Date of Award




Document Type


Degree Name

Doctor of Philosophy (PhD)


Department of Political Science

Content Description

1 online resource (v, 178 pages)

Dissertation/Thesis Chair

Frank J Thompson

Committee Members

Robert T Nakamura, Thomas W Church, James Fossett


Federalism, Implementation, Intergovernmental Relations, Medicaid, Public Policy, Federal government, Intergovernmental cooperation

Subject Categories

Political Science | Public Administration


Variation in the Medicaid program has frequently been studied across states, and considered a product of political, fiscal and administrative factors. Few studies have considered variation in Medicaid as a product of federal bureaucratic behavior. This study examines federal variation, and uses federalism, intergovernmental relations and public policy lenses to compare two cases where classes of recipients were being disenrolled from Medicaid, in apparent conflict with federal regulations. In one case, when individuals moved from county-to-county and became disenrolled in Medicaid, the federal bureaucrats used most of the implementation tools at their disposal to try to bring states back into compliance by simply transferring cases. In another, when inmates were being disenrolled from Medicaid upon incarceration, and not being re-enrolled upon release, federal bureaucrats used few of the same tools to establish corrective action. This research focused on answering the question of why the variation in federal activity took place, and how the bargaining and negotiation that the federal principals did engage in impacted the implementation behavior of the state agents.