Making Enrollment a Snap for people with disabilities with a SNAP Cross-Enrollment

Johns Hopkins University, Baltimore MD

Investigators

Abstract

This five-year pragmatic trial is embedded in an existing program providing SNAP cross-enrollment outreach and enrollment assistance program among approximately 1 million Michigan Medicaid beneficiaries. This project will be conducted in partnership with Michigan Department of Health and Human Services and Benefits Data Trust and with guidance from an Advisory Committee. The proposed study will leverage the program’s random selection of households for treatment to estimate the effect of SNAP outreach and enrollment assistance among low-income adults with functional limitations. Households are randomly selected for either an information-only arm or an information plus assistance arm while a 3rd equivalent group waits for treatment, forming a control comparison arm by default. Medicaid data from adults aged 18 and older will be used to identify people with functional limitations, including those who: (a) receive disability benefits (e.g. SSDI, or, if younger than age 65, SSI); (b) are Medicaid eligible due to disability or blindness; (c) are eligible for home and community-based services or (d) are home help recipients needing assistance with Activities of Daily Living. Outcomes will be measured using Medicaid claims and SNAP utilization data. Aim 1 characterizes Medicaid beneficiaries at baseline with disproportionately lower SNAP utilization (participation and benefit amounts) for people with and without functional limitations and examine interactions with age, and presence of ambulatory care-sensitive conditions. Aim 2 evaluates the impact of a cross-benefit enrollment intervention on health care utilization, including inpatient hospital and emergency department utilization (emergency department visits; hospitalization and length of stay; end-of-the-month utilization; and utilization for ambulatory care-sensitive conditions) and on nursing home utilization (admission and length of stay) among community-dwelling adults with functional limitations. Aim 3 evaluates the impact of a cross-benefit enrollment intervention on SNAP utilization (participation and benefit amounts) and tests SNAP utilization as a mediator of intervention effectiveness health care utilization among community-dwelling adults with functional limitations. Aim 4 tests for effect modification of the intervention impact based on age, and presence of ambulatory care-sensitive conditions, among community-dwelling adults with functional limitations. Through these aims, this study evaluates a promising new intervention that may improve food affordability for low-income adults with functional limitations, who experience disproportionately high rates of food insecurity.