Originally published by Nutrition Insight. 

08 May 2019 — US families with young children who experienced a reduction or cut off in Supplemental Nutrition Assistance Program (SNAP) benefits, due to increased income, are more likely to experience food insecurity and report poor health following the benefits change. This is according to new research from Children’s HealthWatch, based out of Boston Medical Center (BMC). The report emphasizes that families who had their benefits reduced suffered more negative impacts than families who were cut off. The researchers note that at first this appeared counterintuitive, but now seems to support the fact that income increases large enough to result in a cutoff may help buffer families from some hardships. Moving forward, they argue that policymakers should consider ways to make SNAP reductions less abrupt for working families, and smooth the transition out of receiving benefits so that families have a chance to stabilize financially.

SNAP serves as a buffer against food insecurity for millions of low-income Americans. Food insecurity and other economic hardships have been associated with adverse health, developmental, behavioral and educational issues for children and their caregivers. The majority of SNAP participants with children have earned income. However, many low-wage workers have unstable working hours, work seasonal jobs or have sporadic overtime hours that can result in unpredictable income fluctuations. When family income increases, it can trigger rapid reductions or the termination of SNAP benefits.

“It was surprising to us that the families whose benefits had been reduced experienced more negative outcomes than those who were cut off, including greater odds of housing instability, children and caregivers being in fair or poor health and maternal depressive symptoms,” Stephanie Ettinger de Cuba, MPH, Executive Director of Children’s HealthWatch at BMC and researcher at Boston University School of Medicine (BUSM), tells NutritionInsight.

“Families whose benefits had been reduced still qualified for SNAP – clearly the income increase was not sufficient to offset the reduction in SNAP. Still, it is important to recognize that both SNAP benefit reductions and cutoffs were associated with serious health consequences for families and children and ripple effects to other basic needs,” she adds.

The impacts of the benefit reduction or cutoff disproportionately affect children, as their rapid growth means they are more sensitive to nutritional change.

Children’s HealthWatch surveyed over 8,500 families in five US cities from 2007-2015 who participated in SNAP in the previous year. Twenty percent reported a reduction in SNAP benefits because of income increase, while 16 percent reported benefits being cut off because of income increase.

The impacts of the benefit reduction or cutoff disproportionately affect children, as their rapid growth means they are more sensitive to nutritional change. Moreover, children’s well-being is tightly intertwined with their families’ well-being. To care for children, the researchers advise policymakers to consider the overall wellbeing of the families. This study on SNAP loss and reductions demonstrates how basic needs in the family budget do not exist in isolation: reductions or loss in one area have ripple effects to other needs, Ettinger says.

Compared to families with consistent SNAP benefit levels, those whose benefits were reduced or cutoff were more likely to experience food insecurity, energy insecurity and were more likely to forgo healthcare for family members because they could not afford it. Families whose benefits were reduced experienced more negative outcomes than those who were cut off – including greater odds of housing instability, children and caregivers being in fair or poor health and maternal depressive symptoms.

Moving forward
The researchers suggest that the economic amount of SNAP benefits should be increased. “There is strong evidence, including from the National Academies of Medicine, to show that the SNAP benefit amount is inadequate for the consistent purchase of a healthy diet. Increasing the SNAP benefits is one way to smooth the SNAP benefits decline as families increase their income,” says Ettinger.

There is also a pilot study in Massachusetts called the Healthy Incentives Program, which matches SNAP dollars up to a certain limit for fresh fruits and vegetables at farmers’ markets, CSAs and other venues, she explains. An expansion of the pilot to grocery stores and more states would be significant, says Ettinger, and research identifying the specific ways that children’s nutrition and health may be improved with the expansion would provide vital evidence for positive change.

“Policymakers could take into account the timing and amount of income increases over a longer period to provide a more realistic picture of family employment and income stability,” says Deborah A. Frank, MD, founder of Children’s HealthWatch at BMC and Professor of Child Health and Well-Being at BUSM.

The unintended impacts on child health of benefit loss immediately following potentially short-lived income increases are too great for us to continue with the status quo, Frank concludes. Lastly, Ettinger highlights how it is imperative that science guides decision-making on such nutrition assistance programs.