Poster #60 - State SNAP Benefit Reductions and Food Insufficiency Among Medicare–Medicaid Dual-Eligible Beneficiaries

• In Event: Friday Poster Reception

Abstract

During the COVID-19 pandemic, Supplemental Nutrition Assistance Program (SNAP) Emergency Allotments increased benefits to the maximum level for each household size to alleviate food insecurity. However, states terminated this provision at different times between 2021 and 2023, creating substantial state-level variation in benefit generosity. This paper examines the impact of state-level termination of SNAP Emergency Allotments on food insufficiency and broader material hardship, such as difficulty paying for usual household expenses, among Medicare–Medicaid dual-eligible beneficiaries.

Individuals enrolled in both Medicare and Medicaid, known as Medicare–Medicaid dual-eligible beneficiaries, represent a high-need population because they tend to have greater medical complexity and fewer financial resources than other Medicare beneficiaries. Food insecurity in this group is closely linked to medication non-adherence and preventable hospitalization.

SNAP Emergency Allotments expired nationwide in February 2023, although 18 states terminated benefits earlier. I use this policy variation to implement a staggered difference-in-differences (DiD) design proposed by Callaway and Sant’Anna (2021). The study uses data from the Household Pulse Survey (Weeks 25–53; February 2021–January 2023). The analytic sample includes 22,864 respondents who reported enrollment in both Medicare and Medicaid and participation in SNAP. Models include state and survey-week fixed effects, and event-study specifications were used to assess dynamic treatment effects and pre-trends.

The termination of SNAP Emergency Allotments increased food insufficiency by 10.0 percentage points (95% CI: 0.2–19.7; p = 0.046), representing a relative increase of approximately 36% from baseline. Event-study estimates indicate that this adverse effect emerged with a lag of two to three months. In contrast, the estimated increase in difficulty paying for usual household expenses (3.8 percentage points) was not statistically significant (p = 0.27). This study contributes to the literature on safety-net policy by providing evidence on how reductions in nutrition assistance affect material hardship among medically vulnerable populations.

These findings suggest that dual-eligible beneficiaries in early-terminating states absorbed the financial shock of Emergency Allotment termination primarily by reducing food consumption while maintaining other expenses. More broadly, the results highlight the policy implications of state-level discretion within a federal safety-net system. In a context where states have significant authority over safety-net implementation, variation in the timing of safety-net retrenchment can generate measurable disparities in material well-being among medically vulnerable populations. As the federal role shrinks and state discretion expands, understanding the consequences of state policy variation may be critical to preventing state policy decisions from exacerbating health and economic inequities and increasing downstream public healthcare costs.

Author

• Hyeryung Jo, Syracuse University
  Presenting Author