Clinical trial NCT04888832: The Effect of Work Requirements in SNAP in Virginia
Official title: Disparities in Medicaid and SNAP Participation: the Effects of Work Requirements and the COVID-19 Pandemic
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Health Disparities
Food Security
Keywords: Supplemental Nutrition Assistance Program
work requirements
Medicaid
Lead sponsor: Harvard Medical School (HMS and HSDM)
Sponsor class: OTHER
Collaborators: name: Abdul Latif Jameel Poverty Action Lab
name: National Institute on Minority Health and Health Disparities (NIMHD)
First posted: 2021-05-17
Enrollment: 12500
Sex: ALL
Minimum age (years): 18
Maximum age (years): 49
Standard ages: ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: FACTORIAL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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)

Primary outcomes:
measure: SNAP enrollment
timeFrame: Up to 24 months after randomization
measure: Employment status
timeFrame: Up to 24 months after randomization
measure: UI covered earnings
timeFrame: Up to 24 months after randomization
measure: Non-UI covered earnings
timeFrame: Up to 24 months after randomization
Secondary outcomes:
measure: Number of jobs held
timeFrame: Up to 24 months after randomization
measure: Medicaid participation
timeFrame: Up to 24 months after randomization
measure: Hospitalizations
timeFrame: Up to 24 months after randomization
measure: Credit scores
timeFrame: Up to 24 months after randomization
measure: Evictions
timeFrame: Up to 24 months after randomization
measure: Crime (records of charges, convictions)
timeFrame: Up to 24 months after randomization
measure: Food insecurity
timeFrame: Survey to be administered approximately 1 year after randomization begins
measure: Self-reported health
timeFrame: Survey to be administered approximately 1 year after randomization begins
measure: Depression score
timeFrame: Survey to be administered approximately 1 year after randomization begins
measure: Non-work community engagement activities
timeFrame: Survey to be administered approximately 1 year after randomization begins
measure: Forced moves, housing instability
timeFrame: Survey to be administered approximately 1 year after randomization begins
measure: Reasons for exiting SNAP
timeFrame: Survey to be administered approximately 1 year after randomization begins
measure: Barriers to employment
timeFrame: Survey to be administered approximately 1 year after randomization begins
measure: Hours worked per week
timeFrame: Survey to be administered approximately 1 year after randomization begins
measure: Difficulty paying medical bills
timeFrame: Survey to be administered approximately 1 year after randomization begins
measure: Uninsurance
timeFrame: Survey to be administered approximately 1 year after randomization begins
Other outcomes:
Locations:
city: Glen Allen
country: United States
facility: Virginia Department of Social Services (Home Office)
state: Virginia
Study officials:
References: