A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs rR » el , wr . i --_ > (i, a Pi! 3 ' ft af ¥ ™ ny oa \h 7 -\ Es \ ( | a a » 3 a . ~ Py, - ca = 1 "4 NU a 7 FOUNDATION Introduction Food and nutrition programs provide a critical safety net, yet many New Yorkers cannot or do not participate in programs that could help them access the food they need to thrive. Access to and perceptions of these programs vary by individual and social factors that, if better understood, could lead to greater participation. Based on a 1,507-person statewide Survey of. Food and Health from the New York Health Foundation, this brief outlines overall participation in food and nutrition programs, details the experiences of food-insecure individuals-those who lack consistent access to enough food for an active, healthy life-and recommends actions to improve food security and health. KEY FINDINGS INCLUDE: @ Nearly 90% of Supplemental Nutrition Assistance Program (SNAP) participants and 87% of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants agree that the benefits are easy to use. ® More than one-quarter (28%) of food-insecure New Yorkers don't participate in any food or nutrition program. ®@ Program participation and perceptions vary widely by race/ethnicity, geography, and health status. For example: >» Food-insecure Asian New Yorkers are only half as likely to be enrolled in SNAP as their Hispanic peers (26% compared with 52%). > More than 80% of white food-insecure families approve of the variety of food school meals provide, compared with only 37% of Asian families, 45% of Black families, and 58% of Hispanic families. > Suburban New Yorkers experiencing food insecurity are less likely to find WIC easy to use (69%) compared with their rural (85%) and urban (94%) peers. > Only 60% of food-insecure New Yorkers with a chronic health condition say that food pantries offer high-quality food, compared with 88% of their peers without a chronic illness. A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs na New Yorkers' Experiences: Food & Nutrition Programs New Yorkers Rate the Food and Nutrition Programs They Participate in Highly New Yorkers who participate in public benefits, emergency food, and meals programs rate them highly. For example, 89% of SNAP participants and 87% of WIC participants agree that the benefits are easy to use. And 82% of WIC participants also agree that their local stores carry enough WI1C-approved items. New Yorkers Who Participate in SNAP and WIC Rate the Programs Highly 89% yar Fa el) alas agree that their participants find LE Ge Sac local stores carry find the benefits the benefits easy enough WIC- LWA Ke MU ists) to use. approved items. Many Food-Insecure New Yorkers Do Not Participate in Any Food or Nutrition Program Despite the crucial role that food and nutrition programs play, some food-insecure individuals are not eligible, and many of the programs available are under-enrolled. More than one- quarter (28%) of food-insecure New Yorkers did not participate in any food or nutrition program in the last 12 months. Participation varies substantially according to race and ethnicity, as well as geography. A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs Ew New Yorkers' Experiences: Food & Nutrition Programs Food-Insecure New Yorkers Who Don't Participate in Any Food or Nutrition Program By Health Status By Race Asian 39% 26% Chronically Ill Black/AA Not 31% Hispanic Chronically Ill White By Geography Rural Suburban 38% Urban 23% Food-insecure New Yorkers report substantial barriers to both eligibility and enrollment in food programs. To apply or recertify, 63% of food-insecure individuals say that travel to the benefits offices is problematic. A majority worry about the required paperwork, and half are concerned that they earn too much to qualify. Stigma is another major barrier: half of food- insecure New Yorkers worry that people will find out they participate in food benefits and do not want to rely on government programs. While barriers to food assistance programs are consistent across race and ethnicity, stigma related to participation varies. More than half of white, Asian, and Hispanic food-insecure individuals cite stigma as a major concern, whereas only 35% of Black food-insecure respondents do. A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs Em New Yorkers' Experiences: Food & Nutrition Programs Food-Insecure New Yorkers' Top Concerns about Using Food and Nutrition Programs Paperwork concerns Difficulty traveling to agency Concern about assets Concern others find out Do not want to rely on government Food-Insecure New Yorkers' Concerns about Participating in Food and Nutrition Programs, by Health Status Concern about paperwork Difficulty traveling fo agency Concern about assets Concern others find out Do not want to rely on government 58% 54% 62% 63% 46% 57% 48% 57% 53% 64% Hi Chronically