The Effect of Work Requirements in SNAP in Virginia

Food Security Clinical Trial

Official title:

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

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT04888832
• Other study ID #: IRB19-0859
• Secondary ID: 5R01MD014970-02
• Status: Not yet recruiting
• Phase: N/A
• Start date: July 2023
• Est. completion date: December 2024

Study information

• Verified date: March 2023
• Source: Harvard Medical School (HMS and HSDM)
• Contact: Timothy J Layton, PhD
• Phone: 573-353-1566
• Email: Layton[@]hcp.med.harvard.edu
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 12500
• Est. completion date: December 2024
• Est. primary completion date: December 2024
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 49 Years

Eligibility

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)

Related Conditions & MeSH terms

• Food Security
• Health Disparities

Intervention

Other:
• Work requirement exemption months
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.

Locations

Country	Name	City	State
n/a

Sponsors (3)

Lead Sponsor	Collaborator
Harvard Medical School (HMS and HSDM)	Abdul Latif Jameel Poverty Action Lab, National Institute on Minority Health and Health Disparities (NIMHD)

Outcome

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