Supplemental Nutrition Assistance Program Policy Research Articles

State expansion of Supplemental Nutrition Assistance Program eligibility and rates of firearm-involved deaths in the United States

IntroductionPoverty is a consistent correlate of firearm-involved mortality, yet little work has considered the effects of social and economic policies on these deaths. This study examined associations of state elimination...

Association of state policies modifying Supplemental Nutrition Assistance Program (SNAP) eligibility and cancer stage at diagnosis.

214 Background: Food insecurity is associated with access to care and is particularly prevalent among adolescents and young adults (AYA) with cancer. The Supplemental Nutrition Assistance Program (SNAP) was designed to minimize food insecurity for low-income households. Under the broad-based categorial eligibility (BBCE) policy, states were given the ability to relax requirements for qualifying for SNAP through increasing the income limit or eliminating the asset test. While most SNAP policy changes under the BBCE policy occurred from 2009-2011, it is unknown whether these policies affect access to care among AYA with cancer. We sought to determine whether state SNAP eligibility policies were associated with stage at diagnosis among AYA patients. Methods: We utilized the Surveillance, Epidemiology, and End Results database to obtain data from 2006-2019 for newly diagnosed patients with cancer ages 18-39 years from 11 states. All cancer types were included with the exception of liquid tumors and other unstaged cancers. Difference-in-differences analyses were utilized to evaluate changes in the percentage of localized and distant stage diagnoses from pre- to post-policy enactment between states that enacted (1) asset test elimination or (2) increased income limit policies. Linear probability models were adjusted for state and year fixed effects, race, ethnicity, sex, metropolitan residence, marital status, county-level income, cancer type, and Medicaid expansion effects. We also accounted for state-level clustering via clustered standard errors. Event study analyses were utilized to assess the plausibility of the parallel trends assumption. Results: A total of 157,380 AYAs with cancer were identified. In adjusted difference-in-differences analyses, there was a 0.67 percentage point (PP) (95% CI = 0.15 to 1.19, P=.012) increase in localized stage cancer diagnoses and a -0.81 PP (95% CI = -1.41 to -0.21, P=.008) decrease in distant stage cancer diagnoses in states with increased income limits for SNAP eligibility relative to other states. There were no statistically significant changes in the percentage of localized (0.87 PP, 95% CI = -1.27 to 3.00, P=.43) or distant (0.05 PP, 95% CI = -1.44 to 1.55, P=.94) stage cancers with policies eliminating the asset test. Among patients with cervical cancer, where screening is recommended in this age group, there were extremely similar patterns. Conclusions: State policies increasing income eligibility limits for the Supplemental Nutrition Assistance Program were associated with a higher percentage of localized stage and a lower percentage of distant stage cancers among adolescents and young adults. These data add to a growing body of literature suggesting that policies that address social determinants of health may improve access to care.

State Supplemental Nutrition Assistance Program Policies and Substance Use Rates

Introduction. Food insecurity is associated with the development of substance misuse and use disorders (SUD). This study sought to estimate associations between state Supplemental Nutrition Assistance Program (SNAP) eligibility policies and substance-related outcomes. Methods. 2014-2017 SNAP Policy Database and 2015-2019 National Survey on Drug Use and Health state-level estimates were used to estimate associations between state SNAP eligibility policies and alcohol use disorder (AUD), opioid misuse, illicit drug use disorder (IDUD), SUD, and needing but not receiving SUD treatment. State SNAP policies included those that 1) do not disqualify individuals with a felony drug conviction from SNAP and/or 2) expand SNAP eligibility by increasing the income limit or removing the asset test. Analyses were conducted January-May 2023. Results. States that adopted both SNAP eligibility policies had reduced rates of AUD (adjusted rate ratio (aRR): 0.92; 95% CI0.86, 0.99), opioid misuse (aRR:0.94; 95% CI0.89, 0.98), IDUD (aRR:0.91; 95% CI0.85, 0.98), SUD (aRR:0.91; 95% CI0.85, 0.97), and needing but not receiving SUD treatment (aRR:0.92; 95% CI0.87, 0.98) compared to states with neither policy. Among states that did not adopt increases to the income limit or removal of the asset test, those that removed the felony drug disqualification had lower rates of IDUD, SUD, and needing but not receiving SUD treatment, compared to those that maintained a disqualification. Conclusions. Expanded SNAP eligibility could help reduce rates of substance misuse and SUD. Opting out of the federal disqualification on SNAP participation for those with felony drug convictions may be particularly beneficial.

