Abstract
Using data from 113 in-depth interviews with beneficiaries of social welfare programs, I examine the ease of access to the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC); the Supplemental Nutrition Assistance Program (SNAP); and Medicaid during the COVID-19 pandemic. Policy changes that were enacted in response to COVID-19 were explicitly designed to reduce the administrative burden of program participation. I find that while WIC and Medicaid participants reported easier access to benefits, SNAP saw high demand and bureaucratic constraints that undermined access. SNAP participants encountered difficulties that they attributed to burdensome experiences to administrative exclusion. I show how applicants perceived organizational practices as excluding eligible populations from participation in government programs and undermining policies that were designed to reduce administrative burdens.
The COVID-19 epidemic created a catastrophic public health and economic crisis. The pandemic stressed weak health care systems and strained the U.S.’s already fragmented and underresourced welfare bureaucracies. Early accounts of job loss and economic hardship, for example, revealed just how difficult it could be to access unemployment insurance and nutrition assistance programs. (Aaron 2020; Gassman-Pines, Ananat, and Fitz-Henley 2020; Moynihan and Herd 2020).
Barriers to accessing public benefit programs have long been a subject of scholarly attention. Researchers define these barriers as administrative burdens: “onerous experiences” with policy implementation (Burden et al. 2012, 742) that can include learning costs, compliance costs, and psychological costs to prospective program participants. Because of learning costs, for example, eligible households may fail to access benefits; in other words, they may be unaware of assistance programs, do not know they are eligible, or do not know how to apply (Moynihan, Herd, and Harvey 2015). Compliance costs—in the form of complex applications and extensive document requirements—may actually discourage program uptake. Finally, with psychological costs, eligible households may forgo benefits because the process of applying is too stressful and stigmatizing (Barnes and Henly 2018; Barnes, Michener, and Rains 2023; Herd and Moynihan 2019).
While the coronavirus pandemic revealed some of the weaknesses of the U.S. welfare state, it also led to sweeping policy changes aimed at reducing these burdens. The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid Relief and Economic Security Act (CARES) gave states the option of reducing administrative burdens in the Supplemental Nutrition Assistance Program (SNAP); the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC); and Medicaid. States could apply for waivers to extend eligibility periods, streamline application processes, offer remote appointments, and allow self-reporting of information to determine eligibility (Center on Budget and Policy Priorities 2020; U.S. Department of Agriculture 2020; Centers for Medicare and Medicaid Services 2020).
In theory, these policy changes should have reduced the barriers to accessing benefits throughout the pandemic, and some evidence suggests this was the case, with the uptake of public programs increasing from prepandemic levels. SNAP program participation increased by 11 percent from 2019 to 2020 (Toossi, Jones, and Hodges 2021). Medicaid participation increased by 15.2 percent from February 2020 to January 2021 (Centers for Medicare and Medicaid Services 2021). The WIC program saw variation in enrollment rates across states and a slight (3 percent) national increase in program participation (Center on Budget and Policy Priorities 2021). Yet large surveys of families impacted by COVID-19 during this time suggest an underutilization of assistance programs early in the pandemic (Harper et al. 2022), especially among Black Americans (Ohri-Vachaspati, Acciai, and DeWeese 2021). Further, qualitative studies documenting the implementation of the COVID-19 policy changes offer mixed evidence on how their rollout increased access or improved the quality of bureaucratic encounters (Barnes and Petry 2021; Barnes and Riel 2022).
In sum, then, the evidence on program participation through the COVID-19 pandemic cannot be explained by the administrative burden framework alone. Reducing burdens through policy design can solve the problem of onerous program experiences (Herd and Moynihan 2019), but the focus on policy design obscures how administrative exclusion—organizational practices that exclude eligible populations from program participation—can undermine the very policy changes designed to reduce burdens (Brodkin and Majmundar 2010; Lipsky 2010). For example, workers may respond to the pressures to manage or reduce caseloads by losing paperwork, misapplying policy rules, or avoiding applicants’ calls or questions.
Policy innovations enacted in response to the coronavirus epidemic offer an opportunity to examine the effectiveness of burden-reducing policy changes in an organizational context where practices—due to the realities of street-level work—can exclude eligible individuals from accessing programs. More research is needed to demonstrate whether and how COVID-19 policy changes diminished administrative burdens for families. This article takes up this question. In the case of SNAP, WIC, and Medicaid, I ask, How did COVID-19 policy changes, designed to reduce administrative burden, improve access to programs and the quality of bureaucratic encounters for program applicants and beneficiaries?
