Work Requirements for Food Security

Overseen By Adrianna McIntyre, PhD

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: Harvard Medical School

Disqualifiers: Disability, Dependents, Waived work requirements, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

12500 Participants Needed

Trial Summary

What is the purpose of this trial?

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.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment 'Work requirement exemption months' for food security?

The study on food incentives for tuberculosis patients in Russia shows that providing food can significantly improve adherence to treatment among socially marginalized groups, suggesting that similar approaches could enhance food security by ensuring consistent access to food. ^{1 2 3 4 5}

How does the treatment 'Work Requirements for Food Security' differ from other treatments for food insecurity?

The 'Work Requirements for Food Security' treatment is unique because it involves implementing work requirements for participation in food assistance programs like SNAP, which can lead to reduced participation and benefits. Unlike other treatments that might focus on direct food provision or financial assistance, this approach ties eligibility to employment, potentially impacting access to food and health resources. ^{6 7 8 9 10}

Eligibility Criteria

This trial is for Virginia residents aged 18-49 who can work and don't have dependents, making them subject to SNAP's work requirements. It aims to understand how these rules affect health insurance coverage, job status, and food security.

Inclusion Criteria

I am between 18-49 years old and qualify for Virginia's SNAP as an able-bodied adult without dependents.

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)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants are assigned to different intervention groups with varying work requirement exemptions and recertification periods

12-24 months

Follow-up

Participants are monitored for outcomes such as SNAP enrollment, employment status, and health metrics

24 months

Treatment Details

Interventions

• Work requirement exemption months

Trial Overview The study examines the impact of giving some people extra months without SNAP work requirements. Researchers will see if this changes employment rates, health inequalities, or access to food during economic downturns like the COVID-19 crisis.

Participant Groups

Group I: Control Group Active Control 1 Intervention

No change to work requirements or recertification period

Group II: Intervention Group 1 Active Control 1 Intervention

Standard 6-month recertification period, additional 6-month work requirement exemption

Group III: Intervention Group 2 Active Control 1 Intervention

Standard 6-month recertification period, additional 12-month work requirement exemption

Group IV: Intervention Group 3 Active Control 1 Intervention

Standard 6-month recertification period, additional 12-month work requirement exemption

Group V: Intervention Group 4 Active Control 1 Intervention

12-month recertification period (6-month extension), additional 6-month work requirement exemption

Who Is Running the Clinical Trial?

Harvard Medical School

Lead Sponsor

Trials

30

Recruited

40,700+

Harvard Medical School (HMS and HSDM)

Lead Sponsor

Trials

208

Recruited

1,421,000+

Abdul Latif Jameel Poverty Action Lab

Collaborator

Trials

31

Recruited

273,000+

National Institute on Minority Health and Health Disparities (NIMHD)

Collaborator

Trials

473

Recruited

1,374,000+

Findings from Research

Implementing a co-designed mealtime assistance process in a 31-bed ward led to a significant reduction in wasted meals from an average of 3 per day to 0, which also decreased food waste by 0.43 kg per patient daily.

Patients who received mealtime assistance showed no new incidences of aspiration pneumonia or swallowing difficulties, indicating that the intervention not only improved meal access but also enhanced patient safety and nutritional outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing risk of development or exacerbation of nutritional deficits by optimizing patient access to mealtime assistance. Teeling, SP., Coetzee, H., Phillips, M., et al.[2020]

The project developed clinical indicators for nutrition interventions in high-risk patients across oncology, cardiovascular, and surgical settings, emphasizing timely nutrition support within specific timeframes after admission.

Key recommendations include ensuring no patient is on a clear-liquid diet without nutrition support for more than 5-7 days, and that patients at moderate or high risk receive proper nutrition assessments and care plans within 72 hours of admission.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Clinical indicators for oncology, cardiovascular, and surgical patients: report of the ADA Council on Practice Quality Assurance Committee. Queen, PM., Caldwell, M., Balogun, L.[2019]

A performance improvement process in a 28-bed ICU led to better patient outcomes by increasing the use of enteral nutrition over parenteral nutrition and starting nutrition support sooner.

The implementation of educational programs and a systematic approach resulted in meeting patients' protein and energy needs, ultimately enhancing nutrition support practices and achieving cost savings for the community hospital.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Enhanced enteral and parenteral nutrition practice and outcomes in an intensive care unit with a hospital-wide performance improvement process. Schwartz, DB.[2019]

Providing food incentives significantly improved adherence to tuberculosis (TB) drug treatment among homeless patients, with 59% of those receiving food continuing treatment without interruption compared to only 31% in a control group.

