“It Takes a While to Get Used to”: The Costs of Redeeming Public Benefits

Abstract

Scholars have examined how administrative burden creates barriers to accessing public benefits but have primarily focused on the challenges of claiming benefits. Less is known about the difficulties beneficiaries face when using public benefits, especially voucher-based public assistance programs. I argue that the costs of learning how to redeem benefits can discourage program use and undermine policy goals. To enrich the administrative burden framework, this study draws from a qualitative analysis of 43 participants in the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) to develop a new subset of learning costs—redemption costs. I argue that two conditions: limited portability and reliance on third-party agents create redemption costs for beneficiaries. I apply these two conditions to two other voucher-based programs: the Housing Choice Voucher Program and the Child Care Subsidy. Examining redemption costs can help clarify when and where beneficiaries experience burdens, reasons behind discontinuity in program participation, and why public programs fail to meet objectives.

Introduction

In recent years, public administration scholars have revisited the study of administrative burden—or citizens’ onerous experiences with policy implementation (Burden et al. 2012). Scholars underscore how administrative burden undermines effective policy implementation in ways that increase inequality and shape citizens’ views of bureaucrats and the state (Barnes and Henly 2018; Moynihan and Soss 2014; Nisar 2018). On the whole, this nascent but growing body of research surmises that administrative burden raises formidable barriers to accessing public benefits that strain citizen-state interactions.

Recent efforts to conceptualize administrative burden identify the challenges of learning about benefit programs and eligibility guidelines (learning costs), the stigma of accessing benefits (psychological costs), and demanding application processes that require extensive documentation and paperwork (compliance costs) (Herd and Moynihan 2019). However, citizens incur most of these costs during bureaucratic encounters when they attempt to claim public benefits or services. We know less about beneficiaries’ “onerous experiences” when using or redeeming public benefits. For example, programs like Social Security have a seamless redemption processes. Potentially eligible participants apply for benefits online, over the phone, or in-person and, once deemed eligible, receive cash to spend on household needs.¹ In contrast, other programs create complex and costly redemption processes by restricting beneficiaries to certain services and goods or relying on third-party actors to redeem benefits.

The challenges of redeeming benefits are especially relevant as new public management consumer choice models and voucher-based systems have emerged in public service delivery. Vouchers are emblematic of New Public Management approaches to increasing bureaucratic efficiency by leveraging private markets (Kettl 2005). Rather than directly funding agencies to provide services and benefits, program beneficiaries are given vouchers to purchase benefits and can choose from a range of third-party actors or service providers. Despite the prevalence of consumer choice models, administrative burden studies have not yet examined how program beneficiaries navigate these systems to redeem benefits. What costs do citizens encounter when attempting to use public benefits? Under what conditions do these costs emerge? I argue the redemption process is a type of bureaucratic encounter that occurs outside of conventional bureaucracies (Kahn, Katz, and Gutek 1976). These potentially costly encounters can discourage continued program use or undermine policy goals.

While some studies reveal the psychological cost or stigma of using benefits, I introduce the concept of redemption cost—the challenges citizens experience when redeeming public benefits—as a subset of learning costs that can deter continued program use. I argue that—along with learning about eligibility guidelines and how to access benefits—beneficiaries must also learn how to use or redeem benefits. These costs emerge primarily in voucher-based programs in which policy implementation includes third-party actors. I argue that redemption costs can vary by the extent to which benefits are portable and that redemption depends on third-party agents. Under these conditions, beneficiaries must work to correctly identify the nature of the public benefit (i.e., what service or product is eligible for redemption) and identify third parties that both accept benefits and comply with policy guidelines for redemption.

This study enriches the administrative burden framework by developing concepts to help explain aspects of policy implementation that occur outside of bureaucracies. I do so by examining the challenges beneficiaries encounter when using public benefits. The administrative burden framework should incorporate the multiple actors involved in policy implementation as consumer choice models and vouchers become more commonplace across policy contexts. Doing so can clarify the costs that undermine the use of public benefits and services, help identify points of policy intervention that can boost program uptake, encourage continuity in program use, and ultimately support policy objectives.

Using an in-depth case of studies of three means-tested programs—the Special Supplemental Nutrition Assistance Program for Women, Infant, and Children (WIC), the Child Care Subsidy Program, and the Section 8 Housing Choice Voucher Program (HCV)—I demonstrate these costs and their importance in redeeming benefits. All three programs play a crucial role in the US social safety-net, yet they are often understudied in administrative burden research. WIC is the third-largest nutrition assistance program in the United States and serves over half of all infants (Kline et al. 2020). The HCV program provides subsidized housing to 2.2 million families (Center on Budget and Policy Priorities 2019), while the Child Care Subsidy serves 1.3 million children each month (Dwyer, Tran, and Minton 2019). Further, these programs reflect a consumer choice model and exhibit patterns of declining or discontinuous program uptake over time. For example, despite its wide reach and importance in supporting child and maternal health, research shows national declines in WIC participation and coverage rates—the percentage of eligible individuals enrolled in the program (Gray et al. 2019). The Child Care Subsidy shows similar dips in enrollment and coverage rates. Program enrollment has declined since 2004 and, in 2016, only 8% of eligible children received subsidies based on federal income limits and 12% of eligible children received subsidies based on state income guidelines (Ullrich et al. 2019). Most notably, scholars find patterns of discontinuity in subsidy receipt among low-income families (Davis et al. 2016; Henly et al. 2017). While studies have pointed to waitlists and limited access to the HCV program, research has also revealed the challenges in navigating landlords and the rental market—challenges that can diminish or influence voucher use in ways that undermine policy goals (Deluca and Rosenblatt 2010; Galvez 2010; Rosen 2014). I argue that declining, discontinuous, or subverted uptake over time across these and other voucher-based programs can be attributed—in part—to the costs of redeeming benefits.

Through 43 qualitative interviews of WIC participants, I identify two conditions under which redemption costs emerge—portability, how vouchers restrict beneficiaries to specific services or goods, and variation in third-party agents. I then apply these insights to two additional voucher programs—the Child Care Subsidy Program, and the Section 8 Housing Voucher Choice Program—to demonstrate how these conditions can produce redemption costs. I conclude by discussing theoretical, empirical, and policy implications.

