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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how work requirements for public assistance programs like Medicaid and SNAP affect insurance coverage, job participation, and health outcomes. Researchers focus on whether these requirements impact racial or geographic disparities, especially during the COVID-19 pandemic. Participants will be divided into groups, with some receiving exemptions from work requirements for different lengths of time, known as "work requirement exemption months." The trial seeks individuals eligible for Virginia's SNAP program as "able-bodied adults without dependents" who are currently subject to these work requirements. As an unphased trial, this study provides a unique opportunity to contribute to understanding the broader impacts of policy changes on community health and well-being.

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 prior data suggests that these work requirement policies are safe for public program participants?

Research shows that work requirements, such as those in the SNAP (Supplemental Nutrition Assistance Program), do not directly affect health like a drug would. Instead, these rules can influence access to food and healthcare. Studies have found that SNAP's strict work rules can quickly reduce the number of people receiving benefits, potentially limiting their access to food and healthcare. However, no clear evidence indicates that these rules help people find jobs.

This trial examines the effects of different exemptions from work requirements. These exemptions do not cause physical harm, as they are not medical treatments. The main concern is their impact on participation in public programs and access to resources. In short, the exemptions themselves are safe, but not having these requirements could alter how people access important services. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how adjusting work requirements for food security programs might impact participants' well-being. Unlike the traditional approach, which often mandates consistent work requirements, this trial tests the effects of exempting individuals from these requirements for extended periods. By varying the exemption duration and recertification periods across different groups, researchers hope to understand how these changes could improve food security and stability for participants. This investigation could lead to more flexible, supportive policies that better address the needs of individuals relying on food security programs.

What evidence suggests that this trial's treatments could be effective for improving food security and health outcomes?

Research has shown that work requirements in public programs like SNAP do not help people find jobs. Studies have found that these requirements can actually make it harder for people to access food and healthcare by reducing their benefits. While some evidence suggests that SNAP might discourage work in certain situations, overall, work requirements have not effectively increased employment rates. Data shows no major changes in job outcomes when these requirements are used. This trial will compare different approaches, including a control group with no changes to work requirements and various intervention groups with different work requirement exemption periods, to evaluate their impact on food security and employment outcomes. Therefore, the success of these requirements in reaching their goals remains uncertain. ^{2 3 4 6 7}

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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]

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]

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]

Citations

1. cbpp.org cbpp.org/research/food-assistance/worsening-snaps-harsh-work-requirement-would-take-food-assistance-away

Worsening SNAP's Harsh Work Requirement Would Take ... SNAP's Harsh Work Requirement Takes Food Assistance Away, Does Not Improve Employment Outcomes. Under current SNAP rules, most adults aged 18 ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6727315/

The Effects of SNAP Work Requirements in Reducing ... SNAP work requirements rapidly reduce caseloads and benefits, reducing food and health access. Effects on participation could be similar for work requirements ...

3. aei.org aei.org/research-products/report/snap-and-employment-what-is-the-evidence/

SNAP and Employment: What Is the Evidence? Broadly, the evidence indicates that SNAP can disincentivize work and that work requirements may help address that problem in certain contexts ...

4. www2.census.gov www2.census.gov/library/working-papers/2024/adrm/ces/CES-WP-24-54.pdf

The Effect of Food Assistance Work Requirements on Labor ... We find that at the ABAWD age cutoff, there is no statistically significant evidence of a discontinuity across static and dynamic employment outcomes. At the ...

5. brookings.edu brookings.edu/articles/snap-cuts-in-the-one-big-beautiful-bill-act-will-significantly-impair-recession-response/

SNAP cuts in the One Big Beautiful Bill Act will significantly ... OBBBA ended exemptions from time limit work requirements for veterans, those experiencing homelessness, and former foster care youth.

6. fns.usda.gov fns.usda.gov/snap/work-requirements

SNAP Work Requirements SNAP has two sets of work requirements, the general work requirements and the able bodied adult without dependents (ABAWD) work requirements.

7. kff.org kff.org/medicaid/medicaid-waiver-tracker-approved-and-pending-section-1115-waivers-by-state/

Medicaid Waiver Tracker: Approved and Pending Section ... This page tracks approved and pending Section 1115 waiver provisions (including expansions and restrictions) related to eligibility, benefits, ...