This project will examine the impact of losing Supplemental Nutrition Assistance Program (SNAP) benefits on healthcare outcomes and healthcare disparities based on race/ethnicity and disability. Racial/ethnic minorities and people with disabilities experience healthcare disparities in the areas of disease prevention and management, unfavorable clinical events, and acute healthcare expenditures. Food insecurity may affect these disparities: food insecure individuals forgo needed care and medications more often, use emergency and inpatient care more often, and require higher expenditures than food secure individuals. Meanwhile, racial/ethnic minorities and people with disabilities are 2.2 and 2.8 times as likely to be food insecure as non- minorities and people without disabilities, respectively, face starker tradeoffs between food and resources such as housing, and have greater sensitivity to food insecurity given greater economic and health vulnerabilities. SNAP has been shown to reduce food insecurity and is disproportionately utilized by racial/ethnic minorities and people with disabilities. SNAP policy changes could therefore affect healthcare outcomes for racial/ethnic minorities and people with disabilities in different ways than for others. For example, initial studies by our team and others suggest SNAP may reduce poor healthcare outcomes and Medicaid expenditures, particularly for people with disabilities. However, these studies were limited to population-level or cross- sectional data, and all studied non-random changes to SNAP. Further, no studies have examined the effects of SNAP on healthcare disparities empirically. In this project, we exploit a natural experiment in which arbitrary errors in the Massachusetts eligibility evaluation system caused 75,200 SNAP recipients to receive arbitrary terminations despite actually still being eligible. Moreover, because of recent legislation in the state, we will have access to comprehensive longitudinal SNAP, medical claims, and other public health data on the entire state population. Using these linked data and growth curve modeling, we will examine the impact of losing SNAP benefits on healthcare outcomes and disparities related to disease prevention and management (Aim 1), unfavorable clinical events (Aim 2), and healthcare expenditures (Aim 3). We hypothesize SNAP losses are associated with worse healthcare outcomes and elevated racial/ethnic and disability-based disparities. Cuts to SNAP benefits are routinely debated, but there is limited information on how benefit losses for current recipients would affect healthcare outcomes. Our study will help fill this gap. More broadly, programs like SNAP target determinants of health and healthcare disparities, yet their potential effects on these outcomes have received minimal study. By adding to this literature, our analyses will further the NIH Health Disparities Strategic Plan?s goal of supporting ?research on the factors underlying health disparities.?
Food insecurity is widespread in the United States and is associated with worsened healthcare outcomes, particularly for racial/ethnic minorities and people with disabilities. The Supplemental Nutrition Assistance Program (SNAP, formerly the ?Food Stamp Program?) has been shown to reduce food insecurity, but little is known about the relationship between SNAP and healthcare outcomes and disparities, with no studies using rigorous causal methods on individual-level data. Capitalizing on a natural experiment created when tens of thousands of Massachusetts SNAP recipients had their benefits arbitrarily terminated due to errors in the state?s eligibility evaluation system, as well as a unique set of linked SNAP, Medicaid, and public health department data from Massachusetts, this project will examine the effects of SNAP on preventive healthcare utilization (Aim 1), unfavorable clinical events (Aim 2), and healthcare expenditures (Aim 3).
