# Work Requirements and Health Care Disparities in Medicaid: A Randomized  Controlled Trial

> **NIH NIH R01** · HARVARD MEDICAL SCHOOL · 2021 · $578,222

## Abstract

Project Summary/Abstract:
 Work requirements are becoming increasingly common in major public assistance
programs, and starting in 2018, several states have received approval from the federal
government to require employment or other qualifying “community engagement activities” to
obtain Medicaid coverage. 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. More than a dozen states have proposed new Medicaid work
requirements in the past year, but there is little rigorous evidence on the effects of these policies
in public programs. We 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 impending work requirements. We will be able to separate the causal impact of enforcing
a work requirement from two other new features of Virginia's Medicaid program: additional
verification requirements and premiums. Our experimental design will enable us to test for any
interactions between work requirements, premiums, and verification requirements. We will study
the impacts of each policy on health insurance coverage, access to care, employment, and
health outcomes using a mix of administrative data and a new beneficiary survey, and we will
oversample several populations of interest, including racial/ethnic minorities and low-income
rural residents. In doing so, we will identify the overall policy impacts of these policies, and we
will also assess who is most affected by each component to determine the impact of these
Medicaid policy changes on racial, ethnic, socioeconomic, and geographic disparities.

## Key facts

- **NIH application ID:** 10375831
- **Project number:** 7R01MD014970-03
- **Recipient organization:** HARVARD MEDICAL SCHOOL
- **Principal Investigator:** Timothy Layton
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $578,222
- **Award type:** 7
- **Project period:** 2020-01-07 → 2023-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10375831

## Citation

> US National Institutes of Health, RePORTER application 10375831, Work Requirements and Health Care Disparities in Medicaid: A Randomized  Controlled Trial (7R01MD014970-03). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10375831. Licensed CC0.

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