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Multi-Site Implementation: Medicaid Section 1931(b) in California

  • Jacob Alex Klerman
  • Amy G. Cox
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    This paper uses the implementation of the new Medicaid 1931(b) program in California and its 58 counties to consider multi-site implementation. Given California's county-operated welfare system, the California Department of Health Services (CDHS) made policy that each of the state's 58 counties was to implement. Combining unusually rich administrative data, official documents, and qualitative field work, the authors find that actual implementation occurred as much as several years later than was required by state-level policy, with considerable heterogeneity across the counties, and that the heterogeneity was to a great extent due to the details of computer systems. The paper concludes with a discussion of the implications of these results for implementation and the study of implementation.

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    Paper provided by RAND Corporation Publications Department in its series Working Papers with number 249.

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    Length: 33 pages
    Date of creation: Mar 2005
    Date of revision:
    Handle: RePEc:ran:wpaper:249
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    1. Robert Moffitt & Barbara Wolfe, 1990. "The Effect of the Medicaid Program on Welfare Participation and Labor Supply," NBER Working Papers 3286, National Bureau of Economic Research, Inc.
    2. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-77, June.
    3. Rebecca M. Blank, 1989. "The Effect of Medical Need and Medicaid on AFDC Participation," Journal of Human Resources, University of Wisconsin Press, vol. 24(1), pages 54-87.
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