The Virginia Work Requirements Experiment

Last registered on July 02, 2019


Trial Information

General Information

The Virginia Work Requirements Experiment
Initial registration date
June 21, 2019

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
July 02, 2019, 4:23 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.


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Primary Investigator

Harvard Medical School

Other Primary Investigator(s)

PI Affiliation
Harvard Medical School
PI Affiliation
University of Virginia
PI Affiliation
Harvard Medical School
PI Affiliation

Additional Trial Information

In development
Start date
End date
Secondary IDs
Work requirements are increasingly common in major public assistance programs, initially implemented in cash support (TANF) and food assistance (SNAP) programs, and starting in 2018 in Medicaid. Proponents of work requirements contend that these policies increase beneficiary engagement in work and community activities and may lead to better health. Opponents of work requirements suggest that many low-resource households will lose much-needed benefits, without commensurate improvements in employment. There is limited evidence on the causal impact of work requirements in modern public assistance programs, even as more than a dozen states have proposed new Medicaid work requirements in the past year. We propose a randomized-controlled trial (RCT) of work requirements in Virginia, leveraging state support for the RCT evaluation. We will be able to separate the causal impact of work requirements from another new feature of Virginia’s Medicaid program: monthly premiums. We will study impacts of both policies on employment, earnings, insurance status, and access to care using a mix of administrative and survey-collected data.
External Link(s)

Registration Citation

Gray, Colin et al. 2019. "The Virginia Work Requirements Experiment." AEA RCT Registry. July 02.
Former Citation
Gray, Colin et al. 2019. "The Virginia Work Requirements Experiment." AEA RCT Registry. July 02.
Experimental Details


In 2020, Virginia will begin requiring beneficiaries to participate in at least 80 hours a month of employment or other “community engagement” activities to maintain coverage. With support from the state’s Medicaid agency, we will conduct a randomized controlled trial studying the impacts of this policy on coverage, access to care, employment, and health, with a particular focus on changes in racial/ethnic and geographic disparities in these outcomes.
Intervention Start Date
Intervention End Date

Primary Outcomes

Primary Outcomes (end points)
1. Disenrolled from Medicaid
2. Employed
3. Uninsured
4. Delays in Care Due to Cost
5. Number of Hospitalizations
6. Number of Office Visits
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The study will consist of four distinct treatment arms. These arms are the result of two cross-randomized interventions: a two-armed design (I, II) randomizing work requirements, and a two-armed design (A, B) randomizing the concurrent implementation of Medicaid premiums.
Experimental Design Details
Not available
Randomization Method
Randomization done in office by a computer
Randomization Unit
Was the treatment clustered?

Experiment Characteristics

Sample size: planned number of clusters
100,000 households
Sample size: planned number of observations
150,000 individuals
Sample size (or number of clusters) by treatment arms
25,000 individuals premiums (Group IB), 25,000 individuals work requirements (Group IIA), 25,000 individuals control (Group IA). 75,000 individuals both work and premium requirements (Group IIB).
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)

Institutional Review Boards (IRBs)

IRB Name
Institutional Review Board of the Harvard Faculty of Medicine
IRB Approval Date
IRB Approval Number