Universal Free School Meals and Children's Health: Evidence from Pandemic-Era Federal Waivers

• In Event: Nutrition Assistance Policies: Changes, Participation, and Health Outcomes

Abstract

Background: Universal Free School Meals (UFSM) have gained increasing policy attention as a structural intervention to improve child nutrition, reduce food insecurity, and promote health equity. During the COVID-19 pandemic, federal waivers (March 2020–June 2022) allowed all U.S. schools to provide free meals, substantially expanding access. Following waiver expiration, some states continued UFSM while others reverted to charging for meals, creating a natural experiment. While prior research shows that UFSM increases school meal participation, less is known about its downstream effects on modifiable diabetes risk factors, including weight status, food hardship, mental health, and health behaviors. 

Methods: This study uses nationally representative cross-sectional data from the National Survey of Children’s Health (2020–2023) (N=103,206) to assess how the expiration of pandemic-era UFSM waivers affected children’s health outcomes. Outcomes include receipt of free/reduced-price school meals, weight status(overweight/obesity), household food hardship, physical activity, and mental health (depression and anxiety). We apply a difference-in-differences design leveraging state variation in UFSM continuation after June 2022, comparing pre-post changes in states that did not extend UFSM to those that did. Models adjust for child and household characteristics and include state and year fixed effects. Event-study analyses are used to assess parallel trends and dynamic policy effects. 

Results: Results indicate that the expiration of UFSM waivers was associated with a decline in receipt of free/reduced-price school meals. Children in states that did not extend UFSM experienced increases in household food hardship and worsening mental health outcomes, including higher rates of mild depression, as well as reductions in physical activity. Changes in weight status were more modest and less consistent. Subgroup analyses suggest that adverse effects were more pronounced among female children and older adolescents, particularly for psychological and behavioral outcomes. 

Implications: These findings suggest that removing universal free access to school meals may have negative consequences for children’s food security and behavioral health. As states consider adopting or sustaining UFSM policies, these findings underscore the importance of school meals as a population-level intervention to mitigate early-life risk factors for type 2 diabetes and reduce health disparities.

Author

• Guangyi Wang, University of California, San Francisco
  Presenting Author