| Sumario: | A study was conducted to examine the structure of bureaucratic decisions in state Medicaid, and more specifically, to attempt to discern an underlying pattern in Medicaid optional service adoptions across the U.S. during the period from 1985 through 1994. The cumulative, or Guttman, scaling model, with which the process of adopting services according to their degree of difficulty is consistent, was tested against empirical data. The results indicate that states differ in the degree to which they extend services into more controversial aspects of health care and that their willingness to do so follows a clear cumulative pattern: States initiate more controversial, limited services only after they have already adopted a complete range of services that are extensively acceptable to the public and governmental officials. This cumulative pattern in administrative decisions discloses much about the nature of bureaucratic actions in state-level social welfare programs.
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