ili! HE Not Chronically Ill A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs Za New Yorkers' Experiences: Food & Nutrition Programs Food-Insecure New Yorkers' Concerns about Participating in Food and Nutrition Programs, by Race Concern about paperwork Difficulty traveling to agency Concern about assets Concern others find out Do not want to rely on government 35% 53% 45% 60% 58% 67% 57% 56% 66% 45% 40% 52% 50% 62% 50% 55% 59% 52% 53% 58% HM Asion Black J Hispanic (I white Food-Insecure New Yorkers' Concerns about Participating in Food and Nutrition Programs, by Geography Concern about paperwork Difficulty traveling to agency Concern about assets Concern others find out Do not want to rely on government 37% 59% 61% 55% 54% 68% 34% 52% 52% 35% 52% 55% 57% 47% 60% MH Rural | Suburban =-s i urban A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs New Yorkers' Experiences: Food & Nutrition Programs SNAP Helps New Yorkers Afford the Food They Need to Thrive SNAP, also known as food stamps, helps families afford the food they need to thrive by providing a cash benefit to use across food retail outlets. Yet only 45% of New Yorkers who identify as food insecure used SNAP in the last 12 months. At the same time, the population of eligible but unenrolled individuals in New York is low-89% of SNAP-eligible New Yorkers participate in the program. This discrepancy suggests that the federal eligibility criteria prevent many food-insecure individuals in the State, where the cost of Living is high, from participating in SNAP, Experts estimate that in New York, a family of four would need to earn at least $119,150 to cover basic living costs such as food, medical care, and childcare, and yet a family of that size earning more than $55,500 in gross income does not qualify for SNAP23 Food-Insecure New Yorkers' Participation in SNAP By Health Status By Race Asian 26% AT% Chronically Ill > Black/AA ronically a7% Hispanic i 52% Not Chronically Ill White bo 42% By Geography 53% Rural Suburban 36% Urban 17% | U.S. Department of Agriculture, Food and Nutrition Service. SNAP participation rates by state, all eligible people. 2020. https://www.fns.usda.gov/usamap#. Accessed April 2022. 2 Massachusetis Institute of Technology. Living Wage Calculation for New York. https://livingwage. mitedu/states/36. Accessed January 2023. 3 New York State Office of Temporary and Disability Assistance. Supplemental Nutrition Assistance Program (SNAP). https://otda.ny.gov/programs/snap/. Accessed January 2023. A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs Zi New Yorkers' Experiences: Food & Nutrition Programs Understanding the differences in SNAP participation based on underlying individual and social factors could help to target outreach and ultimately bolster participation. Food-insecure individuals with a chronic illness participate in SNAP at higher rates than do food-insecure individuals without a chronic illness. Rates also vary by race and ethnicity, with only one- quarter of Asian food insecure New Yorkers having participated in SNAP in the last 12 months, compared with half of their Hispanic counterparts participating. Food-insecure individuals living in suburban areas (36%) are also less likely to participate in SNAP than their urban and rural counterparts. Approximately 90% of SNAP participants think the program is easy to use, but only about half report that the benefits are enough. In fact, fewer than half of individuals with chronic conditions, Asian individuals, and individuals Living in rural and suburban areas found the benefits adequate.4 When asked how to improve the program, SNAP participants suggest increasing the benefit amount, Other popular suggestions include improving application and distribution methods {e.g., shorter approval timeline, multiple disbursements per month); expanding the types of items individuals could buy with SNAP (e.g., hot foods, household goods like paper towels); and expanding participant eligibility requirements (e.g., increase the income limit). "| get food stamps, but with inflation, | just don't have enough to last all month. | only eat once a day, and try to stretch the food out. | can't afford fresh vegetables and fruit." - survey Respondent More New Yorkers Should be Enrolled in WIC WIC helps low-income pregnant, postpartum, and breastfeeding people, as well as infants and children up to age five, purchase the food they need. Participation is associated with more nutritious diets, better birth outcomes, lower risk of infant mortality, and better brain development.® 4 At the time the survey was conducted, every SNAP participant across New York was receiving additional benefits granted by a federal public health emergency waiver. When these emergency allotments end in March 2023, every household will receive fewer benefits. 