ABSTRACT
The USDA Supplemental Nutrition Assistance Program (SNAP) provides food and financial assistance to food-insecure individuals and families. In the midst of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, SNAP benefits evolved. Policy changes and federal legislation expanded SNAP eligibility, raised benefit levels, and introduced program waivers that enabled online ordering to reduce participants’ exposure to community-acquired SARS-CoV-2. Although rapid expansion of SNAP benefits in the online space represents significant progress for federal food assistance, changes also introduced unforeseen partiality in how benefits and services were accessed and utilized, as illustrated by 2 populations and regions in the early months of the SARS-CoV-2 pandemic: low-income older adults in rural Alabama and low-income Hispanic adults in urban California. Opportunities exist to build on the recent progress in SNAP, while also ensuring continued inclusiveness of eligible persons. Efforts should be informed by evidence that supports equitable access to federal food assistance.
Keywords: nutrition incentive programs, SNAP Online, food insecurity, SARS-Cov-2 pandemic, food assistance
The SARS-Cov-2 pandemic influenced how federal food-assistance resources are delivered and accessed. Data from 2 regions demonstrate it is essential to understand who benefits and how to reach them.
Introduction
Established in 1939 (1), the intent of the USDA's Supplemental Nutrition Assistance Program (SNAP) was to alleviate hunger and stimulate the purchase of surplus commodity foods among persons in need. While many aspects of the program have changed since its inception, SNAP's primary directive of improving access to safe, affordable, and nutritious food has remained consistent.
In 2004, a marked change to SNAP occurred when the electronic benefits transfer (EBT) system replaced paper stamps, enabling participants to use a dedicated debit card to purchase foods at outlets accepting EBT benefits. Since then, arguably no single event has influenced SNAP more than the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which has pressed the transformation of SNAP more in 2 mo than in the previous 2 decades. The Coronavirus Preparedness and Response Supplemental Appropriations Act (2), Families First Coronavirus Response Act (3), and Coronavirus Aid, Relief, and Economic Security Act (4) collectively expanded SNAP eligibility for adults without dependents, provided increased benefits to tens of millions of American families, and introduced program flexibilities and waivers that enabled the expansion of existing EBT-enabled ordering capabilities in states declaring public health emergencies (5).
While recent expansion of online EBT-enabled food ordering and purchasing has been particularly notable for promoting equitable access during the pandemic, these changes may have unintentionally introduced other challenges. Early implementation efforts indicate that many SNAP participants are unaware of or unable to access online services.
Methods
The USDA Gus Schumacher Nutrition Incentive Program (GusNIP)—formerly the Food Insecurity Nutrition Incentive Program (FINI)—provides funding to programs designed to increase produce purchases through point-of-sale incentives at farmers’ markets and grocery stores among SNAP participants (6). In 2019, GusNIP funded the Nutrition Incentive Program Training, Technical Assistance, Evaluation, and Information Center (NTAE) to coordinate reporting and evaluation of GusNIP grantee projects. The NTAE is also charged with determining effectiveness of the GusNIP program in achieving the legislative goals (7) of increasing fruit and vegetable purchases and improving the nutrition and health status of low-income participants (8).
The purpose of this case study report is to describe how 2 former and current grantees of FINI (Wright's Market, ¡Más Fresco!) and GusNIP (¡Más Fresco!) piloted online enrollment within their nutrition incentive programs, which enabled EBT-supported food ordering and purchasing during the early months of the SARS-CoV-2 pandemic in rural Alabama and urban California, respectively. We also discuss challenges and opportunities associated with access and utilization of online resources in these regions. Data were collected by NTAE-affiliated scientists using stakeholder interviews and document review. This study was approved by a blinded institutional review board. Human subjects approval to conduct the interviews with persons affiliated with the 2 organizations highlighted in this case study—¡Más Fresco! and Wright's Market—was obtained from Montana State University Institutional Review Board, protocol CBS060320-EX.
Results
Wright's Market: 2018 FINI pilot grantee; Opelika, Alabama
Wright's Market (9) SNAP Online launched in March 2020 as the culmination of several years of preparatory work to ensure their e-commerce system seamlessly linked with customers’ SNAP EBT benefits. Eligible SNAP participants established accounts, selected and paid for groceries using their EBT card, and received groceries curbside or delivered to their home address. Wright's e-commerce website, configured to help SNAP customers identify eligible products, went live in March 2020. Prior to March 2020, SNAP purchases comprised 40% of Wright's in-store sales. While this proportion has remained consistent throughout the pandemic, only 20% of Wright's e-commerce sales have been SNAP-related, and a majority of SNAP purchases are delivered to homes and not received curbside.
In March and April 2020, Wright's Market staff observed that their SNAP Online customers tended to be younger, more technologically savvy, and more likely to live “in town” versus at a more rural or remote address. Reaching elderly and rural SNAP-eligible customers in Alabama has remained a tremendous challenge, and deliveries to remote areas are costly and unsustainable as currently designed. In response, Wright's has begun to partner with local organizations to serve as drop-off and pick-up locations for grocery orders in remote areas. Potential partners include faith-based organizations, town and city governments, Head Start centers, medical centers, and universities. One of these partners, the Diabetes Center at East Alabama Medical Center, contributed funds to extend the impact of Wright's Fair Food Network's GusNIP grant, while another partner, Auburn University, has already contributed faculty, staff, and student expertise to explore how SNAP Online can be sustainably implemented in rural communities. Wright's has been successful in SNAP Online in part because of their ongoing engagement and partnership with surrounding communities, and ongoing goals are to foster a more inclusive and sustainable SNAP Online experience that will effectively serve rural and remote communities in Alabama and create a distribution model that is replicable across similar communities.
¡Más Fresco! More Fresh: 2016 FINI grantee, 2019 GusNIP grantee; San Diego, CA
In 2016, University of California San Diego Center for Community Health received a FINI grant to launch a SNAP incentive program. The ¡Más Fresco! More Fresh SNAP Incentive Program (10) gives SNAP participants 1 dollar for every SNAP dollar spent buying fresh fruits and vegetables at 6 participating Northgate Gonzalez Market locations in Los Angeles, Orange, and San Diego Counties. The program serves predominantly Hispanic and Latinx communities and is offered in English and Spanish. Community health workers, or promotores, are engaged to recruit SNAP participants to ¡Más Fresco! at store events annually in January–April. Since the program's inception, >4500 SNAP households across Southern California enrolled.
¡Más Fresco! found alternative ways to reach eligible participants as the pandemic forced promotores to remain at home in spring 2020. Outreach to potential program participants occurred in several ways. The program fast-tracked pre-existing plans to implement a digital platform to enable SNAP participants to enroll in ¡Más Fresco! The participant portal (supported by the Qualtricsࣨ) has the capability to collect data and coordinate communication using wireless and connected technologies and email and SMS (short message service) services.
¡Más Fresco! staff developed an enrollment “e-postcard” that included direct links to the program website. The e-postcard was disseminated to partners who serve low-income populations, including the 2-1-1 San Diego Help Line connecting community members to essential health services. ¡Más Fresco! staff conducted partner trainings across Southern California, enabling sharing and promotion of ¡Más Fresco! and online SNAP enrollment. The free webinars were provided to community residents, students, nonprofit organizations, cultural centers, researchers, elected officials, city planners, private and public-sector businesses, and English- and Spanish-language broadcast media.
More than 350 SNAP participants enrolled online between 1 April and 30 June 2020. Demographic data suggested an emerging divide of language and access among participants. Prior to stay-at-home orders in California, 80–90% of SNAP participants at ¡Más Fresco! in-store enrollment events were primarily Spanish speaking. After 13 March 2020, this proportion dropped to 35%. Furthermore, 21% of online enrollees compared with 2% of in-store enrollees indicated they wished to receive program reminders via e-mail, while text message reminders remained more popular among in-store enrollees (84%) compared with online enrollees (53%).
These differences indicate that additional work is warranted to understand potential barriers to digital enrollment and ensure that program participants continue to have the same opportunities post–SARS-CoV-2. Consequently, ¡Más Fresco! is in the process of conducting a study to determine the most effective digital outreach methods among participants with limited English proficiency. These data will inform future efforts to enable online incentive redemption for all 41 Northgate Gonzalez Market locations.
Discussion
Expansion of SNAP online was accelerated by the SARS-CoV-2 pandemic. ¡Más Fresco! was able to successfully enroll SNAP participants in nutrition incentive programs and Wright's Market facilitated online EBT-enabled food purchasing and offered produce incentives to SNAP participants in store and online.
Formative data collected by Wright's Market and ¡Más Fresco! during the pandemic suggest that participation in programs with an online format can be particularly challenging for elderly rural people in Alabama and persons with limited English proficiency in San Diego. These findings highlight the need to understand specific barriers to participation in federal food assistance during the SARS-CoV-2 pandemic. Prior to March 2020, it was well established that eligible seniors in larger, more rural states (11) and persons with limited English proficiency (12) were less likely to be enrolled in SNAP. Systematic evaluation of differences must now take place to ensure these groups do not face even greater challenges when seeking assistance post–SARS-CoV-2 and in the months to come.
