Work Requirements and Health Care Disparities in Medicaid: A RandomizedControlled Trial

医疗补助中的工作要求和医疗保健差异：随机对照试验

• 批准号: 10307098
• 负责人: Timothy Layton
• 金额: $ 27.35万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-07 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10307098
• 关键词: Adult; Advocate; Affect; Affordable Care Act; Awareness; Caring; Cessation of life; Communities; Data; Drug Prescriptions; Education; Employment; Enrollment; Ethnic Origin; Experimental Designs; Family; Federal Government; Financial Hardship; Health; Health Insurance; Health Services Accessibility; Health Status; Healthcare; Hour; Household; Income; Individual; Insurance; Insurance Coverage; Lead; Low income; Measures; Medicaid; Medical; Medical Assistance; Mental Health; Mental Health Services; Outcome; Patient Self-Report; Policies; Population; Poverty; Primary Health Care; Public Assistance; Qualifying; Race; Randomized; Randomized Controlled Trials; Reporting; Research Design; Resources; Risk; Services; Surveys; Testing; Uninsured; United States Centers for Medicare and Medicaid Services; Virginia; Work; base; beneficiary; community engagement; disparity reduction; ethnic disparity; ethnic minority; experience; geographic disparity; health care availability; health care disparity; health disparity; improved; interest; lens; outcome prediction; physical conditioning; poverty reduction; programs; racial and ethnic; racial and ethnic disparities; racial disparity; racial minority; rural Americans; rural area; rural disparities; rural dwellers; socioeconomic disparity; suburb; waiver

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.

项目摘要/摘要： 工作要求在主要公共援助中变得越来越普遍 计划，从2018年开始，几个州已经获得了联邦政府的批准 政府须规定就业或其他合资格的“社区参与活动” 获得医疗补助覆盖范围。工作要求的支持者认为，这些政策 增加受益人对工作和社区活动的参与度，这可能会导致更高的 收入和更好的健康。另一方面，反对工作要求的人认为 许多资源不足的家庭将失去急需的福利，而没有相应的福利。 就业情况有所改善。十多个州已经提出了新的医疗补助工作 过去一年的要求，但关于这些政策的效果几乎没有严格的证据 在公共节目中。我们建议在弗吉尼亚州进行一项工作要求的随机对照试验， 利用州政府的支持，免除部分医疗补助扩展参与者的 国家迫在眉睫的工作要求。我们将能够区分执法的因果影响 弗吉尼亚州医疗补助计划的另外两个新功能的工作要求：附加 验证要求和保费。我们的试验性设计将使我们能够测试任何 工作要求、保费和验证要求之间的相互作用。我们会研究 每项政策对医疗保险覆盖范围、获得护理的机会、就业和 使用管理数据和新的受益者调查的组合的健康结果，我们将 对若干感兴趣的人群进行过抽样，包括少数族裔和低收入人群 农村居民。在此过程中，我们将确定这些政策的整体政策影响，我们 还将评估受每个组件影响最大的人员，以确定这些组件的影响 针对种族、民族、社会经济和地理差异的医疗补助政策变化。