Shifting administrative burden to the state: The case of medicaid take-up

Administrative burden is an individual's experience of policy implementation as onerous. Such burdens may be created because of a desire to limit payments to ineligible claimants, but they also serve to limit take-up of benefits by eligible claimants. For citizens, this burden may occur through learning about a program; complying with rules and discretionary bureaucratic behavior to participate; and the psychological costs of participating in an unpopular program. Using a mixed-method approach, the authors explain process changes that reduced individual burden and demonstrate how this resulted in increased take-up in Medicaid in the state of Wisconsin. The findings inform the planned expansion of Medicaid under the Patient Protection and Affordable Care Act. A key design principle for Medicaid and other means-tested programs is that it is possible to increase program take-up while maintaining program integrity by shifting administrative burdens from the citizen to the state.