For about 5 years, from 2015-2020 while I was completing medical and graduate school in San Antonio, my family which consisted of myself, my wife, and our growing family (first one, then two, then three daughters) received SNAP benefits. While I do not claim to be an expert on the subject, I believe my experience gave me a unique perspective on aspects of SNAP that I had not previously considered thoroughly. After first briefly providing a generalized overview of the program, I hope to touch on a few perceived lingering limitations: 1) barriers to household participation, 2) barriers to ensuring proper nutrition, and 3) barriers to self-sufficiency. These limitations should be considered by pediatricians as they encounter patients and families who have food insecurity, so advice and resources can be helpful to and suitable for the families.
The Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, is a federal program that provides nutrition benefits to eligible low-income individuals and families (1). Eligibility is dependent on multiple factors including income, household resources, and work requirements. The application and approval processes occur via local state agencies; and while most eligibility rules are in federal law, state agencies have some discretion in how they calculate household resources (2).
As point of reference, in Texas, a household of four people can have no more than $2,839 in gross monthly income—or 130% of the federal poverty level—to qualify based on income. Additionally, Texas law limits household resources, defined as the sum of “countable liquid resources plus excess vehicle value,” to $5,000 or less for a family to receive SNAP benefits (3). This means a family with a savings account of $6,000 would not receive SNAP benefits in Texas.
Texas distributes SNAP benefits monthly by electronically transferring monetary value to a card that can then be used to purchase food items in stores, similar to how you would use a debit card (4). The maximum monthly benefit allotment is based on household size, but the actual amount distributed to any particular family may vary based on their net income. Again, using a family of four as an example, the maximum monthly allotment is $680, which would provide on average $5.67 per person per day (2).
Barriers to household participation
The Center on Budget and Policy Priorities reports SNAP benefits reached 73% of eligible individuals in Texas in 2016 (5). Examining the 27% of eligible individuals who did not receive SNAP benefits could lead us to assume the families managed without needing the benefits. On the other hand, we could wonder what is preventing this number from being closer to 100%. Pediatricians would hope that no family felt compelled to sacrifice nutrition, most of all for their children, in the name of self-reliance or resiliency, especially when programs are already in place to provide support.
This internal battle of need versus self-reliance became real when my wife and I realized our meager income would be insufficient for the needs of our growing family. I never anticipated I would be the recipient of government assistance programs. I prided myself in hard work and frugality. It was only after some initial hesitancy and frankly feeling ample shame and defeat that we ultimately applied for and received SNAP benefits. Lesson number one, I recognize stigma remains surrounding the receipt of “welfare aid.” Indeed, multiple studies have cited stigma as an obstacle preventing individuals from seeking help (6-8). Furthermore, a study published earlier this year reported a statistically significant association between food stamp participation and depressive symptoms in men (9). From this, we should see efforts are warranted to destigmatize receipt of government benefits.
Second, the application process itself can be a veritable barrier. At the most simplistic level, individuals might not be familiar with SNAP and the benefits offered through this program. Others may not know where to begin or how to apply. In fact, according to a 2008 study assessing 1,390 potentially eligible women in California as to the reasons they did not apply for the Food Stamp Program, 34.6% cited lack of information (7).
Even with information, additional challenges remain. While potential eligibility is often represented by a simple table presenting income limits, the process is much more intricate. Ascertaining eligibility can be confusing given the various requirements and exemptions. Take for example a student, is she eligible? What about a legal immigrant? The answer to both of these questions is maybe. Without understanding all that determines eligibility, coupled with how time-consuming and tedious the application can be (not to mention the renewal process that occurs every 6 months), eligible individuals may question whether it will even be worth the effort. Fortunately, my wife took on this burden. Without her effort, the benefit application and frequent renewal would likely have been put off resulting in inevitable delay or expiration of benefits for my family. A simplification of the application process would do much to promote increased participation.
Barriers to ensuring proper nutrition
Unlike others who have written on the difficulties of living on a SNAP budget, personally, my family never struggled to stretch our SNAP benefits out over the course of the month. The benefits greatly expanded our monthly food budget; and with proper planning (again thanks to my wife), we found our monthly allotment to be more than sufficient to eat both healthy and well. Our fridge and pantry were always stocked, and it was not unusual to have excess roll over to the next month. This is not to discredit others’ hardships living with only SNAP benefits, that just wasn’t my personal experience. Evidence suggests 25% of households receiving SNAP benefits exhaust their monthly allotment by the end of the first week after issuance, and more than 50% do so by the end of the second week (10). This strongly suggests a majority of SNAP participants could likely benefit from guidance in appropriate meal planning and budgeting.
I also found the lack of restrictions on how benefits could be spent surprising. With the exception of alcoholic drinks, benefits could be used to purchase any food or beverage from candy and soda to freezer meals to fresh meats and produce, and there are no limitations on how much could be spent on a particular item. If we wanted to spend all our benefits on Oreos and milk, we could have (probably to the delight of our daughters). This was in stark contrast to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which specifically limits individuals to the purchase of particular food items and in specific quantities (11). In addition, WIC provides one-on-one counseling with nutritionists, recipes, and nutrition classes to empower households to eat healthy.
