“Every system is perfectly designed to give the results it gets.”
Context: Social determinants drive 80% of health outcomes, clinical care drives 20% (see County Health Rankings Model).
Food insecurity, unemployment, and poverty increased during the great recession (2008) and was exacerbated by the COVID-19 pandemic. Yet SNAP (Supplemental Nutritional Assistance Program–food stamp) enrollments have not increased.
NH is some of the lowest participation in the US for federal food programs (36th in SNAP, 47th in school breakfasts, 32nd in Child and Adult Food Programs, etc.). (Extra credit question: Why is this?)
It is estimated that $1 in SNAP generates $1.50 in economic benefits.
Senior food bank executive in NH: ” We have low enrollment because people are embarrassed to apply.”
But doe this imply that New Hampshire’s 36th in the country enrollment ranking is caused by excess “embarrassment” about applying for food stamps in NH?
How easy is it to apply for food stamps–if you do or do not have internet access?
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Before You Start the Application
You may need the following information for each person in the household to help you complete this application. You should try to gather as much of it as possible before you start. It may take 20-45 minutes to complete your application, depending on the number of people in the household.
- Personal information including social security numbers, birth dates, etc.
- Income from self-employment, jobs and other income, such as child support
- Expenses such as housing, medical care and dependent care
- Asset information including vehicles, life insurance, bank accounts, homes, property, etc.
- Current or recent health insurance and/or Medicare information
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Actions (focused on SNAP):
- Clarify the aim: e.g. Increase proportion of eligible NH residents successfully applying for food stamps to 90% by [specific date].
- Create will to improve the system:
- Estimate potential benefit to food deprived residents and the state as a whole with successful SNAP enrollments
- Benefit to residents: #Eligible residents X Average $$ benefit per resident per month
- Benefit to state of NH: 0.5 (economic multiplier) X Net $$ benefit to residents = State economic benefit (from inflow of federal dollars)
- Estimate potential benefit to food deprived residents and the state as a whole with successful SNAP enrollments
- Understand the current system state.
- Create fishbone diagram on potential reasons why people don’t successfully apply for food stamps.
- Create a simple flow diagram of steps to apply for food stamps.
- Collect baseline data from important cohorts
- Ineligible residents
- Eligibile residents
- Who do not apply
- Who apply and do not get food stamps
- Who apply and get food stamps
- Rapidly test change ideas
Lingering Questions
- How many applications does NH DHHS Bureau of Family Assistance get per month?
- What fraction of applications are successful?
- Who interacts most with unenrolled eligible residents? E.g.
- Grocery stores
- Medicaid providers
- Homeless shelters
- Employment agencies
- Schools
What questions or insights do you have about the NH food stamp system?
NH Collective Health Impact 