To answer this question, I draw on data from 113 in-depth qualitative interviews with individuals who attempted to or successfully claimed SNAP, WIC, and Medicaid benefits in North Carolina throughout the COVID-19 pandemic; and the data suggest that applicants and beneficiaries experience variation across SNAP, WIC, and Medicaid in terms of the quality of bureaucratic encounters and access to benefits. Most respondents reported easier access to WIC and Medicaid and positive interactions with bureaucrats in those programs. In contrast, SNAP applicants and beneficiaries reported mixed or negative bureaucratic encounters and described stigmatizing interactions; in some cases, bureaucrats were altogether inaccessible. Many of these participants attributed these negative experiences to administrative exclusion—in particular, workers’ efforts to manage the high demand for SNAP benefits throughout the pandemic. The findings suggest that burden-reducing policies vary in their effectiveness across assistance programs and should be pursued in tandem with efforts to support bureaucratic capacity to meet growing demands for assistance.
Administrative Burden
Administrative burden reflects the “onerous experiences” individuals have with policy implementation (Burden et al. 2012, 742). Burdens consist of learning costs—the costs of learning about programs, whether you qualify, how to apply, and how to use benefits (Barnes 2021; Herd and Moynihan 2019). Compliance costs—the costs of providing information and documents to determine eligibility—can also discourage program uptake (Heinrich 2016; Moynihan, Herd, and Harvey 2015). Applications may be long and complex, and programs may require extensive documents to prove citizenship, residency, income, and household size—all of which may deter people from claiming benefits (Herd 2015). Finally, psychological costs—the stress and stigma of claiming benefits—may keep eligible individuals from applying (Bhargava and Manoli 2015; Stuber and Schlesinger 2006). Claimants can experience diminished autonomy from intrusive, stigmatizing interactions with bureaucrats or experience stress when trying to meet the compliance demands of programs (Barnes and Henly 2018; Barnes, Michener, and Rains 2023; Hattke, Hensel, and Kalucza 2020; Watkins-Hayes 2011). Scholars argue that these barriers to benefits are a product of intentional, hidden politics that deliberately restrict or deter access to benefits “through the design of bureaucratic procedures and access requirements” (Peeters 2020, 577).
Administrative burden research has clarified the different dimensions of learning and compliance costs (Barnes 2021), revealed how individuals make sense of onerous bureaucratic encounters (Barnes and Henly 2018), and demonstrated how individuals leverage “administrative literacy” and social capital to successfully claim benefits (Döring 2021; Masood and Nisar 2021). Studies of administrative burdens have also shown how they disproportionately harm the most vulnerable—racial and ethnic minorities, marginalized populations, and those who lack the cognitive capacity to bear the burdens of accessing benefits (Christensen et al. 2020; Chudnovsky and Peeters 2020; Nisar 2018; Ray, Herd, and Moynihan 2023). This body of research is also beginning to demonstrate the relationships between costs (Barnes and Riel 2022; Bhanot 2021; Linos, Quan, and Kirkman 2020; Moynihan et al. 2022). That is, recent studies show how the process of learning about eligibility categories can complicate how individuals apply for benefits and, thus, increase compliance costs (Moynihan et al. 2022); and, on the other hand, how reducing compliance costs can decrease the psychological costs of programs (Baekgaard et al. 2021; Hattke, Hensel, and Kalucza 2020).
Administrative burden scholars and economists have prescribed policy changes to reduce burdens and increase program participation. For example, research shows the impact of information dissemination and application assistance in increasing enrollment across a range of assistance programs (Aizer and Currie 2004; Bartlett, Burnstein, and Hamilton 2004; Bertrand, Luttmer, and Mullainathan 2000; Bhargava and Manoli 2015; Daponte, Sanders, and Taylor 1999; Figlio, Hamersma, and Roth 2015; Heinrich 2016; Nisar 2018). Streamlining application processes can reduce compliance costs and boost program uptake (Wolfe and Scrivner 2005). Herd et al.’s (2013) earlier work on Wisconsin’s Medicaid program—called Badger Care—demonstrates how autoenrollment, presumptive eligibility, and online applications boosted program uptake. Likewise, SNAP research shows how lengthening eligibility periods, eliminating in-person interviews, and offering online applications have increased program participation over time (Herd and Moynihan 2019).
