Implementation Theory Revisited . . . Again: Lessons from the State Children's Health Insurance Program

Abstract

This article examines the implementation of the State Children's Health Insurance Program (SCHIP) in three states: Massachusetts, Georgia, and Ohio. It examines the effectiveness of four theoretical driving forces in explaining implementation using a multiple case study analysis. Data were compiled using legislative histories, key informant interviews, public record, and media content analysis and were analyzed using a triangulation of sources. Findings suggest that the driving forces as conceptualized in the literature are only partially helpful when examining the implementation of federal redistributive health policy in these states. A pursuit of rationality approach was the most explanatory of the driving forces followed by an organizational‐policy fit when there was limited capacity to implement new policy. Overall, implementation was found to be more related to state‐level capacity and the state's previous programmatic experiences. Policy innovation was more likely to occur when capacity was high and where goals agreement drove the process.