Association of Work Requirements With Supplemental Nutrition Assistance Program Participation by Race/Ethnicity and Disability Status, 2013-2017

• Published in: JAMA health forum Vol. 3; no. 6; p. e205824
• Main Authors: Brantley, Erin, Pillai, Drishti, Ku, Leighton
• Format: Journal Article
• Language: English
• Published: Chicago American Medical Association 26.06.2020
• Subjects: Disability; Ethnicity; Food security; Food stamps; Health Policy; Hispanic people; Low income groups; Nutrition; Online Only; Original Investigation; People with disabilities; Race
• ISSN: 2574-3805; 2574-3805; 2689-0186
• DOI: 10.1001/jamanetworkopen.2020.5824

Importance Increased work requirements have been proposed throughout federal safety net programs, including the Supplemental Nutrition Assistance Program (SNAP). Participation in SNAP is associated with reduced food insecurity and improved health. Objectives To determine whether SNAP work requirements are associated with lower rates of program participation and to examine whether there are racial/ethnic disparities or spillover effects for people with disabilities, who are not intended to be affected by work requirements. Design, Setting, and Participants This nationally representative, pooled cross-sectional study examined how changes in SNAP work requirements at state and local levels in the US are associated with changes in food voucher program participation. The study combined information on state and local SNAP work requirements with repeated cross-sections from the 2012 through 2017 American Community Survey (with outcomes covering 2013 to 2017). The analytical approaches were based on difference-in-difference and triple-difference methods, after controlling for other economic and social factors. The sample included low-income adults without dependents, stratified by racial/ethnic group and disability status. The study also included parents who would otherwise meet work requirement criteria as a comparison group to estimate triple-difference models. This accounted for otherwise unobserved factors affecting trends in SNAP participation within local areas. Data were analyzed from January 2019 through March 2020. Exposure Residence in areas where SNAP work requirements apply. Main Outcomes and Measures The primary outcome is SNAP participation measured by whether anyone in the household received food vouchers at any point over the prior 12 months. Results The final analytical sample included 866 000 low-income adults (weighted mean [SE] age, 33.6 [0.01] years; 42.5% [SE, 0.07%] men). The racial/ethnic breakdown was 56.5% (SE, 0.07%) non-Hispanic white respondents, 19.4% (SE, 0.06%) non-Hispanic black respondents, 17.7% (SE, 0.06%) Hispanic respondents, 2.5% (SE, 0.02%) Asian respondents, and 3.9% (SE, 0.03%) respondents of other or multiple races. In final triple-difference models, work requirements were associated with a 4.0 percentage point decrease in participation (95% CI, –0.048 to –0.032;P < .001) for childless adults without disability, equivalent to a 21.2% reduction in SNAP participation (95% CI, –25.5% to –17.0%). For childless adults with disability, work requirements were associated with a 4.0 percentage point reduction (95% CI, –0.058 to –0.023;P < .001), equivalent to 7.8% fewer SNAP participants with disability (95% CI, –11.2% to –4.4%). When the final models were stratified by race/ethnicity, benefit reductions were larger for non-Hispanic black adults (7.2 percentage points; 95% CI, –0.092 to –0.051;P < .001) and Hispanic adults (5.5 percentage points; 95% CI, –0.072 to –0.038;P < .001) than for non-Hispanic white adults (2.6 percentage points; 95% CI, –0.035 to –0.016;P < .001). Conclusions and Relevance Because of the association of SNAP with food security and health, work requirements that lead to benefit loss may create nutritional and health harm for low-income Americans. These findings suggest that there may be racially disparate consequences and unintended harm for those with disability.