Panel Paper: The ACA Medicaid Expansion and Participation in the Food Stamps Program

Friday, November 9, 2018
Wilson A - Mezz Level (Marriott Wardman Park)

*Names in bold indicate Presenter

Paulette Cha and José J. Escarce, University of California, Los Angeles

This study aims to determine whether Medicaid expansion under the ACA facilitates access to food stamps. We hypothesize that that children may gain access to food stamps through their adult family members’ Medicaid enrollment, and that any effect will be concentrated in states that jointly process Medicaid and food stamps.

We use data from the Current Population Survey December Basic Survey and the Food Security Supplement from 2010 to 2016 (IPUMS-CPS). In the period covered by this study, 32 states including DC expanded Medicaid. Our population includes approximately 125,000 individuals across all states with incomes under 138 percent of the federal poverty line, the threshold for adult Medicaid under the ACA. We use a triple-differences strategy to identify the combined effect of state Medicaid expansion and joint processing of Medicaid and SNAP on food stamps participation above and beyond the Medicaid expansion’s effect for states that do not process jointly. Our preferred model controls for individual characteristics, state-by-year unemployment, and includes full sets of state and year fixed effects.

We estimate a 4.4 percentage point increase in food stamps participation attributable to joint processing in Medicaid expansion states, or an increase of about 9 percent above the 48.8 mean percent participation rate in our study population. This estimate is significant at the 95 percent level of confidence using standard errors robust to heteroskedasticity and clustered by state. Further, we find that the effects are concentrated among those in families with children.

Based on these results, we conclude that the Medicaid expansion—in addition to increasing health insurance coverage—connects low-income adults and their families to food stamps. The food stamps program is one of the most effective poverty reduction programs for low-income families, and exposure to the program has been shown to produce positive health consequences for children (Alaimo et al. 2001, Casey et al. 2001). Moreover, recent work has found that children exposed to food stamps have reduced incidence of metabolic syndrome in adulthood (Hoynes et al. 2016). This knowledge and our findings suggest that the ACA Medicaid expansion to adults will eventually be understood to be a multi-generational investment in public health.