5 Caulfield LE at al. Maternal and child outcomes associated with the Special Supplemental Nuttition Program for Women, Infants, and Children (WIC). U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. htips://effectivehealthcare.ahrq.gov/sit default/files/product/pdf/cer-253-maternal-child-outcomes-wic.pdf. Accessed April 2022. A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs na New Yorkers' Experiences: Food & Nutrition Programs Despite these benefits, only 59% of eligible New Yorkers are enrolled in the program.® As with SNAP, differences in participation vary by individual and social factors. For example, white food-insecure individuals are almost twice as likely as Black food-insecure individuals to participate. Uroan New Yorkers are more likely to participate compared with rural and suburban individuals. Participation may also vary based on individuals' perceptions of program convenience. For example, Asian and white individuals are much more likely to report that WIC is easy to use compared with Hispanic and Black individuals. Urban New Yorkers are more likely to report finding WIC benefits easy to use compared with rural and suburban participants. Similarly, urban food-insecure individuals are more likely to report stores stocking enough WIC foods compared with those in rural or suburban areas, Participants' Perceptions of WIC Overall By Race 94% 87% Easy fo use Easy to use 92% Stores have enough wic tors 82% 83% Stores have enough WIC foods 86% By Geography IB Asion iam Black imi Hispanic mimi White 85% Easy to use 94% Stores have enough WIC foods 90% me Rural 4=mm@Suburban ma Urban 6 U.S. Department of Agriculture, Food and Nutrition Service. WIC 2019 Eligibility and Coverage Rates. https://www,fn v/wic/2019-eligibility-cover -tates#5, Accessed April 2022. A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs zw New Yorkers' Experiences: Food & Nutrition Programs Common areas that survey respondents identified for improvement include expanding the items that are eligible (e.g., milk of different fat content); increasing the benefits (e.g., more money to cover formula), and improving application and distribution methods (e.g., making the application easier). Participation in School Meals Programs Varies by Race, Ethnicity, and Location The National School Lunch Program (NSLP) provides nutritional, free, or reduced-cost breakfast and lunch to students each school day? Participation in school meals varies significantly based on locale, Fewer rural food-insecure families participate in the program compared with suburban and urban families. Participating families' perceptions of school meals vary by race and ethnicity. While 81% of white food-insecure families approve of the variety of food school meals provide, less than half of Asian families (37%) do, with Hispanic and Black families' approval falling somewhere in between. Participants' Perceptions of School Meals Overall By Race Approve of the variety 67% Approve of the variety 81% Children like the food 77% Children like the food 87% By Geography Asion Elm Black Hispanic I White Approve of the variety 69% 76% Children like the food 72% 79% MiRural MWSuburban M™iurban 7 New York State Office of Temporary and Disability Assistance. School breakfast and lunch programs. https://otda.ny.gov/workingfamilies/schoollunch.asp. Accessed June 2022. A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs za New Yorkers' Experiences: Food & Nutrition Programs During the COVID-19 pandemic, the federal government also created a temporary alternative to ensure students had the food they needed to learn, Pandemic Electronic Benefit Transfer (P-EBT). P-EBT provided the cash value equivalent of school meals for families to use at grocery stores, similar to SNAP benefits.? Rural food-insecure families were less likely to use P-EBT. Just more than half of rural families who participated in school meals (56%) used P-EBT, compared with 72% of their suburban and 82% of their urban counterparts. Racial disparities also persist, with Asian New Yorkers much less likely to have participated in P-EBT. School Meals Participants Who Used P-EBT Overall By Race Asian 60% 76% Black/AA 82% Hispanic White 78% 75% By Geography 56% Rural Suburban 72% Urban 82% 8 New York City Department of Education. Pandemic Electronic Benefit Transfer Program (P-EBT) food benefits. https://www.schools nyc,.gov/school-life/food/food-benefits. Accessed June 2022. A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs | 10 | New Yorkers' Experiences: Food & Nutrition Programs Clients Largely Approve of the Food that Pantries and Food Banks Provide, but Have Difficulty Accessing It Food banks and their partner food pantries provide free food for families in need. Typically, these entities receive federal funding through The Emergency Food Assistance Program {TEFAP), as well as state, local, and private funds. -Survey Respondent "We have one food bank in our area, but they