~AARP

JULY 2022

 

OLDER ADULT SNAP PARTICIPATION SERIES PUBLIC POLICY INSTITUTE

Spotlight
Solutions: State Policies Associated
with Higher Participation

Rachel Bleiweiss-Sande and Andrew Gothro
Mathematica

Olivia Dean
AARP Public Policy Institute

This is the last of three AARP Public Policy Institute Spotlights analyzing SNAP participation
among older adults. In this paper, we identify relationships between state SNAP administration
policies and the SNAP participation rate among adults ages 60 and older who are eligible for
SNAP. Our analysis finds that broad-based categorical eligibility (BBCE), Supplemental Security
Income-Combined Application Project (SSI-CAP), and extended recertification periods were
associated with higher SNAP participation among eligible older adults.

In 2020, more than 5 million adults ages 60
and older were food-insecure, meaning they
had limited or uncertain access to adequate
food.' The Supplemental Nutrition Assistance
Program (SNAP) is the nation's largest
antihunger program and helps millions of
people who are at risk for food insecurity.
SNAP provides financial assistance to many
low-income and food-insecure individuals and
families to help buy the food they need. The
program may also improve health and lower
health care costs; research shows that SNAP
enrollment among older adults is associated
with fewer hospital and emergency room visits
and long-term care admissions."

Despite SNAP's importance, older adults have
historically had much lower participation in
SNAP than other age groups. Our analysis in
the first Spotlight of this series found that, in
2018, more than 70 percent of adults ages 60
and older who were estimated to be eligible
for SNAP did not participate in the program.
Qualitative research has identified common
reasons for nonparticipation, such as a
confusing and burdensome application process,
stigma, and discomfort with technology.*

Efforts to increase SNAP enrollment among
eligible older adults are important, because
nutrition plays an important role in healthy
aging.* Those eligible but not enrolled are

low-income, and some may face difficult
decisions like having to make trade-offs
between nutritious food and medicine. The
U.S. Department of Agriculture's (USDA)
Food and Nutrition Service allows states

to apply to various demonstration projects
(hereafter referred to as policies) that aim

to improve SNAP program efficiency and to
make it easier for eligible people to access
benefits. This paper analyzes the association
between specific state policy options and SNAP
participation among adults ages 60 and older.

As described in detail in the next section,

we focus on four SNAP policies (Sometimes
referred to in this report as policies of interest):
broad-based categorical eligibility (BBCE),
Elderly Simplified Application Project (ESAP),
Supplemental Security Income-Combined
Application Project (SSI-CAP), and standard
medical deduction (SMD). Although our
previous two Spotlights in this series focus on
adults ages 50 and older, this paper focuses on
those ages 60 and older because some of the
policies specifically target that age group.

From a policy standpoint, our findings proved
notable. Two policies of interest-BBCE and
SSI-CAP-as well as extended recertification
periods (an aspect of some ESAPs) were
associated with higher SNAP participation
among eligible older adults.
JULY 2022

 

Data Limitations

This report reflects data from 2018, and

the economic conditions have changed
significantly since. In particular, the
COVID-19 pandemic, which begin in

early 2020, significantly disrupted the
economy and caused widespread job loss.
Heightened inflation in 2021 and into 2022
has raised food prices and has stretched the
resources of families throughout the United
States, potentially altering families' SNAP
participation decisions. Nevertheless, this
analysis contributes to a greater understanding
of the likely impact of state policies on SNAP
participation among older adults.

Our analysis treated all policies as equal
despite variation in how they are implemented
across states. Data available on certification
period lengths also pertained to all ages rather
than to older adults. However, extended
certification periods for all ages are likely

to be highly correlated with those for older
individuals, making it a good proxy measure.
Additional research could analyze how various
components of each policy affect SNAP
participation. For example, ESAP was not
associated with higher SNAP participation in
our analysis, but the program is implemented
differently across states, and some aspects may
be more successful than others in boosting
SNAP participation.

