Food Insecurity and Health: Addressing Food Needs for Medicaid Enrollees as Part of COVID-19 Response Efforts

Appendix A: Overview of Major Federal Nutrition Assistance Programs

SNAP is the largest federal nutrition assistance program, with approximately 35.7 million people in 18 million households participating in the program in FY 2019.1 SNAP provides monthly benefits to help eligible low-income households purchase food at authorized grocery stores and other food outlets.

WIC operates through federal grants to states to support access to supplemental foods, health care referrals, and nutrition education for low-income, nutritionally at-risk pregnant, postpartum, and breastfeeding women; infants; and children up to age five. WIC benefits can take the form of vouchers for purchase of authorized items at qualifying food stores, nutrition and breastfeeding education, health screenings, and immunization screening and referral.2 WIC participants may also receive a monthly “food package” tailored to nutrition needs. In 2019, approximately 6.4 million women, infants, and children participated in WIC.3

National School Meal Programs. The National School Lunch Program (NSLP) and the School Breakfast Program (SBP) operate in public and nonprofit private schools as well as residential childcare institutions. All meals served under the programs receive federal subsidies, and free or reduced-price lunches and breakfasts are available to qualifying low-income students. In 2019, over 4.8 billion lunches were served to 29.6 million children,4 and over 2.4 billion breakfasts were served to nearly 14.8 million children under these programs.5

Table 1: Income Eligibility Standards for Medicaid and Federal Nutrition Assistance Programs
Program Income Eligibility Limit Notes
Medicaid Minimum 138% FPL for children, pregnant women, and parents and other adults in states that have implemented the ACA Medicaid expansion. Most states have higher income eligibility limits for pregnant women and children.

Eligibility for parents and other adults is very limited in states that have not adopted the ACA Medicaid expansion.

SNAP 130% FPL gross monthly AND 100% FPL net monthly Households with an elderly/disabled member are only required to meet the net income limit.

Work requirements, with some exceptions, and resource limits also apply.

WIC States can set gross income limits between 100% FPL and 185% FPL for pregnant and postpartum women, infants, and young children. Individuals must also be identified by a health professional as being at nutrition risk.
School Meal Programs 130% FPL gross monthly income for free school meals

185% FPL gross monthly income for reduced-price school meals

Appendix B: Tables

Appendix Table 1: Household Food Sufficiency among Adult Medicaid Enrollees, by Characteristic, July 16-July 21, 2020
Enough Food to Eat in Past 7 Days Sometimes/Often Not Enough Food
to Eat
in Past 7 Days
Overall 77% 23%*
  18-34 74% 26%*
  35-54 74% 26%*
  55-64 83% 17%*
  65+^ 86% 14%
  Male^ 79% 21%
  Female 76% 24%*
  White^ 79% 21%
  Black 75% 25%*
  Hispanic 73% 27%*
  Asian 81% 19%
  Other 80% 20%
  <$25,000 71% 29%*
  $25,000 – <$50,000 79% 21%*
  $50,000+^ 88% 12%
Self-Reported Health Status
  Excellent/Very Good^ 87% 13%
  Good 78% 22%*
  Fair/Poor 69% 31%*
NOTE: * Indicates statistically significant difference from the reference group (indicated with ^) at the p<0.05 level. Persons of Hispanic origin may be of any race but are categorized as Hispanic for this analysis; other groups are non-Hispanic. Food insufficiency is defined as sometimes or often not having enough to eat.
SOURCE: KFF analysis of Week 12 of the Household Pulse Survey Public Use File (July 16-July 21).
Appendix Table 2: Participation in Nutrition Support Programs among Medicaid Enrollees Prior to the Coronavirus Pandemic,
by Characteristic, 2018
Family Receipt of Nutrition Support
Overall 47% 25%
  0 to 5 49% 51% *
  6 to 18 48% 17% *
  19 to 34 43% 26% *
  35 to 64 49% 12%
  65+^ 46% 8%
  Male^ 46% 25%
  Female 49% 24%
  White^ 46% 20%
  Black 56% * 27% *
  Hispanic 46% 29% *
  Asian 26% 15%
  AIAN 61% * 36% *
  Other 64% 26%
Income (% of FPL)
  <100% FPL 68% * 31% *
  100-200% FPL 40% * 24% *
  200%+ FPL^ 21% 14%
  Northeast 47% * 20% *
  Midwest 51% 23%
  South^ 54% 27%
  West 38% * 25%
Self-Reported Health Status
  Excellent/Very Good^ 43% 27%
  Good 50% * 24%
  Fair/Poor 59% * 15% *
NOTE: * Indicates statistically significant difference from the reference group (indicated with ^) at the p<0.05 level. N/A: Point estimates do not meet minimum standards for statistical reliability. SNAP is the Supplemental Nutrition Assistance Program and WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children. AIAN refers to American Indians and Alaska Natives. Persons of Hispanic origin may be of any race but are categorized as Hispanic for this analysis; other groups are non-Hispanic. The US Census Bureau’s poverty threshold for a family with two adults and one child was $20,212 in 2018.
SOURCE: KFF analysis of 2018 National Health Interview Survey.
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