haven't had many food donations, so we get by with whatever little food we can get." In the last 12 months, 35% of food-insecure New Yorkers visited a food pantry or food bank. Large majorities of those individuals are happy with the food they received, although there are disparities by race and ethnicity, Black families most frequently report liking the food served (82%); Asian families report liking the food the least (60%), but are most likely to agree that the food is of high quality (85%). Participants' Perceptions of Food Pantries/Food Banks Overall Like food 71% Food is high-quality 67% By Race 82% Like Food 85% Food is high-quality 74% Hi Asian Ml Black EE Hispanic BI White By Health Status Like food Food is high-quality m= Chronically Ill maNot Chronically Ill By Geography Like food 75% Food is high-quality 78% m= Suburban mi Urban m= Rural A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs New Yorkers' Experiences: Food & Nutrition Programs Obtaining food from food pantries and food banks is challenging. Three out of four individuals report that the pantry runs out of food often; has inconvenient or limited hours; has long lines and wait times; or limits the number of times users can visit. Challenges vary by where clients live: for example, urban New Yorkers are more likely to report longer lines or wait times compared with rural or suburban individuals. Challenges of Obtaining Food from Food Pantries/Food Banks Overall Runs out of food 1% Inconvenient hours 75% Long lines/walt times 77% Limits number of visits 79% By Race Runs out of food 76% Inconvenient hours 80% 76% 85% 79% 75% Long IInes/walt times Limits number of visits 84% 84% HM Asian EE Black HE Hispanic HE Whiie By Health Status Runs out of food Inconvenient hours Long lines/wait times Limits number of visits mm Chronically Ill mai Not Chronically Ill By Geography Runs out of food Inconvenient hours Long lines/wait times Limits number of visits m= Rural mg Suburban mm Urban A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs Recommendations Policymakers in New York State can take actions to improve participation in programs like SNAP, WIC, and school meals. Specifically, government officials should: ® Make universal school meals permanent. New York State should continue to push the federal government to extend universal school meals permanently. In the absence of federal action, New York should consider covering the cost. Several states, including California and Maine, committed to provide free school meals for all students when the federal universal meals program ended, and a majority of New Yorkers agree the State should follow suit. @ Make application and recertification measures easier for SNAP and WIC participants. Nine out of ten New Yorkers agree that the State should create a single, streamlined application for SNAP, WIC, and Medicaid. There is also broad support to make measures enacted during the COVID-19 pandemic permanent. Some measures, like SNAP remote interviews and use of telephonic signatures, officials should choose to keep. Other measures, like WIC remote benefit recertification and benefit boosts for produce, New York Officials should advocate to the U.S. Department of Agriculture for their continuation. @ Increase outreach for and tailor programs to increase participation. Public benefits and emergency food programs may not be equally serving groups of individuals. For example, Asian individuals who are food-insecure are less likely to participate in SNAP (26%) compared with approximately half of Hispanic, Black, and white individuals. They are also less likely to enjoy the food that pantries provide, less likely to approve of the variety in school meals, and less likely to enjoy school foods. Targeting outreach to different groups, understanding reasons for low participation, and tailoring programs to the degree possible could help increase participation. @ Provide incentives for food insecurity screening and referral processes. Health care providers do not routinely screen for food insecurity, despite the high health care costs associated with the condition. Screening and referral processes, when implemented with fidelity, can reduce hunger and increase medical adherence. And a majority of food- insecure New Yorkers would like to have more conversations about food with their doctors. @ Explore ways to prevent food insecurity in the summer. Ninety-six percent of New York families that participated think the federal P-EBT program should be extended. The State should consider ways to provide cash benefits to students' families over the summer in the absence of federal action. A Critical Safety Net: New Yorkers' Experiences with Food and Nutrition Programs Ee VOICE: TVG MAIL: WEB: 212-664-7656 | 646-421-6029 | 1385 Broadway, www.nyhealthfoundation.org 23rd Floor A eel New York, NY 10018 Improving the state of New York's health