Conditioning State Responses to External Influences: The Role of Internal Moderators in State Adoption of Public Policy Change.

This study proposes that the extent to which external factors influence state policy adoption depends, in part, on internal state characteristics, with external factors consisting of other states and the federal government and internal factors consisting of a particular state's political, economic, and programmatic circumstances. This insight is grounded in the study of program implementation, which suggests that policy necessarily evolves and adapts to local conditions, and in the study of institutions in sociology, which suggests that intra-organizational factors condition organizational responses to institutional pressures. The relevance of this insight for comparative state policy research is examined by applying mixed modeling techniques to data describing adoption of annual percentage reductions in Medicaid nursing facility per diem rates from 1981-1998. Results indicate that internal conditions favorable to adoption tend to magnify the effects of external influences, whereas internal conditions unfavorable to adoption tend to diminish their effects. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]