Association for Public Policy Analysis & Management

Existing studies of the health effects of food assistance programs have primarily focused on diet and nutrition (Butler & Raymond 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 Supplemental Nutrition Assistance Program (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 Electronic Benefit Transfer (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 whose health conditions make them sensitive to daily fluctuations in nutritional intake, such as pregnant women.

We examine linked administrative data from SNAP and Medicaid for the state of Missouri over the 2008-2010 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. We examine how the date of SNAP issuance changes the probability that a pregnant woman will go to the emergency room. We find that women who receive SNAP benefits in the third week of the calendar month are less likely to submit a pregnancy-related ER claim in the third or fourth week of the month than they are earlier in the month.  This pattern is not observed among women who receive SNAP in the first week of the month. Additionally, using multivariate analysis, we find women who receive high levels of SNAP benefits are less likely to submit an ER claim. 

 Results from this study 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.