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NCT Number: NCT04888832

The Effect of Work Requirements in SNAP in Virginia

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.

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Key information

Age range

18 year–49 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Virginia Department of Social Services (Home Office)

Glen Allen, Virginia, 23060, United States

Location status: Recruiting

Location contact

Heeju Jang-Paulsen

CONTACT

[email protected]

About this study

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.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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)

Treatment and study plan

Work requirement exemption months

Other

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

Primary outcomes

  1. SNAP enrollment

    Time frame: Up to 24 months after randomization

    Collected administratively (DSS records)

  2. Employment status

    Time frame: Up to 24 months after randomization

    Collected administratively (VEC records)

  3. UI covered earnings

    Time frame: Up to 24 months after randomization

    Collected administratively (VEC records)

  4. Non-UI covered earnings

    Time frame: Up to 24 months after randomization

    Collected administratively (federal tax records)

Secondary outcomes

  1. Number of jobs held

    Time frame: Up to 24 months after randomization

    Collected administratively (DSS records)

  2. Medicaid participation

    Time frame: Up to 24 months after randomization

    Collected administratively (DSS records)

  3. Hospitalizations

    Time frame: Up to 24 months after randomization

    Collected administratively (Virginia Health Information)

  4. Credit scores

    Time frame: Up to 24 months after randomization

    Collected administratively (credit bureaus)

  5. Evictions

    Time frame: Up to 24 months after randomization

    Collected administratively (court records)

  6. Crime (records of charges, convictions)

    Time frame: Up to 24 months after randomization

    Collected administratively (court records)

  7. Food insecurity

    Time frame: Survey to be administered approximately 1 year after randomization begins

    Collected by survey

  8. Self-reported health

    Time frame: Survey to be administered approximately 1 year after randomization begins

    Collected by survey

  9. Depression score

    Time frame: Survey to be administered approximately 1 year after randomization begins

    Collected by survey

  10. Non-work community engagement activities

    Time frame: Survey to be administered approximately 1 year after randomization begins

    Collected by survey

  11. Forced moves, housing instability

    Time frame: Survey to be administered approximately 1 year after randomization begins

    Collected by survey

  12. Reasons for exiting SNAP

    Time frame: Survey to be administered approximately 1 year after randomization begins

    Collected by survey

  13. Barriers to employment

    Time frame: Survey to be administered approximately 1 year after randomization begins

    Collected by survey

  14. Hours worked per week

    Time frame: Survey to be administered approximately 1 year after randomization begins

    Collected by survey

  15. Difficulty paying medical bills

    Time frame: Survey to be administered approximately 1 year after randomization begins

    Collected by survey

  16. Uninsurance

    Time frame: Survey to be administered approximately 1 year after randomization begins

    Collected by survey

Study contacts

Contact information is provided by the study sponsor or research team.

Adrianna McIntyre, PhD

CONTACT

[email protected]

5863068889

Timothy J Layton, PhD

CONTACT

[email protected]

573-353-1566

Sponsors and collaborators

Lead sponsor

Harvard Medical School (HMS and HSDM)

Other

Collaborators

  • Abdul Latif Jameel Poverty Action Lab
  • National Institute on Minority Health and Health Disparities (NIMHD)

Registry information

Official study title

Disparities in Medicaid and SNAP Participation: the Effects of Work Requirements and the COVID-19 Pandemic

Important dates

Study start
2024
Primary completion
2025
Study completion
2026
First posted
May 17, 2021
Registry last updated
Mar 5, 2025

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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