For patients who were part of the study for shorter periods, 95% adhered to their TB treatment while receiving food incentives, highlighting the effectiveness of this approach in supporting treatment compliance.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Food incentives improve adherence to tuberculosis drug treatment among homeless patients in Russia. Gärden, B., Samarina, A., Stavchanskaya, I., et al.[2022]

Nurse leaders emphasize that older patients require additional support to meet the new standards for hospital food in England.

The call for extra support highlights the importance of ensuring that nutritional needs are adequately addressed for older patients in hospital settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mandatory guidelines aim to raise quality of meals in hospital. Triggle, N.[2019]

The 1996 welfare reform bill limited noncitizens' access to the Food Stamp Program, which significantly impacted older immigrants' participation and food security, as shown in a study of 3,175 low-income older adults.

Older immigrants living in households with a higher percentage of eligible members were more likely to participate in the Food Stamp Program and experienced lower food insecurity, highlighting the importance of household composition in social policy development.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Welfare reform and older immigrants: food stamp program participation and food insecurity. Nam, Y., Jung, HJ.[2019]

The new rule allows food stamp households with Supplemental Security Income (SSI) applicants and recipients to apply for food stamp recertification at Social Security Administration (SSA) offices, providing greater accessibility.

This change is a response to a legal judgment in the case of James Campbell, et al. v. United States Department of Agriculture, et al., and aims to streamline the recertification process for many households.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Food stamp program; recertification of SSI households--Food and Nutrition Service, USDA. Final rule. [2000]

Implementing work requirements for the Supplemental Nutrition Assistance Program (SNAP) is linked to a significant decrease in participation, with a 21.2% reduction among childless adults without disabilities and a 7.8% reduction among those with disabilities.

The negative impact of these work requirements is more pronounced among non-Hispanic black and Hispanic adults, indicating potential racial disparities in access to food assistance and the associated health benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association of Work Requirements With Supplemental Nutrition Assistance Program Participation by Race/Ethnicity and Disability Status, 2013-2017. Brantley, E., Pillai, D., Ku, L.[2022]

The rescission of six federal waivers in 2019 significantly burdened Maryland SFSP sponsors, leading to increased workload, costs, and staffing challenges, as well as a reduction in the variety and number of meals served.

Sponsors expressed a strong need for state-level advocacy to apply for waivers in the future, highlighting the importance of collaboration between food authorities and antihunger advocates to improve summer meal programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Impact of Waivers on Summer Meal Participation in Maryland. Harper, K., Lu, SV., Gross, J., et al.[2022]

The implementation of work requirements in the Supplemental Nutrition Assistance Program (SNAP) led to a 3.0% decrease in total SNAP participation and a 4.5% decrease in SNAP households, affecting around 600,000 participants from 2013 to 2017.

These work requirements resulted in a significant reduction of approximately $2.5 billion in federal SNAP benefits in 2017, indicating that such policies can rapidly decrease access to food and health resources for vulnerable populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of SNAP Work Requirements in Reducing Participation and Benefits From 2013 to 2017. Ku, L., Brantley, E., Pillai, D.[2021]

References

1. England pubmed.ncbi.nlm.nih.gov

Reducing risk of development or exacerbation of nutritional deficits by optimizing patient access to mealtime assistance. [2020]

2. United States pubmed.ncbi.nlm.nih.gov

Clinical indicators for oncology, cardiovascular, and surgical patients: report of the ADA Council on Practice Quality Assurance Committee. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Enhanced enteral and parenteral nutrition practice and outcomes in an intensive care unit with a hospital-wide performance improvement process. [2019]

4. Sweden pubmed.ncbi.nlm.nih.gov

Food incentives improve adherence to tuberculosis drug treatment among homeless patients in Russia. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Mandatory guidelines aim to raise quality of meals in hospital. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Welfare reform and older immigrants: food stamp program participation and food insecurity. [2019]

7. United States pubmed.ncbi.nlm.nih.gov

Food stamp program; recertification of SSI households--Food and Nutrition Service, USDA. Final rule. [2000]

8. United States pubmed.ncbi.nlm.nih.gov

Association of Work Requirements With Supplemental Nutrition Assistance Program Participation by Race/Ethnicity and Disability Status, 2013-2017. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

The Impact of Waivers on Summer Meal Participation in Maryland. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

The Effects of SNAP Work Requirements in Reducing Participation and Benefits From 2013 to 2017. [2021]