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Summary For many Americans who live at or below the poverty threshold, ­ ccess a to healthy foods at a reasonable price is a challenge that often places a strain on already limited resources and may compel them to make food choices that are contrary to current nutritional guidance. To help allevi- ate this problem, the U.S. Department of Agriculture (USDA) administers a number of nutrition assistance programs designed to improve access to healthy foods for low-income individuals and households. The largest of these programs is the Supplemental Nutrition Assistance Program (SNAP), formerly called the Food Stamp Program, which today serves more than 46 million Americans with a program cost in excess of $75 billion annually. The goals of SNAP include raising the level of nutrition among low-income households and maintaining adequate levels of nutrition by increasing the food purchasing power of low-income families. Households receive the maximum SNAP benefit if the family has no net income to contribute to food purchases; households with income combine the SNAP allotment with other household resources. Currently there is d ­ ebate about whether there are different ways to think about the adequacy of the SNAP allotment. Factors such as time needed to purchase and pre- pare foods from basic ingredients as described in the Thrifty Food Plan (TFP), knowledge and skills needed to plan and prepare healthy meals, the diversity of cultural preferences, food access constraints, and regional/­ seasonal price fluctuations all may have an impact on the adequacy of SNAP allotments for achieving the program goals. In addition to these indi­ idual, v household, and environ­ ental factors, program characteristics—the way m ­ the allotments are calculated (including the maximum benefit guarantee, 1

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2 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM the benefit reduction rate, and the calculation of net income deductions)— are important to consider in defining adequate allotments. The committee reviewed the evidence for the impact of these factors and characteristics on the purchasing power of SNAP allotments and assessed their role in con- tributing to the feasibility of defining allotment adequacy. STUDY TASK AND APPROACH In response to questions about whether there are different ways to define the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, USDA’s Food and Nutrition Service (FNS) asked the Institute of Medicine (IOM) and the National Research Council (NRC) to conduct a study to examine the fea- sibility of defining the adequacy of SNAP allotments, specifically: • the feasibility of establishing an objective, evidence-based, science- driven definition of the adequacy of SNAP allotments consistent with the program goals of improving food security and access to a healthy diet, as well as other relevant dimensions of adequacy; and • data and analyses needed to support an evidence-based assessment of the adequacy of SNAP allotments. In addressing its task, the committee considered questions posed by the sponsor with respect to the above two primary dimensions of the task. These questions provided further guidance for the committee’s review of the evidence. Appendix E outlines these additional questions and indicates where they are addressed in the report. The committee conducted a comprehensive review of the current evidence, including the peer-reviewed published literature and peer- reviewed government reports. Although not given equal weight with peer-reviewed publications, some non-peer-reviewed publications from nongovernmental organizations and stakeholder groups also were consid- ered because they provided additional insight into the behavioral aspects of participation in nutrition assistance programs. In addition to its evidence review, the committee held a data gathering workshop that tapped a range of expertise relevant to its task. To examine the feasibility of defining the adequacy of SNAP allot- ments, the committee constructed a framework (Figure S-1) showing the constraints on a household’s ability to achieve program goals. To define the components of the framework and establish the boundaries of its evi- dence review, the committee focused on the two dimensions of its task—the feasibility of objectively defining SNAP benefit adequacy consistent with improving food security and access to a healthy diet, and data and analyses ­

