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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
First received
Last updated
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
Health authority
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)

Study Design


Related Conditions & MeSH terms


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
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