Inpatient Medicaid Usage and Expenditure Patterns After Changes in Supplemental Nutrition Assistance Program Benefit Levels

Abstract

IntroductionFood insecurity worsens health outcomes and is associated with increased health care usage and expenditures. The Supplemental Nutrition Assistance Program (SNAP) reduces but does not eliminate recipients’ food insecurity. We sought to determine whether inpatient Medicaid usage and expenditure patterns responded to an April 2009 increase in SNAP benefit levels and a subsequent November 2013 decrease.MethodsInterrupted time series models estimated responses to the 2009 and 2013 SNAP changes in the Medicaid population, compared responses between Medicaid and Medicare recipients, and compared responses between Medicaid recipients with different likelihoods of having a disability. Analyses used 2006 through 2014 Healthcare Cost and Utilization Project National (previously Nationwide) Inpatient Sample data.ResultsAfter the 2009 SNAP increase, Medicaid admission growth fell nationally from 0.80 to 0.35 percentage points per month (a difference of –0.45; 95% CI, –0.72 to –0.19), adjusting for enrollment. After the 2013 SNAP decrease, admission growth rose to 2.42 percentage points per month (a difference of 2.07; 95% CI, 0.68 to 3.46). Inflation-adjusted monthly Medicaid expenditures followed similar patterns and were associated with $26.5 billion (in 2006 dollars) in reduced expenditures over the 55 months of the SNAP increase, and $6.4 billion (in 2006 dollars) in additional expenditures over the first 14 months after the SNAP decrease. Effects were elevated for Medicaid compared with Medicare recipients and among people with a high likelihood of having a disability.ConclusionAlthough alternative causal explanations warrant consideration, changes in SNAP benefit levels were associated with changes in inpatient Medicaid usage and cost patterns.

Strengthening the Public Health Impacts of the Supplemental Nutrition Assistance Program Through Policy

“…In addition, participation in one safety net program may have cobenefits for another. For example, SNAP participation and higher benefit amounts have been associated with reduced hospitalizations, emergency department claims, inpatient expenditures, and nursing home admissions among Medicare and Medicaid enrollees (60,61,84,96,103,104,109). These data suggest that participation in multiple safety net programs may reduce utilization of costly health services, with a net positive effect on federal spending.…”

Chronic disease self-management within the monthly benefit cycle of the Supplemental Nutrition Assistance Program

“…Other policy recommendations to address the high cost of medically appropriate diets and end-of-month insufficiency, detailed in Table 3, include increasing the size of benefits and distributing SNAP benefits more frequently during the month. While increasing benefit size is a politically challenging proposition, evidence suggests that increasing benefit size could significantly reduce emergency department medical claims and Medicaid expenditures (53,54) , meaning this investment in food security could potentially both improve population health and reduce government medical spending.…”