The Effect of Work Requirements in SNAP in Virginia

Study Overview
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Brief Summary
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More than a dozen states have proposed or plan to implement work requirements in Medicaid, and similar requirements already exist nationally in the Supplemental Nutritional Assistance Program (SNAP), yet evidence on the effects of these policies is limited. In cooperation with the state of Virginia, the investigators plan to conduct a randomized controlled trial studying the impacts of work requirements in public programs on insurance coverage, SNAP participation, employment, and health, with a particular focus on changes in racial/ethnic and geographic disparities in these outcomes. The COVID-19 epidemic and concurrent economic downturn creates additional urgency around these issues, and the investigators will use a combination of national administrative data and a new population survey to assess disparities in employment, health care, and food insecurity during this crisis.

Detailed Description
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Work requirements are becoming increasingly common in major public assistance programs, with federal requirements for most adults to work in order to participate in the Supplemental Nutritional Assistance Program (SNAP, previously known as food stamps), and more than a dozen states proposing similar requirements in Medicaid. Proponents of work requirements contend that these policies increase beneficiary engagement in work and community activities that may lead to higher incomes and better health. On the other hand, opponents of work requirements suggest that many low-resource households will lose much-needed benefits, without commensurate improvements in employment. The investigators propose a randomized controlled trial of work requirements in Virginia, leveraging state support for exempting a portion of Medicaid expansion enrollees from the state's proposed work requirements. The investigators are also working with the state to explore the impact of work requirements in SNAP. They will study the impacts of each policy on health insurance coverage, access to care, employment, food insecurity, and health outcomes using a mix of administrative data and a new beneficiary survey. Our analysis will oversample several populations of interest, including racial/ethnic minorities and low-income rural residents. In doing so, investigators will identify the overall policy impacts of these policies, and will also assess who is most affected by each component to determine the impact of these policy changes on racial, ethnic, socioeconomic, and geographic disparities. Meanwhile, the COVID-19 epidemic and concurrent economic downturn create additional urgency around the issues of employment and participation in social programs. Using a combination of national administrative data and a new population survey, this study will also provide a timely assessment of disparities in employment, health care, and food insecurity during the current public health and economic crises.

Official Title
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Disparities in Medicaid and SNAP Participation: The Effects of Work Requirements and the COVID-19 Pandemic

Conditions
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Health Disparities, Food Security

Intervention / Treatment
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* Other: Work requirement exemption months


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Eligible for Virginia's SNAP program as an able-bodied adult without dependents (ABAWD) and thus subject to work requirements (this eligibility is age restricted to 18-49) Exclusion Criteria: Categorical exemption from work requirements for any reason (e.g., has a disability, has dependents, resides in a geographic area where work requirements have been waived due to elevated employment)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 49 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Control Group<br>No change to work requirements or recertification period | |
| Active Comparator: Intervention Group 1<br>Standard 6-month recertification period, additional 6-month work requirement exemption | Other: Work requirement exemption months<br>* Cross-randomized intervention will test effect of additional exemption months before work requirements in SNAP become binding and extensions of the standard SNAP recertification period.<br>* Other names: Change to recertification timeline;|
| Active Comparator: Intervention Group 2<br>Standard 6-month recertification period, additional 12-month work requirement exemption | Other: Work requirement exemption months<br>* Cross-randomized intervention will test effect of additional exemption months before work requirements in SNAP become binding and extensions of the standard SNAP recertification period.<br>* Other names: Change to recertification timeline;|
| Active Comparator: Intervention Group 3<br>Standard 6-month recertification period, additional 12-month work requirement exemption | Other: Work requirement exemption months<br>* Cross-randomized intervention will test effect of additional exemption months before work requirements in SNAP become binding and extensions of the standard SNAP recertification period.<br>* Other names: Change to recertification timeline;|
| Active Comparator: Intervention Group 4<br>12-month recertification period (6-month extension), additional 6-month work requirement exemption | Other: Work requirement exemption months<br>* Cross-randomized intervention will test effect of additional exemption months before work requirements in SNAP become binding and extensions of the standard SNAP recertification period.<br>* Other names: Change to recertification timeline;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| SNAP enrollment | Collected administratively (DSS records) | Up to 24 months after randomization | 
| Employment status | Collected administratively (VEC records) | Up to 24 months after randomization | 
| UI covered earnings | Collected administratively (VEC records) | Up to 24 months after randomization | 
| Non-UI covered earnings | Collected administratively (federal tax records) | Up to 24 months after randomization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of jobs held | Collected administratively (DSS records) | Up to 24 months after randomization | 
| Medicaid participation | Collected administratively (DSS records) | Up to 24 months after randomization | 
| Hospitalizations | Collected administratively (Virginia Health Information) | Up to 24 months after randomization | 
| Credit scores | Collected administratively (credit bureaus) | Up to 24 months after randomization | 
| Evictions | Collected administratively (court records) | Up to 24 months after randomization | 
| Crime (records of charges, convictions) | Collected administratively (court records) | Up to 24 months after randomization | 
| Food insecurity | Collected by survey | Survey to be administered approximately 1 year after randomization begins | 
| Self-reported health | Collected by survey | Survey to be administered approximately 1 year after randomization begins | 
| Depression score | Collected by survey | Survey to be administered approximately 1 year after randomization begins | 
| Non-work community engagement activities | Collected by survey | Survey to be administered approximately 1 year after randomization begins | 
| Forced moves, housing instability | Collected by survey | Survey to be administered approximately 1 year after randomization begins | 
| Reasons for exiting SNAP | Collected by survey | Survey to be administered approximately 1 year after randomization begins | 
| Barriers to employment | Collected by survey | Survey to be administered approximately 1 year after randomization begins | 
| Hours worked per week | Collected by survey | Survey to be administered approximately 1 year after randomization begins | 
| Difficulty paying medical bills | Collected by survey | Survey to be administered approximately 1 year after randomization begins | 
| Uninsurance | Collected by survey | Survey to be administered approximately 1 year after randomization begins | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Supplemental Nutrition Assistance Program, work requirements, Medicaid