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Heflin paper on administrative churn in SNAP published in Medical Care

Dec 31, 2019

Administrative Churn in SNAP and Healthcare Utilization Patterns

Colleen Heflin, Leslie Hodges & Chinedum Ojinnaka

Medical Care, December 2019

Colleen Heflin

Colleen Heflin


Administrative churn occurs when a household exits the Supplemental Nutrition Assistance Program (SNAP) and then returns to the program within 4 months. Although a number of studies have examined health care utilization patterns related to Medicaid administrative churn less is known about health care utilization patterns among Medicaid-insured SNAP enrollees.


To investigate the characteristics and health care utilization patterns of Medicaid insured SNAP participants who experience SNAP administrative churn.

Research Design: 

Retrospective cohort study using 2010–2013 SNAP benefit data from the state of Missouri linked to Medicaid claims data for the same time period. Individual fixed effect regression analysis was used to investigate differences in health care claims for churners and nonchurners across various health care settings.


Missouri residents ages 18–64 who were Medicaid-insured SNAP enrollees.


Inpatient, outpatient, emergency department (ED), and pharmacy claims, and churn status.


Half of the authors' sample (49.63 percent) experienced administrative churn. In the descriptive analyses, churners had fewer claims for prescription drugs than nonchurners (25.42 percent versus 30.47 percent), but more claims for ED visits (3.79 percent versus 2.74 percent). Adjusting for individual fixed characteristics, inpatient claims occurred with more frequency during periods of churn than while on SNAP, whereas ED, outpatient, and pharmacy claims occurred with less frequency during periods of churn than while on SNAP.


SNAP administrative churn was very common among the authors' study sample. Given that health care utilization patterns varied for churners compared with nonchurners, it is important that researchers and public health professionals not assume stable SNAP receipt among participants.