The Effect of Work Requirements in SNAP in Virginia

February 28, 2025 updated by: Tim Layton, Harvard Medical School (HMS and HSDM)

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

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.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Recruiting

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

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.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Estimated)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
12500

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact

The name and contact information for the person who can answer enrollment questions for a clinical study. Each location where the study is being conducted may also have a specific contact, who may be better able to answer those questions.

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

18 years to 49 years (Adult)

Accepts Healthy Volunteers

Yes

Description

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 Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

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

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
No Intervention: Control Group
No change to work requirements or recertification period
Active Comparator: Intervention Group 1
Standard 6-month recertification period, additional 6-month work requirement exemption
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.
Other Names:
  • Change to recertification timeline
Active Comparator: Intervention Group 2
Standard 6-month recertification period, additional 12-month work requirement exemption
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.
Other Names:
  • Change to recertification timeline
Active Comparator: Intervention Group 3
Standard 6-month recertification period, additional 12-month work requirement exemption
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.
Other Names:
  • Change to recertification timeline
Active Comparator: Intervention Group 4
12-month recertification period (6-month extension), additional 6-month work requirement exemption
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.
Other Names:
  • Change to recertification timeline

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
SNAP enrollment
Time Frame: Up to 24 months after randomization
Collected administratively (DSS records)
Up to 24 months after randomization
Employment status
Time Frame: Up to 24 months after randomization
Collected administratively (VEC records)
Up to 24 months after randomization
UI covered earnings
Time Frame: Up to 24 months after randomization
Collected administratively (VEC records)
Up to 24 months after randomization
Non-UI covered earnings
Time Frame: Up to 24 months after randomization
Collected administratively (federal tax records)
Up to 24 months after randomization

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Number of jobs held
Time Frame: Up to 24 months after randomization
Collected administratively (DSS records)
Up to 24 months after randomization
Medicaid participation
Time Frame: Up to 24 months after randomization
Collected administratively (DSS records)
Up to 24 months after randomization
Hospitalizations
Time Frame: Up to 24 months after randomization
Collected administratively (Virginia Health Information)
Up to 24 months after randomization
Credit scores
Time Frame: Up to 24 months after randomization
Collected administratively (credit bureaus)
Up to 24 months after randomization
Evictions
Time Frame: Up to 24 months after randomization
Collected administratively (court records)
Up to 24 months after randomization
Crime (records of charges, convictions)
Time Frame: Up to 24 months after randomization
Collected administratively (court records)
Up to 24 months after randomization
Food insecurity
Time Frame: Survey to be administered approximately 1 year after randomization begins
Collected by survey
Survey to be administered approximately 1 year after randomization begins
Self-reported health
Time Frame: Survey to be administered approximately 1 year after randomization begins
Collected by survey
Survey to be administered approximately 1 year after randomization begins
Depression score
Time Frame: Survey to be administered approximately 1 year after randomization begins
Collected by survey
Survey to be administered approximately 1 year after randomization begins
Non-work community engagement activities
Time Frame: Survey to be administered approximately 1 year after randomization begins
Collected by survey
Survey to be administered approximately 1 year after randomization begins
Forced moves, housing instability
Time Frame: Survey to be administered approximately 1 year after randomization begins
Collected by survey
Survey to be administered approximately 1 year after randomization begins
Reasons for exiting SNAP
Time Frame: Survey to be administered approximately 1 year after randomization begins
Collected by survey
Survey to be administered approximately 1 year after randomization begins
Barriers to employment
Time Frame: Survey to be administered approximately 1 year after randomization begins
Collected by survey
Survey to be administered approximately 1 year after randomization begins
Hours worked per week
Time Frame: Survey to be administered approximately 1 year after randomization begins
Collected by survey
Survey to be administered approximately 1 year after randomization begins
Difficulty paying medical bills
Time Frame: Survey to be administered approximately 1 year after randomization begins
Collected by survey
Survey to be administered approximately 1 year after randomization begins
Uninsurance
Time Frame: Survey to be administered approximately 1 year after randomization begins
Collected by survey
Survey to be administered approximately 1 year after randomization begins

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Harvard Medical School (HMS and HSDM)

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
National Institute on Minority Health and Health Disparities (NIMHD)
Abdul Latif Jameel Poverty Action Lab

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
April 1, 2024

Primary Completion (Estimated)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
May 1, 2025

Study Completion (Estimated)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
December 1, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
May 7, 2021

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 11, 2021

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
May 17, 2021

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
March 25, 2025

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
February 28, 2025

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
February 1, 2025

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • IRB19-0859
  • 5R01MD014970-02 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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