Administrative Easing: Rule Reduction and Medicaid Enrollment

Source: Ashley M. Fox, Edmund C. Stazyk, Wenhui Feng, Public Administration Review, Volume 80 Issue 1, January/February 2020
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From the abstract:
Administrative burden is widely recognized as a barrier to program enrollment, denying legal entitlements to many potentially eligible individuals. Building on recent research in behavioral public administration, this article examines the effect of voluntary state reductions in administrative burden (administrative easing) on Medicaid enrollment rates using differential implementation of the Affordable Care Act. Using a novel data set that includes state‐level data on simplified enrollment and renewal procedures for Medicaid from 2008 to 2017, the authors examine how change in Medicaid enrollment is conditioned by the adoption of rule‐reduction procedures. Findings show that reductions in the administrative burden required to sign up for Medicaid were associated with increased enrollments. Real‐time eligibility and reductions in enrollment burden were particularly impactful at increasing enrollment for both children and adults separate from increases in Medicaid income eligibility thresholds. The results suggest that efforts to ease the cognitive burden of enrolling in entitlement programs can improve take‐up.

Evidence for Practice
– The administrative burden associated with enrolling in social safety net programs in the United States imposes high costs on applicants. As a consequence, many eligible individuals do not receive the benefits that they are lawfully entitled to.
– Insights from behavioral economics, including streamlining of the enrollment process and automated benefit determinations, can be effectively employed—in some cases—to reduce the cognitive burden associated with program enrollment processes and increase take‐up of benefits.
– States that have implemented simple changes to enrollment processes, including administrative verification of income and real‐time decision‐making, have seen greater increases in Medicaid enrollments than those that did not implement such changes.