NYHealth Testimony on Hunger and Food Insecurity in New York City

NYHealth Senior Program Officer Julia McCarthy submitted the following testimony to the New York City Council Committee on General Welfare’s May 29, 2024, oversight hearing on hunger and food insecurity. In her testimony, she offered several recommendations to address food insecurity and connect New Yorkers with the food they need to thrive:

The New York Health Foundation (NYHealth) is a private, independent foundation that seeks to improve the health of all New Yorkers, especially people of color and others who have been historically marginalized. Our Healthy Food, Healthy Lives program works to advance policies and programs that link New Yorkers with the food they need to thrive. Our work has provided us with in-depth knowledge of food insecurity’s widespread impact on the health of children, families, and the communities in which they live.

NYHealth has a longstanding commitment to fighting hunger and food insecurity in New York City. Since 2014, we have invested millions of dollars to improve food security across New York State. For example, NYHealth has supported campaigns to improve the quality of food in the emergency food system, to make it easier for individuals to access nutrition benefit programs, and to expand universal school meals across the State. Notably, NYHealth’s investments helped secure universal free school lunch for New York City’s 1.1 million public school children.

Access to nutritious food affects health. Food-insecure New Yorkers are twice as likely as their food-secure counterparts to report poor health.[1] They are also more likely to have lower diet quality, higher rates of diet-related disease, and higher health care costs.[2],[3],[4]

Across New York State, access to nutritious food remains a concern for millions of people. NYHealth has conducted a number of analyses to understand food insecurity and its implications for New Yorkers. Our statewide Survey of Food and Health showed that food insecurity is strongly associated with worse health.[5] Over the past four years, NYHealth has been examining food insufficiency (a more severe, short-term version of food insecurity) in New York State using U.S. Census data. Our most recent analysis shows that, in 2023, food insufficiency in New York was as high as it was at the peak of the COVID-19 pandemic.[6] These recent high rates of food insufficiency are likely the result of the end of pandemic-era safety net programs like increased Supplemental Nutrition Assistance Program (SNAP) benefits, expanded Child Tax Credits, and pandemic electronic benefit transfer (P-EBT) payments.

Not only has overall food insufficiency increased in the last two years, but disparities have also widened by race, ethnicity, and income level. One in five Black and Hispanic New Yorkers experienced food insufficiency last year—three times the rate for white New Yorkers. Almost one in three New Yorkers in the lowest income bracket (those with annual income of less than $25,000) experienced food insufficiency, which is 15 times the rate for New Yorkers in the highest income bracket (those with annual income of $100,000 or more).[7] These findings show that stronger safety net programs are critical, especially for historically marginalized populations in New York.

In light of these recent data and policy developments, below are recommendations to address food insecurity in New York City:

Ensure timely processing of nutrition benefits. Nutrition benefits such as SNAP reduce food insecurity and remain our most effective tool to combat hunger.[8],[9] More than 1.7 million City residents are currently enrolled in the program, but many report obstacles to enrollment.[10] In our 2022 Survey of Food and Health, SNAP recipients reported the need for improvements to the application process and distribution methods.[11] Most recently, amidst high rates of food insecurity, SNAP applicants have faced troubling barriers to timely enrollment. [12]

The United States Department of Agriculture (USDA) considers timely processing rates above 95% as acceptable.[13] But in fiscal year 2023, New York City only processed approximately 40% of applications on time.[14] The 2024 Preliminary Mayor’s Management Report suggests similarly dismal rates.[15] By contrast, prior to and during the first year of the pandemic, the City’s SNAP processing rates were closer to 90%, when caseloads also exceeded 1.6 million people.

Reports in March 2024 that the Human Resources Administration (HRA) had nearly cleared the backlog of SNAP applications, hired nearly 1,000 new staff since last year, and strengthened remote application processes are encouraging. Despite this promising progress, given recent processing data, the City must continue to address barriers to SNAP access and maximize enrollment for eligible New Yorkers, including ensuring that HRA has the staff it needs. New York City should and can regain its position as a national leader in maximizing SNAP enrollment.

Continue to invest in the Community Food Connection program. Many families experiencing food insecurity either do not qualify for nutrition benefits or have remaining needs even with benefits, so they turn to emergency food sources. Annually, 1.4 million New Yorkers rely on the emergency food system, including the City’s Community Food Connection (CFC).[16] The Foundation’s statewide Survey of Food and Health found that, of those who visited a food pantry or bank in 2021, a majority are happy with the food available; two-thirds report that pantries have food their families like to eat and that the food is of good quality.[17]

New York City Food Policy Alliance members, including Equity Advocates, Westside Campaign Against Hunger, and Met Council, have been working to educate officials on the benefits of permanently including fresh produce in the emergency food system. They and other partners successfully advocated for $30 million in new funds, bringing the City’s total emergency food investment up to $52 million and allowing it to provide fresh fruits and vegetables permanently.[18] To ensure that New Yorkers continue to have access to fresh foods in times of crisis, the City should continue to support CFC adequately.