Administrative Burden and Bureaucratic Encounters

From the vantage point of citizens seeking to access benefits, scholars have conceptualized administrative burden as encompassing psychological costs, compliance costs, and learning costs (Moynihan, Herd, and Harvey 2015). Psychological costs consist of the stress and stigma of applying for or participating in programs, while compliance costs refer to the “burdens of following administrative rules and regulations,” which can range from the costs of completing forms to providing documentation to bureaucrats (Moynihan, Herd, and Harvey 2015, 45). Finally, learning costs include the process of collecting information about public services and assessing how they are relevant to the individual. As Moynihan, Herd, and Harvey (2015) explain, “citizens must learn about the program, whether they are eligible, the nature of benefits, and how to access services” (p. 46). When defining learning costs, scholars focus on lower levels of uptake because eligible citizens lack information about programs. For example, scholars attribute low uptake rates for the Earned Income Tax Credit, Supplemental Nutrition Assistance Program (SNAP), and the Child Care Subsidy to the learning costs of these programs (Bartlett, Burstein and Hamilton 2004; Bhargava and Manoli 2011; Shlay et al. 2004). Simply stated, individuals who are eligible are either unaware of the programs or incorrectly believe they were not eligible for benefits.

While integral to identifying barriers to accessing means-tested assistance, this nascent line of research focuses primarily on how potential program participants are aware of benefits and understand eligibility guidelines. I argue that there is an additional cost to citizens’ “onerous experience of policy implementation,” namely the challenges beneficiaries experience in learning how to use or redeem benefits.

To understand the costs of redeeming benefits, research should examine program-related interactions that may occur outside of bureaucracies. Yet, most of the costs elucidated by the administrative burden framework occur in encounters between citizens and bureaucrats within agencies. For example, compliance costs occur when citizens must compile documents and submit applications to agencies to claim benefits or when citizens must respond to the discretionary demands of bureaucrats for information (Barnes and Henly 2018; Herd and Moynihan 2019). Although some studies point to psychological costs of using public assistance in programs like SNAP and WIC (Chauvenet et al. 2019), most studies of psychological costs emphasize the demeaning interactions citizens have with bureaucrats and the “loss of autonomy” citizens experience when applying for and maintaining benefits (Barnes and Henly 2018; Nisar 2018; Soss 1999; Watkins-Hayes 2011). Collectively, these costs can discourage program uptake (Moynihan, Herd, and Harvey 2015).

Traditionally, the research examines program-related interactions that occur in bureaucracies. Kahn and colleagues’ (1976) classic typology of bureaucratic encounters defines an encounter as “a meaningful social transaction,” and a “discrete episode” between two individuals (p. 180). Bureaucratic encounters can reflect “organizational behavior” or transactions that occur between individuals within organizations and—the most commonly studied in administration burden research—“service seeking,” encounters where individuals outside of an organization engage a person inside the organization to meet a need (p. 181). Bureaucratic encounters can also consist of bureaucracies “reaching out”, wherein a member of an organization initiates transactions with a person outside of the organization (p. 182). These encounters include transactions with law enforcement, military conscription, and taxation. Finally, bureaucratic encounters can occur “beyond the organization” in which the initiator and target of the transaction are outside of the formal organization. Kahn and colleagues classify friendships, marriages, and interactions between neighbors as encounters that are beyond the organization.

To extend the focus of administrative burden research beyond service seeking encounters with bureaucracies, Heinrich (2016) revisits Kahn and colleagues’ (1976) classic typology. Heinrich builds on this work by casting the efforts of individuals and nonprofit organizations to provide information about welfare-claiming process as a type of bureaucratic encounter. However, the advent the new public management in social policy implementation introduces additional extra-organizational bureaucratic encounters that can include recipients’ interactions with third-party actors when redeeming benefits. The costs of these encounters warrant study and may contribute to population declines in program participation, discontinuity in program participation over time, or eligible participants leaving programs altogether. Further, these costs can lead to redemption patterns that undermine policy aims.

New Public Management and Consumer Choice

Since the 1980s, new public management has emerged as a global movement towards reducing the role of government and increasing the quality and efficiency of public service provision (Green-Pedersen 2002; Kettl 2005). Accordingly, countries have decentralized and privatized service delivery across health, education, and welfare services and introduced forms of accountability designed to enhance performance (Kettl 2005).

New public management approaches have also introduced market logics into service delivery (Jantz et al. 2018; Le Grand 1991; Kettl 2005; Morgan and Campbell 2011). In theory, the market should produce higher quality services and more efficient policy outcomes through market competition. In the case of grants and contracts, competitive processes should lead third parties to reduce the costs of service delivery (Le grand 1991; Morgan and Campbell 2011). Consumer choice models should also harness market competition to encourage efficiency and quality in public service provision. Instead of directly funding agencies, the government provides vouchers to consumers who select third-party agents or service providers. Consumers’ agency to choose providers should incentivize third-party agents to offer cheaper services that reflect consumer preferences (Le Grand 1991).

Consumer choice models have emerged across the world and a range of policy contexts. In Great Britain, consumer choice models in health services stem from the 1990s reforms, which introduced quasi-markets and competition among providers for National Health Service funding (Ferlie et al. 1996; Fotaki 2007; Le Grand 1991). Since 2008, consumers have had the autonomy to purchase health care from any provider (Lewis, Smith, and Harrison 2009). In Israel, a choice-based model is used for elderly care (Cohen, Benish, and Shamriz-Ilouz 2016). The Israeli National Insurance Institute contracts home care provision to for-profit and nonprofit organizations. Once deemed eligible for home care services, recipients can choose among a range of home care providers (Cohen, Benish, and Shamriz-Ilouz 2016). Health care in Sweden and employment services in Germany and Australia follow a similar consumer choice model (van Berkel 2014; Fotaki 2007; Jantz et al. 2018). In the US context, voucher-based systems are used in employment services, child care, nutrition assistance, housing, health care, and—to a lesser degree—education (Barnes 2020; Chauvenet et al. 2019; Morgan and Campbell 2011).

These consumer choice models introduce a set of bureaucratic encounters that occur outside of bureaucracies—between individuals who are seeking to use services and third-party agents that are tasked with providing public services and goods. In these cases, eligibility determination occurs within conventional service-seeking encounters (Kahn, Katz, and Gutek 1976), but to redeem benefits beneficiaries must find a third-party that will provide the service or good.

For example, in the case of the Supplemental Nutrition Assistance Program (SNAP), formerly known as Food Stamps, eligibility determination occurs during “service seeking” bureaucratic encounters in which individuals engage bureaucrats by submitting an application and documents that help workers determine eligibility and the amount of benefits. Once applicants are deemed eligible, recipients redeem SNAP benefits in a retail setting. A similar process occurs in Medicaid—a public health program targeting low-income families. Market-based reforms designed to enhance consumer choice have introduced multiple steps to program uptake that include service-seeking bureaucratic encounters and transactions between third-party agents in the form of managed-care organizations or health care providers (Maskovsky 2000). Eligibility determination occurs in local social service agencies, but beneficiaries must choose selected benefit plans from managed-care organizations and choose health care providers that accept Medicaid reimbursements (Coughlin et al. 2008).