More recent work demonstrates some of the merits of COVID-19 policy innovations in reducing administrative burden and improving bureaucratic encounters (Barnes and Petry 2021; Morris et al. 2022; Ventura, Martinez, and Whaley 2021). For example, a study of Washington State’s implementation of remote WIC appointments throughout the pandemic finds that WIC recipients expressed satisfaction with remote service delivery (Morris et al. 2022). However, quantitative evidence raises questions about the impact of COVID-19 policy changes on administrative burdens. On the one hand, program enrollment numbers point to increases in SNAP and Medicaid enrollment during the first year of the pandemic. Yet survey research suggests that eligible families underutilized SNAP early in the pandemic, and quantitative analysis of Medicaid enrollment suggests that neither job loss (Dague et al. 2022; Frenier, Nikpay, and Golberstein 2020) nor simplified application processes were associated with increases in Medicaid enrollment (Khorrami and Sommers 2021). WIC enrollment numbers further highlight the limits of COVID-19 policy changes. Some states like North Carolina reported modest increases in enrollment, while others reported marginal boosts in uptake or declines in program participation (Toossi, Jones, and Hodges 2021).
It is worth asking whether the actual, on-the-ground implementation of policy may have limited the reach of the burden-reducing changes and thus contributed to these patterns in program participation. For example, eligible households may have been excluded from programs because of the limited capacity of bureaucrats.
Administrative Exclusion and Administrative Burden
The administrative exclusion perspective provides insight into how bureaucratic capacity can undermine burden-reducing policy changes. While administrative burden focuses on the policy design features that contribute to onerous bureaucratic encounters, administrative exclusion refers to the organizational practices and street-level constraints that create barriers to accessing programs. Brodkin and Majmundar define administrative exclusion in the context of Temporary Assistance for Needy Families (TANF) as “non-participation attributable to organizational factors rather than claimant preferences or substantive eligibility status” (2010, 827). They find that features of TANF’s governance, its limited resources, and the pressures to reduce caseload encouraged organizational practices that excluded eligible applicants. Caseworkers lost paperwork, misapplied policy rules, or failed to respond to claimants’ calls or inquiries.
Some scholars think of these “hidden costs” of welfare claiming as how bureaucrats cope with the realities of policy implementation at the street level: ambiguous policy goals, limited resources, and high caseloads (Lipsky 2010). For example, when policy goals and organizational constraints consign bureaucrats to a gatekeeping role (Barnes 2020; Soss, Fording, and Schram 2011), individuals may experience intrusive questions and scrutiny during the application process and stigmatizing experiences with workers rather than positive supportive encounters (Barnes and Henly 2018; Soss 1999; Watkins-Hayes 2011). Despite such constraints, some bureaucrats may use their discretion to provide informal support like referrals and social support to clients (Lavee 2021; Tummers et al. 2015); meanwhile, others may engage in behaviors characterized as “bureaucratic entitlement,” where workers faced with limited resources may ration access to benefits through “mechanisms to limit services to eligible citizens” and “impose costs and inconvenience on clients” (Lipsky 1984, 8). In this sense, workers use learning, compliance, and psychological costs as tools to discourage program take-up. Benefit delays and denials along with inaccessible caseworkers constitute the “hidden costs” of claiming benefits.
In sum, administrative burdens can become a tool for administrative exclusion. Poor work conditions can lead street-level bureaucrats to use features of program design—the built-in compliance, learning, and psychological costs prescribed by policies—to deter access to programs. Workers’ high caseloads and limited resources can increase the learning, psychological, and compliance costs of welfare claims. As just one example, when communication about policy changes is poor or lacking, applicants will inevitably be unaware of changes that have been explicitly designed to ease burdens (Barnes and Riel 2022). In other instances, when workers make mistakes or are just inaccessible, applicants may bear the costs of resubmitting paperwork or get lost in the bureaucratic maze.
Given the relationship between the explicit costs of claiming benefits (administrative burden) and administrative exclusion (the hidden costs of welfare claiming), I argue that administrative exclusion may undermine COVID-19 policy reforms aimed at reducing administrative burdens in critical safety-net programs.
WIC, SNAP, and Medicaid
Policy background
WIC
WIC offers nutrition assistance to low-income mothers and children under five. As the third-largest nutritional assistance program, WIC served 6.3 million households in 2022 and nearly half of all infants born that year (U.S. Department of Agriculture 2023). To be eligible for the program, individuals must be either pregnant, six months postpartum, or a child under the age of five. Applicants must also exhibit a nutritional risk such as low birth weight, low maternal weight, and anemia. Individuals are income eligible if their household income falls below 185 percent of the poverty line or if they receive SNAP, Medicaid, or TANF (Gray et al. 2019).
