The Effect of Work Requirements in SNAP in Virginia

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: Recruiting
• Conditions: Health Disparities; Food Security
• Intervention / Treatment: Other: Work requirement exemption months

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: Interventional
• Enrollment (Estimated): 12500
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Timothy J Layton, PhD; Phone Number: 573-353-1566; Email: Layton@hcp.med.harvard.edu
• Study Contact Backup: Name: Adrianna McIntyre, PhD; Phone Number: 5863068889; Email: amcintyre@g.harvard.edu

Study Locations

• United States
  • Virginia
    • Glen Allen, Virginia, United States, 23060
      • Recruiting
      • Virginia Department of Social Services (Home Office)
      • Contact: Heeju Jang-Paulsen; Email: HeeJu.Jang-Paulsen@dss.virginia.gov

Participation Criteria

Eligibility Criteria

• 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

How is the study designed?

Design Details

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

Number of Arms

5

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
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

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

Collaborators and Investigators

• Sponsor: Harvard Medical School (HMS and HSDM)
• Collaborators: National Institute on Minority Health and Health Disparities (NIMHD); Abdul Latif Jameel Poverty Action Lab

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2024
• Primary Completion (Estimated): May 1, 2025
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: May 7, 2021
• First Submitted That Met QC Criteria: May 11, 2021
• First Posted (Actual): May 17, 2021

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 28, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Keywords: Medicaid; Supplemental Nutrition Assistance Program; work requirements
• Other Study ID 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