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

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

Study Contact Backup

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:
  • Change to recertification timeline
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:
  • Change to recertification timeline
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:
  • Change to recertification timeline
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:
  • Change to recertification timeline

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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