Nutrition Policy Institute researchers were awarded a $199,786 grant from the California Collaborative for Pandemic Recovery and Readiness Research Program, also known as CPR³. The grant funds a collaborative project with NPI principal investigator Lorrene Ritchie, co-principal investigator Susana Matias from the University of California, Berkeley and the CACFP Roundtable. The project, “Child and Adult Care Food Program: Impacts of COVID-19 Changes to Meal and Snack Reimbursement Rates on Family Childcare Home Providers, Children and Families – Phase 2”, builds on a current project to understand the impact of COVID-19 changes to CACFP reimbursement rates for family child care homes on CACFP participation, food quality, and food security. The one-year project began on July 1, 2023 and includes Kassandra Bacon as project manager, Celeste Felix as data analyst, Reka Vasicsek as research coordinator, Meirong Liao as Administrative Coordinator, Hannah Thompson as statistical consultant, and Ken Hecht as policy advisor. A goal of the CPR³ Program is to generate policy-relevant evidence to improve the health and well-being of California residents in the wake of the COVID-19 pandemic. The CPR³ Program is funded by the California Department of Public Health. California Department of Public Health will not be involved in study design, data collection, data analysis and interpretation, manuscript development, or the decision to publish.

The United States responded to the COVID-19 pandemic by expanding a variety of social safety net programs. Policy responses across the U.S. included workplace protections, workers compensation, and a provision of childcare for essential workers. However, families' experiences with the pandemic-related changes to safety net programs are still not well explored. University of California researchers conducted a study to understand take up, utilization, and experiences with social safety net programs among families with young children in California during COVID-19. Thirty four California parents and caregivers of young children were interviewed from August 2020 to April 2021. Interviewees reported experiencing some benefits of increased safety net support early in the pandemic, including improved food security and counseling support for those studying at community colleges. But generally, parents reported being overwhelmed and stressed and that insufficient childcare and housing instability were not addressed by the social safety net system. Study findings suggest that policy responses carry potential to alleviate economic-related stressors, like food insecurity and also highlight a critical need to strengthen support for families. This study was conducted by the Assessing California Communities' Experiences with Safety Net Supports Survey (ACCESS) study team, including: Alyssa Mooney, Kaitlyn Jackson, Rita Hamad, and Mekhala Hoskote from the UC San Francisco, Philip R. Lee Institute for Health Policy Studies, Lia C.H. Fernald from the UC Berkeley School of Public Health and Wendi Gosliner from the UC Agriculture and Natural Resources, Nutrition Policy Institute. This research was published in BioMed Central Public Health and supported by a grant from the Robert Wood Johnson Foundation.

Food banks and food pantries are expected to see a surge in demand due to increasing food insecurity. Photo by Ismael Paramo, Unsplash

Reduction of SNAP benefit deepens crisis of inflation, high cost of living, low wages

Starting this month, many of the estimated 3 million people in the CalFresh program – California's version of SNAP (Supplemental Nutrition Assistance Program) – will be facing hunger and making difficult decisions to meet their most basic needs. In late March, participants received the last of the pandemic-related emergency aid that significantly boosted their monthly benefits. The reduction varies by household size and income; for example, in April a single-person household could see a drop from $281 per month to $23.

“The emergency food allotments had a tremendous impact in our communities and across the nation,” said Shannon Klisch, academic coordinator for the Youth, Families and Communities Program for UC Cooperative Extension in San Luis Obispo and Santa Barbara counties. “One study estimated that these allotments kept more than 4 million people out of poverty across the U.S. in the last quarter of 2021, and reduced child poverty by 14%.”

SNAP increases during the pandemic made many Californians more food-secure, with some participants reporting that their allotments finally had been enough to feed their families for the month, according to Wendi Gosliner, a project scientist at the Nutrition Policy Institute (a program of UC Agriculture and Natural Resources). But, with the benefit reductions, food insecurity is emerging again as a serious concern.

“It is inconceivable that a nation this wealthy should have so many people experiencing hunger,” Gosliner said. “And here in California, with the high cost of living, ongoing inflation and extreme income and wealth disparities, people are being forced to explore every possible avenue just to feed themselves and their families.”

To help ensure they are receiving the maximum allotment, Klisch recommends that CalFresh participants – especially those who applied during the pandemic and are relatively new to the program – double-check their information.

“If the county doesn't have your most up-to-date information, call your county worker if you've changed your address, if you've experienced decreased income, if your housing costs have gone up, or if you have new expenses – like child or dependent care expenses or medical expenses – these can help you qualify for more CalFresh funds,” she explained.

For families with school-aged children, Klisch said they can stretch their food dollars and promote healthy eating by encouraging their children to eat breakfast and lunch at school through California's universal free school meals, and all families with children under 18 can watch for the next issuance of the P-EBT (Pandemic EBT) card, worth potentially hundreds of dollars.

