Are They Deserving of Support?: Dual SNAP and Medicaid Enrollment and Household Financial Standing Among ABAWDs

• In Event: Strengthening Supports, Identifying Gaps: How Place and Policy Shape Access to Human Services

Abstract

Even before the passage of the One Big Beautiful Bill Act (OBBB) –legislation expected to retrench social assistance to low-income people—able-bodied adults without dependents (ABAWDs) already occupied a precarious position within the U.S. safety net.  ABAWDs, who are broadly defined as low-income working-age adults without dependents or a government-determined disability, have historically had limited access to means-tested assistance beyond the Supplemental Nutrition Assistance Program (SNAP), with Medicaid becoming available to some to some after the Affordable Care Act (ACA) expanded eligibility to childless adults in 2014. Yet, childless adults in SNAP and Medicaid face major barriers to employment, including limited education, chronic health conditions, and behavioral and mental health challenges.  

Using 2010–2019 data from the National Longitudinal Survey of Youth 1997 cohort, this study addresses three research questions: (1) How is simultaneous enrollment in both SNAP and Medicaid associated with household income-to-poverty ratio (IPR) among ABAWDs? (2) Did the 2014 ACA Medicaid expansion alter the relationship between dual SNAP and Medicaid enrollment and the household IPR among ABAWDs?

This study employs a two-stage analytic strategy. First, individual fixed effects models estimate within-person changes in IPR across survey waves, controlling for stable unobserved characteristics and time-varying education, marital status, and age, to assess whether simultaneous enrollment in SNAP and Medicaid is associated with changes in household IPR compared to single-program or no enrollment. Second, an interrupted time series design is layered onto the fixed effects framework to test whether this relationship changed after Medicaid expansion made dual enrollment newly accessible to ABAWDs.  

Three preliminary findings emerge. First, pooled OLS comparisons show that dually enrolled ABAWDs average 142% of the federal poverty level compared to 198% among those receiving only SNAP, reflecting greater financial need among dual enrollees. Second, individual fixed effects models reveal that neither SNAP nor Medicaid alone is significantly associated with within-person changes in household IPR, while dual enrollment is associated with a significant decline (β = -0.545, p<0.05), suggesting that only dual enrollment is associated with within-person IPR changes. Third, before the 2014 ACA Medicaid expansion, dual enrollment was not significantly associated with within-person changes in IPR (β = +0.45, n.s.), likely because few ABAWDs could access both programs. After expansion, however, dual enrollment was associated with significantly lower IPR (β = -1.38, p<0.01), indicating post-expansion dual enrollees were more financially vulnerable. 

These findings carry urgent policy relevance in light of the OBBBA, which expands work requirements in Medicaid and broadens the SNAP-ABAWD designation to include older adults and parents with older children. As policymakers consider restricting simultaneous access to both programs through expanded work requirements, these findings suggest that doing so would remove support from ABAWDs at precisely the moments when they are most financially vulnerable.

Authors

• Jennifer Renee Daniels, Morgan State University
  Presenting Author

• Frania Mendoza Lua, California State University Fullerton
  Non-Presenting Co-Author