SNAP Restrictions for Drug Felons: A Recipe for Food Insecurity and Higher Healthcare Costs in the US

Objectives: In 1996, President Clinton signed the Personal Responsibility and Work Opportunity Act (PRWOA), a law that imposed a lifetime ban on the Supplemental Nutrition Assistance Program (SNAP) for drug felons and their households. States had discretion to adopt, modify, or lift the ban. We examined the association of State PRWOA-SNAP policies from 2001-2016 with county-level rates of food insecurity among children and adults and healthcare costs associated with food insecurity. Methods: States' PRWOA annual policies from 2001-2016 were reviewed using Westlaw. States were categorized as having (1) lifted, (2) modified, or (3) adopted a full ban on SNAP from 2001-2016 using the mode values of the annual SNAP-ban categories. SNAP-ban categories were linked with county-level food insecurity rates from Map the Meal Gap data and estimates of per-capita healthcare costs associated with food insecurity, obtained from published estimates that used National Health Interview Survey and Medical Expenditure Panel Survey data. County-level food insecurity rates among children and adults, and per-capita healthcare costs associated with food insecurity were compared across the three SNAP-ban categories using one-way ANOVA and Tukey post-hoc tests. Results: From 2001-2016, 12% of US Counties had lifted (n=381), 38% had modified (n=1197), and 50% had adopted a full ban (n=1564) on SNAP. Child food insecurity rates varied significantly across SNAP-ban categories (p < 0.001), with lower rates in counties with a lifted (1.19% ± 0.26%, p < 0.001) or modified ban (1.75% ± 0.18, p < 0.001) than those with a full ban. Adult food insecurity rates varied significantly (p < 0.001), with lower rates in counties that lifted (1.37%± 0.21%, p < 0.001) or modified the ban (1.10% ± 0.14%, p < 0.001) than with a full ban. Per capita healthcare costs associated to food insecurity varied significantly across SNAP-ban categories (p < 0.001). Counties that lifted ($23.36 ± $3.39, p < 0.001) or modified the ban ($15.69 ± $2.28, p < 0.001) had lower per-capita healthcare costs associated to food insecurity than Counties with a full ban. Conclusions: State policies limiting SNAP access for drug felons and their households were associated with higher food insecurity among children and adults, and higher healthcare costs. Funding Sources: NIEHS K12ES033593.