Missed opportunities to address SNAP for nonenrolled children

BACKGROUND: Primary care is an important setting to identify and support children who are eligible but not enrolled in the Supplemental Nutrition Assistance Program (SNAP) (the SNAP Gap), although there is concern that these programs may be limited in reach. We sought to identify patterns of health care use among eligible but unenrolled children. 

METHODS: We conducted a cross-sectional analysis of the 2021 Medical Expenditure Panel Survey. We identified 975 SNAP eligible/nonenrolled children with household incomes less than 200% of federal poverty level. SNAP eligibility was modeled using income, employment, and household composition and SNAP enrollment was self-reported. We categorized health care encounters across 9 visit types and calculated annual primary care attendance rates. Multivariable logistic regression was used to measure associations with race, language, and chronic conditions. 

RESULTS: SNAP eligible/nonenrolled children received an average of 6.04 health care encounters in 2021. Only half (52.9%) received a primary care visit. Primary care attendance was lowest for Black children (odds ratio [OR] = 0.40 [95% CI 0.20-0.81], P = .01), children speaking languages other than English (OR = 0.53 [95% CI 0.32-0.89], P = .02) and children without a chronic condition (OR = 0.08 [95% CI 0.04-0.15], P < .001). Visits to medical specialists (20.4% of all visits), behavioral health clinicians (10.9%), and dentists (10.0%) were the most common nonprimary care services received by SNAP eligible/nonenrolled children. 

CONCLUSION: In a nationally representative sample of children who were potentially eligible but nonenrolled in SNAP, we found low primary care attendance in 2021 with evidence of racial and linguistic disparities. Clinicians beyond the primary care system are well-positioned to support children who jointly underuse government nutrition programs and primary care services.