• Sarah L Szanton, Laura J Samuel, Rachel Cahill, Ginger Zielinskie, Jennifer L Wolff, Roland J Thorpe, and Charles Betley.
• Johns Hopkins University School of Nursing, 525 N Wolfe street, Baltimore, Maryland, 21205, USA. sszanto1@jhu.edu.
• BMC Geriatr. 2017 Jul 24; 17 (1): 162.

BackgroundAlthough it has long been known that a broad range of factors beyond medical diagnoses affect health and health services use, it has been unclear whether additional income can decrease health service use. We examined whether Supplemental Nutrition Assistance Program (SNAP) receipt is associated with subsequent nursing home entry among low income older adults.MethodsWe examined the 77,678 older adults dually eligible for Medicaid and Medicare in Maryland, 2010-2012. Zero inflated negative binomial regression, adjusting for demographic and health factors, tested the association of either lagged SNAP enrollment or lagged benefit amount with nursing home admission. We used Heckman two-step model results to calculate potential savings of SNAP enrollment through reduced nursing home admissions and reduced duration.ResultsOnly 53.4% received SNAP in 2012, despite being income-eligible. SNAP participants had a 23% reduced odds of nursing home admission than nonparticipants (95% CI: 0.75-0.78). For SNAP participants, an additional $10 of monthly SNAP assistance was associated with lower odds of admission (OR = 0.93, 95% CI: 0.93-0.93), and fewer days stay among those admitted (IRR = 0.99, 95% CI: 0.98-0.99). Providing SNAP to all 2012 sample nonparticipants could be associated with $34 million in cost savings in Maryland.ConclusionsSNAP is underutilized and may reduce costly nursing home use among high-risk older adults. This study has policy implications at the State and Federal levels which include expanding access to SNAP and enhancing SNAP amounts.

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