Inaccessible by Design? The Politics of Medicaid Take-Up

• In Event: Health Policy Feedback

Abstract

Not everyone who is eligible for social safety net policies enrolls in them. Policy design and administrative burden are both ways government controls who can access government benefits. I argue the interaction of policy design and administrative burden is particularly important because state legislators and bureaucrats make strategic decisions. In one state, a policy may have generous eligibility requirements and offer extensive benefits, but if the application process is confusing and bureaucrats are unhelpful, benefits may not actually be accessible to many the policy could possibly help. In another state, legislators may design a strict policy, but bureaucrats work hard to help everyone who is eligible overcome the administrative burden and enroll. In this paper, I use multiple regression, imputation, and post-stratification (MRP) on administrative data and Census data to estimate Medicaid take-up. I then use these take-up estimates to identify systematic differences in who is eligible but not enrolled in Medicaid between and within all U.S. states. I use regression analysis to assess how these differences can be explained by administrative burdens and other policy design decisions states make for the Medicaid programs. To measure Medicaid policy design and administrative burden, I have compiled measures from a variety of sources, such as state and federal websites, the Kaiser Family Foundation, and Code for America, and I have used surveys to construct several of my own, such as how long it takes individuals to find a state’s Medicaid application from a web search.

Author

• Tracee Morgan Saunders, University of Iowa