Once enrolled in the program, participants receive nutritional education that promotes healthful eating and breastfeeding support. Participants also receive a food package that includes a list of WIC-eligible food items. WIC nutritionists tailor the food package to reflect dietary recommendations and the participants’ food preferences.
SNAP
SNAP offers nutrition assistance to more than 41 million low-income households through cash-like benefits that can only be used to purchase food (Center on Budget and Policy Priorities 2022). Eligibility is determined by income, assets, and household size. To qualify, households must have incomes at or below 130 percent of the federal poverty line. In some states, households should have assets that fall below a threshold.
Medicaid
Medicaid provided health coverage for over 76 million people in 2021. Although Medicaid is an entitlement program, the federal and state governments share the costs of benefits and the administrative costs of the program (U.S. Department of Health and Human Services 2018). The federal government requires states to cover specific eligibility groups and services, but states have the discretion to expand the eligibility groups and services they provide. Consequently, Medicaid programs vary across states (Campbell 2014; Michener 2018).
Compliance costs
Before the COVID-19 pandemic, all three programs (WIC, SNAP, and Medicaid) had extensive compliance costs (Herd et al. 2013; Homonoff and Somerville 2021; Woelfel et al. 2004). While the WIC programs did not require applicants to fill out an application form, the program required participants to attend quarterly appointments where staff members walked them through an intake process (Gray et al. 2019). WIC offers participants one year of eligibility but required participants to attend two appointments—an initial certification and recertification—in person. During in-person appointments, workers collected anthropometric measures like height, weight, and blood draws from participants to assess and track nutritional risk. Quarterly appointments are a form of compliance costs that can deter continued program use (Panzera et al. 2017). To determine whether they are eligible, applicants bear additional compliance costs by submitting forms of identification and proof of residency.
SNAP and Medicaid have similar pre-COVID-19 compliance costs but more flexibility in the application process. In North Carolina, both programs allowed individuals to apply by mail, online, or in person at a local department of social services (North Carolina Department of Health and Human Services 2022b). However, applicants bore more extensive compliance costs: Medicaid required them to submit documents that verify identity and residency (e.g., driver’s licenses, birth certificates, and recent wage stubs), although SNAP participants could provide a Medicaid card to verify income eligibility. For some applicants, Medicaid required participants to verify income and assets by submitting documents like up-to-date financial statements from sources of income (e.g., social security, pensions, retirement, and child support) (North Carolina Department of Health and Human Services 2022a). For the SNAP program, workers interviewed applicants once the application was received. When the eligibility period ended, SNAP and Medicaid beneficiaries had to resubmit their application and documents to verify continued eligibility. For SNAP, beneficiaries would recertify every six months. For Medicaid, recipients would recertify annually.
COVID-19 Policy Changes
SNAP COVID-19 policy waivers
Throughout the pandemic, FFCRA allowed states greater flexibility in how they implemented SNAP programs. For example, waivers permitted states to conduct remote interviews or to waive interview requirements at the application and recertification stage (Center on Budget and Policy Priorities 2020). States could also adopt telephonic signatures to facilitate remote interviews (Center on Budget and Policy Priorities 2020) and waive recertification requirements by extending the eligibility period by six months. Finally, FFCRA suspended work requirements and time limits for childless, able-bodied SNAP participants under the age of 50 (Rosenbaum et al. 2020).
Along with waivers that eased the application and recertification process, the FFCRA increased the generosity of benefits. For example, states could temporarily provide an emergency supplement for households that did not receive the maximum benefit amount and provide SNAP benefits (Pandemic EBT [electronic benefit transfer]) to households with children receiving free or reduced lunch who were missing school meals due to remote learning (Center on Budget and Policy Priorities 2020; U.S. Department of Agriculture 2020). Taken together, these changes reduced the compliance cost of program participation and boosted the generosity of the program.
WIC COVID-19 policy waivers
WIC application and recertification processes also shifted during the pandemic to accommodate social distancing practices. The FFCRA allowed states to waive physical requirements for WIC appointments and permitted WIC to offer proof of residence and income digitally. WIC clinics could defer reporting anthropometric data or allow WIC participants to self-report anthropometric data, which is used to assess nutritional risk. Waivers also allowed states to issue benefits remotely (North Carolina Department of Health and Human Services 2020, 2022c). By eliminating in-person appointments and changing reporting requirements, these changes reduced the compliance costs of WIC program participation that have been shown to discourage program uptake (Panzera et al. 2017; Rosenberg, Alperen, and Chiasson 2003; Woelfel et al. 2004).
