Overview
The Supplemental Nutrition Assistance Program (SNAP)-the largest food program administrated by the U.S. Department of Agriculture (USDA)-is an effective tool to combat food insecurity and related negative impacts on health. By facilitating easier access to SNAP benefits throughout the COVID-19 pandemic, states are helping mitigate poor health outcomes for millions of Americans. This article highlights new evidence on the relationship between SNAP enrollment and reduced Medicaid costs and details how state Medicaid agencies can leverage contracts with Medicaid managed care organizations (MCOs) to advance SNAP enrollment.
SNAP Participation Is Linked to Better Outcomes and Lower Medicaid Spending
The severe health and economic crises brought on by the COVID-19 pandemic upended a decades-long decline in America's rate of food insecurity.1 In 2020, more than 38 million Americans (11.8 percent) lived in households that lacked access to nutritionally adequate food, a nine percent increase from 2019.2 The pandemic also exacerbated existing racial inequities-2020 food insecurity rates among Black and Latino households were triple and double the rate of white households, respectively.3
The federal government modified SNAP eligibility and enhanced benefits to reduce hardship for households struggling to get enough food. In March 2020, the Families First Coronavirus Response Act temporarily suspended the three-month cap on SNAP benefits for unemployed adults without children and allowed states to offer additional emergency allotments to many SNAP households. The USDA also offered states select administrative flexibilities to make it easier for individuals to apply for and maintain SNAP benefits, including waiving applicant interviews and application processing requirements. Nearly all states pursued available flexibilities, actions that state agencies report have made it easier to facilitate and maintain SNAP enrollment.
By taking steps to address food insecurity during the pandemic, states are doing much more than protecting families from hunger-increasing SNAP participation can reduce negative health outcomes. The link between inadequate access to nutritional food and poor health is well established. Food insecurity is associated with behavioral health conditions in children,4, 5 increased rates of diabetes6 and hypertension7 in adults, and a greater likelihood of poor health in seniors.8
Newly published research shows that SNAP participation can also lower Medicaid costs. A North Carolina-based study of more than 115,000 adults ages 65 and older found that higher SNAP enrollment is associated with fewer hospital and long-term care admissions and a decrease in emergency room visits-an estimated $2,360 annual reduction in Medicaid spending per person.9
Medicaid Managed Care Can Serve as a Vehicle to Promote SNAP Enrollment
Despite the positive connection between SNAP participation and overall health, pre-pandemic estimates show that about one in six Americans eligible for SNAP do not participate in the program. To further advance SNAP enrollment, states can leverage their MCO contract requirements. As evidenced by Manatt Health's recent report and corresponding 50-state survey titled "In Pursuit of Whole Person Health: A Review of Social Determinants of Health (SDOH) Initiatives in Medicaid Managed Care Contracts and 1115 Waivers," many states identify food insecurity as a priority SDOH domain, with 24 states requiring MCOs to address food insecurity as part of their contractual obligations.
For example, New Hampshire's MCOs are required to help individuals with unmet resource needs, including food insecurity, by facilitating referrals, assisting with the completion and submission of applications, and developing relationships that actively link members to supports. Plans are also required to report to the state the number of service referrals provided to members. Similarly, as part of population health management requirements, MCOs in Michigan must identify individuals experiencing food insecurity, refer members to appropriate resources, and annually measure and report on the effectiveness of their interventions to the state.
While many states have made the connection between access to nutritional food and better health, requirements that explicitly direct MCOs to link individuals to SNAP benefits are still emerging. Out of the 21 states that require health plans to coordinate with and connect members to state and federal public benefit programs, only Texas, Rhode Island and North Carolina specify SNAP as one of such programs in their contracts. Texas requires its MCOs to make best efforts to establish relationships with SNAP, among other programs, to help facilitate member referrals. Health plans in Rhode Island must provide individuals with direct assistance or support services to access SNAP and other programs offering support for basic necessities. Most directly, North Carolina requires its MCOs to provide in-person assistance-including filling out and submitting applications-for SNAP and other programs that can improve health and family well-being.
Conclusion
Increasing SNAP enrollment not only improves access to nutritionally adequate food but also reduces poor health outcomes and health care costs. Through their Medicaid managed care contracts, states can promote SNAP participation by requiring MCOs to help individuals enroll in SNAP benefits and report on their outcomes. State interest in levers to increase SNAP participation is likely to grow, particularly given the program's essential role in improving health and supporting an equitable pandemic recovery.
Footnotes
1 Feeding America. "The Impact of the Coronavirus on Food Insecurity in 2020 & 2021." March 2021. Available here.
2 USDA Economic Research Service. "Household Food Insecurity in the United States in 2020." September 2021. Available here.
3 Ibid.
4 Whitaker R.C., Phillips S.M., Orzol S.M. "Food Insecurity and the Risks of Depression and Anxiety in Mothers and Behavior Problems in Their Preschool-Aged Children." Pediatrics. 2006; 118(3): e859-68. Available here.
5 Huang J., Oshima K.M., Kim Y. "Does Food Insecurity Affect Parental Characteristics and Child Behavior? Testing Mediation Effects." Soc Serv Rev. 2010; 84(3): 381-401. Available here.
6 Seligman H.K., Bindman A.B., Vittinghoff E., Kanaya A.M., Kushel M.B. "Food Insecurity is Associated with Diabetes Mellitus: Results from the National Health Examination and Nutritional Examination Survey (NHANES) 1999-2002." J Gen Intern Med. 2007; 22(7): 1018-23. Available here.
7 Stuff J.E., Casey P.H., Szeto K.L., Gossett J.M., Robbins J.M., Simpson P.M., et al. "Household Food Insecurity is Associated with Adult Health Status." J Nutr. 2004; 134(9): 2330-5. Available here.
8 Lee J.S., Frongillo E.A. "Nutritional and Health Consequences Are Associated with Food Insecurity among U.S. Elderly Persons." J Nutr. 2001; 131(5): 1503-9. Available here.
9 Berkowitz S.A., Palakshappa D., Rigdon J., Seligman H.K., Basu S. "Supplemental Nutrition Assistance Program Participation and Health Care Use in Older Adults." Ann Internal Med. October 2021. Available here.
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