Medicaid Re-enrollment, SNAP Participation, and Racial Disparities: Evidence from the SIPP 2018 Panel (2017–2020)

• In Event: Medicaid Access and Enrollment

Abstract

Background

Medicaid churning remains a persistent policy challenge. The post-pandemic Unwinding disenrolled over 25 million individuals, nearly 70% for procedural rather than eligibility-based reasons. Much research examines who loses coverage; far less examines what facilitates return. Drawing on administrative burden theory, we ask whether SNAP participation predicts Medicaid re-enrollment, and whether the association depends on when participation is measured. SNAP may facilitate renewal through two channels: familiarity acquired through recurring recertification, and the availability of active records for eligibility verification. Given that administrative burdens fall disproportionately on minoritized populations, we also describe re-enrollment patterns by race and ethnicity.

Data and Methods

We use the SIPP 2018 Panel (2017-2020), measuring Medicaid and SNAP participation annually. We identify low-income adults aged 18-64 enrolled in Medicaid in year t−1 who lost coverage in year t at household income below 200% FPL, and model whether they regained coverage by t+1. SNAP participation is measured in both the year preceding the loss and the year of the loss. Of 447 loss episodes, 194 occurred early enough for re-enrollment to be observed; exclusion was unrelated to SNAP receipt or race and ethnicity. Logistic regressions adjust for race and ethnicity and loss year, with person-clustered standard errors.

Results

Twenty-four percent regained coverage within a year. SNAP participation in the year of loss predicted higher odds of re-enrollment (44.6% vs. 15.9%; OR = 4.58, 95% CI [2.19, 9.54]); participation in the preceding year showed a weaker association (33.3% vs. 18.9%; OR = 2.28 [1.12, 4.66]). Entering both measures simultaneously isolates which timing matters. Only receipt in the year of loss remained associated with re-enrollment (OR = 4.74, p = .002); prior-year receipt did not (OR = 0.94, p = .908). Adults with SNAP in the prior year but not the year of loss re-enrolled at rates similar to non-recipients (18.5% vs. 15.3%). Higher re-enrollment appeared across racial and ethnic groups rather than in any one, and persisted after adjusting for income, citizenship, coverage type at loss, and household composition, and in weighted, state-clustered, penalized-likelihood, expansion-state, and pre-pandemic specifications.

Implications

Timing, not accumulation, is what distinguishes adults who regain coverage. Only participation at the moment of loss carries an independent association once both measures are considered together, which locates the mechanism in the administrative record rather than in what applicants learn from repeated encounters with agencies. An open SNAP case supplies the income verification that lets Medicaid renewal proceed without applicant action; a closed one does not, however recently it closed. This shifts where the leverage lies. Automated verification and interagency data-sharing reach people at the point of renewal, while application assistance does not persist once a case ends. It also identifies a population that integration efforts currently miss: adults who leave SNAP keep their familiarity with the system but lose the record that automates renewal, and they return to coverage at rates resembling those who never participated. As states rebuild enrollment systems after the Unwinding, maintaining active cross-program records may protect coverage more than expanding one-time enrollment support.

Authors

• Soohyun Yoon, University of Illinois
  Presenting Author

• Jeehae Kang, University of Illinois
  Non-Presenting Co-Author

• Chi-Fang Wu, University of Illinois
  Non-Presenting Co-Author