In addition to these options for food assistance, Klisch pointed to programs that can help people save money on other household expenses, such as California Alternate Rates for Energy Programs (CARE) and Affordable Connectivity Program. Local food banks are also gearing up across the state to handle an expected surge in clients in need of emergency food; a list of California food banks can be found at cafoodbanks.org/our-members.

“We ask a lot of low-income families and workers to navigate and piece together various programs, applications, and benefits when we don't commit to a strong safety net,” Klisch said. “On the other hand, when people have enough money for food, everyone benefits through decreased health care costs and increased economic activity.”

Gosliner also said that people should look into their eligibility for WIC (Special Supplemental Nutrition Program for Women, Infants and Children), as well as the federal Earned Income Tax Credit (EITC) and CalEITC, poverty-alleviation benefits underused by Californians.

“People should make sure they are accessing all the safety net benefits for which they are eligible,” Gosliner said.

One way CalFresh participants can maximize their food dollars is to have their EBT benefits "matched" by a participating farmers market. Photo by Shannon Klisch

Market Match, other nutrition incentive programs can help

Through programs like Market Match, available at about 300 farmers markets across California affiliated with the Ecology Center, CalFresh participants can have their EBT benefits “matched” by their local market (usually up to $10 or $15 per visit).

“People are looking to get creative about how to stretch their food dollars, and Market Match is one way to do that,” said Klisch, who has led UCCE efforts to help promote the program along the Central Coast since 2017.

Striving to expand access to fresh fruit and vegetables and to support local farms, UCCE and CalFresh Healthy Living, UC worked with partners to increase CalFresh redemption at farmers markets in San Luis Obispo and northern Santa Barbara counties.

In 2017, about $48,000 in CalFresh and Market Match benefits were redeemed at farmers markets in the area. In 2022, the total was more than $207,000 – a 327% increase. According to Ecology Center figures for the entire state, CalFresh and Market Match spending at farmers markets jumped 161% from 2019 to 2021, up to $13 million.

Gosliner, whose research has shown that these nutrition incentive programs are associated with increased food security, noted that “the people who use Market Match absolutely love the program and feel it is incredibly helpful.” She also added that the California Department of Social Services is developing a pilot program that would offer match incentives for purchasing fruits and vegetables at larger food retailers.

Although the biggest of its kind, Market Match is just one of the programs across California that provide “matches” for healthy food purchases under the California Nutrition Incentive Program, which in turn is primarily funded by GusNIP (the nationwide Gus Schumacher Nutrition Incentive Program).

GusNIP dollars – and SNAP overall – are governed by the federal Farm Bill, typically renewed every five years and currently being negotiated by Congress.

Few primary care providers screened for food insecurity during the pandemic and screening rates were lower during virtual appointments, according to a UC Davis study led by Cooperative Extension specialist Cassandra Nguyen. (Getty)

Study finds even fewer screened during virtual appointments

As jobless rates rose during the COVID-19 pandemic, millions more Americans experienced food insecurity because they lacked consistent access to food. National health organizations recommend primary care providers screen patients for food insecurity, since not having access to enough food can lead to chronic diseases. 

But research from the University of California, Davis, finds that only 7% of primary care providers screened patients for food insecurity. If the appointment was virtual or telehealth, only 3% asked patients about their access to food. The American Journal of Preventive Medicine published the research.

“These rates are surprising and seem relatively small in comparison with what seems like a growing awareness of food insecurity during the pandemic,” said lead author Cassandra Nguyen, an assistant professor of Cooperative Extension in the UC Davis Department of Nutrition. 

She said the findings may indicate that health care providers were prioritizing emergency responses to COVID-19. The research showed that once people had access to COVID-19 vaccines, screening for food insecurity increased to 10%.

Barriers to telehealth screenings

Screening for food insecurity at telehealth appointments remained low even after vaccines became available. Nguyen said that may suggest telehealth appointments have unique barriers.

“One of those barriers could be a concern about privacy and whether the patient is alone or feels comfortable discussing a potentially stigmatizing experience such as food insecurity. This may deter a primary care provider from asking about it,” Nguyen said.

Screening might also be more difficult if patients aren't familiar with the technology needed or if there are technological disruptions during telehealth appointments. Nguyen said more study is needed about potential barriers given the increased popularity of telehealth appointments since the pandemic.

The research examined electronic health records and clinic data from a national network of more than 400 community health centers in 16 states. It examined encounters between March 11, 2020, and Dec. 31, 2021. Screening typically involves a primary care provider asking the patient to answer that either or both of the following two statements is often true or sometimes true: 

• Within the past 12 months we worried whether our food would run out before we got money to buy more. 
• Within the past 12 months the food we bought just didn't last and we didn't have money to get more.

Co-authors include Rachel Gold with OCHIN Inc. and Kaiser Permanente Northwest Center for Health Research; Alaa Mohammad, Dedra Buchwald and Clemma Muller with Washington State University; Molly Krancari, Megan Hoopes and Suzanne Morrissey with OCHIN Inc.

The National Center for Advancing Translational Sciences of the National Institutes of Health, and the National Institute of Diabetes and Digestive and Kidney Diseases supported the research.