State expansion of supplemental nutrition assistance program eligibility and rates of interpersonal violence

IntroductionFood insecurity is associated with an increased likelihood of interpersonal violence. The Supplemental Nutrition Assistance Program (SNAP) is the largest program addressing food insecurity in the U.S. States can eliminate the asset test and/or increase the income limit for SNAP eligibility, expanding the number of households receiving assistance. We examined the association of state elimination of the asset test and increases in the income limit with rates of interpersonal violence, including intimate partner violence (IPV), other relationship violence (violence by a parent, friend, etc.), and stranger violence. MethodsWe used data from the SNAP Policy Database and state-level estimates of rates of interpersonal violence per 1000 population ages ≥12 years from the 2012–2014 to 2016–2018 National Crime Victimization Survey. ResultsStates that adopted both SNAP eligibility policies (eliminated the asset test and increased the income limit) had a lower rate of IPV (β = −0.4, 95% CI -0.9, 0.0) and other relationship violence (β = −2.4, 95% CI -3.8, −1.1) compared to states that did not adopt either policy. The rate of stranger violence (β = −0.5, 95% CI -2.3, 1.4) did not differ for states that adopted both policies compared to states that did not adopt either policy. Rates of IPV (β = −0.4, 95% CI -0.9, 0.2), other relationship violence (β = −1.2, 95% CI -3.2, 0.7), and stranger violence (β = −0.2, 95% CI -2.0, 1.6) did not differ for states that eliminated the asset test only compared to states that did not adopt either policy. ConclusionExpanding SNAP eligibility may help prevent interpersonal violence at the population-level.

The Association of Supplemental Nutrition Assistance Program Participation and Food Insufficiency among Households with Children in the United States during COVID-19

BackgroundAs the expansion of Supplemental Nutrition Assistance Program (SNAP) benefits and pandemic emergency assistance programs ended in late 2021, little is known about subsequent trends in food insufficiency (FI) among households with children. ObjectivesThis research examined the association between SNAP participation and FI among households with children in the United States, particularly non-Hispanic Black (Black) and Hispanic households. MethodsThis cross-sectional analysis used Household Pulse Survey data collected from December 2021 to May 2022. Spatial analysis was conducted to visualize FI and SNAP participation rates across 50 states. With state SNAP policy rules as exogenous instruments and sociodemographic factors as control variables, 2-stage probit models were utilized to assess the SNAP and FI association among all (n = 135,074), Black (n = 13,940), and Hispanic households with children (n = 17,869). ResultsApproximately 13.9% [95% confidence interval (CI): 13.85%, 13.99%] of households experienced FI, and 20.4% (CI: 20.35%, 20.51%) received SNAP benefits. Among Black and Hispanic households, higher rates were observed, with 23.3% (CI: 23.12%, 23.4%) and 20.8% (CI: 20.61%, 20.95%) experiencing FI and 36.3% (CI: 36.1%, 36.5%) and 26.9% (CI: 26.61%, 27.13%) receiving SNAP benefits. These rates varied across states, ranging from 8% (Utah) to 21.1% (Mississippi) for FI and from 8.8% (Utah) to 32.7% (New Mexico) for SNAP participation. SNAP participants demonstrated a 12% lower likelihood of FI than nonparticipants (CI: –0.18, –0.05, P < 0.001). Among Black households, SNAP participants had a 29% lower likelihood of FI than nonparticipants (CI: –0.54, –0.03, P < 0.001). However, SNAP participation was not significant among Hispanic households (P = 0.99), nor did it narrow the FI gap between Hispanic and non-Hispanic households (P = 0.22). ConclusionsSNAP participation was associated with lower levels of FI among households with children, particularly for Black households. However, there was no significant association between SNAP participation and FI among Hispanic households with children.