Neither the descriptive nor regression analyses
in this report show causal relationships
between specific policies and participation
rates. The regression model adjusts for some
potential confounding factors to give us greater
confidence in the outcome estimates, but
results could still reflect factors not included in
the model.

Background

The four policies we focus on in this paper aim
to make it easier for eligible people to enroll in
SNAP as well as reduce administrative burden
and the amount of churn, or frequent entry
and exit, from SNAP.

In our analysis, we considered several other
SNAP-related factors or policies that could

be associated with SNAP participation to
control for their potential effect. These factors
included:

e Program administration. States may
choose to centralize (state level) or
decentralize (county level) administrative
responsibilities for SNAP.

e Reporting requirements. States may
impose different requirements for SNAP
recipients to report changes in income or
other circumstances."

e Online applications. States can provide
flexibility to households applying for and
renewing SNAP benefits by offering online
applications and opportunities to recertify
their benefits online.

e Phone recertification interviews. States
can offer households the option of a phone
interview to recertify their SNAP benefits
rather than appearing at a SNAP center in
person.

e Call centers. Call centers can support
local SNAP offices by conducting eligibility
and determination processing, handling
case maintenance and recertifications, or
answering customer questions. Call centers
could result in faster customer service to
applicants but could present barriers to
access for some groups by removing or
limiting options for in-person access to
eligibility staff.

e Certification length. State agencies
have flexibility in determining how long
households are certified for benefits. In
general, SNAP households must submit a
periodic report of household and financial
circumstances at least once every six
months during the certification period.
Households with older individuals and
no earned income might have 24-month
certification periods with 12-month
reporting requirements or no periodic
reporting required at all.®
JULY 2022

 

Elderly Simplified
Application Project
(ESAP)

Supplemental Security
Income-Combined
Application Project (SSI-
CAP)

Standard Medical
Deduction (SMD)

Broad-based Categorical
Eligibility (BBCE)

 

ATPL yi a eager

Elderly (60+) SNAP households
with no earned income, and
some projects include disabled
households with no earned
income.

Typically one-person
households eligible for SSI
(low-income older adults or
people with disabilities).

SNAP households with at least
one person age 60 or older ora
person with a disability.

Households meeting more
expansive income and asset
thresholds for other means-
tested programs, such as SSI or
noncash Temporary Assistance
for Needy Families (TANF)
benefits.

 

Description

States may choose from a menu of policy options aimed
at easing SNAP application and processing burdens for
older households. Components of a state's ESAP could
include a streamlined SNAP application form, verification
of reported household and financial information

through data matching, provisions for applicants to self-
declare some information about income and expenses,
waiver of the recertification interview, and an extended
certification period of up to 36 months.

The SSI-CAP functions through a partnership with

the Social Security Administration (SSA), enabling
individuals applying for SSI to apply for SNAP at the
same time through a combined application* CAPs are
intended to reduce the administrative burden for both
applicants and staff by allowing older adults and people
with disabilities to apply for SNAP without visiting a
SNAP office; by simplifying the SNAP application; by
typically providing standard benefit amounts; and, for
some states, by allowing longer certification periods. A
modified model of the CAP uses SSA data for outreach
to eligible SSI households to bring additional eligible
people into SNAP.

Like ESAP, SMD allows states to streamline administrative
procedures and the application process for older
individuals. This policy gives states the option to
establish a standard deduction from the household
income of older individuals or those with disabilities

for out-of-pocket medical expenses of more than $35

per month, instead of calculating and deducting actual
expenses. Households might still choose to claim actual
medical expenses if they are above the SMD threshold.

In states with BBCE, households eligible for other means-
tested programs, provided they also qualify for a positive
SNAP benefit, are "categorically eligible" for SNAP. These
households must provide documentation of income

and some expenses to calculate SNAP benefits, but
categorical eligibility is decided by the asset and income
limits that a state sets for its TANF noncash benefit
program.' These vary substantially across states and can
be up to 200 percent of the federal poverty level.

 

* SSI provides monthly payments to adults and children who have low income and resources and who are blind or disabled.

} The TANF program provides payments to low-income individuals and families to help them pay for food, housing, and other essentials.

