Effective Implementation in Practice: Integrating Public Policy and Management by Sandfort Jodi;Moulton Stephanie; & Stephanie Moulton

Author:Sandfort, Jodi;Moulton, Stephanie; & Stephanie Moulton [Sandfort, Jodi & Moulton, Stephanie]
Language: eng
Format: epub
Publisher: John Wiley & Sons, Incorporated
Published: 2015-01-20T00:00:00+00:00

Analyzing the Integration of the Core Program

As we mentioned at the outset of this chapter, we are interested in organizations to the extent that they contribute to the integration and functioning of a core program related to larger public policy issues. At the organizational level, this core program is significantly shaped by the rules and processes put in place in both authorizers and service providers—intentionally and unintentionally. Consider the take-up of Medicaid benefits by eligible clients in a particular state. While states' Medicaid policies are typically evaluated based on their generosity with eligibility requirements, a recent study of Wisconsin's system found that administrative processes significantly affected the extent to which eligible beneficiaries enrolled in benefits.18 A change to Wisconsin's Medicaid processing system that required beneficiaries to document their employment status using a paper form, completed and signed by their employer and then mailed to a third-party verification center, was associated with a 20 percent decline in Medicaid enrollment among children and a 17.6 decline in parent enrollment in the state.19 When Wisconsin subsequently moved to a technology-driven process that placed the administrative burden on the authorizing organization rather than the beneficiary, the number of eligible beneficiaries enrolling in the program dramatically increased.

Making a change to Wisconsin's Medicaid process was not a formal legislative decision, made at the level of the policy field. Nor did frontline workers who processed applicants on a day-to-day basis make the change. Certainly feedback from both the policy field and the front lines likely informed the problem and the solutions ultimately adopted. However, it was the authorizing organization—in this case, the state Medicaid agency—that ultimately made the programmatic changes that substantially affected implementation outcomes in Wisconsin's program. In the sections that follow, we explore more generally how programs are shaped at the organizational level.

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