Given the global prevalence of consumer choice models, I introduce the concept of “redemption costs” to capture the hurdles of redeeming benefits that deter individuals from using these kinds of programs. While redemption costs may not affect initial access to programs, they can help explain why some public assistance programs are underutilized or why beneficiaries leave programs altogether. I argue that redemption costs emerge when benefits have limited portability and redemption depends on third-party agents. Table 1 displays these conditions below.

Portability refers to how vouchers restrict beneficiaries to specific services or goods. In the case of nutrition assistance, portability is affected if programs place restrictions on the brands and size of eligible food. Or, in the case of child care assistance, assistance programs may limit beneficiaries to licensed child care providers that offer care during specific hours. Beneficiaries must learn whether the voucher covers certain services or goods. While beneficiaries may learn about eligible services in the office, they may experience a learning curve when trying to redeem vouchers in practice. The second condition, reliance on third-party agents, refers to broader market conditions—in particular, variation in the quality of vendors. Ideally, market models in social policy enhance beneficiaries’ choices and allow them to choose vendors or service providers that suit their preferences. In practice, evidence suggests that markets can create more confusion for program participants (Morgan and Campbell 2011). Program participants have little information when selecting vendors and seldom choose the best service provider. Varied third-party agents also complicate how beneficiaries redeem benefits. They must learn whether an agent accepts vouchers, learn how agents respond to and treat beneficiaries, and learn which agents are good actors who comply with the implementation guidelines set forth by programs.

Redemption costs can undermine policy goals by prompting early exits from programs, generating instability in program use, or subverting policy aims altogether. For example, difficulties learning which services and goods are eligible may deter beneficiaries from fully redeeming benefits or reapplying for programs. Or, third-party agents may engage in practices that steer beneficiaries into poor quality goods and services that undermine beneficiaries’ choice in the market and ultimately diminish the efficacy of policies. This analysis develops and refines the nature of these costs and makes the case for a broader application to other policy cases. In doing so, I help identify where and when administrative burden occurs—insights that can inform policy implementation and practice.

Current Study

While empirical studies across disciplines point to some specific challenges of using public assistance programs, there have not been efforts to develop theory that identifies broader conditions that make benefit redemption difficult. To address this gap, I use evidence from 43 qualitative interviews to examine the challenges of using WIC benefits. I demonstrate how limited portability and variation among third-party agents increase the costs of redeeming benefits. To make the case for a broader application of redemption costs, I apply these conditions to two other voucher-based programs, the Child Care Development Block Grant or the Child Care Subsidy Program and the Housing Choice Voucher Program (formerly known as Section 8). I briefly review policy briefs, legislation, and the central findings from studies of the Child Care Subsidy Program and Housing Choice Voucher Program that highlight the challenges of using these programs.

Policy Case: WIC

WIC is the third-largest food assistance program in the United States, serving 7.8 million families in 2018 (Kline et al. 2020). The program serves nearly half of all infants born in the United States and offers nutritional assistance to support low-income women with children under the age of five who are at risk for malnutrition (Kline et al. 2020). Women are eligible if they are pregnant, non-breastfeeding up to 6 months postpartum, or breastfeeding up to a year postpartum. Children are eligible from infancy to their fifth birthday. Temporary Assistance to Needy Families (TANF), Medicaid, and SNAP recipients are automatically eligible to receive WIC. Applicants whose family income is below 185% of the federal poverty line, but are not eligible for SNAP, TANF, or Medicaid, are also eligible for WIC (Gray et al. 2019). In addition to meeting the income guidelines, applicants must also exhibit nutritional risks, such as anemia, low maternal weight gain, or inadequate growth in children. WIC participants remain eligible for a year after their initial certification, but they must attend quarterly appointments, which includes a 6-month recertification appointment where nutritional risk is reassessed and three other appointments that focus on nutrition education and distributing benefits.

WIC nutrition benefits include nutrition education in which nutritionists assess nutrition risks, make dietary recommendations, and create a food package that is tailored to meet families’ needs. Food packages consist of a list of foods specified by brand and size that program participants can purchase at a WIC-participating retailer (Tiehen and Frazão 2016). Prior to the introduction of electronic WIC benefits, foods were listed on a paper voucher that participants redeemed in a single grocery store visit. WIC participants were issued multiple vouchers at each WIC appointment to cover a 3-month span. Electronic WIC or eWIC now gives participants flexibility on when to redeem benefits. WIC employees load benefits on an electronic bank transfer (EBT) card and participants can purchase WIC-approved foods in their food package across multiple grocery visits (Kline et al. 2020). In North Carolina, participants’ eWIC cards come with an app that allows program participants to scan and identify WIC-approved foods and keep track of the food items they have redeemed in their food package (Kline et al. 2020).

Since 2011, WIC enrollment and coverage rates—the percentage of the eligible population that participates in the program—have declined.² Further, cases continue to fall despite efforts to streamline eligibility processes and WIC appointments. Thus, some of the costs of claiming and maintaining WIC benefits may occur outside of application and recertification appointments, when participants redeem WIC benefits in retail settings.

Methods

The reported findings are from a qualitative study of WIC program participant experiences. The study was approved by Duke University’s Institutional Review Board (C0613). Data were collected from 43 in-depth interviews with WIC participants that were conducted from October 2015 through December 2017.³ I recruited participants through fliers posted in WIC offices and in person by asking participants to take part in the study at the end of their WIC appointments. After obtaining informed consent, I conducted interviews in participants’ homes or at locations they preferred either directly following their WIC appointment or within a week of recruitment into the study. Study participants received a $30 cash incentive for participating in the study. Interviews ranged from 30 to 60 min. I assigned pseudonyms for the names of WIC participants and retailers to protect their identities.

Sample

Participants ranged from new applicants to those who had several years of experience with WIC offices. Table 2 displays WIC participant characteristics.

The sample of WIC participants generally reflects the national demographic makeup of WIC participants. However, the sample includes more African American participants. National averages suggest that most WIC participants are non-Hispanic White (58.7%), and the most recent estimates for North Carolina report similar rates of program use among whites (58%). In the sample, most participants interviewed were African American (53.5%). In addition, I captured WIC participants who had long-term program experiences and multiple children. Over half (56%) of the respondents interviewed resided in a rural community. Forty-four percent of participants interviewed lived in a suburban community. Less than half of the sample reported employment at the time of the interview and most (88.4%) reported participation in other means-tested programs such as SNAP, Work First, and Medicaid.

