A few weeks ago, kactus of the excellent OurWord.org had a moving post on the often sadistic bureaucracies that welfare recipients are forced to navigate, sometimes on a daily basis: "I've decided that there must be a giddy sense of power that comes from being able to command poor people to stand in line, at the drop of a hat." Definitely worth reading in full, and I meant to link to it before, but forgot until coming across a related passage in David K. Shipler's The Working Poor:

The system is also plagued by welfare cheats. They are not people who receive welfare illicitly. The more damaging welfare cheats are the caseworkers and other officials who contrive to discourage or reject perfectly eligible families. These are the people who ask a working poor mother a few perfunctory questions at the reception desk, then illegally refuse to give her an application form, despite the law's provision that anyone of any means may apply. It is a clever tactic, say the lawyers, because they cannot intervene on behalf of a client who has applied.

The welfare cheats are the officials who design Kafkaesque labyrinths of paperwork that force a recipient of food stamps or Medicaid or welfare to keep elaborate files of documents and run time-consuming gauntlets of government offices while taking off from work. "I have clients with daily planners that are filled more than mine are," said Ellen Lawton, an attorney at [a nutrition] clinic.

If you want to stay on welfare, you have to provide pieces of paper proving that your children have been immunized and are attending school. If you want food stamps, you have to deliver pay stubs and tax returns. If you want a job, you need day care for your children, and if you can't afford it, you have to get a day-care voucher, and if you want a voucher, you have to prove that you're working. Getting a voucher involves multiple visits to multiple offices—during working hours, of course. Caught in this Catch-22, one mother put herself on waiting lists at infant day-care centers all over the city; meanwhile, her caseworker told her that she had to get a job before she could get day care paid for. Lawton quoted the caseworker: "So if you're on a waiting list, you need to find somebody who's gonna watch your kid."

Every demand for a document provides an opportunity for a cutoff, because no matter how meticulous a recipient may be, pieces of paper seem to get lost in the bureaucracy. "I just had a client like this last week," said Lawton. "She had received three different notices informing her in three different ways that she was being cut off. One of the issues was that she hadn't provided a certain piece of paper about her attendance at a [job-training] program. And she said she had provided the paper, but they lost it. Fine, we provided another piece of paper. She receives another notice that she's going to be cut off. Well, it's actually a different computer system that's generating notice, so she has to take time off from her program to go and get another piece of paper, bring it to the office…. Being poor is a full-time job, it really is."

It also promotes absurdity. One mother, desperate to get her asthmatic child out of a harmful apartment, obtained a letter from her pediatrician saying the house was making the child sick, which technically qualified her for emergency assistance, Zotter said. But the welfare department's receptionist turned her away three times, telling her that she already had housing and couldn't even apply for temporary shelter as long as she wasn't homeless. The mother seriously considered moving out and making herself homeless to qualify. As the lawyer was explaining forcefully to a caseworker how the welfare department had broken the law, "she gave up and she moved to Atlanta, because she said she just didn't feel like the system was helping her."

Just under half such cases can be solved with an attorney's phone call, Zotter estimated. One involved the mother of another patient who was denied an application for emergency food stamps. "If you're really low income you can get food stamps within twenty-four to forty-eight hours," Zotter said, "and then they do your verification and see if you really qualify. And they wouldn't let her apply for it. I just called them up and said, this is her income, she has no resources, she qualifies for this, you have to give it to her. And they did."

Blessed are the poor who have lawyers on their side.

A few scattered thoughts. First, especially with Medicaid, it's worth noting that many programs have perverse incentives on this front. When states are facing budget crunches, they certainly try to make things difficult and deter as many low-income families as possible from signing up—and these efforts are usually greatest during downturns, when more people than usual need coverage. Those eligible also tend to be, as Shipler notes, the easiest people to deter. This partly explains why some 10 million people who are eligible for Medicaid are not enrolled, although there are lots of other reasons. On the other hand, if everyone was enrolled in one universal health care system, there would be no need for extensive verification, and much of the bureaucracy could be slashed. (And Medicaid's administrative costs are already lower than the private sector.) Not to mention the fact that no one would be turned away.

Second, it's very likely that the conservative push to hand programs such as Medicaid entirely over to the states will give those states even greater incentive to save money by deterring people from signing up. (On a related note, see this paper by Michael Bailey for evidence that "devolution" creates a race to the bottom, as states try to reduce the level of services they provide in order to dissuade recipients from moving to their states.)

There's also no reason to think the increasing drive to privatize social services would improve the "Kafkaesque labyrinth." The situation kactus describes seems like a result of prevailing cultural attitudes towards welfare recipients, that, as she says, they should "wait in line without complaint, cuz that's what you get for daring to be poor and looking for a handout." Shipler's book gives a similar sense, that attitudes towards the poor play a huge role here. See this interview by Richard Moffitt for one theory on why this cultural shift came about. (Although he seems to overlook a point or two...)