State expansion of Supplemental Nutrition Assistance Program eligibility and rates of foster care entries

BackgroundState expansion of Supplemental Nutrition Assistance Program (SNAP) eligibility under broad-based categorical eligibility (BBCE) is associated with decreases in household poverty and food insecurity, child protective services investigations, and mental health and substance use disorders among adults, key contributors to foster care entry. ObjectiveTo examine the association of state expansion of SNAP eligibility under BBCE with rates of foster care entries. ParticipantsFoster care entries among children ages <18 years. MethodsWe used 2005–2019 data from the SNAP Policy Database and the Adoption and Foster Care Analysis and Reporting System (AFCARS). We conducted difference-in-differences analyses and generated event study plots adjusting for state economic conditions (percent population unemployed, median household income) and policies (minimum wage, refundable Earned Income Tax Credits, maximum Temporary Assistance for Needy Families benefit for a family of 3). ResultsOn average, there were 1.8 fewer foster care entries (95 % confidence interval (CI) −2.8, −0.8) per 1000 children per year in states that expanded SNAP eligibility than there would have been if they had not expanded eligibility. Average decreases in foster care entries were similar among young (−1.7 per 1000 children per year, 95 % −3.1, −0.3) and school-age (−1.8 per 1000 children per year, 95 % CI −2.7, −0.8) children and larger among Black non-Hispanic (−5.6 per 1000 children per year, 95 % CI −9.1, −2.0) than among White non-Hispanic (−1.4 per 1000 children per year, 95 % CI −2.2, −0.6) children. The magnitude of these decreases increased with greater time since policy adoption. ConclusionsResults add to growing evidence that programs and policies that support and stabilize household economic and material conditions may contribute to reductions in foster care entries at the population-level.

Moving policies toward racial and ethnic equality: The case of the supplemental nutrition assistance program*

AbstractWe analyze the role played by the Supplemental Nutrition Assistance Program (SNAP) in alleviating or exacerbating inequality across racial and ethnic groups in food expenditures and in the resources needed to meet basic food needs (the “food resource gap”). To do this, we propose a simple framework that decomposes differences across groups in SNAP benefit transfer levels into three components: eligibility, participation, and generosity. This decomposition is then linked to differences in food expenditures and the food resource gap. Our results reveal that among the three components, differences in eligibility contribute the most to SNAP benefits differentials for Black and Hispanic households relative to White households. Given that SNAP is often a target of policy changes, we employ the framework to provide counterfactual analyses of how selected SNAP policy changes can impact group differences in benefits and, ultimately, disparities in food expenditures and the food resource gap. The proposed framework can be applied to analyze other safety net programs.

Association of State Supplemental Nutrition Assistance Program Eligibility Policies With Adult Mental Health and Suicidality

Food insecurity is associated with an increased likelihood of poor mental health and suicidality. The Supplemental Nutrition Assistance Program (SNAP) is the largest program addressing food insecurity in the US; under broad-based categorical eligibility (BBCE), states have the option to expand SNAP eligibility to a greater number of households by eliminating the asset test or increasing the income limit for eligibility. To examine the association of state elimination of the asset test and increases in the income limit for SNAP eligibility with rates of mental health and suicidality outcomes among adults. This ecological cross-sectional study used 2014 to 2017 data on US adults from the National Vital Statistics System and 2015 to 2019 data on US adults from the National Survey on Drug Use and Health (NSDUH) State-Level Small Area Estimates. Analyses were conducted between September and November 2022. State elimination of the asset test only and state adoption of both SNAP eligibility policies (ie, state elimination of the asset test and increases in the income limit) for 2014 to 2017 from the SNAP Policy Database. Number of adults with a past-year major depressive disorder, mental illness, serious mental illness, or suicidal ideation and number of adults who died by suicide. Analyses included 407 391 adult NSDUH participants and 173 085 adults who died by suicide. State elimination of the asset test only was associated with decreased rates of past-year major depressive episodes (rate ratio [RR], 0.92; 95% CI, 0.87-0.98) and mental illness (RR, 0.91; 95% CI, 0.87-0.97) among adults. State adoption of both SNAP eligibility policies (ie, state elimination of the asset test and increases in the income limit) was associated with decreased rates of past-year major depressive episodes (RR, 0.92; 95% CI, 0.86-0.99), mental illness (RR, 0.92; 95% CI, 0.87-0.98), serious mental illness (RR, 0.91; 95% CI, 0.84-0.99), and suicidal ideation (RR, 0.89; 95% CI, 0.82-0.96). Results suggested a decreased rate of suicide death (RR, 0.93; 95% CI, 0.84-1.02) in states with both policies compared with states with neither policy, although this result was not statistically significant. State adoption of policies that expand SNAP eligibility may contribute to decreased rates of multiple mental health and suicidality outcomes at the population level.

