Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2022 Sep 1;5(9):e2230150. doi: 10.1001/jamanetworkopen.2022.30150.
In the Supplemental Nutrition Assistance Program (SNAP), families may temporarily lose benefits for which they are still eligible because of administrative issues. This lapse in benefits, referred to as churning, increases the risk of food insecurity for families, which is linked with poorer health.
To examine the rate of churning among SNAP participants with young children and evaluate the association of administrative policy changes with churning risk.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional study of recertifications among 9735 SNAP-participating households with at least 1 child younger than 6 years from May to November 2019 tested whether there were sociodemographic differences in churning risk. An interrupted time series analysis of recertifications among 70 799 households from January 1, 2014, to December 31, 2019, tested whether state-level administrative policy changes were associated with churning risk. Data were analyzed between February and November 2021.
Three Massachusetts SNAP administrative policy changes.
Churn episodes, defined as losing SNAP benefits after a deadline for eligibility recertification followed by receiving benefits again within 30 days, measured using state SNAP administrative data.
In 2019, a total of 9752 recertification events occurred among 9735 households (3841 [39.4%] Hispanic, 2138 [21.9%] non-Hispanic Black, and 3533 [36.2%] White) with at least 1 child younger than 6 years participating in SNAP. Of these households, 3984 (40.9%) experienced SNAP churning for a period of 1 to 30 days because of missed recertification forms in any given month. Churning was more common among Hispanic households (by 3.9 percentage points; 95% CI, 1.2-6.6 percentage points) than non-Hispanic White households and more common among households with more than 1 child younger than 6 years (by 5.6 percentage points; 95% CI, 3.0-8.1 percentage points) compared with smaller households. Among households that churned, non-Hispanic White households lost a mean of $10.51 (95% CI, $10.16-$10.86) in benefits per household member, and non-Hispanic Black households lost an additional $1.10 (95% CI, $0.47-$1.74) per household member. On implementation of a task-based, first-available-caseworker model, mean churn episode length was significantly shorter immediately on introduction of the model (-0.30 days per each month after the policy change; 95% CI, -0.52 to -0.07 days) and over time (-0.23 days per each month after the policy change; 95% CI, -0.26 to -0.20 days). At the addition of a second policy change to expand participants' access to simplified reporting requirements, a decrease was seen in the trend in the probability of a churn episode by -0.74 percentage points per month (95% CI, -0.87 to -0.62 percentage points). A third policy to expand online services for submitting recertification paperwork was not associated with a change in churn risk over time.
Churning in SNAP is common among households with young children and is disproportionately experienced by Black and Hispanic households and lower-income households. Administrative changes to simplify caseworkers' workloads and streamline eligibility reporting for participants may reduce churn.
重要性：在补充营养援助计划（SNAP）中，由于行政问题，符合条件的家庭可能会暂时失去福利。这种福利中断被称为“ churn”，增加了家庭食品不安全的风险，而这与较差的健康状况有关。
目的：研究有年幼子女的 SNAP 参与者 churn 的比率，并评估行政政策变化与 churn 风险的关联。
设计、地点和参与者：这是一项横断面研究，研究了 2019 年 5 月至 11 月期间至少有 1 名 6 岁以下儿童的 9735 户 SNAP 参与者的重新认证情况，测试了 churn 风险是否存在社会人口学差异。2014 年 1 月 1 日至 2019 年 12 月 31 日期间，对 70799 户家庭进行了重新认证的中断时间序列分析，测试了州级行政政策变化是否与 churn 风险相关。数据分析于 2021 年 2 月至 11 月之间进行。
暴露：马萨诸塞州的三项 SNAP 行政政策变化。
主要结果和测量：churn 事件，定义为在资格重新认证的最后期限后失去 SNAP 福利，然后在 30 天内再次获得福利，使用州 SNAP 行政数据进行测量。
结果：2019 年，在至少有 1 名 6 岁以下儿童参加 SNAP 的 9735 户家庭（3841[39.4%]为西班牙裔，2138[21.9%]为非西班牙裔黑人，3533[36.2%]为白人）中，共有 9752 次重新认证事件发生。这些家庭中，有 3984 户（40.9%）因为在任何一个月错过了重新认证表格，而经历了 1 至 30 天的 SNAP churn。与非西班牙裔白人家庭相比，西班牙裔家庭的 churn 更为常见（高出 3.9 个百分点；95%CI，1.2-6.6 个百分点），而与较小的家庭相比，有多个 6 岁以下儿童的家庭更为常见（高出 5.6 个百分点；95%CI，3.0-8.1 个百分点）。在 churn 的家庭中，非西班牙裔白人家庭每户成员失去了 10.51 美元（95%CI，10.16-10.86 美元）的福利，而非西班牙裔黑人家庭每户成员额外损失了 1.10 美元（95%CI，0.47-1.74 美元）。在实施基于任务的、第一个可用个案工作者模式后，平均 churn 事件长度在政策变化实施后立即显著缩短（政策变化后每月减少 0.30 天；95%CI，0.52-0.07 天），并且随着时间的推移而缩短（政策变化后每月减少 0.23 天；95%CI，0.26-0.20 天）。在增加第二项政策以扩大参与者简化报告要求的机会后，churn 事件的概率趋势每月下降 0.74 个百分点（95%CI，0.87-0.62 个百分点）。第三项扩大在线服务以提交重新认证文件的政策与 churn 风险随时间变化无关。
结论和相关性：SNAP 中的 churn 在有年幼子女的家庭中很常见，并且不成比例地由黑人和西班牙裔家庭以及低收入家庭经历。简化个案工作者工作量和简化参与者资格报告的行政变更可能会减少 churn。
