The Trump Administration seeks to require that low-income adults using public benefit programs like Medicaid meet work requirements or lose their benefits. These policies have been under active consideration by federal and state policy officials and under review by the courts. Since work requirements had not been adopted in Medicaid before 2018, there was no direct evidence of their effects. To analyze the potential effects of work requirements in Medicaid, we evaluated the impact of similar requirements in the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps). We analyzed the consequences of gradually adopting SNAP work requirement in 2,410 counties across the country from 2012 to 2017. Longitudinal two-way fixed effects models estimated that work requirements rapidly caused more than one third of targeted participants to lose benefits.
This analysis formed a basis for state-specific estimates of the impact in nine states that had been approved by the federal government to adopt Medicaid work requirements under special demonstration project waivers. The timing of policy development and implementation and of simultaneous legal challenges required a rapid and innovative approach to policy analysis, based on evaluating the effects in a similar public benefit program for low-income adults. To communicate to diverse technical, policy, and legal audiences, we developed a multipart dissemination strategy that included publication in a respected peer-reviewed journal, a policy brief/blog and inclusion in a legal amicus curiae brief submitted to a federal court of appeals.