Administrative Burdens in SNAP and Medicaid: Prevalence, Determinants, and Consequences

• In Event: How are families navigating fragmented social support systems?

Abstract

Background. Social safety net programs such as SNAP and Medicaid often have complex rules around eligibility, documentation, and ongoing compliance, and participation can involve stressful—or even hostile—interactions with program staff. These experiences are commonly described as administrative burdens. Research on administrative burden and its impacts is growing (e.g., Herd & Moynihan, 2019; Madsen et al., 2022), and the Biden Administration sought to address these issues through its Burden Reduction Initiative. However, the field has been limited by the lack of a standard approach to measuring administrative burdens. In this study, we administered a new seven-item scale measuring learning, compliance, and psychological burdens to a nationally representative sample of low-wage workers enrolled in SNAP and/or Medicaid. We examine the prevalence of these burdens and their association with hardship outcomes. In addition, we assess whether organizational features—including benefits agency staff workloads and state benefit website design—are related to beneficiaries’ experiences of administrative burden.

Sample, Data, and Method. We draw on the Workforce Economic Inclusion and Mobility survey, administered to a nationally representative sample of 2,511 low-wage U.S. workers. To measure state agency workloads, we use data from the Annual Survey of Public Employment and Payroll and the American Community Survey. To assess state benefit website design, we scraped the SNAP benefit websites of all U.S. states and used Google Chrome’s Lighthouse Navigation Report to generate standardized metrics of website usability and performance. The study has three components. First, we descriptively examine workers’ experiences of administrative burden and assess correlations between burden and health-related hardship outcomes. Second, we link state staffing measures to the survey and estimate linear probability models of the relationship between agency workloads and administrative burden. Finally, we estimate a set of linear probability models to examine the association between SNAP website performance and administrative burden.

Preliminary Results. Roughly half of individuals enrolled in SNAP or Medicaid experienced at least one form of administrative burden, most commonly uncertainty about eligibility. Burdens were more common among SNAP participants than Medicaid participants, and were associated with health-related hardships, including hunger risk and difficulty affording medical care. We also find that a 10% increase in benefits agency staff workloads corresponds to an 8–11 percentage point increase in the probability of experiencing administrative burdens. In addition, worse SNAP application website performance is associated with higher levels of administrative burden.

Implications. These findings indicate that major public programs such as SNAP and Medicaid—which serve tens of millions of people—impose substantial burdens on many beneficiaries, and that burdens are highest among those with the greatest need. If equitable access to food, nutrition, and health care is a policy priority, reducing the costs imposed on individuals seeking to access benefits must also be a priority. Policymakers should consider streamlining applications, improving the design of mobile- and web-based enrollment processes, and expanding broad-based categorical eligibility to reduce duplicative eligibility verification across programs with similar criteria.

Author

• Stephen Patrick Roll, Washington University in St. Louis
  Presenting Author