"I Just Want My Life Back to Normal:" the Costs of Bureaucratic Adaptation to the COVID Policy Changes in SNAP and Medicaid

Background and Purpose: The onset of the COVID-19 pandemic raised new public health concerns and ushered in an unprecedented economic crisis. The COVID-19 pandemic also led to important policy changes that eased access to assistance programs. Federal policy waivers have loosened application guidelines, extended eligibility periods, and eased how beneficiaries can use benefits. These changes have eased access to public assistance programs. However, the economic fallout of the pandemic has increased demand for public assistance programs by 30 to 40 percent across states—a demand that has outpaced the capacity of many resource-constrained social service agencies. Given sweeping policy changes and growing demand, I investigate how welfare bureaucrats have adapted to unprecedented demand and new ways of engaging clients (e.g. remote telework, new application guidelines, extended eligibility deadlines). I draw on the administrative burden and street-level bureaucracy framework. The administrative burden research examines the barriers to accessing public assistance benefits, identifying learning, compliance, and psychological costs as deterring the use of programs. This literature focuses on how applicants encounter burdens and how policy can be designed to reduce burdens but has not examined the costs, or onerous experiences with policy implementation, that bureaucrats experience while adapting to policy changes. The street-level bureaucracy framework offers some insights on the challenges of adapting to new policy changes and increased demand for assistance by highlighting how work conditions—resource constraints and ambiguous policy goals—can undermine policy implementation.

Methods: This study draws from 30 in-depth qualitative interviews with Supplemental Nutrition Assistance Program (SNAP) and Medicaid workers in North Carolina. I use a modified grounded theory approach to examine whether and how SNAP and Medicaid workers adapt to policy changes: remote interviews, extended recertification deadlines, and changes in income reporting due to the Families First Coronavirus Response Act. These changes were designed to reduce the administrative burden for applicants amidst the COVID-19 pandemic.

Results: Interviews with SNAP and Medicaid workers suggest that workers experience psychological costs in adapting to COVID policy changes. For example, workers reported stress in managing unprecedented demand for benefits, shifting roles and tasks, and processing vague and often incomplete applications. I find that workers received rapid conflicting information about policy changes throughout the pandemic that dramatically shifted their responsibilities and tasks—contributing to the stress of policy implementation. These psychological costs stem from constraints highlighted in the street-level bureaucracy literature—limited resources, ambiguous policy goals, and challenging performance standards.

Conclusion/Implications: While the Families First Coronavirus Response Act changed policies in ways that reduced administrative burden for families, agency resources and federal and state performance standards remained the same. Sharp increases in caseloads coupled with pressures to meet federal and state performance standards constrained workers’ capacity to assist applicants. Implications of these findings for reducing the psychological costs to workers of policy innovation will be discussed.