The structure of bureaucratic decisions in the American states

This paper examines the structure of bureaucratic decisions in state Medicaid programs, More specifically, the analysis tries to discern an underlying pattern in Medicaid optional service adoptions across the American states during the period from 1985 through 1994. These adoptions result from state-level administrative initiatives rather than federal or state legislative actions. The analysis shows that states differ in the extent to which they extend services into more controversial aspects of health care. And their willingness to do so follows a dear cumulative pattern: States initiate more controversial, limited services only after they have already adopted a full range of services that are widely acceptable to the public and governmental officials. This cumulative pattern in administrative decisions reveals a great deal about the nature of bureaucratic actions in state-level social welfare programs. This study also produces an empirical measure of bureaucratic policy outputs that can be used as an analytic variable in other research efforts.