Does the Supplemental Nutrition Assistance Program Affect Hospital Utilization Among Older Adults? The Case of Maryland.

Laura J Samuel,Ginger Zielinskie,Sarah L Szanton,Rachel Cahill,Jennifer L Wolff,Pinchuan Ong,Charles Betley

doi:10.1089/pop.2017.0055

Abstract

This study sought to examine whether Supplemental Nutrition Assistance Program (SNAP) participation and benefit levels are associated with reduced subsequent hospital and emergency department utilization in low-income older adults. Study participants were 68,956 Maryland residents aged ≥65 years who were dually enrolled in Medicare and Medicaid (2009–2012). Annual inpatient hospital days and costs and emergency department visits were modeled as a function of either 1-year lagged SNAP participation or lagged SNAP benefit amounts, controlling for sociodemographic characteristics, autoregressive effects, year, health status, and Medicaid participation. SNAP participation (adjusted odds ratio [aOR] = 0.96, 95% confidence interval [CI]: 0.93, 0.99), and, among participants, each $10 increase in monthly benefits (aOR = 0.99, 95% CI: 0.99–0.99) are associated with a reduced likelihood of hospitalization, but not emergency department use. The authors estimate that enrolling the 47% of the 2012 population who were eligible nonparticipants in SNAP could have been associated with $19 million in hospital cost savings. Accounting for the strong effects of health care access, this study finds that SNAP is associated with reduced hospitalization in dually eligible older adults. Policies to increase SNAP participation and benefit amounts in eligible older adults may reduce hospitalizations and health care costs for older dual eligible adults living in the community.

Highlights

One third of US older adults, comprising 13 million older adults, currently live on incomes less than 200% of the poverty level, according to Census data
This study sought to examine whether Supplemental Nutrition Assistance Program (SNAP) participation and benefit levels are associated with reduced subsequent hospital and emergency department utilization in low-income older adults
Accounting for the strong effects of health care access, this study finds that SNAP is associated with reduced hospitalization in dually eligible older adults

Summary

Introduction

One third of US older adults, comprising 13 million older adults, currently live on incomes less than 200% of the poverty level, according to Census data. Disparities exist among older adults who have health insurance through Medicare,[1] and are not attributable to access to primary care providers.[3,4] One study found that non–health sector resources are associated with a reduced risk of hospital readmission in low-income older adults,[5] suggesting that social determinants of health affect hospital utilization. SNAP provided, on average, $129 in supplemental monthly income for an average of 1.3 people in an older adult household in 2014.6 This transfer comprises a relatively large supplemental income source for these adults, whose average monthly gross income was $876.6 by targeting financial support toward food needs, SNAP can improve access to a higher quality diet for food insecure adults.[7] There is evidence of reduced caloric intake, poorer dietary quality,[8] and greater risk of hypoglycemia[9] for low-income adults at the end of the month when funds run low. Because adults with food insecurity often report cost-related medication nonadherence and difficulty paying bills,[11,12] food assistance may allow them to use their limited money for medications and other health-related necessities

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