Tt Although households with older individuals do not need to meet the gross income limit for SNAP under federal eligibility policies, some state
BBCE policies apply a gross income test that applies to households with older individuals.
JULY 2022

 

Key Findings

Results from our descriptive analysis showed
that states with our policies of interest generally
had higher participation rates, although our
multivariate regression analyses found that only
certain policies were associated with greater
SNAP participation among older adults.

States with policies of interest generally have
higher participation rates.

One way to examine the relationships between
state policies and SNAP participation is to
consider "pooled" SNAP participation rates.
These rates are calculated by dividing the total
number of SNAP participants in a group of
states by the total number of people estimated
to be eligible in those states.

TABLE 1

A pooled SNAP participation rate is the number of
SNAP participants among a group of states divided
by the number of people estimated to be eligible in
those states.

In 2018, most states (41) had implemented

a BBCE policy, 17 had an SSI-CAP, 21 had an
SMD, and 9 had an ESAP. For each policy of
interest, pooled participation rates among
adults ages 60 and older were higher in states
with the policy than without, except for those
with an SMD (table 1). Pooled participation
rates were highest among states with an
SSI-CAP (52 percent) and those without an
SMD (53 percent). This does not necessarily

SNAP Policies and Participation Rates among Individuals Ages 60 and Older, Fiscal Year 2018

Pooled SNAP
Participation Rate

Number Minimum Maximum
of Participation Rate Participation Rate

 

SNAP Policy

2)

AS FS (%) (%)

Elderly Simplified Application Project (ESAP)

States with an ESAP 48.4 9 30.5 67.3
States without an ESAP 47.6 42 22.5 77.8
Supplemental Security Income-Combined Application Project (SSI-CAP)
States with a CAP 51.7 17 30.5 73.4
States without a CAP 43.2 34 22.5 77.8
Standard Medical Deduction (SMD)
States with an SMD 40.8 21 22.5 77.8
States without an SMD 53.1 30 28.4 73.4
Broad-based Categorical Eligibility (BBCE)
States with a BBCE policy 49.2 41 30.5 77.8
States without a BBCE policy 37.9 10 22.5 42.2
Number of Policies
States with none of the policies 39.7 3 28.4 41.9
States with one policy 44.4 20 22.5 63.9
States with two policies 53.0 17 32.0 77.8
States with three policies 46.7 10 30.5 70.5
States with four policies 41.0 1 41.0 41.0

 

Source: Supplemental Nutrition Assistance Program (SNAP) Quality Control (QC) data file and Current Population Survey Annual

Social and Economic Supplement microsimulation model.

Note: We defined state participation in ESAPs, SSI-CAPs, SMDs, and BBCE according to the U.S. Department of Agriculture's SNAP
state options reports, 12th, 13th, and 14th editions; Mathematica's technical documentation for the Fiscal Year 2018 SNAP QC
Database; and the QC Minimodel reports from 2017, 2018, and 2019. In cases of disagreement between the reports, we deferred to the
technical documentation reports. We use "SNAP policies" to refer to SNAP demonstrations and policies.
JULY 2022

 

mean that SMD is not working to improve
participation, because the analysis was
looking for patterns in the data and not

trying to explain causal relationships. A 2016
study found benefits to the SMD beyond
participation, including a higher share

of households claiming medical expense
deductions and an increase in the average size
of medical expense deductions, both of which
increase benefit levels.'

Overall, state participation rates increased by
several percentage points between 2016 and
2018. In 2018, maximum participation rates
ranged from 67 percent for states with an
ESAP to 78 percent for states with BBCE or an
SSI-CAP. We found the highest participation
rates among states with two or three policies
in place. However, many factors beyond
these policies affect SNAP participation,
some of which are accounted for in our linear
regression analysis (next section).

BBCE and SSI-CAP are associated with higher
older-adult SNAP participation.

