U.S. federal safety net programs provide food, nutrition, and health care assistance to eligible low-income individuals and families, with many of these programs expanding benefits and easing enrollment requirements during the COVID-19 pandemic. Using longitudinal survey data from the ACCESS cohort of low-income California families, researchers explored the repeated loss and gain of access to multiple safety net programs, known as ‘churning’, and associations with mental and physical health from 2019 to 2023.
The study identified six distinct trajectories of participation in the Supplemental Nutrition Assistance Program, or SNAP, the Special Supplemental Nutrition Program for Women, Infants, and Children, or WIC, and Medicaid, including stable multi-program coverage, single-program use, and high levels of churning, with overall declines in full program participation after 2021. Participants in stable full-program trajectories generally had better self-reported health outcomes, while those in churning or partial-coverage clusters experienced greater increases in food insecurity and poor physical and mental health over time. A trajectory involving participation in SNAP and Medicaid only was also associated with higher odds of depressive and anxiety symptoms compared to full-program participation. Further, vulnerable groups, including lower-income individuals and Black and Hispanic participants, were disproportionately represented in high-churning and less stable churnings.
Ultimately, the study demonstrated that administrative instability and program churning were common across safety net participation trajectories, and that stable access to multiple programs was associated with better health equity. The study highlights the need for policy solutions such as cross-program coordination, data sharing, and recruitment strategies to better support vulnerable populations.
This study was published in the journal SSM - Population Health. It was conducted by Sydney Dougan, Lia Fernald, and Elise Sheinberg with the School of Public Health at UC Berkeley, Kaitlyn Jackson and Rita Hamad with the Harvard School of Public Health, Wendi Gosliner with the Nutrition Policy Institute, and Kristina Dang with the University of Southern California. This study was funded by the Robert Wood Johnson Foundation, the Tipping Point Foundation, the University of California Office of the President, and the Berkeley Population Center at the University of California, Berkeley (National Institute for Child Health and Human Development of the National Institutes of Health, Award no. 5T32HD101364).