Are Older Adults Who Receive Supplemental Nutrition Assistance Program Benefits Healthier Than Eligible Non-Recipients? Evidence from the Health and Retirement Study

Background and Significance: This research examines the impact of Supplemental Nutrition Assistance Program (SNAP) participation on the health status of older adults.  Extant studies on the topic have found that among food insecure older adults, SNAP participants had similar or poorer self-reported health and displayed greater risks of hospitalization and mortality relative to nonparticipants.  These studies, however, used non-randomized cross-sectional designs that are susceptible to selection effects whereby program participation may be both a cause and consequence of poor health.  Thus, any presumed relationship that is revealed between SNAP participation and poor health-related outcomes may be due to a greater propensity among older adults with poor(er) health to enroll in the program.  As such, this study used event history modeling to examine the effects of SNAP participation on the health status and risk of hospitalization of older adults.   

Methods: This investigation used longitudinal data from the 2002-2012 Waves of the Rand version of the Health and Retirement Study to estimate separate discrete-time hazard models of poor self-reported health and overnight hospital stays among older adults.  The study incorporated both contemporaneous and lagged program participation variables to distinguish the effects of recent enrollment versus past enrollment in SNAP.  The final sample to be used for analysis included 6,657 individuals ages 60 and older who were followed for up to 6 waves (i.e., 12 years) to see whether they reported fair or poor health or an overnight hospital stay during the study period. 

Results: The findings revealed that among food insecure older adults, contemporaneous SNAP participants were 3.83 (95% C.I., 2.68-5.49) times more likely to report fair or poor health and 2.75 (95% C.I., 2.08-3.62) times more likely to report an overnight hospital stay relative to non-participants.  Among food secure older adults, contemporaneous SNAP participants were 29% (95% C.I., 11-50%) more likely to report fair or poor health and 19% (95% C.I., 4-37%) more likely to report an overnight hospital stay relative to non-participants.  While these findings are consistent with prior research indicating that program participants report poorer health and display greater risk of hospitalization relative to non-participants, incorporating lagged participation variables revealed more favorable program effects.  Among food insecure older adults, lagged participation decreased the likelihood of an overnight hospital stay by 46% (95% C.I., 10-67%).  Among food secure older adults, lagged participation decreased both the likelihood of reporting fair or poor health by 67% (95% C.I., 37-61%), and also the likelihood of reporting an overnight hospital stay by 18% (95% C.I., 2-32%). 

Conclusions and Implications: While correlating contemporaneous SNAP participation with health outcomes may indicate that program participants fare worse than non-participants in the way of self-reported health and hospitalization risk, this is likely due to selection effects whereby older adults with poorer health are more likely to enroll in the program.  By using a longitudinal design that incorporated both contemporaneous and lagged effects of SNAP participation, this study provides evidence that, contrary to prior research findings, program participation may indeed be beneficial in maintaining the health of older adults.