- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04888832
The Effect of Work Requirements in SNAP in Virginia
March 24, 2023 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
Not yet recruiting
Conditions
Intervention / Treatment
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 (Anticipated)
12500
Phase
- 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
- 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
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
Ages Eligible for Study
18 years to 49 years (Adult)
Accepts Healthy Volunteers
Yes
Genders Eligible for Study
All
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 |
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
|
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:
|
Active Comparator: Intervention Group 2
Standard 6-month recertification period, additional 12-month work requirement exemption
|
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:
|
Active Comparator: Intervention Group 3
Standard 6-month recertification period, additional 12-month work requirement exemption
|
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:
|
Active Comparator: Intervention Group 4
12-month recertification period (6-month extension), additional 6-month work requirement exemption
|
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:
|
What is the study measuring?
Primary Outcome Measures
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
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.
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 (Anticipated)
July 1, 2023
Primary Completion (Anticipated)
December 1, 2024
Study Completion (Anticipated)
December 1, 2024
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 27, 2023
Last Update Submitted That Met QC Criteria
March 24, 2023
Last Verified
March 1, 2023
More Information
Terms related to this study
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
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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