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SUMMARY 3 Factors Affecting Food Security and Access to a Healthy Diet Total Resources Individual/Household Factors Financial/In-Kind Income SNAP benefits Dietary knowledge Other program benefits Attitudes/preferences Household income Cultural influences Other resources Skills/abilities (e.g., emergency food Space/equipment assistance) Special needs Purchasing and Program Goals Consumption Time Patterns Food Security Amount available for Amounts of food Access to a Healthy Diet securing/preparing food Environmental Factors Kinds of food Prices Location Transportation Benefit Formula, Nutrition Allowed Retail Restrictions/ Eligibility Criteria Education Outlets Incentives SNAP Program Characteristics FIGURE S-1  Framework for determining the feasibility of defining the adequacy of SNAP allotments. NOTE: Solid lines represent the food purchasing and consumption process for households participating in SNAP, independent of the program. Dashed lines rep- resent the influence of SNAP program characteristics on this process. needed to support an objective, evidence-based assessment of benefit ade­ quacy. The committee’s framework describes how the SNAP program fits into a household’s overall process of acquiring and providing food for all family members. It consists of three major parts: (1) the program goals of food security and access to a healthy diet; (2) total resources, individual/ household factors, and environmental factors that influence the process through which households purchase and consume foods; and (3) elements of the SNAP program characteristics that interact with the process through which households may achieve program goals. CONCLUSIONS AND RECOMMENDATIONS Conclusions The committee’s conclusions are based on the findings derived from its review of the available evidence. These conclusions formed the basis for the committee’s recommendations.

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4 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM Conclusion 1: The Adequacy of SNAP Allotments Can Be Defined Based on the available evidence, it is feasible to define objectively the adequacy of SNAP allotments. Doing so entails identifying the factors that affect the ability of participants to attain food security and access to a healthy diet. The committee’s review of the evidence found that it is possible to identify those factors, and the committee has done so in its framework and in the following two conclusions and the findings that support them. The available evidence has some limitations, but it is possible to obtain the evidence needed for a science-driven definition of allotment adequacy. First, evidence must be taken into account on the degree to which specific indi- vidual, household, and environmental factors influence SNAP participants’ purchasing power, given a dollar value of their SNAP benefits. Second, evidence must take into account the impact of factors related to the com- putation of the dollar value of the SNAP allotment itself, as well as other SNAP program characteristics. Conclusion 2: The Adequacy of SNAP Allotments Is Influenced by Individual, Household, and Environmental Factors Evidence obtained by the committee in its data gathering workshop and in its review and assessment of the literature revealed that the opportunity for SNAP participants to meet the program goals, given a dollar value of their SNAP benefits, is influenced by a number of individual, household, and environmental factors that impact the purchasing power of the allot- ments. The committee found that a definition of the adequacy of SNAP allotments must account for these factors according to the magnitude and significance of their influence on the allotment’s purchasing power. Although SNAP allotments might be adequate in the absence of these fac- tors, the evidence suggests that these factors can act as barriers to obtain- ing nutritious foods and preparing nutritious meals consistent with the assumptions of the Thrifty Food Plan (TFP). The evidence on individual, household, and environmental factors that constrain the purchasing power of SNAP allotments is most robust for four factors: • The SNAP allotment, which is based on the TFP, assumes the purchase of many basic, inexpensive, unprocessed foods and ingre­ dients requiring substantial investment of participants’ time to produce nutritious meals. The evidence shows that the time re- quirements implicitly assumed by the TFP are inconsistent with the time available for most households at all income levels, particularly those with a single working head. By failing to account for the fact that SNAP participants, like other households, need to purchase

