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

BMC Health Services Research

Research

Asos Mahmood¹  Cyril F. Chang²  Noah E. Hammarlund³  Aram Dobalian⁴  Hyunmin Kim⁵ 

[1] Center for Health System Improvement, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA;Department of Medicine-General Internal Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA;Department of Economics, Fogelman College of Business and Economics, The University of Memphis, Memphis, TN, USA;Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA;Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA;School of Health Professions, The University of Southern Mississippi, 118 College Drive #5122, 39406, Hattiesburg, MS, USA;

关键词: Supplemental Nutrition Assistance Program;    Health Care Reform;    Affordable Care Act;    Medicare and Medicaid;    Dually eligible beneficiaries;    Low-income;    Older adults;   

DOI  :  10.1186/s12913-023-09557-7

 received in 2023-01-12, accepted in 2023-05-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe Affordable Care Act (ACA) provisions, especially Medicaid expansion, are believed to have “spillover effects,” such as boosting participation in the Supplemental Nutrition Assistance Program (SNAP) among eligible individuals in the United States (US). However, little empirical evidence exists 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.MethodsWe extracted 2009 through 2018 data from 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’s implementation. The outcome, SNAP participation, was measured annually from 2009 through 2018. The year 2014 was set as the intervention point when the Medicare-Medicaid Coordination Office started facilitating Medicaid applications online for eligible Medicare beneficiaries.ResultsOverall, the change in the probability of SNAP enrollment from the pre- to post-intervention period was 17.4 percentage points higher among low-income older Medicare enrollees, compared to 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), Asians (β = 0.408, P = .047), and all non-Hispanic adults (β = 0.030, P < .001).ConclusionsThe 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 and Hispanics.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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Fig. 2