Measuring and Increasing CalFresh (SNAP) Cross-Enrollment among Medi-Cal (Medicaid) Members

• In Event: SNAP Participation

Abstract

There is rigorous evidence that the Supplemental Nutritional Assistance Program (known as CalFresh in California) improves nutrition, food security, and health outcomes among participants. While statewide estimates suggest that 41% of likely eligible Californians are not enrolled in CalFresh and accessing its short- and long-term benefits, little is known about the take-up gap within specific high-need populations. This analysis focuses on members of California’s Medicaid program (Medi-Cal), which covers more than one third of the state’s population and—given its income-based eligibility requirements — likely contains a large share of individuals who are eligible for CalFresh. Additionally, many Medi-Cal members manage chronic conditions, disabilities, and complex health needs; participation in CalFresh could improve food security and address a critical health-related social need among this population.

This paper examines the rate of CalFresh participation among Medi-Cal members and designs a low-cost outreach strategy to address it. Using administrative data from the Medi-Cal program, we develop a novel approach to simulate CalFresh eligibility at the individual level and estimate the CalFresh cross-enrollment rate among Medi-Cal members. Our findings show that approximately half of Medi-Cal members are likely eligible for but unenrolled in CalFresh. Cross-enrollment rates vary across various client characteristics; for example, Chinese-speakers have a lower cross-enrollment rate than English-speakers, and cross-enrollment rates generally decline as earned income increases. These estimates provide a rigorous empirical baseline for understanding the scope of CalFresh cross-enrollment within the Medi-Cal population and identifying subgroups where targeted outreach may have the greatest impact.

Building on the CalFresh individual-level eligibility estimates, we design a stepped wedge randomized controlled trial to experimentally evaluate the effectiveness of a low-cost strategy to increase CalFresh enrollment among likely-eligible Medi-Cal members. Multilingual text and email messages will be delivered through managed care plans to inform members of their likely CalFresh eligibility and encourage them to apply. Message delivery will be randomly staggered in two waves to ensure every likely-eligible member is informed of their potential eligibility for CalFresh. We will assess the impact of the treatment on both a) applications to CalFresh, and b) successful enrollment in CalFresh. We additionally explore whether the treatment effect is heterogeneous across client characteristics such as age, language, race/ethnicity, income, household composition, pregnancy status. 

Beyond the CalFresh context, this analytical simulation and targeted outreach methodology can be leveraged to encourage enrollment in a broad range of social safety net programs. Further, this methodology can be scaled up to accommodate and evaluate more intensive efforts (such as personalized outreach calls or clinic-based enrollment assistance) to encourage beneficiaries to access the full range of safety net supports they are entitled to.

Author

• Willetta May Waisath, California Department of Social Services
  Presenting Author