Health DisparitiesNCT04888832
The Effect of Work Requirements in SNAP in Virginia
A study testing Work requirement exemption months in people with Health Disparities and Food Security, run by Harvard Medical School (HMS and HSDM) at 1 site in United States.
Trial 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. Read more about this study
- Who is it for?
- Ages 18 to 49 yearsHealthy volunteers can take part
- Conditions the study is for
- Health Disparities, Food Security
- What is being tested?
- Work requirement exemption months
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 12,500 participants
- Where
- 1 siteUnited States
- Study dates
- 1 Apr 2024to Dec 2026
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 49 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- 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)
Who cannot join
- 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)
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
United States1 site, 1 recruiting
- Recruiting
Virginia Department of Social Services (Home Office)
Glen Allen, Virginia, 23060
Heeju Jang-Paulsen, HeeJu.Jang-Paulsen@dss.virginia.gov
About this study
Official title: 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.
Read the 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.
- Conditions
- Health Disparities, Food Security
- Being tested
- Work requirement exemption months
- Keywords
- Supplemental Nutrition Assistance Program, work requirements, Medicaid
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Work requirement exemption monthsOther
Also called Change to recertification timeline
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.
| Study group | Role | What they receive |
|---|---|---|
| Control Group | No intervention | No change to work requirements or recertification period |
| Intervention Group 1 | Active comparator | Standard 6-month recertification period, additional 6-month work requirement exemption Receives: Other: Work requirement exemption months |
| Intervention Group 2 | Active comparator | Standard 6-month recertification period, additional 12-month work requirement exemption Receives: Other: Work requirement exemption months |
| Intervention Group 3 | Active comparator | Standard 6-month recertification period, additional 12-month work requirement exemption Receives: Other: Work requirement exemption months |
| Intervention Group 4 | Active comparator | 12-month recertification period (6-month extension), additional 6-month work requirement exemption Receives: Other: Work requirement exemption months |
What is being measured
The primary outcome is the main question the study is designed to answer.
SNAP enrollment
Collected administratively (DSS records)
Measured: Up to 24 months after randomization
Employment status
Collected administratively (VEC records)
Measured: Up to 24 months after randomization
UI covered earnings
Collected administratively (VEC records)
Measured: Up to 24 months after randomization
Non-UI covered earnings
Collected administratively (federal tax records)
Measured: Up to 24 months after randomization
Secondary outcomes (16)
Number of jobs held
Collected administratively (DSS records)
Measured: Up to 24 months after randomization
Medicaid participation
Collected administratively (DSS records)
Measured: Up to 24 months after randomization
Hospitalizations
Collected administratively (Virginia Health Information)
Measured: Up to 24 months after randomization
Credit scores
Collected administratively (credit bureaus)
Measured: Up to 24 months after randomization
Evictions
Collected administratively (court records)
Measured: Up to 24 months after randomization
Crime (records of charges, convictions)
Collected administratively (court records)
Measured: Up to 24 months after randomization
Food insecurity
Collected by survey
Measured: Survey to be administered approximately 1 year after randomization begins
Self-reported health
Collected by survey
Measured: Survey to be administered approximately 1 year after randomization begins
Depression score
Collected by survey
Measured: Survey to be administered approximately 1 year after randomization begins
Non-work community engagement activities
Collected by survey
Measured: Survey to be administered approximately 1 year after randomization begins
Forced moves, housing instability
Collected by survey
Measured: Survey to be administered approximately 1 year after randomization begins
Reasons for exiting SNAP
Collected by survey
Measured: Survey to be administered approximately 1 year after randomization begins
Barriers to employment
Collected by survey
Measured: Survey to be administered approximately 1 year after randomization begins
Hours worked per week
Collected by survey
Measured: Survey to be administered approximately 1 year after randomization begins
Difficulty paying medical bills
Collected by survey
Measured: Survey to be administered approximately 1 year after randomization begins
Uninsurance
Collected by survey
Measured: Survey to be administered approximately 1 year after randomization begins
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted17 May 2021
- Study start1 Apr 2024
- Primary completion1 May 2025 (estimated)