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SUMMARY 5 value-added foods that save preparation time, the current value of the SNAP allotment substantially limits the flexibility and purchas- ing power of SNAP benefits. • The food prices faced by SNAP participants vary substantially across geographic regions of the country and between rural and urban areas. However, SNAP benefits are adjusted only for Alaska and Hawaii. SNAP participants in locales with higher food prices are likely to find it more difficult than those in areas with lower prices to purchase the types and amounts of foods specified in the TFP as adequate to meet their needs for a nutritious diet. The evidence points further to a lack of data on the extent to which food prices influence the ability of SNAP participants to purchase nutritious foods. • There is evidence that low-income households face higher transac- tion costs in achieving food security and access to a healthy diet relative to higher-income households. For example, low-income and minority populations are more likely than other groups to ex- perience limited access to supermarkets and other large retail out- lets, such as big-box stores, that offer a broad range of nutritious foods at reasonable cost. Individuals without access to such venues experience greater disparity in the availability of healthy foods, such as fresh fruits and vegetables, in their neighborhood food outlets. In addition, a lack of transportation infrastructure com- monly leads to limited food access in small towns and rural areas. • Nutrition education programs for low-income participants that include training in food purchasing and preparation skills appear to have some effectiveness in changing behavioral outcomes. This finding lends credence to the theory that skills are a limiting factor in the ability of some SNAP participants to maximize the pur- chasing power of the current SNAP allotments. However, existing evidence on the influence of nutrition knowledge and skills on the ability of SNAP participants to purchase and prepare nutritious foods consistent with the assumptions of the TFP is insufficient to support a conclusion about the relevance of these factors to an evidence-based definition of the adequacy of SNAP allotments. Conclusion 3: The Adequacy of SNAP Allotments Is Influenced by Program Characteristics The evidence suggests that a number of factors related to how the dollar value of SNAP allotments is calculated, as well as other SNAP pro- gram characteristics, can influence the feasibility of defining an adequate SNAP allotment. The evidence supports the conclusion that the maximum

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6 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM monthly benefit, the benefit reduction rate, and the net income calcula- tion have important impacts on the definition of the adequacy of SNAP allotments. • Maximum benefit guarantee—The maximum SNAP benefit, cur- rently based on assumptions of the TFP plus the temporary up- ward adjustment that occurred under the American Recovery and Reinvestment Act of 2009, may not always be sufficient to allow participants to purchase the food components and prepare the meals specified by the TFP for several reasons. As noted above, the time available for most households at all income levels, particu- larly those with a single working head, is insufficient to meet the assumptions of the TFP, and thus the allotments do not sufficiently account for the costs of purchasing foods that must be further pre- pared. Also as noted above, the TFP does not account for many types of geographic price variation. In addition, limited evidence suggests that some SNAP households with no net income as defined under the program and residing in high-cost locales with limited access to food outlets are unable to purchase the foods included in the market basket underlying the TFP. Although the committee found compelling evidence on the time costs of meal preparation and on geographic price variations, the evidence on how best to incorporate these factors into the SNAP benefit formula is less compelling. The committee also identified as an issue affecting the adequacy of SNAP allotments the fact that the annual maximum benefit update occurs following a 16-month lag. The June cost of food is used to update the TFP in October, but then is not updated again until the following October, 16 months later. Because of the impact of inflation and other factors on food prices, this lag in the benefit adjustment can significantly reduce the purchasing power of SNAP allotments. • Benefit reduction rate—The original assumption underlying the benefit reduction rate is that the average U.S. household spends 30 percent of its income on food. This assumption is outdated and inconsistent with the current average spending pattern across income levels in the United States of about 13 percent of pretax income spent on purchases of all food consumed, both at home and away. Although lower-income households spend a greater por- tion of their income on food (e.g., 16.8 percent in 2010) compared with higher-income households (e.g., 11.7 percent in 2010), the percentage is still substantially less than the 30 percent assumption currently used or the lower effective benefit reduction rate that results after other parts of the benefit formula have been applied. ­