Political Party and Policy Choices: Explaining State Variation in SNAP Participation

ABSTRACT Although the majority of studies on the Supplemental Nutrition Assistance Program (SNAP) examine determinants of caseload size, we identify drivers of variation in SNAP participation rates between states, with a special focus on state-level political dynamics and policy implementation choices made by states. Using a panel regression analysis of state-specific administrative policies, as well as political and demographic variables spanning a 20-year period, we find that the party in control of state government has a large impact on SNAP participation rates, and political control often interacts with and counteracts the effect of SNAP policies on enrolling eligible low-income residents.

Sugar sweetened beverage restriction or fruit and vegetable purchase incentive in Supplemental Nutrition Assistance Program (SNAP): Participant’s voice and choice behavior

ABSTRACT This mixed methods study assessed the perceptions of food choices among SNAP participants and SNAP-eligible non-participants when exposed to two alternative SNAP policy options: restrictions on sugar-sweetened beverages (SSBs) and incentives for fruit and vegetable (FV) purchases. Twelve focus groups that included a randomized food choice experiment were conducted in seven counties in Georgia, involving 73 participants. Participants had a favorable view toward incentivizing FV; responses toward SSB restrictions were mixed. FV incentives were associated with greater spending on FV and lower spending on SSBs, and SSB restriction was associated with lower spending on SSBs.

Association of State Expansion of Supplemental Nutrition Assistance Program Eligibility With Rates of Child Protective Services–Investigated Reports

States in the US have the option to eliminate the asset test and/or increase the income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility under a policy called broad-based categorical eligibility (BBCE). Given associations of economic hardships, including food insecurity, with child protective services (CPS) involvement, state adoption of these policies may be associated with changes in rates of CPS-investigated reports. To examine the association of state elimination of the asset test and increases in the income limit for SNAP eligibility under BBCE with rates of CPS-investigated reports. This cross-sectional ecologic study used data from 2006 to 2019 obtained from the SNAP Policy Database and the National Child Abuse and Neglect Data System Child Files and difference-in-differences analyses. The data were analyzed from March to September 2022. The study used CPS-investigated reports for suspected child abuse and neglect from 37 US states to examine elimination of the asset test, from 36 states to examine increases in the income limit, and from 26 states to examine adoption of both policies. State elimination of the asset test, increases in the income limit, and adoption of both policies to expand SNAP eligibility. Number of CPS-investigated reports, overall and specifically for neglect and physical abuse, per 1000 child population. From 2006 to 2019 for all 50 states and the District of Columbia, there were a total of 29 213 245 CPS-investigated reports. By race and ethnicity, 19.8% of CPS-investigated reports were among non-Hispanic Black children and 45.7% among non-Hispanic White children (hereafter referred to as Black and White children). On average, there were 8.2 fewer CPS-investigated reports (95% CI, -12.6 to -4.0) per 1000 child population per year in states that eliminated the asset test, 5.0 fewer CPS-investigated reports (95% CI, -10.8 to 0.7) per 1000 child population per year in states that increased the income limit, and 9.3 fewer CPS-investigated reports (95% CI, -15.6 to -3.1) per 1000 child population per year in states that adopted both SNAP policies than there would have been if these states had not adopted these policies. There were decreases in CPS-investigated reports for neglect in states that adopted either or both policies, and small decreases in CPS-investigated reports for physical abuse in states that increased the income limit or adopted both policies. There were decreases in CPS-investigated reports among both Black and White children. For example, there were 6.5 fewer CPS-investigated reports among Black children (95% CI, -14.6 to 1.6) and 8.7 fewer CPS-investigated reports among White children (95% CI, -15.8 to -1.6) in states that adopted both SNAP policies than there would have been if these states had not adopted these policies. Results from this cross-sectional study suggest that state expansion of SNAP eligibility through elimination of the asset test and increases in the income limit may contribute to decreases in rates of CPS-investigated reports. These results can inform ongoing debates regarding SNAP policy options, specifically BBCE, and prevention efforts for child abuse and neglect.

