Abstract
Background. Food insecurity worsens health outcomes. The Supplemental Nutrition Assistance Program (SNAP) partially but incompletely alleviates food insecurity. Policy changes elevated SNAP benefit levels from April 2009 to October 2013 and reduced levels starting in November 2013. The 2009 SNAP increase was associated with decreased Medicaid costs and hospital admissions in Massachusetts, especially for people with chronic illnesses. We examine both the 2009 and 2013 SNAP changes using national Medicaid data and compare effects for people with different likelihoods of having disabilities. Methods. Monthly data were summarized from the Healthcare Cost and Utilization Project National (Nationwide) Inpatient Sample from 2006-2014. Inpatient costs, admissions, and average length of stay for each month were used as dependent variables in interrupted time series models adjusting for inflation, enrollment, and other covariates. An algorithm assigned disability likelihood to each admission, allowing for comparisons of different disability likelihood groups. Results. After the 2009 SNAP increase, inflation-adjusted Medicaid cost growth nationally fell from +0.85 percentage points per month relative to January 2006 to +0.36 percentage points per month (–0.49, 95% CI: –0.73, –0.25), saving $945,000,000 over 55 months in 2006 dollars. After the 2013 SNAP decrease, cost growth rose to +2.09 percentage points per month (1.73, 95% CI: 0.37, 3.09), costing $850,000,000 over 14 months. Similar patterns were observed for monthly admissions. Effects were elevated among people with a high disability likelihood. Conclusions. Changes in SNAP benefit levels were associated with changes in US inpatient Medicaid cost and utilization patterns, particularly for people with disabilities.