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SUMMARY 7 Evidence suggests that a lower benefit reduction rate more closely aligned with current household spending patterns would likely give households greater incentive to combine workforce partici- pation with the receipt of SNAP benefits by reducing the penalty for working. • Calculation of net income deduction—The committee found evi- dence that several program characteristics used to determine net income and the monthly allotment may not adequately capture the impact of additional extraordinary household costs that reduce the allotment’s purchasing power. Regarding the shelter deduc- tion, considerable evidence shows that a substantial proportion of SNAP households face housing costs in excess of the current cap on the shelter deduction, which results in overestimation of the net income participants have available to purchase food. Deduc- tions allowed for medical expenses for persons 60 and older and the disabled may influence the purchasing power of the allotment for those individuals but do not address out-of-pocket medical costs for nonelderly, nondisabled participants, although more evidence is needed to understand the impact of such expenses on the adequacy of the SNAP allotment. Evidence is more limited on whether the current 20 percent earned income deduction is adequate to cover the additional expenses incurred by SNAP re- cipients who work. Recommendations The committee offers its recommendations in three areas. First, it rec- ommends elements that should be included by USDA-FNS in an evidence- based, objective definition and measurement of the adequacy of SNAP allotments. Second, it recommends monitoring and assessment of the ade­ quacy of SNAP allotments, needed for evaluation and adjustment over time. Third, it recommends additional research and data needed to support an evidence-based definition of allotment adequacy. In addition, the committee describes other research considerations that would further understanding of allotment adequacy. Specific data and analytical challenges to the primary research effort are identified at the conclusions of Chapters 3 and 4. Defining and Measuring the Adequacy of SNAP Allotments To define the adequacy of SNAP allotments objectively using currently available evidence requires consideration of a range of factors identified by the committee as likely to have an impact on the allotments’ purchasing power. As a first step, the committee established a framework for consider-

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8 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM ing factors that can have an impact on defining allotment adequacy. With this in mind, the committee offers the following recommendations. Recommendation 1: In defining allotment adequacy, the U.S. Depart- ment of Agriculture (USDA) Food and Nutrition Service (FNS) should in- clude consideration of the influence of specific individual, household, and environmental factors on Supplemental Nutrition Assistance Program (SNAP) participants’ purchasing power given the dollar value of their SNAP benefits. Specific individual, household, and environmental fac- tors to consider in a definition of the adequacy of SNAP allotments are •  ime—USDA-FNS should recognize the cost–time trade-offs in- T volved in procuring and preparing a nutritious diet. The dollar value of the Thrifty Food Plan (TFP), with its strong reliance on preparation of meals from basic ingredients, does not account for time constraints faced by most households at all income levels, particularly those with a single working head of household, which necessitate purchasing value-added or prepared foods with a higher cost. USDA-FNS should examine the impact of accounting for cost–time trade-offs, for example, by — pplying a time adjustment multiplier to the cost of the TFP or a reviewing options for adjustments to the current cost of the plan, and — djusting the earned income deduction to reflect more accurately a time pressures for participants who are working. •  eographic price variation—USDA-FNS should recognize the G substantial variation in food prices that exists across geographic regions of the contiguous United States and between rural and urban areas. USDA-FNS should examine possible approaches to accounting for this variation, such as through adjustments to the maximum benefit that take into account — ricing or price adjustments for food in high-cost (including p urban and rural areas) as well as low-cost regions; — hether the shelter cap should be increased, particularly in high- w cost regions; and — lternatives to the TFP, such as the Low-Cost Food Plan. a •  ccess to food outlets—USDA-FNS should assess the impact of A limited access to certain food outlets (e.g., supermarkets) that may affect the ability of some SNAP participants to purchase a variety of healthy foods at reasonable cost. Evaluation and assessment of access barriers should include the degree to which, and for whom, they constrain the SNAP allotment that would otherwise be ad- equate to meet the program goals.

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SUMMARY 9 Recommendation 2: In defining allotment adequacy, U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) should also consider evaluating specific program characteristics that affect the allot- ment’s actual dollar value, as well as the extent to which the allotment is targeted to individual Supplemental Nutrition Assistance Program (SNAP) participants. Specific program characteristics to consider in a definition of allotment adequacy are •  aximum benefit guarantee—USDA-FNS should evaluate the M need to — djust the current timing scheme for the cost-of-living adjust- a ment to the Thrifty Food Plan (TFP) to reduce the 16-month lag in updates; — pdate adjustments for economies of scale to reflect current data u on the impact of family size on family food spending; and —orrect for misalignment in the assumptions of the TFP that c serve as the basis for determining the maximum benefit guaran- tee to account for current lifestyle and meal patterns that include the purchase of food products that reduce the need for in-home preparation time. •  enefit reduction rate—USDA-FNS should evaluate whether there B is a need to adjust downward the current benefit reduction rate, which is currently set at 30 percent but has a lower effective rate, to reflect the current purchasing behaviors of U.S. households. •  alculation of net income—USDA-FNS should evaluate whether C there is a need to adjust the design of the net income calculation to better reflect the ability of SNAP participants to purchase food within the boundaries of their incomes. Particular attention should be given to the adequacy of the current earned income deduc- tion; the cap on the excess shelter deduction; and the possibility of expanding the out-of-pocket medical deduction to nonelderly, nondisabled populations. Monitoring Assessment of the Adequacy of SNAP Allotments The committee’s findings suggest that an evidence-based definition of the adequacy of SNAP allotments requires ongoing monitoring of the abil- ity of SNAP participants to use the allotments to achieve the program goals. To this end, it is important to know the proportion of SNAP participants that are more food secure and consuming healthier diets as a result of the program, and within what time frame. Understanding the impact of SNAP benefits on these outcomes would contribute to the broader knowledge base used to define the adequacy of SNAP allotments.