Interview Schedule

Semi-structured participant interviews covered a range of topics: how they learned of the WIC program, what their office experiences with staff were like, and how they used WIC benefits in stores. I asked participants to describe how they used WIC benefits to purchase food in grocery stores and whether they had trouble identifying WIC-approved foods. Respondents were also asked to describe the quality of their interactions with cashiers and store personnel. Sample questions from the interview guide can be found in Appendix A. Field notes and analysis memos were written at the completion of each interview to summarize key themes from each interview and the respondent’s level of engagement. I obtained consent to audio record and transcribe interviews.

Analysis

All transcripts, memos, and field notes were entered into a qualitative software package, NVIVO-11. I followed an interpretive approach to analysis, which emphasizes understanding how participants and staff perceive their interactions (Haverland and Yanow 2012; Schwartz-Shea and Yanow 2013). My analytic approach combined deductive and inductive analysis. I conducted a deductive analysis of interview transcripts informed by the administrative burden literature and inductive analysis, which involved a close read of the interview data to allow new concepts to emerge (Haverland and Yanow 2012).

I started the analysis process with a line-by-line reading of transcripts and initially organized the data by a priori codes drawn from study objectives and previous research. For example, I initially organized interview data by broader categories such as shopping experiences and coded these responses by positive or negative valence. I also coded interview responses by the costs of accessing assistance programs, using terms described in the administrative burden literature (e.g., compliance costs, learning costs, psychological costs). After organizing the data in these broader categories, I then allowed descriptive and analytic categories to emerge from the data through a coding process and refined them through an iterative comparison of WIC participants’ in-depth descriptions of shopping experiences (Glaser and Strauss 1967; Miles and Huberman 1994; Ryan and Bernard 2000). For example, I coded instances in which respondents reported their preferred grocery stores, the valence of their shopping experiences, and any difficulties learning how to use benefits or identifying WIC-eligible foods. I also coded any rationales they used to explain the factors that contributed to the quality of their shopping experiences. I constructed unit-by-code matrices to help identify patterns across participants and across different types of evaluations, which I then used to evaluate further in the context of re-reading interview transcripts (Ryan and Bernard 2000). As a check on the coding process, a research assistant was trained on the interpretive coding method—and coded every third interview with 98% agreement and .91 Kappa score.

Findings

Redemption Costs: Limited Portability

The WIC participants in this study overwhelming reported challenges with redeeming WIC benefits in stores and attribute difficulties to the limited portability of WIC vouchers. WIC nutritionists assess a participant’s nutrition needs and offer tailored food packages that reduce nutrition risks. Food packages are also based on distinct categories of eligibility—whether participants are pregnant, breastfeeding, have an infant, or have a child over the age of one. Participants are restricted to the items listed within their food packages. Given these restrictions, most WIC participants interviewed remarked that they learned how to use WIC benefits to purchase food over time. As Kelly notes, “It takes a while to get used to it.” She further described how she “learned” the WIC program.

When I first started out, yeah, because I didn’t know what was on WIC. Some stores don’t have it labeled, so you just have to kind of like figure out what…. Over the years I’ve learned WIC; now I know it like the back of my hand.

Most respondents (n = 28, 65%) reported challenges in identifying WIC-approved foods. WIC participants still experienced difficulties in learning which foods were WIC-approved even after the introduction of the EBT cards for WIC benefits. For example, Sarah explained that to use WIC you must identify WIC-eligible products and brands. She observed that WIC shoppers can make mistakes, even when stores label WIC-approved foods.

The only thing is making sure you get the right type of food. The right type of eggs because they have certain eggs. Most of the time in (Grocery Store A) they have a WIC ticket under the eggs. It could be like Grade A eggs or (Grocery Store B) brand eggs….You just have to know what foods to get. Like last week, I went to get some grapes. I picked up one bag of grapes. It was $8 and wasn’t on the WIC ticket. I picked up another type of grapes. $6 and some change, but it was. Like some red ones and the green ones. The red ones are not on there, but the green ones are. You have to know which types of fruits and which things the WIC will allow you to get.

Christie commented that she had difficulty using her WIC benefits “at first” because she had “no clue what to get.” Her WIC benefits limited her purchases to certain brands and items. She explained:

At first, like when I first got it, I was like, okay, I have no clue what to get. I don’t know. Because you have to get certain things. You can’t just get anything that you want. You have to get certain brands and, like with the milk, you have to get a [store] brand. You can’t get whole milk; you have to get 2 percent. So you just have to watch what you get. It was difficult at first with the cereal, because I didn’t know how to add the ounces up, but now I know. So now it’s much easier to shop for WIC, but at first, it wasn’t.

Melissa’s reflection on her SNAP and WIC shopping experiences further illustrates the challenges of learning which foods she can purchase with her WIC benefits. She explained that “you got to be doing the math” when shopping with WIC benefits to purchase formula, produce, and cereal. The WIC program not only specifies the kind of foods eligible for purchase, but also the amount of food you can purchase with benefits. Melissa must “do the math” to ensure she has purchased the right size box of cereal and correct ounces of baby food and formula. She explained that “doing the math” is a source of frustration for her and, as she suspects, other WIC participants:

Some of the people have trouble if you pick a different grocery store, you can’t find the brand, you get the wrong brand, you get the wrong size, you’ve got to be doing math….I mean, it’s confusing enough picking your cereal… now I can get this type of Cheerios—not just this type, but now I’ve got to add up boxes to add to this exact amount of Cheerios, but your kid wants this Cheerios. Well, you can’t get that one. So I think people get frustrated.

In contrast, Melissa emphasized the portability of SNAP when comparing how she purchases food with WIC and SNAP benefits. She noted that SNAP works “like cash,” meaning “you don’t have to do anything, and you get hundreds of dollars and you can spend it on whatever you want as opposed to the huge process.” Melissa came to the conclusion that the challenges of using WIC, namely, selecting WIC-approved foods, was “too much trouble” and preferred using her SNAP benefits. “That’s just too much trouble to get some milk and bread; I might as well just pick it off the shelf and use my food stamps. It’s way less trouble….”

Third Parties and Redemption Costs

Third-party agents involved in the redemption process also increased redemption costs for the WIC participants interviewed. In the case of WIC, third-party agents are retailers that are tasked with stocking and selling WIC-approved food items. While suburban WIC participants had a greater selection of retailers relative to rural WIC participants—15 stores in comparison to five—suburban and rural respondents noted that retailers varied in the degree to which they stocked and identified WIC-approved foods. In addition, stores varied in their selection of WIC-approved foods and the extent to which managers trained store personnel and cashiers to process WIC benefits. Variation in the quality of retailers, coupled with food restrictions, increased the costs of redeeming WIC benefits.

