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Food Insecurity Is Prevalent in Iowa’s Medicaid Expansion Population

      Abstract

      Background

      Food insecurity has been identified as an important social determinant of health and is associated with many health issues prevalent in Medicaid members. Despite this, little research has been done around food insecurity within Medicaid populations.

      Objective

      Our objective was to estimate the prevalence of household food insecurity and identify factors associated with experiencing food insecurity in Iowa’s Medicaid expansion population.

      Design

      We conducted a cross-sectional telephone survey between March and May of 2019.

      Participants

      Our sample was drawn from Medicaid members enrolled in Iowa’s expansion program at least 14 months, stratified by Federal Poverty Level (FPL) category. Members who did not have valid contact information were excluded. We selected one individual per household to reduce the interrelatedness of responses. We sampled 6,000 individuals and had 1,349 respondents in the analytic sample.

      Main outcome measure

      Our main outcome was whether a respondent’s household experienced food insecurity in the previous year, using the Hunger Vital Sign screening tool.

      Statistical analyses performed

      We weighted responses to account for the sampling design and differential nonresponse between strata. We estimated the prevalence of food insecurity and used logistic regression to model food insecurity as a function of demographic (age, FPL category, gender, employment, education, race, rurality, and Supplemental Nutrition Assistance Program [SNAP] participation) and health-related (self-rated health, self-rated oral health, health literacy) factors.

      Results

      The estimated prevalence of experiencing food insecurity was 51.3%. Race, gender, education, employment, health literacy, and self-rated health were all significantly associated with food insecurity.

      Conclusions

      Our findings show that food insecurity is prevalent in Iowa’s Medicaid expansion population. Food insecurity should be more widely measured as a critical social determinant of health in Medicaid populations. Policymakers and clinicians should consider interventions that connect households experiencing food insecurity to food resources (eg, produce prescriptions and food pantry referrals) and policies that increase food access.

      Abbreviations

      Iowa Wellness Plan (IWP); Federal Poverty Level (FPL); Healthy Behavior Program (HBP); Supplemental Nutrition Assistance Program (SNAP)

      Keywords

      Abbreviations:

      Iowa Wellness Plan (IWP) (Federal Poverty Level (FPL)), Healthy Behavior Program (HBP) (Supplemental Nutrition Assistance Program (SNAP))
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      Biography

      P. J. Brady is a graduate research assistant, Department of Community and Behavioral Health, University of Iowa College of Public Health, and the University of Iowa Public Policy Center, Iowa City, IA.

      Biography

      N. M. Askelson is an assistant professor, Department of Community and Behavioral Health, University of Iowa College of Public Health, and a research fellow, University of Iowa Public Policy Center, Iowa City, IA.

      Biography

      B. Wright is an associate professor, Department of Family Medicine, University of North Carolina School of Family Medicine, Chapel Hill, NC.

      Biography

      E. Daly is a graduate research assistant, Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA.

      Biography

      E. Momany is a senior research scientist, University of Iowa Public Policy Center, Iowa City, IA.

      Biography

      B. McInroy is a research associate, University of Iowa Public Policy Center, Iowa City, IA.

      Biography

      P. Damiano is a director and research fellow, University of Iowa Public Policy Center, Iowa City, IA.