Opinion | How to Help Patients Who Are Losing SNAP Benefits

We often say that our patients are our teachers. As a pediatrician (Megan Sandel, MD) at Boston Medical Center, New England’s largest safety net hospital, I recently treated a child whose weight was already faltering when their mother had a second child and had to stop working during the COVID-19 pandemic. The additional Supplemental Nutrition Assistance Program (SNAP) emergency allotment made a huge difference in getting my patient back on the growth curve and keeping their newborn sister on a healthy weight trajectory. Even though their mom is back at work, she is now facing a huge reduction in SNAP benefits as pandemic-era policies unwind, putting her children’s health at risk of decline once more.

SNAP is the nation’s largest anti-hunger program. Nearly three-quarters of adults who participate in SNAP are low wage workers, and close to two-thirds of SNAP recipients are children, elderly, or disabled. For decades, research has shown SNAP promotes food security and supports child and family health. SNAP is designed to expand in response to economic downturns and crises. With this understanding, Congress temporarily increased SNAP benefits in March 2020. The extra money prevented widespread hunger and helped families manage other household expenses. But that boost ended in March for more than 16 million families.

In the medical field we make an ethical commitment to “Do No Harm.” Unfortunately, Congress has made the decision to do harm by prematurely rolling back the increased SNAP benefits. While the money will be used to fund other evidence-based child nutrition programs, such as paying for summer meals for school-aged children, taking funds from one child nutrition program to fund another isn’t the answer at a time when the cost of food has skyrocketed, and families face the unwinding of several other temporarily expanded supports, including Medicaid automatic renewal. Fortunately, several opportunities exist for health systems and providers to mitigate the loss of SNAP and potentially stem the rising risk of food insecurity and its related consequences.

First, ensuring that patients are connected to all assistance programs for which they are eligible and maximizing those benefits is critical. Our research at Children’s HealthWatch shows when eligible families participate in multiple public assistance programs, including nutrition assistance and other benefits, they are more likely to be able to afford basic needs and maintain better health. Clinicians should have resources ready to inform patients of program availability, including SNAP, WIC (The Special Supplemental Nutrition Program for Women, Infants, and Children), the School Lunch and Breakfast Program, the Summer Food Service Program, as well as benefits that help families afford housing, child care, and utilities. Clinicians should also develop and foster partnerships with social service organizations that are well-suited to receive patient referrals, and engage and connect patients to these vital assistance programs. Connecting patients to resources in their communities is an important first step and one that requires humility, care, and respect.

Second, health systems should support patients by working with state agencies to maximize opportunities, including those available through Medicaid waivers. Under recent “in lieu of” services guidance from CMS — an option designed to help state agencies offer services that address unmet health-related social needs such as food insecurity — hospitals and health systems can provide services tailored to individuals experiencing food insecurity, such as medically supportive/tailored meals. Additionally, Medicaid 1115 Demonstration waivers allow states to test new care delivery approaches to address patients’ social needs. For example, the Massachusetts 1115 waiver enables funding through which Accountable Care Organizations (ACOs) partner with social service organizations to provide patients with housing and nutrition-related services and supports.

Third, and arguably most importantly, providers and health systems should use their unique position to advocate for local, state, and federal legislative and administrative policies that help reduce food insecurity. Evidence-based advocacy opportunities include streamlining access to multiple assistance programs through co-enrollment and cross-agency coordination, implementing universal school meals, increasing SNAP and WIC benefits so they cover the cost of a healthy diet, and eliminating inequitable eligibility restrictions and program barriers. These policy improvements would have an outsized impact on the health and development of children and families at greatest risk of food insecurity.

The rollback of SNAP emergency allotments will undoubtedly have an effect of the ability of families with children to afford healthful foods necessary for thriving. As clinicians, public health researchers and practitioners, and advocates, we can all play a role in reducing the impact of this harmful policy choice. The time for urgent action in reducing food insecurity and its adverse health consequences is now. The health of millions of children and their families cannot wait.

Megan Sandel, MD, is a professor of pediatrics at the Chobanian and Avedisian School of Medicine and a professor of environmental health at the Boston University School of Public Health. She is also the co-lead principal investigator with Children’s HealthWatch. Charlotte Bruce, MPH, is a senior research and policy analyst at Children’s HealthWatch. Richard Sheward, MPP, is the director of system implementation strategies at Children’s HealthWatch.