Using regression analysis, we evaluated
whether certain state SNAP policies were
associated with higher SNAP participation
rates. We accounted for differences in
demographic and economic characteristics
between states and potential impacts of other
state policies.®

Our model found statistically significant
associations between SNAP participation
rates and two of our policies of interest:
BBCE and SSI-CAP (figure 2). Compared with
having no BBCE policy, having a BBCE policy
was associated with a SNAP participation

Our regression model found the following were
associated with higher SNAP participation rates:
e BBCE

e SSI-CAP

e Longer certification periods

e State-level program administration

rate of nearly 11 percentage points higher.

Put another way, we would expect to see

an 11 percentage-point increase in the SNAP
participation rate for a state that went from
having no BBCE to having a BBCE policy,
holding all other variables constant. The effect
associated with SSI-CAP policies was a bit
smaller. Having SSI-CAP was associated with a
7 percentage-point higher SNAP participation
rate, holding all other variables constant. We
did not find statistically significant associations
between having an ESAP or SMD and SNAP
participation among older individuals.

There were also several statistically significant
findings among the additional policies included
in our analysis. Extended certification periods
were strongly associated with a 14 percentage-
point higher SNAP participation rate, with
longer certification periods linked to higher
participation rates among older adults.
Similarly, state-level program administration
was associated with 8 percentage-point higher
participation.

Our analysis also found a negative
association between simplified reporting and
participation, which was surprising. Earlier
research indicated simplified reporting can
reduce burden for staff and increase client
access to benefits.° The evaluation design

in the current study cannot identify causal
relationships and it is not clear from this
finding alone that simplified reporting causes
decreased participation. More research is
needed to understand the relationship between
simplified reporting and SNAP participation.

Implications for Policy and Future Research

The findings from this analysis point toward
specific policy actions, research needs, and
opportunities.

1. States that have not implemented BBCE
should consider doing so.

Our study is one of the first to examine the
effect of BBCE on participation rates among
older adults, and we find that BBCE is likely to
boost participation among those ages 60 and
JULY 2022

 

FIGURE 1
Estimated Effect of State Policies on SNAP Participation Rate for Adults Ages 60 and Older
HNopolicies MSOnepolicy M®Twopolicies MThreepolicies Four policies N/A

Participation Rate BBCE SMD SSI -CAP ESAP

Wyoming
Arkansas
Utah
Mississippi
California
Kentucky
North Dakota
Texas
Arizona
North Carolina
Idaho

Indiana
Kansas
Nebraska
Virginia
Oklahoma
Alabama
Georgia

lowa

Alaska

South Dakota
Louisiana
South Carolina
United States
Tennessee
West Virginia
Missouri
Montana
New Hampshire
Minnesota
Colorado
District of Columbia
Delaware
Michigan
Ohio

Nevada
Wisconsin
Maryland
New Mexico
Maine
Pennsylvania
Hawaii
Illinois

New Jersey
Connecticut
Washington
Vermont
Oregon
Florida

yyy) 22.5
24.4
ME 28.4
EE «30.5
E315
DE 32.0
32.7
33.4
DE 33.5
Py 33.9
35.6
Py_ 35.9
35.9
DO _ 37.0
EN 33.0
38.2
EE 33.3
EEE «30.0
MN 39.6
MEE 39.9
«40.1
a 40.7
EE 41.0

41.9
EE 41.9
Ps 42.2
Po 42.2
Dy) 42.5
«42.7
Do 42.7
DN 44.0
a 48.7
I 455
DN 49.7
Do 49.7
ys 49.9
Do 52.5
Es 53.2
53.3
Do 59.6
EE 1.3
62.3
«62.8
DN «63.0
63.9
EE 4.5
sc5.2
a 67.1
En c7.3

KANN 646K S8 8K

q

SS658

<q

Vv
v

K446

Massachusetts 70.5
New York I 73.4
Rhode Island I 77.8

RANK K KKK KKK KKK KKK KKK ASK SKK

BBCE = Broad-based categorical eligibility; ESAP = Elderly Simplified Application Project; SMD = standard medical
deduction; SSI-CAP = Supplemental Security Income-Combined Application Project. N/A = not applicable.
JULY 2022

 