THE EFFECT OF SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM GENEROSITY ON DEPRESSIVE SYMPTOMS AMONG OLDER AMERICANS

Abstract Food insecurity has been indicated to associate with more depressive symptoms. Supplemental Nutrition Assistance Program (SNAP) is an established anti-poverty government program that targets food insecurity. The goal of this study was to assess whether SNAP generosity, defined at the state level, impacts the relationship of food insecurity and depressive symptoms among older Americans. We linked state-level SNAP policy data to the individual-level data of older adults (aged 60+) from the longitudinal Health and Retirement Study (Nf12,801). Our study baseline was survey year 2000. A state is considered SNAP generous when it eliminates income/assets limit from its SNAP eligibility criteria. All HRS participants reported their food insecurity status and depressive symptoms biennially. Participants were followed until 2018. We conducted state fixed-effect models adjusted for demographic and health measures. Results indicate household food insecurity was associated with higher risk of elevated depressive symptoms (OR=1.83, 95%CI=1.61, 2.07) from a fixed effect logistic model, and this effect was stronger when living in non-generous states compared with generous states though confidence intervals were too wide to be conclusive (OR_interaction =1.09, 95% CI= 0.83, 1.42). The relative excess risk due to interaction (RERI) was 0.17 (95%CI= -0.30, 0.63). Our study finding suggested that there is no to weak evidence that state-level SNAP generosity may alleviate or offset the risk of depressive symptoms associated with food-insecurity.

Association Between State Supplemental Nutrition Assistance Program Policies, Child Protective Services Involvement, and Foster Care in the US, 2004-2016

Public assistance policies may play a role in preventing child maltreatment by improving household resources among families of low incomes. The Supplemental Nutrition Assistance Program (SNAP) is one of the largest public assistance programs in the US. However, the association of state SNAP policy options to Child Protective Services (CPS) outcomes has not been rigorously examined. To model the association of state SNAP policies with changes in CPS and foster care outcomes in the US over time. This cohort study used panel data to examine the association between SNAP policy options and study outcomes from 2004 to 2016 for 50 US states and the District of Columbia in 2-way fixed-effects regression models. The count of SNAP policies was used as an instrument for SNAP caseloads in instrumental variables models. Data analysis was conducted in November 2021. The adoption of 1 or more state SNAP income generosity policies that improves or stabilizes household resources for SNAP participants. Reports of child maltreatment accepted for CPS investigation, children in substantiated reports, and children receiving foster care services for all forms of maltreatment, and specifically for child neglect per 100 000 child population. The mean (SD) number of SNAP income generosity policies increased from 1.47 (0.95) in 2004 to 2.37 (0.94) in 2010, to 2.49 (0.86) in 2016 across states; the median increased from 1 to 3 (range, 0-4) over the same period. A count of state income generosity policies was associated with large reductions in reports accepted for CPS investigation (-352.6 per 100 000 children; 95% CI, -557.1 to -148.2). Income generosity policy was associated with -94.8 (95% CI, -155.6 to -34.0) fewer substantiated reports and -77.0 (95% CI, -125.4 to -28.6) fewer reports substantiated for neglect per 100 000. Each additional income generosity policy adopted by a state was associated with -45.1 (95% CI, -71.6 to -18.5) to -42.3 (95% CI, -64.8 to -19.8) fewer total foster care placements per 100 000 children. State SNAP policies that improve and stabilize household resources appear to be associated with reductions in CPS involvement and use of foster care. The number of policies implemented had cumulative outcomes beyond individual policy outcomes.