Medicaid COVID-19 policy waivers
FFCRA prohibited states from disenrolling Medicaid beneficiaries until the Public Health Emergency declaration ended (Center on Budget and Policy Priorities 2020). Using section 1135 of the Social Security Act, states can also modify Medicaid enrollment processes. To reduce burdens in the application and recertification process, North Carolina’s Department of Health and Human Services allowed self-attestation for most eligibility requirements and extended eligibility to 12 months during the public health emergency declaration (North Carolina Department of Health and Human Services 2020). In addition, the CARES Act offered states funding to streamline enrollment processes.
Methodology
To understand how WIC-, SNAP-, and Medicaid-eligible families experienced burden-reducing COVID-19 policy changes, I use an interpretive approach for data collection and analysis. An interpretive approach prioritizes how participants perceive and understand their experiences in their own words (Haverland and Yanow 2012; Schwartz-Shea and Yanow 2012). The data come from a larger qualitative study of bureaucratic encounters with WIC, SNAP, and Medicaid in North Carolina. A team of six interviewers conducted 113 in-depth phone interviews with applicants and program beneficiaries from June 2020 through October 2021.
Because this study aims to capture how participants make sense of their program experiences and to understand the connection between administrative burden and administrative exclusion throughout the COVID-19 pandemic, an interpretive approach is most appropriate.
To this end, the research team did not draw a random sample of program applicants and beneficiaries. Instead, the team captured a range of experiences and sampled participants from six North Carolina counties that vary by rurality, racial makeup, and economic conditions. Study participants were recruited through flyers that were mailed from county WIC offices. The research team also posted flyers about the study through social media outlets. The flyers instructed participants to call a hotline to schedule an interview. The interviewers obtained oral consent from study participants and conducted phone interviews that lasted for an average of 60 minutes. Participants received a $30 e-gift card for participating. To protect study participants’ identities, I use pseudonyms instead of participants’ names.
Respondents were, on average, 35 years old and predominately women (95.5 percent) and had two children or more. Most study participants were Black (69 percent) and non-Hispanic (89.5 percent). Most of the sample lacked a college degree but had completed high school (36.6 percent) or attended some college (29.2 percent). Only 40 percent of the sample were employed, and the average monthly income for this sample was $1,394. More than half of the sample of WIC, SNAP, and Medicaid participants interviewed were from urban counties (53.1 percent). A little more than half (51.3 percent) applied to or participated in WIC, SNAP, and Medicaid at the time of the interview; 17 percent of the sample reported interactions with WIC and Medicaid; and 8 percent reported applying for or receiving WIC and SNAP. A smaller portion of study participants reported applying for or receiving only one program—6.2 percent of the sample reported WIC bureaucratic encounters, 5.3 percent reported SNAP bureaucratic encounters, and 1.8 percent reported applying for or receiving Medicaid. Table 1.1 in online Appendix A displays participant characteristics. 1
The sample includes individuals who have received SNAP, WIC, or Medicaid benefits and attempted to apply or recertify their benefits. As a result, interviews capture how individuals attempted to access and maintain benefits throughout the pandemic. The demographic makeup of the sample also diverges from state and national participation rates across these programs. For example, the sample has a larger share of Black Americans in these programs than the state and national WIC, SNAP, and Medicaid populations (Kline, Meyers Mathieu, and Marr 2020; Loveless 2020).
The overrepresentation of Black Americans in this sample reflects the county selection, which prioritized racially diverse, high-poverty counties with a large WIC, SNAP, and WIC-eligible populations. The preponderance of Black perspectives is a strength of the sample. Interviews can deepen our understanding of vulnerable families who were disproportionately harmed by the health and economic crisis of the pandemic (Enriquez and Goldstein 2020).
In semistructured interviews, interviewers asked participants to describe whether and how they accessed benefit programs throughout the pandemic. Interviews asked study participants to describe how they experienced changes in the application and recertification process and how their households benefitted from these COVID-19 policy changes. Interviews also asked respondents to describe the quality of their interactions with staff members given the shift towards remote work. All interviews were audio-recorded and transcribed by a third-party transcriber. Interviewers also wrote memos following each interview that summarized key themes.
Analysis
The research team entered all transcripts into a qualitative software package, NVIVO-12.4. A team of coders followed an interpretive approach to analysis, which combined deductive analysis informed by the administrative burden framework and inductive analysis that followed grounded theory conventions of closely reading transcripts to code for emergent themes (Glaser and Strauss 1967; Haverland and Yanow 2012). The research team began coding by organizing the data by study objectives and interview questions. Using line-by-line analysis of transcripts, coders looked for emergent descriptive and analytic categories. For example, we coded the valence of study participants’ bureaucratic encounters across all three programs, their evaluation of these encounters, and the consequences of access to programs for their families. We used the administrative exclusion concept to code responses that attributed poor program experiences to limited resources, high demand, and overwhelmed workers. Two coders reread transcripts, wrote analytical memos on key themes, and iteratively compared their coding process until they reached 90 percent agreement or more on each code (Glaser and Strauss 1967; Miles and Huberman 1994; Ryan and Bernard 2003).
