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Original Investigation
November 2017

Supplemental Nutrition Assistance Program (SNAP) Participation and Health Care Expenditures Among Low-Income Adults

Author Affiliations
  • 1Division of General Internal Medicine, Massachusetts General Hospital, Boston
  • 2Diabetes Population Health Unit, Massachusetts General Hospital, Boston
  • 3Harvard Medical School, Boston, Massachusetts
  • 4Division of General Internal Medicine, University of California, San Francisco
  • 5Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital & Trauma Center, San Francisco, California
  • 6Quantitative Sciences Unit, Stanford University, Palo Alto, California
  • 7Department of Medicine, Stanford University, Palo Alto, California
  • 8Center for Primary Care, Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2017;177(11):1642-1649. doi:10.1001/jamainternmed.2017.4841
Key Points

Question  Does Supplemental Nutrition Assistance Program (SNAP) participation reduce subsequent health care expenditures?

Findings  Using data from 4447 low-income adults who participated in the National Health Interview Survey (NHIS) and the Medical Expenditure Panel Survey (MEPS), we found that participation in SNAP was associated with lower health care expenditures by approximately $1400 per year.

Meaning  Programs that address food insecurity, such as SNAP, may reduce health care spending.


Importance  Food insecurity is associated with high health care expenditures, but the effectiveness of food insecurity interventions on health care costs is unknown.

Objective  To determine whether the Supplemental Nutrition Assistance Program (SNAP), which addresses food insecurity, can reduce health care expenditures.

Design, Setting, and Participants  This is a retrospective cohort study of 4447 noninstitutionalized adults with income below 200% of the federal poverty threshold who participated in the 2011 National Health Interview Survey (NHIS) and the 2012-2013 Medical Expenditure Panel Survey (MEPS).

Exposures  Self-reported SNAP participation in 2011.

Main Outcomes and Measures  Total health care expenditures (all paid claims and out-of-pocket costs) in the 2012-2013 period. To test whether SNAP participation was associated with lower subsequent health care expenditures, we used generalized linear modeling (gamma distribution, log link, with survey design information), adjusting for demographics (age, gender, race/ethnicity), socioeconomic factors (income, education, Social Security Disability Insurance disability, urban/rural), census region, health insurance, and self-reported medical conditions. We also conducted sensitivity analyses as a robustness check for these modeling assumptions.

Results  A total of 4447 participants (2567 women and 1880 men) were enrolled in the study, mean (SE) age, 42.7 (0.5) years; 1889 were SNAP participants, and 2558 were not. Compared with other low-income adults, SNAP participants were younger (mean [SE] age, 40.3 [0.6] vs 44.1 [0.7] years), more likely to have public insurance or be uninsured (84.9% vs 67.7%), and more likely to be disabled (24.2% vs 10.6%) (P < .001 for all). In age- and gender-adjusted models, health care expenditures between those who did and did not participate in SNAP were similar (difference, $34; 95% CI, −$1097 to $1165). In fully adjusted models, SNAP was associated with lower estimated annual health care expenditures (−$1409; 95% CI, −$2694 to −$125). Sensitivity analyses were consistent with these results, also indicating that SNAP participation was associated with significantly lower estimated expenditures.

Conclusions and Relevance  SNAP enrollment is associated with reduced health care spending among low-income American adults, a finding consistent across several analytic approaches. Encouraging SNAP enrollment among eligible adults may help reduce health care costs in the United States.