Background:

Older adults dually eligible for Medicare and Medicaid have particularly high food insecurity prevalence and healthcare use.

Objective:

We sought to determine whether Supplemental Nutrition Assistance Program (SNAP) participation, which reduces food insecurity, is associated with lower healthcare use and cost for older adults dually eligible for Medicare and Medicaid.

Design:

Incident user retrospective cohort study. We assessed the association between SNAP participation and healthcare use and cost using outcome regression, supplemented by entropy balancing, matching, and instrumental variable analyses.

Setting:

North Carolina, September 2016 through July 2020.

Participants:

Older adults (age ≥65 years) dually enrolled in Medicare and Medicaid but initially not enrolled in SNAP.

Measurements:

Inpatient admissions (primary outcome), emergency department visits, long-term care admissions, and Medicaid expenditures.

Results:

Of 115,868 individuals included, 5093 (4.4%) enrolled in SNAP. Mean follow-up was approximately 22 months. In outcome regression analyses, SNAP enrollment was associated, per 1000 person-years, with fewer inpatient hospitalizations (−24.6, 95% confidence interval [CI] −40.6 to −8.7), emergency department visits (−192.7, 95%CI −231.1 to −154.4), long-term care admissions (−65.2, 95%CI −77.5 to −52.9), and $2360 (95%CI −2649 to −2071) fewer dollars in Medicaid payments per person per year. Results were similar in entropy balancing, matching, and instrumental variable analyses.

Limitations:

Single state; no Medicare claims data available; possible residual confounding.

Conclusions:

SNAP participation was associated with fewer inpatient admissions and lower healthcare costs for older adults dually eligible for Medicare and Medicaid.

Funding Source:

National Institutes of Health