Denied by Design: How Bureaucracy is Hurting Kids and How to Fix It

One Monday morning, Carmen found a letter in her mailbox from the state Medicaid office. Her stomach sank before she even opened it. She feared that this government envelope might not bring good news.

Inside that envelope, she discovered that her Medicaid coverage had been terminated due to a slight increase in income after having picked up a few hours of part-time work. But that wasn’t all. Scanning quickly, she saw that her children had been kicked off, too. No explanation. No warning. Just a line saying that their case was now closed.

This made no sense.

Although Carmen had picked up a few hours of part-time work, just enough to disqualify her, her income was still well below the poverty line. Therefore, her children remained fully eligible. But the state’s automated renewal system had linked everyone’s coverage to her status. When she was dropped, so were they.

She spent the next four weeks on the phone, sending faxes, digging up birth certificates, proof of income, and her oldest daughter’s disability evaluation. She was repeatedly put on hold. She was told the system “didn’t match” her documents and to “try again.” Meanwhile, her 8-year-old missed a physical needed to enroll in soccer. Her 4-year-old’s speech therapy sessions stopped.

Carmen isn’t a rare case: her family’s situation is a feature adopted by some states to weed people out, including eligible children. In such circumstances, technology is being used not to serve families but to sort, surveil, and often exclude. Eligibility automation, when implemented poorly or punitively, turns bureaucracy into a “gotcha game,” making eligible children the collateral damage of adult-level eligibility errors.

But it doesn’t have to be this way. We care for our children – something each of us wants to do – when we apply advances in technology to make it more convenient for kids, rather than harder, to get essential services like health care and healthy food.

We have the technology to match food programs like the Supplemental Nutrition Assistance Program (SNAP) and WIC with Medicaid and Children’s Health Insurance Program (CHIP) eligibility, to auto-enroll kids based on other program participation, and to keep children’s coverage continuous even if a parent’s status changes. It’s called Express Lane Eligibility or Express Lane Enrollment, and it significantly reduces bureaucracy, red tape, and administrative costs.

And yet, far too many policymakers – often the same ones declaring they want to eliminate unnecessary regulations and bureaucracy – are embracing the opposite for children and families.

For example, under H.R. 1 (the so-called “One Big Beautiful Bill Act”), which passed the House by a vote of 215-214 and is being considered in the Senate now, families like Carmen’s could soon face even more barriers, such as pre-certifying a child before applying for the Earned Income Tax Credit or proving over and over again that a child has a qualifying disability. Instead of designing systems to support kids, we are building digital walls and mazes to keep them out.

The Promise of Express Lane Enrollment – Now Under Threat

It didn’t have to be this way for Carmen or for millions of families like hers. We already have the tools to simplify enrollment and reduce red tape while still ensuring only fully qualified children are enrolled in vital programs. In fact, they’re written into law.

Two decades ago, Sens. Jeff Bingaman (D-NM) and Richard Lugar (R-IN) led a bipartisan effort to create Express Lane Enrollment (ELE), a policy mechanism that allows states to use verified data from one public benefit program (like SNAP or the school lunch program) to automatically enroll eligible children into another (like Medicaid or CHIP). This works very effectively and efficiently when both programs rely on comparable income levels and other rules to determine eligibility.

The goal was clear: don’t force families to prove over and over and over again that their children are poor, disabled, residents of their state, or U.S. citizens. ELE allows information already confirmed by one agency unlock access to others. It puts technology and data sharing to use for good.

The Children’s Health Insurance Program Reauthorization Act (CHIPRA) and the Affordable Care Act (ACA) created and expanded support for this approach, giving states the authority and funding to implement ELE as a proven, cost-effective way to close enrollment gaps, especially for children.

As professors Don Moynihan and Pamela Herd write:

Over the past 15 years, reforms have included simplifying applications, eliminating confusing paperwork and automating processes, especially when it comes to renewing benefits. Surveys show that the public supports such service improvements.