FIGURE 2

Estimated Effect of State Policies on SNAP Participation Rate for Adults Ages 60 and Older

 

BBCE _ a +10.8**
SSI-CAP ss 7.1**
SMD 1.0
ESAP -2.7
<
Be
3% [ 6 to 12 months ee 23.6 **
uv
= 5 | More than 12 months eee 4.2
" & State administration -__-es8.**
< °
@ S Apply and recertify 2.1
= s Apply only -4.3
oo. .
= Recertify only -6.9

Phone recert interviews -2.8
SNAP call center

Simplified reporting -3.6**

Percentage Points

Source: Mathematica analysis of Supplemental Nutrition Assistance Program (SNAP) Quality Control data file, Current Population
Survey Annual Social and Economic Supplement microsimulation model, and U.S. Census Bureau American Community Survey.

Note: BBCE = Broad-based categorical eligibility; ESAP = Elderly Simplified Application Project; SMD = standard medical deduction;
SSI-CAP = Supplemental Security Income-Combined Application Project. The coefficients for the main variables of interest in these
results describe estimates of the percentage-point difference in participation rate associated with each policy; in other words, the
effect associated with implementing the policy. Yellow bars indicate a positive association; red bars indicate a negative association;

gray bars indicate no association.

*™ Statistically significantly different from zero at the .05 level, two-tailed test.

older. Holding other variables constant, states
implementing a BBCE policy are likely to see
an increase in SNAP participation. As of 2018,
most states (41) had BBCE in place. Three more
states have implemented BBCE since 2018, and
the remaining states should consider adopting
this policy.

Further, strengthening BBCE policies in states
that already have them may also be effective.
Although our model treated all BBCE policies
equally, BBCE policies differ substantially
across states. It is reasonable to suspect that
more expansive BBCE policies would have a
greater effect on participation. For example,
many BBCE states might be able to boost
participation further by raising or eliminating
the BBCE asset limit or gross income limit (if
these apply to older adults).

2. Policy makers should continue efforts
to strengthen the SSA-SNAP partnership
and to explore data sharing and matching
opportunities.

Federal law already requires that SSI applicants
be given the opportunity to file for SNAP at their
local Social Security Administration (SSA) office,
but this joint application process has not always
worked as seamlessly as intended." USDA

Food and Nutrition Service reimburses SSA for
this work, and USDA and SSA should continue
to strengthen the partnership to ensure all
applicants are given this opportunity.

SSI-CAP goes a step further to streamline
application processes by combining the
application process for SSI and SNAP. Seventeen
states currently operate SSI-CAP, and our
analysis found that SSI-CAP was significantly
associated with higher SNAP participation
JULY 2022

 

among older adults. These results suggest
that expanding SSI-CAP to more states could
improve participation in SNAP among older
adults. SSECAP also reduces administrative
burden for both caseworkers and applicants.

In most states, SSI-CAPs use standardized
benefits that result in some participants
receiving a lower SNAP benefit than they
would have received through the normal SNAP
process. SSA staff in states with SSI-CAP should
have basic training in SNAP eligibility and
should help SSI-CAP applicants opt out and

get connected to SNAP agencies if they believe
they could be eligible for a higher benefit
under the regular process.

Policy makers should also explore other ways
to improve data sharing and matching between
Food and Nutrition Service and SSA and other
federal agencies administering public benefit
programs. This can reduce administration
burden and make it easier for older adults

to enroll in and recertify for SNAP while
protecting privacy and program integrity.

3. States should consider extending SNAP
certification periods.

This study supports previous research showing
that extended certification periods could
raise SNAP participation rates among older
adults. Extended recertification periods can
reduce churning, or frequent entry and exit,
from SNAP." For most SNAP households,
federal regulations stipulate that certification
periods should be a minimum of 6 months
and a maximum of 12 months." States have
the option to extend certification periods

to 24 months for households in which all
members are older (ages 60 and older) or
have a disability. Households participating in
ESAP could have certification periods up to
36 months, whereas those in SSI-CAP could
have certification periods up to 48 months.
States that have not extended certification
periods for these households should consider
doing so, either through existing regulation or
through a demonstration project. At the same
time, the federal government should consider

allowing states to extend certification periods
for households with older or disabled members
regardless of a demonstration project, which
our study shows could boost participation.

