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Do Medicaid and SNAP Reach Those Who Most Need Them?

September 30, 2014 at 12:30 PM

Millions of low-income people qualify for both Medicaid and SNAP (formerly food stamps), but the federal government doesn’t regularly assess how many of them actually receive both.  That’s a significant omission: Medicaid and SNAP address the most basic needs of our poorest citizens, and health care and nutrition assistance likely produce more powerful results when provided together.  A new Urban Institute paper examining joint participation among eligible children and non-elderly adults in five states — something the federal government could do for all states every year — suggests there is substantial room for improvement.

Urban Institute researchers calculated joint participation rates for 2011 in Colorado, Idaho, Illinois, North Carolina, and South Carolina.  (These states participate in the Work Support Strategies initiative, which is developing and testing better ways to deliver key supports for low-income working families.)  They found significant gaps in joint enrollment: in four of the states, only about two-thirds of non-elderly adults and children who were eligible for both Medicaid and SNAP actually received both (see graph).

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The findings are consistent with our 2011 report’s finding that a large share of poor children — who are very likely eligible for both Medicaid and SNAP — aren’t enrolled in both.

(To be sure, both findings predate health reform implementation, so they don’t reflect participation of many newly eligible low-income adults in states that expanded Medicaid.  Nor do they reflect the major changes in Medicaid application and enrollment systems that health reform requires in order to improve participation.)

Over 40 states co-administer Medicaid and SNAP for low-income families, often using joint forms, the same computer systems, and the same eligibility workers, so one program’s performance often depends on the other’s.  Yet the federal agencies that oversee the two programs issue program policy, oversee operations, and assess state performance on the two programs separately.

States are key partners in delivering the safety net, so it’s important to take a holistic view of their performance, not just a program-by-program approach.  An annual federal assessment of the share of Medicaid- and SNAP-eligible people in each state who actually receive both would better inform federal and state officials on how well we serve our poorest families and individuals.


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