Evaluating the Implementation and De-Implementation of Pandemic Era SNAP Expansion Policies on Diet and Health: A Mixed Methods Project

Harvard School Of Public Health, Boston MA

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Abstract

PROJECT SUMMARY The USDA Supplemental Nutrition Assistance Program (SNAP) has played a critical role in mitigating national food insecurity during the pandemic. Since March 2020, many federal and state-level policies have been enacted to expand SNAP eligibility, enhance SNAP benefits, and reduce the administrative burden of applying for and maintaining SNAP benefits. By March 2023, most flexibilities and pandemic-era SNAP benefit boosts were discontinued, resulting in a “hunger cliff” with considerable implications for poverty, food insecurity, and health equity. There are significant knowledge gaps about the implementation and subsequent de- implementation of pandemic-era SNAP policy changes and their effects on the health of low-income Americans. The overall objective of this application is to evaluate the effects of implementation and de- implementation of pandemic-era SNAP expansion policies on adult health outcomes using a mixed methods approach that builds on the project team’s robust existing work. The central hypothesis is that the onset of SNAP expansion policies led to better physical and mental health outcomes, mediated by higher food expenditures, lower food insecurity, and higher diet quality; the sunset of these policies adversely affected health through these same pathways. In Aim 1, the project team will create a novel comprehensive database to document states’ implementation and de-implementation of SNAP expansion policies from 2020 to 2023 through surveys and focus groups with state SNAP administrators. In Aim 2, the project team will conduct a national survey and in-depth interviews with SNAP participants to understand how the expiration of SNAP expansion policies impacted program utilization, food insecurity, and health. Finally, in Aim 3, robust methods for causal inference will be applied to three nationally representative datasets to examine national and state- level SNAP expansion policies on adult health and intermediate outcomes. This project will employ a sequential mixed methods study design to integrate data across all aims and add context and richness to the interpretation of the results. To promote inclusivity and support the dissemination of results to key audiences, the project team will regularly engage with a Policy Advisory Committee, including experts in federal and state/local SNAP policy, poverty alleviation, and nutrition security, and a Client Advisory Committee, comprised of individuals with lived experience using SNAP benefits. This comprehensive and rigorous evaluation will provide important evidence about the effects of the onset and sunset of SNAP expansion policies on the health of low-income Americans. Results from this project will be of direct relevance to policymakers and other stakeholders to inform planning for future public health emergencies and long-term food policy.