Findings
COVID-19 and bureaucratic encounters: Variation across WIC, SNAP, and Medicaid
Despite policy changes aimed at easing access to assistance programs, respondents did not uniformly report positive experiences with these changes. Participants who attempted to access all three programs most frequently reported positive experiences with Medicaid and WIC and negative or mixed experiences with the SNAP program.
Most study participants who received WIC reported positive experiences with remote appointments and with their interactions with WIC staff. Participants described remote WIC appointments as flexible, convenient, and fast. For example, Vera, an urban WIC participant, shared that her remote appointments were easier than pre-COVID-19, in-person office visits because she did not have to arrange transportation in advance. She explained, Well, now everything’s over the phone, so that’s pretty much it now. It used to be me making an appointment. I’d go up there with my son and my WIC card and we do appointments like that. It’s a lot easier to do it over the phone because I don’t have to make sure I have the car that day so I can get to the appointment. I can just pick up the phone when they call and talk to them and tell them what’s going on.
Lydia, another urban participant, emphasized the flexibility of remote appointments. She viewed staff members as more accommodating now that appointments were over the phone. When asked to describe her experiences with WIC during the pandemic, she remarked, I personally haven’t had an issue. Anytime that I’ve had to reschedule an appointment, or if something has happened that day or anything like that, they’re pretty accommodating. Especially with the COVID-19 going on they’ve been good about doing online for certification, like over the phone. They contact you when you’re available. So, I don’t really have anything bad to say.
While most viewed remote appointments as improving their experiences, a few participants expressed disappointment with the brevity of appointments and feeling “rushed.” Laura, an urban mom of two, commented that, given the high demand for help, phone appointments made her feel like she was on a “time limit.” When asked why she disliked the shift to remote appointments, she said, “I can’t go in there and actually physically talk to somebody and tell them my issues without feeling like I’m kind of on a time limit because when you’re on the phone, you know 20 or 30 other people are probably calling in about the same problems.”
Ivy also preferred in-person appointments. For her, phone appointments diminished the quality of her interactions with staff. Staff members were “rude” and “talked over” during her remote appointments. She explained, “Sometimes they could be all right I guess, sometimes they could be rude, it’s just that they don’t let you talk. They just overtalk you. They don’t let you explain to them why you’re calling them. They know why you’re calling, just overtalk you.”
Beyond these rare complaints about remote WIC appointments, most participants valued access to WIC and regarded COVID-19-related program changes as helpful support throughout the pandemic. For example, Renee, a rural SNAP and WIC applicant, remarked, “I think that there would be a lot more people that were hungry or being starved if it wasn’t for the programs.”
Much like WIC recipients, most Medicaid applicants and beneficiaries reported positive experiences with accessing the program. Respondents described a “straightforward” process that required little to no interaction with workers. For example, Simone, an urban mom of two, described her interactions with Medicaid staff as “straight to the point”: “[They] are straight to the point, answer your questions, tell you what you’re going to expect. That’s about it.”
Romana, an urban mother of four, also commented on the ease of accessing Medicaid during the pandemic. Shortly after giving birth, she applied for Medicaid. Since then, she has received her medical card in the mail and has not needed to contact the office: “I just get my card, and that’s it. I don’t have to do no kind of appointments or calling about it, they don’t call me. They just send me my card through the mail, and I’m good to go.”
In contrast, study participants who tried to access or maintain SNAP benefits reported negative bureaucratic encounters. Participants complained of stigmatizing interactions with workers. They also reported difficulties reaching workers to apply for benefits, inquiring about the status of their application, or reporting changes to their income or household due to the pandemic. For example, Marie, a rural mom of five, applied for all three programs during the pandemic. She found the SNAP application process difficult because she could not reach workers. After submitting her application, she had not “gotten a response back, or a letter back.” She explained, “Whenever I call them, I talk to somebody, but then they end up hanging up, and whenever I try calling back, it’s just ringing, and ringing, and ringing.”
