Food insecurity gaps in the Supplemental Nutrition Assistance Program based on disability status

About 67 million American adults have a disability, defined as serious difficulty in activities of daily life.1 National data show that food insecurity rates are up to three times higher among people with any disabilities compared to those without,2,3 meaning that they have limited or uncertain access to adequate food.4 Although the food insecurity rate declined in the U.S. population from 15% in 2011 to 10% in 2021,5 the food insecurity rate did not decline among households that included someone with disabilities6 and people with disabilities were twice as likely to have insufficient food than those without disabilities during the COVID-19 pandemic.7 Importantly, food insecurity is associated with numerous health outcomes among adults, including poorer dietary quality,8,9 glycemic control,10, 11, 12, 13 and overall health,14,15 a higher risk of hypertension, high cholesterol,16 diabetes,17 cost-related medication non-adherence,18 functional limitations,19,20 mobility decline,20 and COVID-19,21 and associated with greater healthcare expenditures,22 and earlier mortality23 and associated with poorer health and higher risk of hospitalization among adults with disabilities.15 Therefore, disability-based disparities in food insecurity may partly account for the health disparities that have been documented based on disability status.24,25 Together, this evidence highlights the urgency of addressing food insecurity for people with disabilities.

The Supplemental Nutrition Assistance Program (SNAP) provides money for food to low-income households and participation in the program is estimated to reduce food insecurity by 30%.26,27 Based on federal guidelines, individuals with incomes ≤130% of the poverty threshold are eligible for the program. Although states administer the program and are allowed to increase the income eligibility limit, only about 6% of SNAP households have incomes above that threshold.28 This is likely because households with incomes ≤130% of the poverty threshold are six times more likely to experience food insecurity than households with incomes ≥185% of the poverty threshold5 and food insecurity is a predictor of SNAP enrollment.29

Importantly, people with disabilities may face barriers to SNAP that are not experienced by people without disabilities. Although the SNAP program has eligibility rules for people with disabilities, SNAP defines disability based solely on receipt of disability benefits, which has a laborious application process and a one-year wait time.30 More than half of U.S. adults with disabilities are employed1 and therefore likely don’t apply for disability benefits. In addition, people with disabilities may face challenges in SNAP enrollment as this cumbersome process is often not accessible.31 People with disabilities also face procedural loop holes, as these individuals may not be able to stay enrolled in SNAP for more than 3 months if they are classified by SNAP as an ‘able bodied adult without dependents’ during waiting periods for disability benefit applications, or may not receive the maximum benefit amount to which they are entitled if they are unable to produce documentation of income, assets, medical expenses and/or housing expenses. Together, these issues likely contribute to barriers to SNAP access for households that include someone with disabilities, but are under-studied aspects.

To fill these knowledge gaps, this study tested two hypotheses among U.S. households who were income-eligible for SNAP. First, we tested the hypothesis that the risk of being food insecure and not participating in SNAP is higher among households that include someone with disabilities than households that do not include anyone with disabilities. Second, because of SNAP’s strict disability definition, we hypothesized whether SNAP participating households that include someone with disabilities have disproportionately lower benefit amounts or shorter duration of benefits than households that do not include someone with disabilities. We further hypothesized these results by disability categories, comparing those with a work-limiting disability and those with a non-work-limiting disability.

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