Beyond the Organization: The Influence of Community and Personal Values on Street-Level Bureaucrats' Responsiveness

Abstract

This article quantifies and explains differences that theoretically do not exist—intrastate differences in Medicaid spending in a state with a highly centralized program and few local discretionary decisions. The differences do exist—and they exist in large part because implementation takes place in different organizational and political settings, settings which affect potential participants' willingness to apply for the programs and the responsiveness of social service workers to their clients. This article links two research domains—interstate policy variation and street-level bureaucratic behavior—to understand why intrastate differences occur in Medicaid spending and participation. It first develops and tests a model to predict Medicaid generosity and participation in Michigan's counties based on supply, demand, and political factors. It then looks more closely at participation and spending in six counties to more fully understand differences in organizational, political, and task environments in those counties. It concludes that while supply, demand, and political factors are important in predicting intrastate Medicaid spending patterns in Michigan, recipient behavior—shaped in large part by the behavior of the social service office leadership and the environment of the county—matters as well.