The Big Impact of Little Barriers to Public Benefits

By Paul Shafer, PhD
October 29, 2021

Paul Shafer is an assistant professor in the Department of Health Law, Policy and Management at the Boston University School of Public Health. His research focuses on the effects of state and federal health insurance policy on coverage, health care use and health equity.

“Administrative burden” is not a phrase that gets the average American, or even policymaker, all that excited. But for those of us who study the social safety net, we know that even small administrative hurdles can have big impacts on how efficiently and equitably people can access programs like Medicaid and unemployment insurance.

While the need for public benefits has surged throughout the country during the pandemic, some states’ administrative requirements made them much easier to access than others. A study by Aditi Vasan and colleagues recently published in JAMA quantifies the impact of one of these state policy differences on participation in a popular food assistance program.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) supports women with low incomes and their children, and the program has proven to help narrow racial and ethnic disparities in infant health. WIC benefits are provided on an electronic debit card, which some states automatically reload (“online states”) and others reload only at in-person WIC office visits (“offline states”).

The authors estimated that offline states experienced a nearly 10% drop (-9.3%) in WIC participation during the first nine months of the COVID-19 pandemic relative to online states. This was a product of both increased participation in online states and decreased participation in offline states. Meanwhile, the authors found that participation in the Supplemental Nutrition Assistance Program (often referred to as “food stamps”) — a program that renews remotely in all states — saw no significant changes in participation during COVID-19.

This is just one in a long line of studies showing how administrative burdens make it harder for Americans, especially those with the least resources, to access benefits for which they are eligible and that are critical to people’s health. Improving our benefits infrastructure could produce big financial savings too, reducing the need for armies of caseworkers to work around outdated systems and better preventing fraud that has been problematic during the pandemic.

A growing public interest technology sector, led by groups like Code for America and Nava PBC, provides hope that we can do better, but state leaders must first agree — regardless of their politics — that government programs can and should work well for everyone.

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