The SNAP Cycle and Diabetes Management During a One-Time Change in Disbursement Schedule

Abstract

OBJECTIVE The 2018–2019 federal government partial shutdown resulted in a one-time disruption to the usual disbursement schedule of Supplemental Nutrition Assistance Program (SNAP) benefits nationwide. We assessed the relationship between this disruption and hyperglycemia and hypoglycemia medical encounters among beneficiaries with diabetes. RESEARCH DESIGN AND METHODS To estimate whether the one-time change in benefit disbursement affected the monthly cycle of hyperglycemia or hypoglycemia encounter rates, we used linked administrative Medicaid claims and SNAP disbursement data from West Virginia in a fixed-effects model with interactions between week of the month and the two months of interest—January and February 2019. We controlled for week, month, year, and county effects as well as individual characteristics, and we clustered SEs by individual. RESULTS We found that the early disbursement of SNAP benefits in January 2019 resulted in a spike in hyperglycemia four times the rate in a typical month. Further, we found a decrease in both hyperglycemia and hypoglycemia in late February. CONCLUSIONS Our findings suggest that the early distribution of benefits led to a temporary increase in food consumption among West Virginia Medicaid beneficiaries with diabetes. Findings from late February also imply that individuals may have a way to prepare for reduced food resources. These results shed new light on the effects of unexpected changes to the timing of safety net payments as well as an understanding of unintended consequences of government shutdowns.

The Impact of Providing Material Benefits to Improve Access to Food on Clinical Parameters, Dietary Intake, and Household Food Insecurity in People with Diabetes: A Systematic Review with Narrative Synthesis

“…Studies were published between 2013 and 2023. One study took place in Australia [ 41 ], and all other studies took place in the United States [ [15] , [16] , [17] , [18] , [19] , 22 , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] ]. In addition, 3 studies took place in a rural location [ 22 , 47 , 48 ], 1 study was in an entire United States state [ 19 ], and the other studies took place in an urban location [ [15] , [16] , [17] , [18] , [41] , [42] , [43] , [44] , [45] , [46] , [49] , [50] , [51] , [52] , [53] , [54] , [55] ].…”

“…One study took place in Australia [ 41 ], and all other studies took place in the United States [ [15] , [16] , [17] , [18] , [19] , 22 , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] ]. In addition, 3 studies took place in a rural location [ 22 , 47 , 48 ], 1 study was in an entire United States state [ 19 ], and the other studies took place in an urban location [ [15] , [16] , [17] , [18] , [41] , [42] , [43] , [44] , [45] , [46] , [49] , [50] , [51] , [52] , [53] , [54] , [55] ]. Settings included primary care or medical specialty clinics [ 17 , 42 , 51 , 52 ], food banks [ 18 , 50 ], public hospitals [ 41 , 43 , 44 , 45 , 53 ], Federally Qualified Health Centers [ 15 , 16 , 22 , [46] , [47] , [48] , 55 ], nonprofit meal provision centers [ 49 ], and a nonprofit essential services center [ …”

“…[ 55 ] 2021 Produce Prescription Programme Urban Federally Qualified Health Center, an outpatient medical clinic serving low-income patients, 2 social services organizations for seniors Adults receiving SNAP Subgroup of people with a diabetes diagnosis n = 699 (total) n = 353 (with diabetes) No information on the number of participants lost to f/up or missing data Increased program use HbA1c, BMI, BP Retrospective cohort Young et al. [ 19 ] 2022 SNAP West Virginia state West Virginia residents aged 18–64 with diabetes enrolled in both SNAP and Medicaid n = 10,119 individuals observed in both periods 0 lost to f/up (outcomes were through retrospective analysis) Corresponding week during a month with regularly timed SNAP disbursement (e.g., week 1 of January) Hypoglycemia HbA1c, glycosylated hemoglobin; BP, blood pressure (includes both systolic and diastolic); f/up, follow-up; F/V, fruit and vegetable; FI, food insecurity; RCT, randomized controlled trial; SNAP, Supplemental Nutrition Assistance Program; T2DM, type 2 diabetes mellitus. …”

“…Two studies did not specify food insecurity criteria [ 43 , 48 ]. Additional eligibility criteria included: current food pantry client [ 18 , 50 ], patient of a Federally Qualified Health Center [ 16 , 22 , 38 , 48 ], patient of a specific healthcare center [ 43 , 51 ], income below 300% of the United States federal poverty line [ 49 ], living in a specific zip code known to have high food insecurity rates [ 45 ], BMI >22 [ 44 ], currently receiving Supplemental Nutrition Assistance Program (SNAP) [ 19 , 55 ], currently enrolled in Medicaid [ 19 ], a caregiver of a child with prediabetes [ 52 ], or Latin American ethnicity [ 54 ]. Study sample sizes were between n = 14 to n = 786 for the prospective studies and n = 24,049 for the retrospective study.…”

“…Increasing access to healthy foods through material benefits may improve glycemia and other clinical parameters by improving adherence to nutritional recommendations and medications [ 13 , 14 ]. A material benefit to improve food access refers to the provision of resources to offset the cost of food, including food coupons/vouchers [ 15 , 16 ], free food [ 17 , 18 ], or financial subsidies/incentives [ 19 , 20 ].…”