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10 SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM Recommendation 3: To assess the correspondence between the def- inition of an adequate Supplemental Nutrition Assistance Program (SNAP) allotment and the attainment of the program goals, and to adjust the definition of adequacy as information on influencing factors evolves, U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) should • D  evelop longitudinal datasets containing appropriate measures of food insecurity, access to a healthy diet, and SNAP participation as part of the evidence base it uses to define adequacy. • A  ssess existing and establish new evaluation protocols that can measure the impact of SNAP participation on food security and access to a healthy diet, accounting for selection biases (e.g., that SNAP participants may be more likely to be food insecure than the general low-income population). • E  valuate additional nutrition monitoring tools, including a stan- dardized measurement tool with which to monitor and assess the ability of SNAP allotments to support a dietary pattern consistent with the Dietary Guidelines for Americans. The committee identi- fied the Healthy Eating Index as one example of a measure that could be adapted to assess whether SNAP participants are meeting recommended dietary goals. Meeting Additional Research Needs The committee identified several factors related to SNAP program par- ticipation that may affect whether some SNAP participants are able to meet the program goals and for which evidence is currently inadequate to fully assess their importance. These factors may affect either directly or indirectly the definition of the adequacy of SNAP allotments. The two broad areas in which additional research is needed to further develop the knowledge base for the potential use of these factors in defining allotment adequacy are educational programs that can help participants increase the purchasing power of the SNAP allotment and access to retail outlets and foods. Recommendation 4: U.S. Department of Agriculture (USDA) Food and Nutrition Service (FNS) should conduct further research in the follow- ing areas to support the definition of allotment adequacy: • T  o better assess how participants’ understanding of nutrition and resource management skills affect the adequacy of Supplemen-

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SUMMARY 11 tal Nutrition Assistance Program (SNAP) allotments, USDA-FNS should — ssess whether and how strengthening the quality (content and a delivery mechanisms) of education in nutrition and resource management skills can support allotment adequacy, for example, through educational outreach such as demonstration projects, and evaluate the level of funding needed to support such pro- grams; and —ssess how effectively these educational programs align with a the needs of SNAP participants and the program’s potential to enhance the purchasing power of SNAP allotments. • T  o evaluate the impact of access to retail outlets on the opportunity for SNAP participants to be food secure and to make nutritious food choices, USDA-FNS should conduct periodic regional cross- sectional surveys to gather information on the cost and availability ­ of foods that are consistent with the recommendations of the ­ ietary Guidelines for Americans. D FINAL THOUGHTS The committee reviewed a range of evidence applicable to the feasibility of defining the adequacy of SNAP benefits in terms of whether the SNAP allotment enables program participants to meet program goals, given their benefit allotment, not whether all participants will in fact reach these goals. The committee’s recommendations are structured to assist USDA-FNS in establishing an objective definition of the adequacy of the SNAP allotment, taking the evidence for these factors into consideration, and to identify specific data and analysis requirements to support an evidence-based assess­ ment of allotment adequacy.

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