Administrative Responsiveness to the Disadvantaged: The Case of Children's Health Insurance

Issues of administrative responsiveness to the disadvantaged (as distinct from formal policy responsiveness) possess important implications for American democracy. In this regard, the administrative practices that facilitate or impede enrollment, or take-up, in social programs deserve attention. This study focuses on two means-tested programs in the context of American federalism, Medicaid and the State Children's Health Insurance Program. Based on an in-depth analysis of seventeen states, we develop an index of administrative responsiveness to the disadvantaged related to take-up. We then explore some possible sources of variation in responsiveness rooted in the task environment, political ideology, good government culture and practice, and signals from political principals. Our findings point to the need to refine and expand upon existing explanations of state variation in social programs. Among other things, this study suggests the political importance of international (not interstate) population mobility and gubernatorial leadership (rather than bureaucratic autonomy) in shaping administrative responsiveness to the disadvantaged. It also points to the need for a contingent approach in examining whether the greater presence of racial minorities tends to depress such responsiveness.