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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

Status
Recruiting
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT04888832
Enrollment
12500
Registered
2021-05-17
Start date
2024-04-01
Completion date
2026-12-31
Last updated
2025-03-05

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Food Security, Health Disparities

Keywords

Supplemental Nutrition Assistance Program, work requirements, Medicaid

Brief 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.

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.

Interventions

OTHERWork 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.

Sponsors

Abdul Latif Jameel Poverty Action Lab
CollaboratorOTHER
National Institute on Minority Health and Health Disparities (NIMHD)
CollaboratorNIH
Harvard Medical School (HMS and HSDM)
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
18 Years to 49 Years
Healthy volunteers
Yes

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)

Design outcomes

Primary

MeasureTime frameDescription
SNAP enrollmentUp to 24 months after randomizationCollected administratively (DSS records)
Employment statusUp to 24 months after randomizationCollected administratively (VEC records)
UI covered earningsUp to 24 months after randomizationCollected administratively (VEC records)
Non-UI covered earningsUp to 24 months after randomizationCollected administratively (federal tax records)

Secondary

MeasureTime frameDescription
EvictionsUp to 24 months after randomizationCollected administratively (court records)
Crime (records of charges, convictions)Up to 24 months after randomizationCollected administratively (court records)
Food insecuritySurvey to be administered approximately 1 year after randomization beginsCollected by survey
Self-reported healthSurvey to be administered approximately 1 year after randomization beginsCollected by survey
Depression scoreSurvey to be administered approximately 1 year after randomization beginsCollected by survey
Non-work community engagement activitiesSurvey to be administered approximately 1 year after randomization beginsCollected by survey
Number of jobs heldUp to 24 months after randomizationCollected administratively (DSS records)
Reasons for exiting SNAPSurvey to be administered approximately 1 year after randomization beginsCollected by survey
Barriers to employmentSurvey to be administered approximately 1 year after randomization beginsCollected by survey
Hours worked per weekSurvey to be administered approximately 1 year after randomization beginsCollected by survey
Difficulty paying medical billsSurvey to be administered approximately 1 year after randomization beginsCollected by survey
UninsuranceSurvey to be administered approximately 1 year after randomization beginsCollected by survey
Forced moves, housing instabilitySurvey to be administered approximately 1 year after randomization beginsCollected by survey
Medicaid participationUp to 24 months after randomizationCollected administratively (DSS records)
HospitalizationsUp to 24 months after randomizationCollected administratively (Virginia Health Information)
Credit scoresUp to 24 months after randomizationCollected administratively (credit bureaus)

Countries

United States

Contacts

Primary ContactTimothy J Layton, PhD
Layton@hcp.med.harvard.edu573-353-1566
Backup ContactAdrianna McIntyre, PhD
amcintyre@g.harvard.edu5863068889

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026