Revisiting Melissa’s perspective demonstrates this point. While she elaborated on the burden of navigating WIC food restrictions throughout the shopping experience, these restrictions became even more onerous when stores carried different WIC-approved food items, did not update WIC-approved foods, or mislabeled these items. Melissa explained that when she returned to the WIC program with the birth of her newborn, she learned that her preferred grocery store did not carry WIC-approved baby food and seldom kept WIC-approved bread in stock.

I remember I went to [Grocery Store C], and since it had been a while since I had a baby with baby food, I looked, and what happened was [Grocery Store C] only carries a certain type that wasn’t the WIC one…. So it’s just really confusing what they have in the store is not always—especially with baby food, not always what it says…. And [Grocery Store C] is always out of the WIC bread.

Because her neighborhood grocery store does not carry all of the WIC-approved items, Melissa visits another grocery store to fully redeem her benefits. She remarked that in some instances, she forgoes redeeming all of her WIC benefits because of the burden of patronizing multiple grocery stores.

Much like Melissa, most WIC participants (n = 34, 79%) noted variation in the quality of retailers and learned over time through trial and error, which stores were WIC friendly. To reduce onerous shopping experiences, respondents found one store to redeem most or all of their WIC benefits. For example, Mary avoids the grocery stores in her community and prefers to redeem her benefits at a grocery store in a neighboring town.

I go to [Grocery store C] because [Grocery store A] sucks when it comes to WIC. They act like brats. And then [Grocery store C] here, I don’t understand how it says WIC under it, and then they’re like, no, you didn’t get the right thing. And I’m like, I’ve been getting the same bread for two years now. I’m telling you, this is the right bread. And they’re like, no, it’s not WIC approved. I’m like, okay, well, you go get it. I tell them, I’m like, you go get it then, because obviously, I get the wrong one every time. So I don’t even come to [my town] and deal with them.

When asked to elaborate on how she decides where to redeem her WIC benefits, Mary explained that she redeems her WIC benefits at stores that correctly label WIC-approved items. She described mislabeled WIC-approved foods as the greatest challenge to redeeming benefits.

Who’s going to be labeled correctly. Because that is the biggest problem. It was like three different breads in their [Grocery store C] or something that will say WIC. Or it’ll say WIC and it’s between two breads and you’re like, well I know it’s whole wheat, so you just grab the whole wheat one, and they’re like it’s not right. Well, maybe you all should label you all’s stuff correctly. Ever think about that?

In addition to incorrectly labeling WIC-approved foods, many respondents commented on how the selection of WIC approved food varied across retailers. They learned, over time, which stores had the best selection of WIC approved foods. For example, Yvette noted that the quality of WIC-approved foods depends on the “location” of the store and would prefer a uniform selection of WIC-approved foods across all stores:

I feel like the location makes a difference. You could go to a (Grocery Store A) in (CITY NAME). You could go get a Jif peanut butter off of WIC. Then you come to (CITY NAME) and you’re getting the store brand. I feel like they shouldn’t give stores the right to choose. I feel like they should be across-the-board equal.

Cynthia similarly shared that she uses her WIC benefits at particular stores—those that have a wide selection of WIC-approved foods and keep these products in stock.

Depending on what store seems to keep those products that I’m looking for because sometimes you may go to the store and they don’t have any bread, they don’t have the wheat bread and they don’t have the one percent milk that they provide…. I always go to [Grocery store A] so I know they have everything and I know where it is. I think one time I tried [Grocery store C] but I couldn’t particularly find everything, so I just prefer to go to [Grocery store A] because I know they always have it.

She added that she avoids smaller stores and stores located in communities with a high concentration of young mothers that may also use the WIC program:

I basically know from shopping as a mother that certain stores don’t always keep certain products. And it could just be based on the neighborhood that they’re out because they have so many mothers that live in that area or something. And if it’s a smaller store, they’re not going to have it. They’re going to run out faster anyway.

Even with Cynthia’s savvy and experience with the WIC program, redeeming benefits remains a challenge. When asked if it was difficult to find WIC-approved products in the store, she described the process as a “headache,” especially if “you switch up stores.” She explained how this happened to her in a recent shopping experience:

Like, for example, if I bought some beans and I was used to getting a certain type of beans here, I might can’t get it at the other store, and I never understand that. So yeah, I’ve tried that, like I’m tired of pinto beans, for example. You can always get pinto beans at any store, but you cannot get lima beans here, you know, some people allow you to get lima beans and the other store may not. So yeah, it can be confusing. But I mean when it comes to certain beans, for example, they say beans in a can and you might bring up the wrong type depending on what store you’re in. So everybody is different.

Application: Housing Voucher Choice Program and Child Care

The comparative case study of the Housing Choice Voucher Program and the Child Care Subsidy aims to extend the application of redemption costs to different policy contexts and illustrate the two conditions that generate redemption costs: limited portability and variation in third-party agents. Much like WIC participants, the Housing Choice Voucher policy narrowly prescribes the kinds of benefits and services that are eligible for redemption. In the case of the HCV program, policy places time constraints on the search for housing and renters face geographical constraints. The Child Care Subsidy similarly prescribes the kinds of eligible care. Subsidy users must find care that fits their work or school hours, which poses a challenge for low-income workers who typically work precarious and nonstandard work hours. In both policy contexts, beneficiaries must navigate a market of third-party agents that can vary in the selection of goods and services offered, how they treat beneficiaries, and how they comply with redemption guidelines. In what follows, I demonstrate how these conditions can raise the cost of redeeming vouchers.

Housing Voucher Choice Program

Public housing legislation in the United States initially subsidized local housing authorities for the construction of housing units for low-income families with the objective of clearing “slums” or addressing “unsafe” or “unsanitary” housing conditions (United States Housing Authority 1938). However, mounting evidence demonstrating concentrated poverty in public housing motivated a shift from constructed units to a voucher-based program that would empower tenants to choose housing in the private market (Owens 2015). A 1974 amendment to Section 8 of the federal Housing and Community Development Act offered subsidies for tenants to find a housing unit in the private market and pay rent subsidized by the government (Owens 2017). Eligibility is determined by household size and income. While income eligibility varies by local contexts, a family’s gross income cannot exceed 50% of the median income of the county or metropolitan area where the family chooses to live. The voucher requires renters to pay 30% of their gross income on rent and utilities (United States Department of Housing and Urban Development 2001). Once approved for a voucher, renters have a specified time period (once 60, now 90 days) to find a participating landlord and a housing unit that has undergone an inspection to ensure the housing meets quality standards. As of 2018, 2.2 million households received housing vouchers (Center on Budget and Policy Priorities 2019).

