

benefits. What explains the variation in the level of administrative burden that

individuals face? We address this question by examining Medicaid procedures

across the 50 U.S. states, identifying different types of administrative barriers.

We find that such barriers tend to be lower in states with unified Democratic

control of political institutions.

Keywords

administrative rules, social policy, citizen–state interaction

Introduction

While politicians wage ongoing legislative battles over which social benefits

the poor should receive, bureaucratic procedures represent an alternative—and

1University of Wisconsin–Madison, USA

2George Washington University, DC, USA

Corresponding Author:

Donald P. Moynihan, University of Wisconsin–Madison, 1225 Observatory Drive, Madison,

WI 53706, USA.

Email: dmoynihan@lafollette.wisc.edu

503540AAS48410.1177/0095399713503540Administration & SocietyMoynihan et al.

research-article2013

498 Administration & Society 48(4)

less visible—means of shaping access to those benefits. By constructing com-

plex, confusing, and time-consuming application procedures, the state can

effectively thwart an individual from accessing benefits, even if eligible by law.

We examine variation in the level of administrative burden that individuals face

when they seek to access social benefits, as well as how political factors may

shape the level of administrative burden states impose on their citizens. Better

understanding of this variation has broad relevance to studies of the political

economy of poverty and inequality (Jacobs & Soss, 2010), social policy

(Brodkin & Majmundar, 2010), public administration (Moynihan & Herd,

2010), and citizen–state interactions (Mettler & Soss, 2004).

Specifically, this article documents, compares, and explains variation in

formal application requirements (i.e., compliance administrative burden)

experienced by individuals accessing a standard federal program across U.S.

state governments: Medicaid. Medicaid is a means-tested health insurance

program for individuals who meet certain income and asset guidelines. The

costs of the program are shared between the state and federal governments,

and states have a great deal of autonomy in structuring their Medicaid pro-

grams—particularly their administrative procedures. Indeed, we find signifi-

cant variation in administrative burden across states and that the level of

burden differs in states governed by Democrats versus Republicans in the

previous decade. This illustrates how political factors may play a role in

structuring the administrative burden faced by applicants for Medicaid, as

well as how states use administrative burdens as an additional (often over-

looked) policy tool, or what Lineberry (1977) refers to as “policymaking by

other means” (p. 71).

When Do Burdens Become Red Tape?

In this article, we conceptualize our dependent variable in terms of adminis-

trative burdens placed on citizens. We define administrative burden as an

individual’s experience of policy implementation as onerous (Burden, Canon,

Mayer, & Moynihan, 2012). A broad stream of literature focuses on the dis-

cretion of street-level government actors in implementing government poli-

cies (Lipsky, 1980, 1984) and how citizens are classified by various policies

(Schneider & Ingram, 1997), but relatively little research has considered the

origins of systematic administrative compliance burdens that citizens face in

their interactions with the state.

Perhaps the closest concept to administrative burden, coming from public

administration scholarship, is that of red tape. Even in this research area, the

definition and study of this concept has been relatively narrow. Red tape is

defined by Bozeman (2000) as “rules, regulations, and procedures that remain