Early Roots of Express Lane – and its Early Lessons

The enactment of the CHIP in 1997 – initially referred to as the State Children’s Health Insurance Program or SCHIP – set the stage for Express Lane Eligibility. With its enactment, the vast majority of children who had no health insurance could receive it through either Medicaid or CHIP. States began to actively look for new approaches to find and enroll the estimated 8 million kids who qualified for coverage but weren’t enrolled.

In 1999, a national organization with a strong base in California, The Children’s Partnership, conducted an analysis supported by KFF that found nearly 70% of the eligible but uninsured children had already qualified for and been enrolled in other publicly-supported need-based program like the National School Lunch Program. This report presented a new and simplified approach (i.e., Express Lane Eligibility) to enroll children in health coverage by relying on findings from similar public programs to expedite enrollment.

Based on this analysis, The Children’s Partnership looked more deeply at the eligibility rules of selected need-based programs, their administrative structures, and their data-sharing rules. The next step was to pilot Express Lane at a state level. In California, 56% of uninsured kids were enrolled in the National School Lunch Program.

As a result, The Children’s Partnership worked with the Los Angeles Unified School District and the County Welfare Directors Association on state legislation to pilot Express Enrollment in California schools. Over 100 schools (urban and rural) participated in the pilot that allowed school lunch applications to serve as the beginning of a Medicaid (Medi-Cal in California) application.

While the pilot enrolled some children in health coverage, reflection and independent evaluations identified a few barriers that kept the pilot from being as successful as possible. Chief amongst them were information technology limitations and the need for greater flexibility in federal Medicaid policy. With these takeaways and a strong case for this expedited enrollment approach in hand,

The Children’s Partnership and fellow advocates worked with Senators Bingaman and Lugar in Congress to write legislation addressing these issues and extending authority for Express Lane to states across the country. With the passage of CHIPRA in 2009, Express Lane was formally established as a tool that states could use to enroll far more eligible unenrolled children in Medicaid and CHIP.

And it worked.

States using Express Lane Enrollment saw meaningful increases in children’s coverage, reductions in churn and procedural disenrollments, and smoother coordination between systems. It shifted the burden from parents to the government, where it belongs, because no child should lose health care just because a form was misplaced, a deadline was missed, or a family couldn't reach someone at the agency.

Just like Medicare is for senior citizens, the assumption for children should be to get kids covered, whether in public or private health insurance.

That Bipartisan Progress is Now Being Reversed

Unfortunately, H.R. 1 threatens to unravel these gains. Under the guise of program integrity and cost-saving, H.R. 1 imposes new administrative burdens that risk stripping children of the very benefits Congress once worked across the aisle to protect.

Professors Moynihan and Herd explain:

. . .Republicans are opting for opaque cuts, which will shed millions of eligible beneficiaries by overwhelming them with pointless paperwork and other needlessly complicated administrative requirements.

Moynihan and Herd write in a related piece:

It’s politically expedient, concealing cuts in confusing bureaucratic changes, but ultimately devastating for the people who are eligible for – and desperately need – social safety net benefits.

Among its provisions:

• Pre-certification of children for the Earned Income Tax Credit (EITC): a change that adds another hoop for low-income children and families and will result in eligible children being excluded simply because their parents cannot navigate or access the right documentation in time.

• Stricter documentation requirements across Medicaid, SNAP, and other programs: undermining streamlined, data-sharing eligibility models like ELE.

• Expanded eligibility surveillance and compliance checks: making enrollment and retention more complex and punitive.

After analyzing the bill’s new administrative burdens and rollback of simplification measures, Moynihan and Herd conclude:

. . .the pattern of using burdens to quietly kick off eligible beneficiaries becomes undeniable. The bill would pause a series of comprehensive new rules, issued by the Biden administration, to make it easier for people to navigate Medicaid’s eligibility and renewal processes.

Instead of using technology to verify once and serve many times – as Express Lane Enrollment was designed to do – H.R. 1 pushes us toward a system where families must repeatedly “prove that they matter,” as Centers for Medicare and Medicaid Services (CMS) Administrator Mehmet Oz recently said, and where technology is used to scrutinize and not support and benefit them.

Children will be among the first to suffer.