In theory, the voucher program would expand renters’ choices of housing in the private market. However, research demonstrates that redeeming vouchers in the private rental market has proved challenging for voucher holders (Deluca et al. 2013; Graves 2016; Rosenblatt and Cossyleon 2018). Studies show that renters’ housing choices seldom reflect their preferences and demonstrate how the HCV program sorts renters into high-poverty communities (Deluca et al. 2013; Rosen 2014).

Research on the HCV program points to the conditions that create redemption costs: limited portability and third-party agents. While housing scholars use the term portability to refer to the voucher holders’ capacity to move out of housing they are unsatisfied with, I broaden the application of this term to include time restrictions that limit the housing search and, as result, the kinds of housing available to voucher holders. Renters must find approved housing within a particular time period and are often constrained by geographical locations (Briggs and Turner 2006; Deluca et al. 2013; Rosenblatt and Cossyleon 2018). For example, Deluca and colleagues (2013) find that voucher holders feel pressured by time limits in their search for housing. These pressures are substantiated by the reality that some voucher holders lose their voucher because they have not found housing in time (Deluca et al. 2013), contributing, in part, to low program uptake (Galvez 2010).

Because of portability constraints, voucher recipients must learn about what housing is available and eligible for the Section 8 program. And the cost of obtaining this information can be high, as studies show that many voucher holders have misconceptions about which neighborhoods could accept their vouchers (Rosen 2014; Rosenblatt and Cossyleon 2018). Further, rental properties that participate in the HCV program are often located in less desirable neighborhoods (Garboden et al. 2018; Owens 2017; Rosenblatt and Cossyleon 2018). Rather than expanding choice for voucher holders, renters face a restricted pool of eligible options—housing that they can find within a limited time period and housing that is often located in high-poverty neighborhoods. Taken together, these restrictions raise the costs of redeeming housing benefits.

Along with limited portability, renters’ ability to redeem housing vouchers depends, in large part, on third-party agents: landlords. As Garboden and colleagues (2018) note, “If landlords in opportunity areas are unwilling to accept subsidized tenants, the potential for the HCV program to improve neighborhood quality is severely limited” (p. 3). Voucher holders must learn which landlords accept vouchers and navigate landlord practices in selecting voucher holders for rental units.

Evidence suggests that many landlords are reluctant to participate in the voucher program because of burdensome HUD requirements (Deluca et al. 2013; Garboden et al. 2018). To participate in the Section 8 programs, landlords must undergo housing inspections to ensure compliance with HUD quality standards and must submit additional paperwork to local housing authorities. These requirements can discourage landlord participation, especially in housing markets that can attract tenants who are willing to pay market rates for rent.

In addition to barriers to landlord participation, many cities have not adopted source-of-income discrimination legislation (SOI), which makes it illegal for landlords to discriminate against voucher holders on the basis of using the voucher (Tighe, Hatch, and Mead 2017). As a result, landlords can refuse to rent to voucher holders. Some modest evidence suggests that SOI legislation can increase program uptake and reduce discrimination and the sorting of voucher holders into high-poverty neighborhoods (Freeman and Li 2014; Galvez 2010). However, some studies suggest that source-of-income discrimination persists even when SOI law exists (Rosenblatt and Cossyleon 2018).

Along with navigating limited housing options, evidence suggests that landlords who are willing to redeem housing vouchers adopt racially discriminatory practices that reinforce patterns of concentrated neighborhood poverty (Briggs 2005; Ross and Turner 2005; Tighe, Hatch, and Mead 2017). Landlords act as powerful gatekeepers to subsidized housing. They can decide whether and how to obtain credit checks and whether to take application fees (Freeman and Li 2014; Rosenblatt and Cossyleon 2018). This discretion can determine whether subsidy voucher holders can redeem benefits, where they redeem housing vouchers, and what the quality of housing options might be. In some instances, landlords leverage this discretion to “sort and trap” section 8 renters into subpar housing in low-income neighborhoods that are financially beneficial to landlords (Rosen 2014, 31). Landlords leverage voucher rules to recruit lower-end tenants with little means to leave and match them with hard-to-rent units. Thus, renters lack agency in the voucher program and are subject to a limited housing supply and landlords’ discretion in whether and how they can redeem their benefits.

Taken together, limited portability and third-party agents create redemption costs that lower program uptake (Deluca and Rosenblatt 2010; Galvez 2010) and sort renters into high-poverty communities (Deluca et al. 2013; Rosenblatt and Cossyleon 2018). These redemption costs undermine one of the policy’s core objectives of expanding housing choice and undercut HUD’s more recent aims of promoting mobility to communities with lower crime rates, better employment opportunities, and better schools (Goetz 2003; Walter, Li, and Atherwood 2015; Walter and Wang 2016).

The Child Care Subsidy

The federal Child Care Development Block Grant (CCDBG) subsidizes the costs of child care for low-income working parents to promote employment and child development. In 2018, the subsidy helped provide child care to more than 1.3 million children each month (Dwyer, Tran, and Minton 2019). Welfare reform consolidated piecemeal federal support for child care for Aid to Families with Dependent Children (AFDC) recipients, broadened the scope to low-income families that did not receive cash assistance, and established a maximum income eligibility guideline of 85% of the state median income (Cohen and Duderstadt 2004; Lynch 2014).

The program is run by the Administration for Children and Families, the division of the federal Department of Health and Human Services that awards grants to states to provide child care. States can match these funds with TANF dollars and develop additional eligibility guidelines regarding family size, employment status, and income levels that comply with broader federal guidelines. States can also administer the program through departments of social services or nonprofit organizations. Federal guidelines require states to maximize parent choice of child care providers by either contracting out the delivery of child care services to child care providers or providing vouchers to purchase child care.

Congress reauthorized the Child Care Development Block Grant Act in 2014 to increase access to high-quality child care.⁴ The legislation expanded eligibility periods to 12 months, emphasized improved health and safety guidelines for child care providers, and promoted quality improvements and better consumer education. In most states, individuals qualify for the program if they are employed or enrolled in a school or training program. Subsidy recipients are approved for a voucher, select a child care provider, and are typically responsible for a co-pay that is determined by income and family size (Cohen and Lord 2005). To participate in the program, child care providers must meet state regulations. Providers receive reimbursement from the state that is determined by the type of care provided (Lynch 2014).

