Leveraging SNAP to Improve Mental Health Outcomes - Social determinants, including those related to food and housing, have a powerful impact on health, but there is uncertainty on how to best leverage policy to improve individuals’ social circumstances and related health outcomes. Presently, 11% of Americans have food insecurity, including 35% of families with incomes below the federal poverty line, and rates of food insecurity have increased dramatically in recent years. A growing literature finds associations between food security and mental health, positing a bi-directional relationship, wherein food insecurity increases stress and anxiety leading to poorer mental health, and serious mental illness impairs consistent access to food. Improving food security may be critical to improving mental health in low-income populations, but opportunities to examine the causal impact of such an intervention are rare. The Supplemental Nutrition Assistance Program (SNAP) has been shown to be effective in reducing, but not eliminating, food insecurity for low-income households. Many families on SNAP have residual food insecurity due to early exhaustion of SNAP benefits. Many policy experts believe that an increased investment in SNAP would both enhance the capacity of recipients to purchase healthy food and smooth the consumption of their benefits, potentially improving health outcomes. But this hypothesis has not been rigorously tested to date. During the pandemic, the federal government took unprecedented steps to increase SNAP benefits to low-income families. In January 2021, SNAP household budgets were increased by 15%, leading to an increase in federal SNAP benefits of about $40 per month on average. We leverage this natural experiment to examine whether increased food security from the SNAP changes reduced mental illness during the pandemic. We will thereby elucidate the causal relationship between food security and mental health, and their links to healthcare utilization. Finally, we will assess changes in the rate of benefit spending to inform the broader design of SNAP policy to optimize health outcomes. Our specific Aims are to a) assess whether increased SNAP budget allotments was associated with changes in indicators of mental health, b) examine the effect of an increase in SNAP budget allotment on the use of, and adherence to, recommended care services, and rates of adverse outcomes and health care costs among low-income individuals with previously diagnosed conditions, and c) estimate whether an increase in SNAP budget allotments impacted patterns of SNAP monthly benefit use. To answer these first-order policy questions, we use data from a novel, linked panel dataset that includes administrative Medicaid claims, administrative claims from the SNAP program, and data on the weekly use of SNAP benefits for beneficiaries. Our team is well-positioned to examine the understudied link between food insecurity and mental health and to assess the related public health, clinical, and policy implications.