The Hidden Costs of Bureaucracy: What Added Burden Means for Children

Moynihan and Herd published a book entitled Administrative Burden: Policymaking by Other Means to describe the hidden or opaque, yet often devastating, costs that citizens face when interacting with government programs. These burdens aren’t merely inconveniences: they are policy choices, embedded in systems that decide who gets help and who gets left behind.

They categorize these burdens into three types:

1. Learning costs: how hard it is to find out what help is available

2. Compliance costs: the effort required to apply, verify, and remain eligible

3. Psychological costs: the stress, stigma, and fear families experience when navigating these systems

For children and families, these “onerous, intrusive, and damaging,” as Moynihan describes them, burdens can accumulate quickly and painfully. When a parent is asked to prove, again and again and again, that their child has a qualifying disability, that they meet income thresholds, that their address hasn’t changed, or that they are “really” eligible, those tasks consume immense time and generate churn, drop-offs, reduced access to care, and suffering.

In a system designed to prevent errors of inclusion at all costs, the errors of exclusion – eligible children losing benefits – are ignored, hidden behind algorithms, spreadsheets, and automation.

With a focus on the behavioral changes needed to improve program take-up, Cass Sunstein and Richard Thaler have coined the term “sludge” to describe some of the deliberate bureaucratic frictions: barriers that clog up access to public benefits. Sludge refers to all the unnecessary steps, confusing paperwork, redundant verifications, and administrative hurdles that create a system of missed deadlines and lost benefits. Unfortunately, there’s often little accountability when children fall through the cracks, especially when those children and their families lack political power.

Take the “pre-certification” requirement for the Earned Income Tax Credit (EITC) in H.R. 1. This creates an added administrative barrier that will result in fewer people accessing EITC benefits they are entitled to. These added burdens land hardest on those with the least time, the fewest resources, and the most to lose.

In the case of children, they can’t file appeals. They can’t navigate websites or upload documents. Their lives are mediated entirely by systems that should work for them, not against them. Kids rely on adults, including policymakers, to do what is best for them, but when these systems break down, when automated renewals drop kids because a parent loses coverage, or when re-certification letters never arrive, the cost is not abstract. It’s missed doctor visits, delayed diagnoses, untreated asthma, a missed physical to play sports, skipped meals, and months of confusion and instability.

In a democracy that claims to value children, these bureaucratic harms should be seen not as accidents, but as policy failures. Or, as Moynihan would put it, they are governance failures disguised as “neutral” rules.

Technology for Good or Bad

Technology is not neutral. It reflects the values and priorities of the systems and people who design it. As Herd, Moynihan, Hillary Hoyes, and Jamila Michener write:

In short, technology is a tool that can be used for good or bad.

It can either be used to dignify and support families or to punish and harm them.

These authors have highlighted this distinction in their critique of how technology is deployed in public administration. They warn that too often, administrative systems are built not to reduce burden, but to amplify it. These systems can be structured around risk aversion and fraud prevention, even when the cost excludes eligible people, including children, from the benefits they need to thrive.

Take the renewed push for “integrity” in benefit programs under H.R. 1. This legislation doubles down on surveillance, pre-certification, and cross-checking requirements: applying technological tools to trigger barriers and automatic denials. It’s a technology of punishment, where systems are designed to create administrative barriers, flag discrepancies, and erect red tape. The result is a government that treats families like potential criminals and children as administrative liabilities.

Contrast that with what technology could look like if it were designed with children in mind:

• Instead of requiring parents to reprove a child’s disability every year, why not build a system that integrates disability determinations across Medicaid, school-based services, and SSI with one shared verification accepted across programs?

• Instead of punishing families because a parent’s employment status changes, why not ensure that children's eligibility is assessed and maintained using school records or SNAP data?

• Instead of forcing families to enroll separately to multiple programs with overlapping rules and documentation, why not design portals that automatically pre-fill applications and recommend every program a child qualifies for?

These are not utopian ideas: they’re working in places that use Express Lane Eligibility and human-centered design. In a world driven by data, computers, and now AI, systems and processes can be designed for good or bad.

The real difference lies in intent.

