Supplemental Nutrition Assistance Program Participation and Health Care Use in Older Adults A Cohort Study

Background: Older adults dually eligible for Medicare and Medicaid have particularly high food insecurity prevalence and health care use. Objective: To determine whether participation in the Supplemental Nutrition Assistance Program (SNAP), which reduces food insecurity, is associated with lower health care use and cost for older adults dually eligible for Medicare and Medicaid. Design: An incident user retrospective cohort study design was used. The association between participation in SNAP and health care use and cost using outcome regression was assessed and supplemented by entropy balancing, matching, and instrumental variable analyses. Setting: North Carolina, September 2016 through July 2020. Participants: Older adults (aged >= 65 years) dually enrolled in Medicare and Medicaid but not initially enrolled in SNAP. Measurements: Inpatient admissions (primary outcome), emergency department visits, long-term care admissions, and Medicaid expenditures. Results: Of 115 868 persons included, 5093 (4.4%) enrolled in SNAP. Mean follow-up was approximately 22 months. In outcome regression analyses, SNAP enrollment was associated with fewer inpatient hospitalizations (-24.6 [95% CI, -40.6 to -8.7]), emergency department visits (-192.7 [CI, -231.1 to -154.4]), and long-term care admissions (-65.2 [CI, -77.5 to -52.9]) per 1000 person-years as well as fewer dollars in Medicaid payments per person per year (-$2360 [CI, -$2649 to -$2071]). Results were similar in entropy balancing, matching, and instrumental variable analyses. Limitation: Single state, no Medicare claims data available, and possible residual confounding. Conclusion: Participation in SNAP was associated with fewer inpatient admissions and lower health care costs for older adults dually eligible for Medicare and Medicaid.