Final Grant Report: Cash vs. Food? How Does Food Stamp Eligibility Affect Food Stamp Enrollment and Food and Health Outcomes of SSI Recipients?

Supplemental Security Income (SSI) has been a source of cash assistance for low-income disabled, blind, and elderly persons since it was created in 1974. One choice states had at the start was whether to make SSI recipients eligible for Food Stamps (a means-tested program to provide vouchers for food) or to instead provide additional cash in the SSI grant. Five states initially included the "cash-out" option in 1974, but between 1974 and 1992, four transitioned to grant Food Stamps eligibility to SSI recipients. In 2019, the final hold-out state of California also ended the cash-out program, making SSI recipients in the state eligible for Food Stamps for the first time. In this report, we present findings about the effects of both the beginning of cash out (did Food Stamp participation and food security change for of recipients of the new SSI program differently for those in cash-out states versus non-cash-out states?) and the end of cash out (how did Food Stamp participation and health outcomes change for SSI recipients when cash out ended in their states, making them eligible for Food Stamps?). We use data from a number of sources, including survey data on beneficiaries of SSI and its precursor programs immediately before and after the implementation of SSI, Food Stamp quality control administrative data, hospital-discharge data, and data on program use from the state of California. We find several intriguing results. First, when SSI was initially implemented in 1974, a large number of recipients in cash-out states lost Food Stamp eligibility, and we show that they experienced a significant increase in food insecurity as as result. Second, using data around the 1992 end of cash out in Wisconsin, we show that Food Stamp use went up, and we show suggestive evidence that hospitalizations for food-related diagnoses went down among the low-income elderly population that was likely to be eligible for SSI. Finally, our preliminary analysis of California suggests that county offces that used more different types of outreach and used more accommodations saw a greater increase in SNAP applications among SSI recipients after cash out ended in California.