Impact of the Affordable Care Act on participation in the Supplemental Nutrition Assistance Program among low-income older Medicare beneficiaries

Abstract

Abstract Background: The Affordable Care Act (ACA) provisions, especially Medicaid expansion, in the United States (US) are believed to have spillover effects, such as boosting the Supplemental Nutrition Assistance Program (SNAP) participation among eligible individuals. However, little is known about the impact of the ACA, with its focus on the dual eligible population, on SNAP participation. The current study investigates whether the ACA, under an explicit policy aim of enhancing the interface between Medicare and Medicaid, has improved participation in the SNAP among low-income older Medicare beneficiaries. Methods: We extracted data from 2009 through 2018 cycles of the US Medical Expenditure Panel Survey (MEPS) for low-income (≤%138 Federal Poverty Level [FPL]) older Medicare beneficiaries (n=50,466; aged ≥65), and low-income (≤%138 FPL) younger adults (aged 20 to <65 years, n=190,443). MEPS respondents of >%138 FPL incomes, younger Medicare and Medicaid beneficiaries, and older adults without Medicare were excluded from this study. Using a quasi-experimental comparative interrupted time-series design, we examined (1) whether ACA’s support for the Medicare-Medicaid dual-eligible program, through facilitating the online Medicaid application process, was associated with an increase in SNAP uptake among low-income older Medicare beneficiaries, and (2) in the instance of an association, to assess the magnitude of SNAP uptake that can be explicitly attributed to the policy implementation. The outcome, SNAP participation, was measured annually from 2009 through 2018. The year 2014 was set as the intervention point when the Duals Office started facilitating Medicaid applications online for eligible Medicare beneficiaries. Results: Overall, a change in the probability of SNAP enrollment from the pre- to post-intervention period was 17.4 percentage points higher in low-income older Medicare enrollees, compared to the similarly low-income, SNAP-eligible, younger adults (β=0.174, P<.001). This boost in SNAP uptake was significant and more apparent among older White (β=0.137, P=.049) and Asian (β=0.408, P=.047) adults. Conclusions: The ACA had a positive, measurable effect on SNAP participation among older Medicare beneficiaries. Policymakers should consider additional approaches that link enrollment to multiple programs to increase SNAP participation. Further, there may be a need for additional, targeted efforts to address structural barriers to uptake among African Americans.