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 importantimplications for American democracy. In this regard, the administrativepractices that facilitate or impede enrollment, or take-up,in social programs deserve attention. This study focuses ontwo 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 developan index of administrative responsiveness to the disadvantagedrelated to take-up. We then explore some possible sources ofvariation in responsiveness rooted in the task environment,political ideology, good government culture and practice, andsignals from political principals. Our findings point to theneed to refine and expand upon existing explanations of statevariation in social programs. Among other things, this studysuggests the political importance of international (not interstate)population mobility and gubernatorial leadership (rather thanbureaucratic autonomy) in shaping administrative responsivenessto the disadvantaged. It also points to the need for a contingentapproach in examining whether the greater presence of racialminorities tends to depress such responsiveness.