A technology of dignity and support puts the burden on the government to prove ineligibility, not on the family to re-prove worthiness over and over and over again. It recognizes that children’s time is sacred, parents’ time is strained, and systems should be built for service, not suspicion.

Yet at the federal level, the priorities are glaringly skewed. Under the Trump Administration, federal agencies, including the Department of Health and Human Services (HHS), have made high-profile pledges to cut “burdensome regulations” on businesses, citing the need to unleash innovation and reduce red tape. In contrast, when it comes to children and families, that deregulatory zeal suddenly vanishes and much more cumbersome and complex procedures are put in place.

In fact, HHS and Congressional allies have pursued a parallel strategy: expanding regulations on low-income children and families, increasing documentation demands, intensifying surveillance, and making public benefit systems more difficult to navigate. The same political actors who argue that businesses should be freed from unnecessary compliance burdens have no hesitation adding layers of bureaucracy to a single mother trying to keep her child insured. It’s a clear double standard: streamline for the powerful, obstruct for those most in need.

This is a moral choice as much as a policy one. Every time we design a website that crashes, phone lines that are not answered, a portal that lacks translation, or an AI system that auto-denies based on incomplete data, we're making a decision about whose lives matter and who should be repeatedly inconvenienced.

Children, especially poor children, deserve better than a digital wall, maze, or endless loop of bureaucracy. We care for kids when we put in place systems that see them, hear them, and support them.

This vision is what is being discussed here by Amanda Renteria with Code for America…

Designing a Child-Centered Digital Future: What Policymakers Must Do Now

The good news is that the path forward isn’t a mystery. We already know what works: technology that reduces friction, policies that trust families, and systems that are built for access, not exclusion – all while ensuring program integrity. The challenge is political, not technical. We must demand a government that uses its tools to lift children up – not lock them out.

Policy Vision: Technology That Serves Children While Upholding Eligibility Standards

1. Support and expand Express Lane Enrollment in federal law. Congress should make ELE a permanent feature of all means-tested programs, ensuring that once a child qualifies for one, they are auto-enrolled in all others they’re eligible for.

2. Guarantee continuous coverage for children, regardless of parental status changes. Use school and program records to maintain eligibility and reduce churn on and off the program.

3. Centralize and streamline disability verification for children across Medicaid, SSI, IDEA, and school-based services – eliminating duplicative documentation that burdens families year after year.

4. Invest in multilingual, accessible, and mobile-friendly digital platforms with real-time support and reminders – designed and tested with the families they are meant to serve.

5. Require administrative burden audits before new rules or tech systems are approved, particularly for programs serving children, families, and people with disabilities.

Calls to Action

For Congress:
Reject harmful proposals in H.R. 1 that impose new pre-certification and documentation requirements for the EITC and CTC. Any program integrity initiative must include child-focused safeguards and automated enrollment systems.

For Federal Agencies:
Reorient digital modernization efforts around the principles of human-centered design (HCD), user-experience design (UX), and administrative burden reduction, centered explicitly on the needs of children and families.

For State Leaders and Program Directors:
Adopt the best practices already proven effective: implement Express Lane Enrollment, protect continuous eligibility, integrate data systems, and co-design with community organizations serving families.

For Advocates and Civic Technologists:
Push for technology that is respectful, prompt, and reliable, as Moynihan urges. Partner with policymakers to audit and reform digital systems through a child-first lens.

In the end, the systems we build are a reflection of what and who we value. We cannot allow a generation of children to be buried under a digital mountain of sludge. Let’s build a public sector that recognizes families not as cases to manage or fraud risks to monitor, but as people to serve with dignity, respect, and care.

Because, yes, kids can’t wait. And they shouldn’t have to navigate a system purposely designed to fail them when we have the technology to improve their lives and well-being.

Let’s show we care for our kids by using advances in technology to make it convenient for busy families to use needed services while we also ensure the accuracy of eligibility determinations. We have accomplished this before and we know how to do it now.

My co-author is Wendy Lazarus, who has had a long career as an advocate and lobbyist for children. She is currently the Director of Kids Impact Initiative and served as Co-President of The Children’s Partnership overseeing the work on Express Lane Eligibility.