273 - Missed Opportunities? Health Care Use Among Children Potentially Eligible but Unenrolled in the Supplemental Nutrition Assistance Program

Poster Number: 273
Publication Number: 273.1130

Background: Twenty percent of U.S. children have inadequate access to food. Participation in the Supplemental Nutrition Assistance Program (SNAP) has been shown to mitigate food insecurity and improve health outcomes. However, under enrollment in SNAP limits its public health benefit; and little is known about the types of health care encounters that SNAP eligible/not enrolled children experience. There is concern that a lack of connection with primary care may limit opportunities to facilitate enrollment in SNAP for these families.

Objective: To examine patterns of health care utilization among SNAP eligible/not enrolled children and associations with socioeconomic and health status.

Design/Methods: We analyzed nationally representative survey data on U.S. households with children (0 to 21 years) in the 2021 Medical Expenditure Panel Survey. We identified SNAP eligible/not enrolled children using 2 steps: first, we modeled federal SNAP eligibility using household composition and income ( < 130% of federal poverty level), and second, we used parental reported SNAP benefits to identify non-enrollees. We used descriptive statistics to examine patterns of primary and non-primary care visits; and multivariable regression to measure associations between socioeconomic and health status and primary care attendance among SNAP eligible/not enrolled children.

Results: We identified 1,843 low-income households with children of which 48.0% were potentially eligible for SNAP but did not receive any benefits. One-half of all SNAP eligible/not enrolled children (50.9%) did not attend a well child or problem-based primary care visit during the year. Many SNAP eligible/not enrolled children who did not attend primary care visits were seen in other settings: dentistry (21%), pharmacy (13%), optometry (7%), and the emergency department (7%); although one-third (31%) did not receive any services. SNAP eligible/not enrolled children who did not receive primary care were more often in fair/poor health (Odds Ratio (OR)=4.2 [95% Confidence Interval (CI): 1.2, 15.2], p=0.03) and food insecure (OR=1.9 [95%CI: 1.1, 3.7], p=0.02).

Conclusion(s): There is significant under enrollment in SNAP among potentially eligible low-income children. SNAP eligible/not enrolled children who infrequently receive primary care services may have worse socioeconomic and health status. Many of these children are seen in other care settings, such as dental offices and emergency departments; although some may not receive any health care services at all, highlighting the importance of addressing food security across the health and non-health care continuum.