4. States should not discount ESAP and SMD.

Although our analysis did not find an
association between ESAP or SMD and
increased SNAP participation among older
adults, policy makers may still want to pursue
them. Among other benefits, ESAP and SMD
could still help applicants and SNAP agency
staff by simplifying the application process and
reducing administrative burden. ESAPs that
include extended certification periods may also
reduce SNAP churn. SMD policies may also have
additional values, such as increased benefits

for the highest-need beneficiaries, that are not
reflected in our results." States should consider
these policies as potential options to meet these
other goals. Future research could help us
understand how specific ESAP implementation
models might affect SNAP participation.

SNAP is a critical but underused program
among older adults; millions who are likely
eligible for the program are not enrolling. This
analysis shows that several policy options that
increase eligibility or streamline and simplify
SNAP application and recertification processes
can help increase participation in the program.

Appendix: Methodology
Data Sources

To estimate state participation rates, we used
data from the fiscal year 2016-2018 SNAP
Quality Control (QC) data files and Current
Population Survey-based trends eligibility
data files. The trends eligibility file is based
on a microsimulation model that Mathematica
maintains for the Food and Nutrition Service.
Mathematica uses this model to estimate SNAP
participation rates in periodic reports for the
Food and Nutrition Service. The fiscal year
2018 trends file uses 2017 and 2018 calendar
year data from the Current Population Survey
Annual Social and Economic Supplement to
create a fiscal year file, which is needed to
JULY 2022

 

make the best comparison with annual SNAP
administrative data. For more details on the
Trends file, see the methodology section of the
report Fiscal Years 2016-2018 Trends in SNAP
Participation."

Participation rates derived from the Trends
data files reflect federal SNAP eligibility
criteria. This approach provides a common
standard for measuring participation across
states and avoids using state-specific eligibility
definitions used in the analysis for the first
Spotlight of this series. The analysis results in
the first paper implied participation rates lower
than the rates used in this analysis.

We defined state participation in ESAPs, SSI-
CAPs, SMDs, BBCE, and other state policies
according to technical documentation for

the SNAP QC data files."* Although there is
variation in how states implement policies, we
treated all policies as equal for our analysis.

To estimate state demographic characteristics,
we used the U.S. Census Bureau's Current
Population Survey and American Community
Survey microdata. Because data from the
Census Bureau is presented by calendar

year, and our analysis used the fiscal year for
participation estimates, we constructed fiscal
year variables by taking a weighted average
of 25 percent of the previous year's data and
75 percent of the year of interest. We limited
estimates to people ages 60 and older for all
demographic variables.

Analysis Methods

We conducted a descriptive analysis of
groups of states implementing SNAP policies
and participation rates, including the

pooled participation rate, and minimum

and maximum participation rates. We also
examined participation rates for groups of
states with one, two, three, all, or no policies.
We calculated these descriptive statistics for
fiscal years 2016-2018.

To estimate the association between SNAP
demonstrations and policies and participation
rates, we used a multivariate linear regression
model that controlled for a predetermined set
of other state policies and demographic and
economic characteristics. We included state
versus county SNAP administration, simplified
reporting options (for all individuals), online
applications, availability of SNAP call centers,
availability of recertification interviews by
phone, and extended certification periods

(for all individuals) as other state policies.

We included state unemployment rate, SNAP
eligibility rate, and sex and race for people
ages 60 and older to control for other state-
level factors likely to be associated with SNAP
participation. For this model, we pooled data
from fiscal years 2016-2018 to ensure adequate
sample size, and we included the year as a
covariate in the model.

 

1 Olivia Dean and Carlos Figueiredo, "Over 9 million Adults Ages 50 and Older Faced Food Insecurity in 2020," Washington, DC: AARP
Public Policy Institute, March 31, 2022, https://www.aarp.org/ppi/info-2022/food-insecurity-adults-50-and-older.html.