Decisions that matter: State Supplemental Nutrition Assistance Program policy restrictiveness limits SNAP participation rate

AbstractObjectiveThe Supplemental Nutrition Assistance Program (SNAP) offers free benefits to qualifying individuals, but participation varies greatly from state to state. We explore the impact of SNAP administration policies, political factors, and socio‐demographic characteristics to explain this variation.MethodWe utilize a policy index that aggregates the effect of 10 SNAP administrative policies to evaluate the effects of policies over time on state SNAP participation rates.ResultsLess restrictive administrative policies are associated with increases in SNAP participation. Additionally, the unified Democratic control of state government, poverty, and unemployment all increase SNAP participation.ConclusionDifferences in SNAP state participation rates are not spurious. More restrictive administrative policies lower participation. Thus, SNAP policies are not purely “administrative” decisions; they can either work to encourage or discourage participation in the program.

Helping College Students Get Supplemental Nutrition Assistance Program: Facilitators of and Barriers to Students Accessing the Federal Nutrition Assistance Program

ObjectiveTo identify effective practices for assisting college students with Supplemental Nutrition Assistance Program (SNAP) applications and explore challenges in student SNAP enrollment. DesignIn-depth interviews with key informants on experiences assisting college students with SNAP applications. SettingUniversity of California campuses. ParticipantsTwenty-one key informants, including staff from the University of California on-campus Basic Needs Centers, campus financial aid offices, county agencies, and food banks. Phenomenon of InterestFacilitators and barriers of college student SNAP enrollment. AnalysisTranscripts were coded to identify emerging themes. ResultsTwo of the most frequently mentioned facilitators were county staff presence on campus for application assistance and a strong relationship between campus staff and the county SNAP agency. A common barrier was inconsistent student SNAP eligibility information and procedures across county offices. Conclusion and ImplicationsFederal coordination with state agencies on student SNAP policy is much needed. This approach could help to eliminate heterogeneous interpretations of student exemptions across counties and between county staff. Future research is warranted to identify policy leverage points at the county, state, and federal levels, such as eliminating the student rule, to ensure equitable access to SNAP among college students.

Do state Supplemental Nutrition Assistance Program policies influence program participation among seniors?

AbstractSenior participation in the Supplemental Nutrition Assistance Program (SNAP) has traditionally been lower than other groups among those eligible, with historical estimates below 50%. We examine the impacts of state SNAP policies on program participation among low‐income senior (age 60 and older) and nonsenior households using data from the 2001 to 2014 December Current Population Survey Food Security Supplement. Our results suggest that policies designed to expand SNAP eligibility modestly increased participation among seniors but led to larger increases among nonseniors. In contrast, we find little evidence of effects of policies related to transaction costs, stigma, or outreach on either group.

Changes in Supplemental Nutrition Assistance Program Policies and Diabetes Prevalence: Analysis of Behavioral Risk Factor Surveillance System Data From 2004 to 2014

Food insecurity is associated with diabetes. The Supplemental Nutrition Assistance Program (SNAP) is the largest U.S. government food assistance program. Whether such programs impact diabetes trends is unclear. The objective of this study was to evaluate the association between changes in state-level policies affecting SNAP participation and county-level diabetes prevalence. We evaluated the association between change in county-level diabetes prevalence and changes in the U.S. Department of Agriculture SNAP policy index-a measure of adoption of state-level policies associated with increased SNAP participation (higher value indicating adoption of more policies associated with increased SNAP participation; range 1-10)-from 2004 to 2014 using g-computation, a robust causal inference methodology. The study included all U.S. counties with diabetes prevalence data available from the Centers for Disease Control and Prevention's U.S. Diabetes Surveillance System. The study included 3,135 of 3,143 U.S. counties. Mean diabetes prevalence increased from 7.3% (SD 1.3) in 2004 to 9.1% (SD 1.8) in 2014. The mean SNAP policy index increased from 6.4 (SD 0.9) to 8.2 (SD 0.6) in 2014. After accounting for changes in demographic-, economic-, and health care-related variables and the baseline SNAP policy index, a 1-point absolute increase in the SNAP policy index between 2004 and 2014 was associated with a 0.050 (95% CI 0.042-0.057) percentage point lower diabetes prevalence per year. State policies aimed at increasing SNAP participation were independently associated with a lower rise in diabetes prevalence between 2004 and 2014.

