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

基本信息

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
项目类别：
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

项目摘要

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：在主要公共援助中，工作要求变得越来越普遍计划，从2018年开始，几个州已获得联邦政府的批准政府需要就业或其他合格的“社区参与活动” 获得医疗补助覆盖范围。支持工作要求的人认为这些政策增加受益人参与工作和社区活动，这可能会导致更高收入和更好的健康。另一方面，工作要求的选项表明许多低资源家庭将失去急需的好处，而不会相称改善就业。超过十几个国家提出了新的医疗补助工作过去一年的要求，但是几乎没有关于这些政策影响的严格证据在公共计划中。我们建议在弗吉尼亚州进行工作要求的随机对照试验，利用国家支持豁免部分医疗补助扩张的支持州即将进行的工作要求。我们将能够分开执行的因果影响弗吉尼亚医疗补助计划的其他两个新功能的工作要求：附加验证要求和保费。我们的实验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。我们将学习每项政策对健康保险范围，获得护理，就业的影响以及使用管理数据和新的受益人调查的健康成果，我们将超过几个感兴趣的人群，包括种族/族裔少数民族和低收入人群农村居民。在这样做的过程中，我们将确定这些政策的总体政策影响，我们还将评估谁受到每个组件最大的影响，以确定这些影响的影响医疗补助政策对种族，种族，社会经济和地理差异的变化。