None of these activities, which are intended to promote healthy eating, are routine for individuals receiving SNAP benefits, and studies have shown the association between individuals receiving SNAP benefits and obesity (12). One such study reported the likelihood for obesity was nearly three times higher for SNAP participants than eligible non-participants (13). If nutrition is the goal, it has been suggested that SNAP be restructured along the framework provided by WIC (14). I believe adjustments can be made to SNAP that both promotes the purchase of healthy foods while still preserving families’ ability to have special items like convenient freezer meals or birthday cake and ice cream. Programs like “Double Up Food Bucks” partners with local funders to match dollar-for-dollar SNAP benefits spent towards fresh produce (up to $20 per day), thus incentivizing the purchase of fruits and vegetables (15). However, this program is limited to select locations (currently only a few farmer markets participate the Dallas area), and expansion of this and similar programs would be a step in the right direction in encouraging healthy eating.
Barriers to self-sufficiency
Following graduation, I was fortunate to be employed with increased income and eliminate my family’s need for ongoing SNAP benefits. But how many beneficiaries are likely to have similar opportunity? For so many the climb is slow. Bonuses are minimal and promotions marginal. SNAP benefits are structured to taper as household income increases, and thus the program avoids the potential negative incentive created by all-or-none benefits (when benefits precipitously terminate at a given income level, individuals may reject small pay increases as the sum total of added income minus lost benefit is less than before and job advancement may appear counter-productive).
I consider SNAP’s current limitation on household resources to be a persistent barrier to helping families obtain self-sufficiency. As mentioned in the overview above, to be eligible for SNAP, households must not have more than $5,000 in combined liquid assets and excess vehicle value, regardless of either family size or income level. While it is justifiable to have resource limitations in place—it would be foolish to allow someone with a sizeable bank account and a garage full of luxury vehicles to receive benefits even if currently unemployed—$5,000 is not substantial considering most financial advisors recommend building up an emergency fund equaling 3 to 6 months of income. In the end, the low resource limit promotes spending over saving and perpetuates poverty over financial security. In my opinion, we should carefully consider an increase in the allowable resources and adjust this amount based on household size, thus allowing families to save for homeownership, “a rainy day”, or catastrophic events like the current pandemic.
I am overwhelmingly grateful for the assistance I personally received via SNAP benefits. SNAP ensured there was sufficient nutritious food on the table for my family when I could not provide it on my own. Numbers clearly demonstrate the substantial hep SNAP imparts to so many. Preliminary data provided by the United States Department of Agriculture reports over 19 million households received SNAP benefits for the fiscal year 2020 (16). In Texas, 1 in 9 individuals received benefits in 2019, and it is estimated that SNAP kept 742,000 Texans, among whom were 389,000 children, out of poverty per year between 2013-2016 (5).
SNAP is a good program and helps many, but good can always become better. As healthcare professionals we can do our part to remove barriers and allow for both improved access and improved health-outcomes for eligible patients and families.
Brett Ipson, MD, PhD
1. “SNAP benefits Recipients”. United States Census Bureau. https://www.census.gov/programs-surveys/saipe/guidance/model-input-data/snap.html
2. “SNAP Eligibility”. USDA Food and Nutrition Service. (2020). https://www.fns.usda.gov/snap/recipient/eligibility
3. “Texas Works Handbook, Part A, Determining Eligibility ”. Texas Health and Human Services (2020). https://hhs.texas.gov/laws-regulations/handbooks/twh/texas-works-handbook
4. “Lone Star Card”. Texas Health and Human Services. https://hhs.texas.gov/services/food/snap-food-benefits/lone-star-card
5. Nchako, C. a. C., L. “A Closer Look at Who Benefits from SNAP: State-by-State Fact Sheets”. Center on Budget and Policy Priorities. (2020). https://www.cbpp.org/research/food-assistance/a-closer-look-at-who-benefits-from-snap-state-by-state-fact-sheets#Texas
6. El Zein, A., Mathews, A. E., House, L., and Shelnutt, K. P. (2018) Why Are Hungry College Students Not Seeking Help? Predictors of and Barriers to Using an On-Campus Food Pantry. Nutrients 10
7. Kaiser, L. (2008) Why do low-income women not use food stamps? Findings from the California Women’s Health Survey. Public Health Nutr 11, 1288-1295
8. Stuber, J., and Kronebusch, K. (2004) Stigma and other determinants of participation in TANF and Medicaid. J Policy Anal Manage 23, 509-530
9. Pak, T. Y. (2020) Welfare stigma as a risk factor for major depressive disorder: Evidence from the Supplemental Nutrition Assistance Program. J Affect Disord 260, 53-60
10. Castner, L., and Henke, J. (2011) Benefit Redemption Patterns in the Supplemental Nutrition Assistance Program. U.S. Department of Agriculture, Food and Nutrition Service, Office of Research and Analysis
11. “Texas WIC”. Texas Health and Human Services. https://texaswic.org/apply?gclid=Cj0KCQiAnb79BRDgARIsAOVbhRrTzoRj-a8UqAajmW9E6YpYWtHU6-i-cHCKUlFmO9EcRBLOYbHq1xcaAgSMEALw_wcB
12. DeBono, N. L., Ross, N. A., and Berrang-Ford, L. (2012) Does the Food Stamp Program cause obesity? A realist review and a call for place-based research. Health Place 18, 747-756
13. Chaparro, M. P., Harrison, G. G., Pebley, A. R., and Wang, M. (2014) The Relationship Between Obesity and Participation in the Supplemental Nutrition Assistance Program (SNAP): Is Mental Health a Mediator? J Hunger Environ Nutr 9, 512-522
14. Levin, S. M., Barnard, N. D., and Saltalamacchia, R. E. (2017) A Proposal for Improvements in the Supplemental Nutrition Assistance Program. Am J Prev Med 52, S186-S192
15. “Double Up Food Bucks”. https://www.doubleuptexas.org
16. “SNAP Data Tables”. USDA Food and Nutrition Service https://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap