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Explaining Incremental and Non-Incremental Change: Medicaid Nursing Facility Reimbursement Policy, 1980-98

Published online by Cambridge University Press:  25 January 2021

Edward Alan Miller
Edward Alan Miller*
Affiliation:
Brown University
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Abstract

Political scientists have long distinguished between incremental and non-incremental policymaking. In this study, I illustrate the relevance of this distinction for comparative state policy research by modeling both incremental and non-incremental change in the same policy area: Medicaid nursing facility reimbursement. I use mixed-modeling techniques to model incremental year-to-year changes in per diem rates and payments per recipient and event history analysis and ordered logit to model non-incremental comprehensive innovation in this policy area. My results indicate that federal action prompted non-incremental change in capital reimbursement policy by limiting state discretion over incremental year-to-year spending decisions. Incremental policy appears to be affected by regional diffusion, but there is no evidence of this effect for non-incremental policy. Furthermore, when a state's fiscal health declined and the demand for government services grew, it was more likely to respond by making incremental adjustments than non-incremental system overhauls. Whereas governing capacity influenced both incremental and non-incremental change, state ideology influenced only incremental change. The rate at which states pursue incremental or non-incremental policy change depends on their relative vulnerability to federal policy changes, their receptivity to neighboring state influences, and their susceptibility to internal political, economic, and programmatic conditions.

Type
Research Article
Information
State Politics & Policy Quarterly , Volume 6 , Issue 2 , Summer 2006 , pp. 117 - 150
Copyright
Copyright © 2006 by the Board of Trustees of the University of Illinois

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