New SNAP Eligibility in California Associated With Improved Food Security and Health

 

In a recent Preventing Chronic Disease article, Hilary Seligman, MD, MAS and colleagues detail their findings from the first study to explore changes in food security among Supplemental Security Income (SSI) recipients before and after new eligibility for the Supplemental Nutrition Assistance Program (SNAP) in California. 

SNAP is the largest federally funded food assistance program operated by the US Department of Agriculture, effectively improving food access, reducing food insecurity, and decreasing poverty among eligible low-income households. A robust body of literature demonstrates that SNAP also improves health outcomes.

In California, beneficiaries of SSI — low-income older adults and adults with disabilities — have not been eligible to receive SNAP benefits. Instead, these populations have been able to use a cash benefit provided by SSI to cover food expenses. However, the value of this cash benefit has not increased over time. Thus, many SSI recipients who were otherwise eligible for SNAP benefits because of low household income were excluded in California. California Assembly Bill 1811 reversed this eligibility policy, effective June 1, 2019, with SNAP uptake rates high after the policy change.

Given the positive effect of SNAP in other populations, the researchers sought to determine whether this policy change was associated with changes in food insecurity and health among people receiving SSI in California.

Most SSI recipients that Seligman and colleagues sampled had successfully enrolled in SNAP in response to the June 2019 policy change. Overall, compared with participants at baseline, participants at follow-up were more food secure and had better general health status, a lower weekly food budget shortfall, less use of free food programs, and less cost-related medication non-adherence.

Seligman and colleagues found the difference in outcomes between those who received SNAP benefits and those who did not was minimal, possibly as a result of a small number of participants who did not receive SNAP which may be due to robust outreach and SNAP being desirable in this population. However, participants who received higher SNAP benefit levels reported lower weekly food budget shortfalls and a smaller percentage of participants at follow-up used free food program resources, suggesting that improvements observed were not related to use of programs other than SNAP.

New food security was associated with lower levels of stress but not with improvements in other health outcomes, including general health status, number of unhealthy days, reliance on free food programs, or trade-offs between food and other basic necessities. Therefore, although minimal improvement in food insecurity, possibly as a result of SNAP enrollment, has numerous benefits, the researchers’ findings suggest that additional improvements in health, lifestyle, and dietary intake may require higher benefit levels or additional interventions. The researchers did not observe improvements in dietary intake associated with the policy change. Low-income older adults and adults with disabilities often have additional barriers to healthy dietary intake in addition to food insecurity, thus, SNAP benefits may be necessary but not sufficient for improving dietary intake in this population. Qualitative interviews shed some light on these barriers; publication of these results is forthcoming.

Disability is one of the strongest risk factors for food insecurity.  Seligman and colleagues found that expansion of SNAP benefits to SSI recipients was associated with improved food security. Thus, interventions such as expansion of SNAP eligibility may be particularly important for reducing inequities in health outcomes in this population.

Hilary Seligman, MD, MAS

Hilary Seligman, MD, MAS is Professor at the University of California San Francisco with appointments in the Departments of Medicine and of Epidemiology and Biostatistics. Dr. Seligman is core faculty at the Philip R. Lee Institute for Health Policy Studies where she directs National Clinician Scholars Program at UCSF. Dr. Seligman is an expert in food insecurity and its health implications across the life course. Her policy and advocacy expertise focus on federal nutrition programs (particularly SNAP), food banking and the charitable food network, hunger policy, food affordability and access, and income-related drivers of food choice. She directs the Food Policy, Health, and Hunger Research Program at UCSF’s Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and the CDC’s Nutrition and Obesity Policy, Research and Evaluation Network. She also serves as Senior Medical Advisor for Feeding America.

New SNAP Eligibility in California Associated With Improved Food Security and Health.

Wang M, Levi R, Seligman H. Prev Chronic Dis. 2021 Apr 1;18:E28. doi: 10.5888/pcd18.200587