Association for Public Policy Analysis & Management

The degree to which food assistance programs such as SNAP have a positive effect on the health of program participants is of great interest to policy makers, who are faced with difficult decisions about whether to expand or contract household benefit amounts and alter eligibility determinants. Existing studies of the health effects of food assistance programs have primarily focused on diet and nutrition (Butler & Raymong 1996; Yen 2010), mental health (Heflin & Ziliak 2008), and the incidence of weight gain or obesity among program participants compared to income-eligible non-participants (Kaushal 2007; Leung, Willett, & Ding 2012). A separate but related literature has examined the relationship between food insufficiency and health outcomes, with particular focus on diet and nutrition (Lyles et al. 2013), mental health (Laraia, Siega-Riz, Gundersen, & Dole 2006;), obesity (Wilde & Peterman 2006), diabetes (Berkowitz et al. 2013; Lyles et al. 2013), and, to a much smaller degree, health care costs (Lee 2012).

There is good reason to expect that SNAP benefits have immediate impacts on participant health because they provide qualifying households with additional means to purchase food on a monthly basis. However, it is well established that low-income households experience a monthly “pay cycle” where income or near-income benefits are depleted before the end of the month. Evidence from EBT records suggests that the average SNAP household has exhausted most of their benefits by the end of the third week of the month. Income constraints at the end of a monthly pay or benefit cycle may limit food consumption and trigger health problems for individuals who have certain health conditions, such as diabetes.

We examine linked administrative data from SNAP and Medicaid for the state of Missouri over the 2008-2011 time period to examine the relationship between receipt of SNAP benefits and monthly patterns in emergency room admissions for Medicaid recipients.  Missouri is the only state in the nation to issue SNAP benefits over a 22 day period; payment date is based on the first letter of the household head’s last name and month of birth. Following Seligman et al. (2014), we compare hospital admissions for hypoglycemia (low blood sugar), a condition that is sensitive to daily food intake, to hospital admissions for appendicitis, which is expected to be unrelated to food intake. We expect that the timing of SNAP benefits affects the likelihood of emergency room admissions for hypoglycemia but does not alter the likelihood of admissions for appendicitis among Missouri Medicaid recipients.

Results from this study will offer strong empirical evidence about the health benefits of SNAP participation.  Additionally, the study will speak to the importance of programmatic decisions, such as the timing of the issuance of program benefits, which may have significant consequences for recipients.