Claire, an urban mom of four, reported similar challenges in reaching SNAP workers throughout the pandemic. In theory, remote application and recertification processes should have eased access to benefits, but when asked to describe her interactions with staff, she responded, “I can’t get ahold of them.” She attributed inaccessible workers to the high demand for benefits. described the office as “struggling,” “backed up,” and “bogged down with the coronavirus.” She also noted rapid turnover among SNAP workers: I think my problem is, every time I get a worker, they’re not there very long. So, I have to start over, new. And since the corona thing they just upped your stuff, and you can’t get ahold of anybody. It’s like a half-hour—20 minutes, 30 minutes, 40 minutes, 50 minutes you can be on the phone. . . . I get something in the mail, and I would call them. And they would say, well, she’s not your worker. And I would say, well, who’s my worker? Well, it says she’s my worker. And well, let me transfer you. And then they transfer me. And they’re like, I don’t know what you’re talking about and then they would transfer me to somebody else. And then they’re like, oh, the person that’s got you is actually on vacation this week; she’ll call you back next week.
Her difficulties accessing SNAP reflect dimensions of administrative exclusion. She reasoned that workers were responding to the high demand for benefits by “upping” the barriers to access. Workers failed to answer her calls or transferred her from worker to worker without addressing her concerns. When describing interactions with SNAP workers during the pandemic, Ebonie shared similar concerns and explained how remote work and remote appointments have made workers at her rural department of social services office less available to help applicants. She explained that applicants and beneficiaries “can’t go in the office” and are limited to reaching workers by phone—which seldom happens. She has tried to leave her questions and concerns at the front desk but only receives help if her concerns are important: We can’t go in the office, ma’am. We only can try to get somebody on the phone but can’t get nobody on the phone then I will just have to run out there and they stop me at the front desk and then you got to leave your questions or whatever you need to talk to or whatever to the person that you need to talk to and they will get in contact with you. And sometimes they would just send a message back down to the person that are on the phone with them, they let, you know, a certain thing and then or either if it’s really very important they probably will come out and speak to you.
Because of this dismissive approach, Ebonie viewed workers as “not caring anymore” and unwilling to make themselves available to people who need help: It’s been very difficult. . . . People now are suffering, and they are social workers so they should make their selves more available to the people, they are needed. Because of the fact that just that they’re sending messages downstairs and let’s just leaving us there, they still can’t explain it, then, you know, what their concerns is and what they need to do. So, like they’re just not in caring anymore.
Gabriela, an urban Hispanic mother of two young children, experienced delayed SNAP benefits and inaccessible workers at the beggining of the pandemic. After submitting her application by mail, she tried to reach the office to ask whether her benefits had been activated but never received a response. She attributed this experience to administrative exclusion and highlighted the downsides of the shift to remote work amidst increased demand for benefits. For her, workers did not respond to her because of high demand: Yeah. Maybe applied during March. We waited. And then maybe we got approved in like April, May. . . . I mean, [it was] probably just the influx. I mean, it took, what, three or four days for them to receive it in the mail, because I did it by paper, like snail mail. And then I remember calling and having some questions about activation and if the monies went from month to month, or if they expired. And I never got a response. I called and tried to get a supervisor and never got a response. . . . I assume the influx of people that were applying and the influx of people in need at this time is high.
In sum, participants attempting to access SNAP benefits experienced challenges with reaching workers, and their rationale for these experiences reflects administrative exclusion. They reasoned that workers, whether intentionally or not, responded to high demand and bureaucratic constraints by creating additional barriers to access for applicants.
Discussion
The COVID-19 pandemic created economic and public health crises but also led to policy innovations that expanded access to assistance programs. FFCRA and CARES permitted states to streamline application and recertification processes through remote appointments, waived interview requirements, extended certification periods, and reduced documentation requirements. Taken together, these changes reduced the compliance costs of program participation throughout the pandemic.
In theory, policy changes should have eased access to benefits, but qualitative findings provide mixed evidence on how well changes to application and recertification processes reduced administrative burden. On the one hand, most WIC applicants and participants reported satisfaction with remote appointments, emphasizing the convenience of phone appointments over office visits. Medicaid recipients also reported positive experiences, noting the ease of accessing benefits with limited interactions with workers. The ease of Medicaid access reflects North Carolina’s extension of eligibility during the pandemic and the limited information required to prove eligibility for the program. However, SNAP applicants and beneficiaries reported difficulties reaching workers to confirm whether their application had been received and processed and whether they had successfully recertified. In short, shifting the application and recertification process from in-person to remote made SNAP workers less accessible to applicants and clients.
