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The continued expansion of the government provision of cash transfers across African countries has led to a growing interest in both the short and long term implications of these programs for citizen-state relations. Under what conditions can the government provision of cash transfer programs increase beneficiaries’ access to the state and complementary public goods? Can cash transfers have long-term transformative effects on citizens’ relationship with the state? We examine these questions through a comparative study of nationwide cash transfer programs in Kenya (Cash Transfer for Orphans and Vulnerable Children) and Ghana (Livelihood Empowerment Against Poverty), which provide poor and marginalized populations with bimonthly monetary transfers to address high levels of poverty amongst vulnerable groups. We find that the cash transfer programs in both countries improve citizens’ access to local-level government offices and information about other government programs and public goods. However, while this increased access to government offices and officials alters marginalized beneficiaries’ long-term perceptions of and relationship with the state in Kenya, the cash transfer in Ghana has resulted in fewer long-term benefits for citizen-state relations. We argue that the differential impacts of the cash transfer programs for long-term citizen-state relationships in Kenya and Ghana are a result of diverse implementation strategies in each country. The cash transfer program under study in Kenya has been largely divorced from the widespread patronage politics that has long characterized the distribution of public goods in Kenya and has thus challenged beneficiaries’ extant perceptions of the state and their relationship with it. In contrast, the distribution of cash transfers in Ghana has been subject to political interference evidenced by significant deviations from the implementation processes outlined in official program documents. Program benefits are distributed thinly as a patronage resource, rather than as a citizenship entitlement, by successive governments to appease their supporters or potential voters. The highly politicized targeting, enrolment and payment regime is compounded by limited generosity of programme benefits and lack of spaces for accountability thus limiting the long-term impacts of the program for citizen-state relations. Our findings highlight the importance of distributive politics and implementation for understanding the conditions under which cash transfers can both increase beneficiaries’ access to the structures of the state and impact long-term citizen-state relations.