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：重大公共援助中的工作要求越来越普遍计划，从 2018 年开始，多个州已获得联邦批准政府要求就业或其他合格的“社区参与活动” 获得医疗补助覆盖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，这可能会带来更高的收益另一方面，工作要求的反对者则认为：许多低资源家庭将失去急需的福利，而没有相应的福利十多个州提出了新的医疗补助工作。过去一年的要求，但几乎没有严格的证据证明这些政策的效果我们提议在弗吉尼亚州进行一项工作要求的随机对照试验，利用国家支持免除部分医疗补助扩展参与者的医疗补助我们将能够区分执行的因果影响。弗吉尼亚州医疗补助计划的另外两个新功能的工作要求：额外我们的实验设计将使我们能够测试任何情况。我们将研究工作要求、奖金和验证要求之间的相互作用。每项政策对健康保险覆盖范围、获得护理、就业和就业的影响使用行政数据和新的受益人调查相结合的健康结果，我们将对几个感兴趣的人群进行过度抽样，包括少数种族/族裔和低收入群体在此过程中，我们将确定这些政策的总体政策影响，然后我们还将评估谁受每个组件的影响最大，以确定这些组件的影响医疗补助政策因种族、民族、社会经济和地理差异而发生变化。