Despite concerns that online enrollment and utilization of SNAP and nutrition incentive programs are problematic for some, the ability for SNAP participants to make online purchases and redeem nutrition incentives remains welcome progress for federal food-assistance programs. It is important to understand whether lack of access to wireless and connected devices or the inability to pay a grocery delivery fee (a disallowed expense under SNAP) or some other phenomenon is responsible for the early data emerging from these 2 very different regions of the United States.
As a nation, we have an opportunity to leverage progress to date into continued momentum and innovation. Future efforts to improve SNAP should be informed by access, utilization, and need, with the long-term goal of strengthening food security for vulnerable populations (Box 11).
Box 1: Recommendations for the expansion of federal food assistance to ensure equity and strengthen food security.
Ensure SNAP Online is adequately supported with policy to continue into the future and expand to other federal food-assistance programs.
Build policy, systems, and environment strategies for federal food assistance that simultaneously include and require nutrition education opportunities that leverage SNAP Ed.
Continue to promote fruit and vegetable purchases and consumption with nutrition incentive programs.
Establish culturally sensitive, user-friendly outreach resources to promote access and engagement to federal food-assistance programs among individuals and families from underserved regions and populations.
Develop and sustain community partnerships to leverage expertise and promote outreach within diverse communities.
Conduct rigorous evaluation of novel strategies and disseminate results rapidly to inform continued efforts to reach vulnerable populations.
Allow local control over policies and implementation to ensure that strategies are appropriately tailored to communities.
ACKNOWLEDGEMENTS
The authors thank Kate Edra and Blanca Meléndrez of UC San Diego School of Medicine, Center for Community Health, and Northgate Gonzalez Market. The authors’ responsibilities were as follows—MDH: conceptualization, writing (original draft preparation), reviewing, and editing; CBS: methodology, institutional review board submission, conceptualization, writing (original draft preparation), reviewing, and editing; CP: conceptualization, reviewing, and editing; JP: conceptualization, data collection, writing, reviewing, and editing; KER and JW: conceptualization, data collection, reviewing, and editing; SH-V: data collection, reviewing, and editing; ALY: conceptualization, reviewing, editing, and supervision; and all authors: read and approved the final manuscript.
Notes
This work was supported by Gus Schumacher Nutrition Incentive Grant Program grant no. 2019–70030-30415/project accession no. 1020863 from the USDA National Institute of Food and Agriculture. MDH, CBS, CP, and ALY were supported by Gus Schumacher Nutrition Incentive Grant Program grant no. 2019-70030-30415/project accession no. 1020863 from the USDA National Institute of Food and Agriculture. JP, KER, and SH-V were supported by Gus Schumacher Nutrition Incentive Grant Program grant no. 2019-70030-30404/project accession no. 102089 from the USDA National Institute of Food and Agriculture. JW is a current FINI Grant partner with the Fair Food Network and consultant with the National Grocers Association Foundation Technical Assistance Center.
Author disclosures: JW is President of Wright's Markets, Wright2U.com, and Wright Food Solutions. The other authors report no conflicts of interest.
The study sponsor did not play any role in study design, collection, analysis, and interpretation of the data; writing the report; or decision to submit this report for publication.
Abbreviations used: EBT, electronic benefits transfer; FINI, Food Insecurity Nutrition Incentive Program; GusNIP, Gus Schumacher Nutrition Incentive Program; NTAE, Nutrition Incentive Program Training, Technical Assistance, Evaluation, and Information Center; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SNAP, Supplemental Nutrition Assistance Program.
Footnotes
SNAP, Supplemental Nutrition Assistance Program.
Contributor Information
Melanie D Hingle, Email: hinglem@email.arizona.edu, Department of Nutritional Sciences, The University of Arizona, Tucson, AZ, USA.
Carmen Byker Shanks, Department of Health and Human Development, Food and Health Lab, Montana State University, Bozeman, MT, USA.
Courtney Parks, Gretchen Swanson Center for Nutrition, Omaha, NE, USA.
Joseph Prickitt, University of California, San Diego, School of Medicine, Center for Community Health, San Diego, CA, USA.
Kyung E Rhee, Department of Pediatrics, University of California, San Diego, School of Medicine, La Jolla, CA, USA.
Jimmy Wright, Wright's Markets, Wright2U.com, Wright Food Solutions , Opelika, AL, USA.
Sarah Hiller-Venegas, Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla, CA, USA.
Amy L Yaroch, Gretchen Swanson Center for Nutrition, Omaha, NE, USA.
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