Food stamp work requirements increase mental health care use

Being exposed to work requirements in order to receive nutrition benefits from the U.S. government significantly increased use of mental health care resources for depression and anxiety, a new Northwestern University study has found. The policy’s negative effects occurred much sooner for women than men.

This is the first study to examine how work requirements associated with the Supplemental Nutrition Assistance Program (SNAP) — sometimes referred to as food stamps — affect mental health.

SNAP improves food security, health and economic wellbeing for low-income individuals and families and is provided by the U.S. Department of Agriculture’s Food and Nutrition Service.

“We’ve known for a while that food insecurity is associated with poor mental health outcomes because of the fear, stigma, depression, anxiety and stress around it,” said corresponding author Lindsey Allen, assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine. “So it’s no wonder peoples’ stress increased when they realized they were going to lose their access to food unless they met these requirements.”  

Health care visits rise after SNAP

While SNAP work requirements are federally mandated, states can get exemptions for counties where economic opportunities are scarce. With rising employment rates and job availability over the past decade, these waivers are being eliminated, exposing hundreds of thousands of SNAP enrollees to the requirements.

In 2016, West Virginia introduced these work requirements in a pilot program for nine counties. The scientists analyzed West Virginia’s Medicaid claims data to assess whether health care visits for depression and anxiety changed after residents in the treatment counties were exposed to SNAP work requirements. The study sample included individuals aged 18 to 49 who were enrolled in both SNAP and Medicaid at the start of the study.


26 and 12
For women, work requirements increased visits for depression and anxiety by 26% and 12%, respectively.


The study found being exposed to work requirements worsened depression and anxiety among those who lived in the nine pilot counties.

For women, work requirements increased visits for depression and anxiety by 26% and 12%, respectively. Visits also increased for men, but at a slower rate than for women. The difference in timing could be due to the larger role women play in managing family feeding, making them more immediately vulnerable to consequences of food insecurity, Allen said.

Doing more harm than good?

The study adds to a growing body of recent evidence that SNAP work requirements do not improve employment rates — their intended outcome — but do reduce SNAP participation, especially among vulnerable groups such as those with no income, the unhoused and those living in rural areas.

“So essentially, these work requirements harm people with no measurable benefit to the economy,” Allen said.

Policy makers and future researchers should seek to better understand these tradeoffs when considering the net impact of SNAP work requirement policies on an already-marginalized population, Allen said.

The study was published July 28 in the journal Health Services Research.

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