This article highlights the important connection between administrative burden and administrative exclusion by showing that burden reductions are only effective if bureaucracies have the resources to implement policies. Despite federal efforts to decrease burdens, study participants reported high psychological costs—stress—when trying to apply for and recertify SNAP benefits. From the participants’ view, SNAP workers coped with limited resources and high demand by making themselves inaccessible. Participants’ rationales about costly program experiences mirror previous research on how clients understand negative bureaucratic encounters (Barnes and Henly 2018) but also invoke dimensions of administrative exclusion as the reason why burden-reducing policies did not always decrease the costs of accessing benefits.
Although limited to 113 participants in North Carolina, this qualitative study aims to advance theory building and future research by providing thick descriptions of how individuals accessed SNAP, WIC, and Medicaid throughout the pandemic. To that end, this study raises some new questions for research.
Along with revealing how administrative exclusion can undercut the impact of COVID-19 policy changes on administrative burdens, these findings demonstrate how the reach of administrative burden reductions varies across assistance programs. In the case of WIC and Medicaid, applicants and beneficiaries reported positive experiences with changes to the application and recertification process. COVID-19 policy changes improved the quality of bureaucratic encounters in these programs. In contrast, the findings suggest that COVID-19 policy changes may have diminished the quality of SNAP program experiences.
This variation warrants more research about the factors that facilitate or upend efforts to ease access to programs. For example, qualitative and mixed-methods research can examine how the features of program design across means-tested assistance programs and the relative demand for assistance throughout the pandemic influenced how families accessed programs. In the case of WIC, in-person appointments are hands-on, multistep, time-intensive appointments in which workers collect health-related data on participants (e.g., heights, weights, and blood samples). By eliminating time-intensive components of appointments, policy waivers may have made workers more accessible and accommodating to increased demand. In contrast, policy changes to SNAP may have added or shifted workers’ responsibilities in ways that decreased their ability to help clients. In-depth case studies can examine and compare workers’ changing roles and responsibilities across assistance programs to draw connections between program design, COVID-19 policy changes, and experiences with administrative burdens.
In the same vein, studies can more deeply probe how street-level factors like performance standards, shifting and confusing policy goals, rising caseloads, and dwindling staff contributed to burdensome bureaucratic encounters throughout the pandemic. Unlike previous stimulus legislation like the American Rescue and Recovery Act, policy changes authorized by the FFCRA and the CARES Act did not distribute additional administrative funds to states to accommodate the increased demand for programs. The increased demand and policy shifts that came with the pandemic may have exacerbated already strained work conditions through higher caseloads and fast-paced policy changes—conditions that may have encouraged administrative exclusion. This analysis presents perspectives from applicants and beneficiaries, but future research can reveal workers’ experiences with these factors in mind. Qualitative interviews and surveys can help identify workers’ coping strategies and expose organizational practices that constitute administrative exclusion.
Finally, the insights from this study raise questions about how federalism contributes to administrative exclusion. This study examines North Carolina, which gives counties greater administrative responsibility in delivering public assistance programs. Consequently, counties are responsible for some of the administrative costs of implementing programs. Research points to county-level variation in program accessibility and to inequities in accessibility and generosity that result from decentralized policy delivery (Kogan 2017; Michener 2018; Soss, Fording, and Schram 2011). Future studies can probe whether differences in state and county systems influenced how families experienced administrative burdens driven by administrative exclusion during the pandemic. Additional research can consider how federalism can create regional differences in coverage rates and experiences with administrative exclusion. Given that southern states have the least generous, most burdensome assistance programs (Campbell 2014; Hardy, Samudra, and Davis 2019; Michener 2019; Parolin, Cross, and O’Brien 2023), studies can examine whether families in the South were less likely to access programs throughout the pandemic.
Supplemental Material
sj-docx-1-ann-10.1177_00027162231201759 – Supplemental material for “I Can’t Get Ahold of Them”: Perceptions of Administrative Burden and Administrative Exclusion across SNAP, WIC, and Medicaid during the COVID-19 Pandemic
Supplemental material, sj-docx-1-ann-10.1177_00027162231201759 for “I Can’t Get Ahold of Them”: Perceptions of Administrative Burden and Administrative Exclusion across SNAP, WIC, and Medicaid during the COVID-19 Pandemic by CAROLYN BARNES in The ANNALS of the American Academy of Political and Social Science
Footnotes
Carolyn Barnes is an associate professor in the Crown Family School of Social Work, Policy, and Practice at the University of Chicago. Her research explores the social and political implications of social policy on low-income populations in the areas of childcare policy, family services, and supports for young children.
Notes
References
Supplementary Material
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