While the program aims to support work and training activities and enrich child well-being, low-income families underutilize the Child Care Subsidy Program (Grobe et al. 2017). Families that do participate in the program have short spells of program use (Grobe et al. 2008; Henly et al. 2017; Pilarz et al. 2016). Some scholars suggest that the administrative burden of applying for and maintaining subsidy benefits discourages long-term program use. The high learning, compliance, and psychological costs of applying for the subsidy deter program participation (Barnes and Henly 2018). Applications are lengthy and require extensive documentation of work and school schedules and information from the child care provider (Adams, Snyder, and Sandfort 2002). Further, shorter eligibility periods, coupled with the high costs of documenting work and child care changes, can lead to subsidy exit (Davis et al. 2016). Finally, studies show that applicants experience negative and stigmatizing encounters with bureaucrats (Barnes and Henly 2018; Sandstrom, Grazi, and Henly 2015).

Beyond complex application processes and negative interactions with bureaucrats in subsidy offices, using child care vouchers can involve significant redemption costs for subsidy recipients. While federal guidelines do no restrict subsidy use to work and school hours, many states limit the portability of the subsidy by requiring care to match recipients work and school schedule (Johnson-Staub, Matthews, and Adams 2015). Yet studies document the challenges of finding care arrangements that correspond with subsidy recipients’ work schedules, especially for low-income parents with unstable employment and nonstandard work schedules (Henly and Lambert 2005; Henly and Lyons 2000; Henly et al. 2017). Subsidy recipients who experience spells of unemployment also experience breaks in subsidy benefits (Grobe et al. 2017; Weber, Grobe, and Davis 2014) and difficulty managing child care arrangements (Krafft et al. 2017; Pilarz et al. 2016). Parents who work precarious hours often rely on multiple child care providers or must change providers to meet scheduling needs. These subsidy recipients must submit additional paperwork to report these changes, which increases the cost of claiming benefits. These challenges are well documented; Henly and colleagues (2017) note that, “families that have difficulties finding care to satisfy their children’s needs or their own employment schedules may ultimately use less stable care arrangements and experience subsidy instability” (p. 498).

By restricting child care to work and school hours, many states⁵ limit parents’ access to high-quality child care options and raises information costs. Many of the child care arrangements that are deemed high quality—licensed child care centers and homes—do not offer care during evenings, overnight, or on weekends, when low-income parents likely need care (Henly et al. 2017). While many states allow parents to use their child care subsidy for family, friend, and neighbor care, evidence suggests that subsidy recipients incorrectly view these informal child care arrangements and family daycares as ineligible for the subsidy (Shlay et al. 2004). Thus, subsidy-eligible parents do not use the child care subsidy because they do not know the kind of care arrangements covered by the program.

In addition to limited portability, parents’ ability to find child care depends on their ability to find third-party agents—high-quality child care providers— that accept the subsidy. Yet descriptive research of local child care markets suggests a spatial mismatch between high-quality child care and subsidy-eligible families (Sandstrom et al. 2018). For example, Sandstrom and colleagues’ (2018) study of child care providers in Illinois and New York find that high-quality child care providers are located in more affluent communities. Many of these providers do not accept the child care subsidy because the market rate for child care far exceeds reimbursement rates. Further, low-income families must compete for spots in high-quality centers that do accept subsidies (Sandstrom et al. 2018). As a result, many low-income families end up using child care arrangements that do not participate in state-initiated quality rating systems and seldom match work hours (Sandstrom et al. 2018, 67–68). Thus, subsidy recipients’ capacity to redeem benefits depends on local child care markets—in particular, the location of high-quality providers. As Sandstrom and colleagues (2018) conclude, improving access may require incentivizing new providers to “establish facilities” in “areas of unmet needs” (p. 68).

In sum, the limited portability of the subsidy voucher and reliance on third-party vendors raise the cost of redeeming benefits. In many states, subsidy recipients’ child care options are constrained to care arrangements that match their work or school schedules, and successful redemption depends on a vendor that accepts subsidy vouchers and, ideally, complies with subsidy programs and quality rating guidelines. These conditions—limited portability and reliance on third-party agents—undermine the policy’s aims of supporting work and child well-being.

Discussion

The qualitative analysis and comparative case study of WIC, HCV, and the Child Care Subsidy program illustrate the learning costs of redeeming public assistance benefits. Using the case of WIC, I demonstrate how two conditions—limited portability and third-party agents—create a learning curve for WIC participants. They must learn which specific food items are covered by the program and learn how to navigate retailers—third-party agents—that vary in the selection of WIC-approved items, quality of customer interactions, and compliance with WIC guidelines.

The HCV program and the Child Care Subsidy program present similar redemption costs. In the case of the HCV program, evidence suggests that time limits for housing searches and geographic constraints limit the portability of the voucher and can cause some renters to lose their voucher, diminishing program uptake (Deluca et al. 2013; Galvez 2010). Limited portability can also lead renters to select rental units that reinforce patterns of racial economic segregation—patterns the consumer choice model of the program is designed to disrupt. Further, variation in landlord practices and discrimination can undermine effective redemption of vouchers. Landlords may discriminate based on race and source of income or trap renters into subpar rental units. Just as WIC participants must learn what goods they can apply benefits to and how to navigate retailer practices, renters must understand what rental units are eligible and learn how to navigate variation in landlord practices.

Child Care Subsidy recipients face similar redemption costs. Subsidy users must learn the eligible forms of child care and identify which third-party agents—child care providers—accept the subsidy. In terms of portability, many states limit the voucher to child care that is offered during the parent’s work and school hours, a condition that seldom fits the nonstandard and precarious work schedules of many low-income families. While the program covers a range of informal and formal providers, studies suggest that parents struggle to find a high-quality center-based providers that accepts the subsidy and offers care during work hours. Unpredictable and nonstandard work schedules coupled with limited high-quality options can disrupt subsidy receipt and undermine the policy’s aims to support work and child development.

While the focus of this qualitative analysis is limited to North Carolina, research on WIC retail experiences across several states points to similar difficulties WIC participants face in redeeming benefits (Chauvenet et al. 2019). The purpose of this analysis is to develop redemption costs as a form of an administrative burden by illustrating the conditions under which challenges emerge. Because the aim is conceptual development, the extent to which I have provided a “thick description” of WIC participants’ experiences and perspectives is ideal over externally valid insights drawn from a large randomized sample (Geertz 1973; Nowell and Albertch 2019). In short, for conceptual development, depth trumps breadth (Lareau 2012).

Further, the application of the conditions developed from the qualitative analysis of WIC experiences to the HCV Program and the Child Care Subsidy program demonstrates the merits of deeper analysis and the conceptual range of redemption costs. While empirical studies of the Child Care Subsidy and HCV Program have illuminated the burden of redeeming benefits, this analysis identifies two broad conditions that can cause redemption costs: portability and third-party agents. Future research can refine and test these conditions to explain patterns in program uptake. Qualitative research can elaborate on degrees of portability and the attributes of markets and third-party actors that complicate benefit redemption. For example, relative to WIC, the SNAP program boasts high program participation and coverage rates (USDA 2020), and these outcomes may be attributed to the relative ease of redeeming benefits. Recipients experience broad portability and little variation in the quality of third-party agents. SNAP recipients receive cash-like benefits with very few food restrictions and can purchase food at most grocery stores regardless of the type and quality of foods sold.

