Administrative Easing: Rule Reduction and Medicaid Enrollment

Administrative burden is widely recognized as a barrier to program enrollment, denying legal entitlements to many eligible individuals. We examine what effect voluntary state reductions in administrative burden (what we call administrative easing) have had on Medicaid enrollment rates using differential implementation of the Affordable Care Act. Using a novel dataset that includes state-level data on simplified enrollment and renewal procedures for Medicaid from 2008-2017, we examine how change in Medicaid enrollment is conditioned by the adoption of rule-reduction procedures. We find that reductions in the administrative burden required to signup 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