- Study completionDec 2026 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Health DisparitiesStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- None (open label)
- Enrolment
- 12,500 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Harvard Medical School (HMS and HSDM)
- Sponsor type
- University, hospital or other
- Collaborators
- Abdul Latif Jameel Poverty Action Lab, National Institute on Minority Health and Health Disparities (NIMHD)
- Responsible party
- Principal investigator, Tim Layton, Harvard Medical School (HMS and HSDM)
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT04888832
- Sponsor's protocol ID
- IRB19-0859
- Other IDs
- 5R01MD014970-02
- Status last verified
- Feb 2025
- First submitted
- 7 May 2021
- Last updated
- 5 Mar 2025
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Study at a glance
From the registry record, last updated by the sponsor on 5 Mar 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Disparities in Medicaid and SNAP Participation: the Effects of Work Requirements and the COVID-19 Pandemic
- ClinicalTrials.gov ID
- NCT04888832
- Acronym / sponsor ID
- IRB19-0859
- Conditions
- Health Disparities, Food Security
- Keywords
- Supplemental Nutrition Assistance Program, work requirements, Medicaid
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 12,500 participants (estimated)
- Lead sponsor
- Harvard Medical School (HMS and HSDM)University, hospital or other
- Collaborators
- Abdul Latif Jameel Poverty Action Lab, National Institute on Minority Health and Health Disparities (NIMHD)
- Study start
- 1 Apr 2024 (actual)
- Primary completion
- 1 May 2025 (estimated)
- Study completion
- Dec 2026 (estimated)
- First posted
- 17 May 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- None (open label)
- Number of arms
- 5
| Arm | Type | Receives |
|---|---|---|
| Control Group | No intervention | –No change to work requirements or recertification period |
| Intervention Group 1 | Active comparator | Other: Work requirement exemption monthsStandard 6-month recertification period, additional 6-month work requirement exemption |
| Intervention Group 2 | Active comparator | Other: Work requirement exemption monthsStandard 6-month recertification period, additional 12-month work requirement exemption |
| Intervention Group 3 | Active comparator | Other: Work requirement exemption monthsStandard 6-month recertification period, additional 12-month work requirement exemption |
| Intervention Group 4 | Active comparator | Other: Work requirement exemption months12-month recertification period (6-month extension), additional 6-month work requirement exemption |
Who may qualify
- Ages
- 18 to 49 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (1 listed)
- 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)
Key exclusion criteria (1 listed)
- 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)
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Work requirement exemption monthsAlso: Change to recertification timelineCross-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 | Intervention Group 1, Intervention Group 2, Intervention Group 3, Intervention Group 4 |
Primary outcome
SNAP enrollment
Time frame: Up to 24 months after randomization
Collected administratively (DSS records)
Employment status
Time frame: Up to 24 months after randomization
Collected administratively (VEC records)
UI covered earnings
Time frame: Up to 24 months after randomization
Collected administratively (VEC records)
Non-UI covered earnings
Time frame: Up to 24 months after randomization
Collected administratively (federal tax records)
16 secondary outcomes
Number of jobs held
Time frame: Up to 24 months after randomization
Medicaid participation
Time frame: Up to 24 months after randomization
Hospitalizations
Time frame: Up to 24 months after randomization
Credit scores
Time frame: Up to 24 months after randomization
Evictions
Time frame: Up to 24 months after randomization
Crime (records of charges, convictions)
Time frame: Up to 24 months after randomization
Food insecurity
Time frame: 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
Depression score
Time frame: 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
Forced moves, housing instability
Time frame: 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
Barriers to employment
Time frame: 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
Difficulty paying medical bills
Time frame: Survey to be administered approximately 1 year after randomization begins
Uninsurance
Time frame: Survey to be administered approximately 1 year after randomization begins
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 5 Mar 2025.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Work requirement exemption months in people with Health Disparities and Food Security, run by Harvard Medical School (HMS and HSDM) at 1 site in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 5 Mar 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Timothy J Layton, PhD (573-353-1566, Layton@hcp.med.harvard.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
SNAP enrollment (time frame: Up to 24 months after randomization). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 Mar 2025.