Studies can also examine the attributes of markets and third-party actors that increase redemption costs for beneficiaries. In this article, I suggest three broad categories of third-party variation that can raise redemption costs for beneficiaries: variation in the selection of eligible benefits and services, variation in how agents interact with or treat beneficiaries, and variation in the agent’s compliance with redemption guidelines. Future qualitative research can enrich and fine-tune these categories by demonstrating what each means in particular policy contexts. Quantitative research can operationalize and test these categories to explain patterns in program uptake.

This analysis makes the case for why administrative burden scholars should reexamine policy goals and chains of implementation with an eye to barriers that may occur outside of service-seeking bureaucratic encounters. Considering multiple agents in policy delivery may help explain negative policy outcomes. In the case of Medicaid, most of the administrative burden and social policy studies have focused on service-seeking encounters to explain program uptake (Moynihan, Herd, and Harvey 2015; Michener 2018). However, the challenges in learning how to redeem these benefits may help explain persistent health disparities and discontinuity in Medicaid use.

Most Medicaid beneficiaries must select health plans from managed-care providers that vary in the kinds of health services and benefits provided. Further, evidence suggests that Medicaid recipients experience insurance-based discrimination—in which patients are treated unfairly because they lack insurance or because of the kind of insurance they have—when searching for physicians (Han et al. 2015). Given the low reimbursement rates, some health care providers do not accept Medicaid (Kullgren et al. 2012). As a result, Medicaid beneficiaries may forgo health care, exacerbating poor health outcomes, and health inequities.

This study also reveals the importance of identifying when and where beneficiaries experience administrative burdens. For example, policy feedback studies suggest neutral or positive experiences with public housing programs (Bruch, Ferree, and Soss 2010). Yet, as I have argued and empirical evidence demonstrates, voucher holders have trouble redeeming benefits with landlords (Rosen 2014). Costly experiences with landlords, rather than the housing authority, can reduce redemption and undermine policy aims. Understanding when and where costs emerge can help scholars make sense of program recipients’ mixed or ambivalent evaluations of program experiences. By analyzing the costs of extra-organizational encounters, redemption costs can help pinpoint the salient aspects of program experiences. Beneficiaries may weigh encounters with agencies and their market experiences differently in how they evaluate programs and how they decide whether to stay or leave. These kinds of insights can directly affect policy interventions. For example, in addition to streamlining application and recertification processes to reduce learning, compliance, and psychological costs, policymakers and administrators could devise ways to incentivize compliance from third-party agents—via legislation, policy rules, greater monitoring, and greater sanctions for failing to meet redemption guidelines.

To alleviate redemption costs, policymakers could loosen restrictions on eligible services and benefits. The policy response to the COVID-19 pandemic may offer some early lessons on whether and how looser restrictions influence continuity in program use. In response to the growing scarcity of WIC-eligible foods, The USDA has given states the opportunity to apply for waivers to expand the selection of WIC-eligible foods in retail settings (USDA 2020). Greater flexibility in what is eligible for redemption may ease shopping experiences.

Finally, policymakers and practitioners can closely monitor and sanction the redemption practices of third-party agents. Federal and state policies require local WIC agencies to monitor vendor compliance. Agencies conduct audits to probe patterns of fraud, overpayments, whether retailers have a minimum inventory of WIC-approved foods, and how store staff members treat WIC customers (Gleason et al. 2013). If stores fail routine audits, they can face temporary sanctions or permanent removal from the WIC program. However, research shows that state and local agencies have not imposed sanctions on stores that violated program guidelines (Gleason et al. 2013). Similar quality control and monitoring components exist in Medicaid and the Housing Choice Voucher Program. Yet these monitoring and sanctioning practices have not successfully curbed discrimination among third-party agents. Although patient care is one component of quality control, Medicaid’s program integrity efforts primarily monitor improper Medicaid payments and fraud rather than how Medicaid providers treat recipients (Centers for Medicare and Medicaid Services 2019). In the case of the HCV program, source of income discrimination laws protect voucher holders, but they are not prevalent or universally enforced across states and locales (Tighe, Hatch, and Mead 2017). Further, quality control for the HCV program focuses on inspecting rental units rather than probing landlords’ behavior towards renters (United States Department of Housing and Urban Development 2001). There are few interventions that target landlords’ discrimination and sorting practices towards renters (Rosen 2014).

Redemption costs aren’t the only costs that preclude utilizing programs, but they are an overlooked aspect of onerous experiences with policy implementation that should be considered in the study of administrative burden and policy design. Some researchers have begun to examine how consumer choice models complicate, in positive and negative ways, how citizens experience the state (Barnes 2020; Morgan and Campbell 2011). But, more theory building is needed to understand how consumer choice can strengthen or strain citizen-state interactions.

Data Availability Statement

The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author.

Conflict of Interest

The author reported no potential conflict of interest.

Funding

This study was funded by the New Perspectives Fellowships from the Duke-UNC USDA Center for Behavioral Economics and Healthy Food Choice Research (BECR). The BECR Center was funded by grant 59-5000-4-0062 from the US Department of Agriculture.

Appendix A. Sample Interview Questions

WIC and Food Purchasing

• 1) What is it like using WIC to purchase food?

• 2) How do you decide which store to go to for your WIC foods? For example, are there some stores that have better WIC food selection, or where WIC items are better labeled?

• 3) How long does it take to figure out what foods you can buy with your WIC vouchers? Then what happens?

• 4) Do you feel that WIC clients should be restricted to buying only certain foods? Why or why not?

• 5) How has eWIC changed the way you shop?

• 6) Can you describe how you purchased foods with your WIC vouchers before eWIC?

• 7) Can you describe how you purchase foods with eWIC now?

• 8) Is it realistic to think that a family on WIC can achieve a healthy diet? PROBE: What makes you say that?

• 9) How does WIC participation affect your purchases of fresh fruits and vegetables? PROBE: Can you find the fruits and vegetables you want at your local store?

• 10) How does WIC affect your purchases of whole-grain foods (bread, pasta, buns, cereal)? PROBE: Are you able to find what you want at your local store?

• 11) Do you shop at farmers’ markets? Why or why not?

• 12) What do you use to make purchases at farmers’ markets? {SNAP/EBT, WIC Farmers’ Market coupons, cash?}

• 13) What do you purchase at farmers’ markets?

References

Footnotes