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.
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
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Enrollment
12,500
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.
Virginia Department of Social Services (Home Office)
Glen Allen, Virginia, United States
RECRUITINGSNAP enrollment
Collected administratively (DSS records)
Time frame: Up to 24 months after randomization
Employment status
Collected administratively (VEC records)
Time frame: Up to 24 months after randomization
UI covered earnings
Collected administratively (VEC records)
Time frame: Up to 24 months after randomization
Non-UI covered earnings
Collected administratively (federal tax records)
Time frame: Up to 24 months after randomization
Number of jobs held
Collected administratively (DSS records)
Time frame: Up to 24 months after randomization
Medicaid participation
Collected administratively (DSS records)
Time frame: Up to 24 months after randomization
Hospitalizations
Collected administratively (Virginia Health Information)
Time frame: Up to 24 months after randomization
Credit scores
Collected administratively (credit bureaus)
Time frame: Up to 24 months after randomization
Evictions
Collected administratively (court records)
Time frame: Up to 24 months after randomization
Crime (records of charges, convictions)
Collected administratively (court records)
Time frame: Up to 24 months after randomization
Food insecurity
Collected by survey
Time frame: Survey to be administered approximately 1 year after randomization begins
Self-reported health
Collected by survey
Time frame: Survey to be administered approximately 1 year after randomization begins
Depression score
Collected by survey
Time frame: Survey to be administered approximately 1 year after randomization begins
Non-work community engagement activities
Collected by survey
Time frame: Survey to be administered approximately 1 year after randomization begins
Forced moves, housing instability
Collected by survey
Time frame: Survey to be administered approximately 1 year after randomization begins
Reasons for exiting SNAP
Collected by survey
Time frame: Survey to be administered approximately 1 year after randomization begins
Barriers to employment
Collected by survey
Time frame: Survey to be administered approximately 1 year after randomization begins
Hours worked per week
Collected by survey
Time frame: Survey to be administered approximately 1 year after randomization begins
Difficulty paying medical bills
Collected by survey
Time frame: Survey to be administered approximately 1 year after randomization begins
Uninsurance
Collected by survey
Time frame: Survey to be administered approximately 1 year after randomization begins
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