2 Seth Berkowitz et al., "Supplemental Nutrition Assistance Program Participation and Health Care Use in Older Adults," Annals of

Internal Medicine 174, no, 12 (December 2021): 1674, 1682, https://www.acpjournals.org/doi/pdf/10.7326/M21-1588.

3 Vivian Gabor et al., "Seniors' Views of the Food Stamp Program and Ways to Improve Participation-Focus Group Findings in
Washington State: Final Report," Sacramento, CA: Health Systems Research, Inc., 2002, https://www.ers,usda.gov/webdocs/

publications/43151/51497_efan02012.pdf?v=0.

4 "Nutrition for Older Adults," MedlinePlus, National Library of Medicine, https://medlineplus.gov/nutritionforolderadults.
html#:~:text=Good%20nutrition%20is%20important%2C%20n0,2%20diabetes%2C%20and%20certain%20cancers.

5 Households assigned to change reporting must report these changes within 10 days of the date the change occurred or within
10 days before or after the end of the month when the change occurs. Under simplified reporting, households are required
to report changes in income outside of certification and scheduled reporting intervals only when their income rises above
130 percent of the poverty level or when work hours for able-bodied adults without dependents fall below 20 hours per week.
JULY 2022

 

6 For this analysis, we categorized states as having certification periods of 6 months or less, 6 to 12 months, or greater than
12 months. For states with various combinations of certification lengths, we categorized them based on the longest option
available. We did not have consistent information on certification periods specific to older individuals for fiscal years 2016-2018, so
this variable applies to all individuals.

7 Grace Bagwell Adams, Jung Sun Lee, Vibha Bhargava, and David A. Super, "Offsetting the Effects of Medical Expenses on Older
Adults' Household Food Budgets: An Analysis of the Standard Medical Expense Deduction," The Gerontologist 57, no. 2 (April 1,

2017): 359-366, https://pubmed.ncbi.nlm.nih.gov/27927729.

8 Controlling for other state policies is important because states have many policy options beyond the four policies of interest in this
study that may affect SNAP participation. Economic and demographic differences can also explain some of the variation in SNAP
participation rates, so controlling them helps isolate the role of our policies of interest.

9 Trippe, Carole, Liz Schott, Nancy Wemmerus, and Andrew Burwick. "Simplified Reporting and Transitional Benefits in the Food
Stamp Program-Case Studies of State Implementation." Report submitted to the U.S. Department of Agriculture, Economic
Research Service. Washington, DC: Mathematica Policy Research, May 2004.

10 "Combined Application Projects," U.S. Department of Agriculture Food and Nutrition Service, https://www.fns.usda.gov/snap/
mbined- ication-proj -0.

11 "Understanding the Rates, Causes, and Costs of Churning in the Supplemental Nutrition Assistance Program (SNAP}," U.S.
Department of Agriculture Food and Nutrition Service, Office of Policy Support, September 2014, https: /Iwww. urban. vorgisites!
f-Ch

 

Assistance-Program-SNAP-,.PDF.

12 "Part 273-Certification of Eligible Households," 7 C.F.R. Part 273, https://www.ecfr.gov/current/title-7/subtitle-B/chapter-Il/
subchapter-C/part-273#p-273.10(f).

13 Grace Bagwell Adams, Jung Sun Lee, Vibha Bhargava, and David A. Super, "Offsetting the Effects of Medical Expenses on Older
Adults' Household Food Budgets: An Analysis of the Standard Medical Expense Deduction."

14 "Trends i in SNAP Participation Rates: FY 2016-2018, " U.S. Department of Agriculture Food and Nutrition Service,

 

15 Ibid.

16 "Technical Documentation for the Fiscal Year 2018 Supplemental Nutrition Assistance Program Quality Control Database and
the QC Minimocel," Washington, DC: Mathematica, October 1, 2019, https://www.mathematica.org/publications/technical-

documentation-for-the-fiscal-year-2018-supplemental-nutrition-assistance-program-quality.

eC
Spotlight 1429200, July 2022

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