Supplemental nutrition assistance program 2009 expansion and cardiometabolic markers among low-income adults

A 2009 Supplemental Nutrition Assistance Program (SNAP) policy change that expanded eligibility and increased benefit amounts has been associated with reduced food insecurity. This study tests the hypothesis that the SNAP policy change corresponds with improved stress- and nutrition-sensitive cardiometabolic markers. This study included non-pregnant participants aged 18–59 with annual family incomes ≤185% of the federal poverty guideline from the repeated cross-sectional NHANES study. Those living in SNAP eligible households (income ≤130% of the poverty guideline) were compared to those who were likely non-eligible (income 131%–≤185%). Difference-in-differences analyses compared hemoglobin A1c (%), CRP (mg/dL), total cholesterol (mg/dL), LDL (mg/dL) and waist circumference (cm) across groups before (2007–2008) and after (2009–2010) the SNAP policy change. Sampling weights were applied. Adjusting for demographic, socioeconomic, household and health factors, there were statistically significant difference-in-differences estimates for hemoglobin A1c (p = 0.003, n = 3723) and total cholesterol (p = 0.028, n = 3710). SNAP eligible adults had no difference in hemoglobin A1c after the policy change and, among those less than 40 years of age, 5 mg/dL lower total cholesterol levels whereas likely non-SNAP eligible adults had 0.14% higher hemoglobin A1c and no difference in total cholesterol after the policy change. The 2009 SNAP expansion was associated with improved nutrition-sensitive cardiometabolic markers in SNAP-eligible adults. This study found less of an upward trend in hemoglobin A1c levels for young and middle aged adults and decreased total cholesterol for young adults. These results highlight the potential role of SNAP to prevent costly chronic conditions among low-income U.S. adults.

The Effects of Changing SNAP Work Requirement on the Health and Employment Outcomes of Able-Bodied Adults without Dependents

Objective The Supplemental Nutrition Assistance Program (SNAP) provides nutritional assistance for United States residents with low income. Current SNAP policy discussion focuses on its work requirement: the Able Bodied Adults without Dependents (ABAWDs) time limit. This study sets out to analyze the effects the work requirement has on ABAWDs’ health and employment status. Methods States can apply a waiver on the ABAWD work requirement if they can establish a labor surplus. Many states had this waiver expired due to economic recovery after the 2008 economic crisis. This study took advantage of a recent natural experiment created by states’ differentiated timelines in phasing out the three-month waiver and applies a triple-differences approach to study the effects of the SNAP work requirement, using data from the Behavioral Risk Factor Surveillance System, 2015–2016. Results SNAP-eligible individuals, including ABAWDS, had more serious physical and mental health conditions compared with higher income individuals. Losing SNAP eligibility increased the incidence of experiencing physically unhealthy days by 14% (p < 0.05) but caused no significant change in employment status. Conclusions The ABAWD time limit on SNAP may have negative consequences when there are insufficient opportunities for employment or positions in governmental Employ and Training programs. More studies are needed to better understand the reason for high SNAP participation even when the unemployment rate suggested a strong economy in 2015–2016. Decision-makers should be cautious in removing SNAP eligibility for ABAWDs or states’ time-limit waivers.

Do State Snap Policies Influence Program Participation Among Seniors?

Senior participation in the Supplemental Nutrition Assistance Program (SNAP) has traditionally been lower than other groups among those eligible, with historical estimates below 50 percent. We examine the impacts of state SNAP policies on program participation among low-income senior (age 60 and older) and non-senior households using data from the 2001-2014 December Current Population Survey Food Security Supplement. Our results suggest that policies designed to expand SNAP eligibility modestly increased participation among seniors but led to larger increases among non-seniors. In contrast, we find little evidence of effects of policies related to transaction costs, stigma, or outreach on either group. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.