Guarantee school food is adequately funded. Food insecurity worsens children’s health; it is associated with increased chronic diseases like asthma.[19] And children with uncertain access to food tend to have lower test scores and a greater likelihood of behavioral health problems, including hyperactivity, depression, and anxiety.[20]  School meals mitigate food insecurity among low-income students and are often the healthiest parts of students’ diets, especially for low-income students. Students who eat school meals consume more fruits and vegetables during mealtimes and have higher quality diets compared to students who do not consume school meals.[21],[22] Our Survey of Food and Health shows that school meals were the most commonly used food access point for New Yorkers in need during the COVID-19 pandemic.[23]

Access to high-quality, culturally responsive, healthy school meals is essential for advancing health equity. In New York City schools, 25% of students are Black and 42% are Hispanic or Latino, but school food often doesn’t meet those students’ needs and preferences.[24] Our statewide analysis shows that, whereas 81% of white families participating in school meals say they approve of the variety of food offered, only 58% of Hispanic families and 45% of Black families approve. Our recent research on food insufficiency also found that, in 2023, food insufficiency rose for Black and Hispanic households across New York State, and that one in eight households with children experienced food insufficiency.[25]

With growing need, healthy and appealing school meals are a lifeline for families struggling to put food on the table.[26] The New York City Department of Education’s (NYC DOE) Office of Food and Nutrition Services (OFNS) has worked relentlessly to implement new approaches to ensure the City’s 1.1 million public school students have the food necessary to maximize their health and succeed in school. For example, OFNS and its partner Wellness in the Schools have developed 100 plant-forward, culturally relevant meals that can be cooked from scratch ingredients across all 1,200 New York City public school buildings. Preserving gains to improve food quality is critical. Proposed City budget contractions reflect precarious economic times, which means kids need nutritious school meals more than ever. Proposed cuts in OFNS’s budget may mean children don’t have continued access to the healthy meals they need to thrive. The City Council has pledged to continue to improve the healthfulness and cultural responsiveness of meals in schools. Making good on that promise means continued support for OFNS to do just that.

Prioritize a successful rollout of the new Summer EBT program. School closures, especially during the summer months, are associated with food insecurity for families.[27]

This year, for the very first time, New York families with children will have access to a new federal program, the Summer Electronic Benefit Transfer (Summer EBT), which will provide low-income families with $40 in food benefits per student for each month school is closed.

Summer EBT could reduce food insecurity, transportation challenges, and time burdens for New York families, while also increasing local economic activity. For example, a USDA evaluation of a Summer EBT demonstration project found that the program reduces very low food insecurity and increases healthy eating.[28]

Though the New York State Office of Temporary and Disability Assistance will administer the program, NYC DOE and HRA can play an important local role to ensure families understand and use the benefit.  City agencies should implement clear local communication about Summer EBT, which is vital for effective uptake, as families with children already face greater obstacles to get and prepare food.

NYHealth is grateful for the shared recognition of the importance of food security for New Yorkers’ wellbeing. We look forward to continuing our partnerships with the City and other organizations connecting New Yorkers with the food they need to thrive.

 

[1]  New York Health Foundation. “NYHealth Survey of Food and Health,” August 2022.  https://nyhealthfoundation.org/resource/nyhealth-survey-of-food-and-health-2022/, accessed April 2024.

[2] Morales, M.E.; Berkowitz, S.A. (2016). The relationship between food insecurity, dietary patterns, and obesity. Current Nutrition Report. 5(1), 54-60.

[3] Gregory, C.A.; Coleman-Jensen, A. Food insecurity, chronic disease, and health among working-age adults. U.S. Department of Agriculture, Economic Research Service. 2017, No. 235. https://www.ers.usda.gov/webdocs/publications/84467/err-235.pdf. Accessed April 2024.

[4] Berkowitz, S.A.; Basu, S.; Meigs, J.B.; Seligman. H.K. (2018). Food insecurity and health care expenditures in the United States, 2011-2013. Health Services Research. 53(3),1600-1620.

[5] New York Health Foundation. “NYHealth Survey of Food and Health,” August 2022. https://nyhealthfoundation.org/resource/nyhealth-survey-of-food-and-health-2022/, accessed April 2024.

[6] Cobbs, E.; Ford, M.M.; McCarthy, J.; Barrett, A.; Havusha, A.; Sandman, D. (2024). “Still Hungry: Food Insufficiency in New York State 2020-2023,” New York Health Foundation, New York, NY.   https://nyhealthfoundation.org/resource/food-insufficiency-in-new-york-state-2020-2023/, accessed April 2024.

[7] Cobbs, E.; Ford, M.M.; McCarthy, J.; Barrett, A.; Havusha, A.; Sandman, D. (2024). “Still Hungry: Food Insufficiency in New York State 2020-2023,” New York Health Foundation, New York, NY. https://nyhealthfoundation.org/resource/food-insufficiency-in-new-york-state-2020-2023/, accessed April 2024.

[8] Zhang, J. Wang, Y. Yen, ST. 2021. “Does Supplemental Nutrition Assistance Program Reduce Food Insecurity among Households with Children? Evidence from the Current Population Survey.” International Journal of Environmental Research and Public Health. 18(6), 3178.

[9] Abt Associates, Inc. “Summer Electronic Benefit Transfer for Children (SEBTC) Demonstration: Summary Report.” U.S. Department of Agriculture, Food and Nutrition Service. May 2016. https://fns-prod.azureedge.us/sites/default/files/ops/sebtcfinalreport.pdf, accessed April 2024.

[10] The City of New York, Mayor Eric L. Adams. (2024). “Preliminary Mayor’s Management Report.” https://www.nyc.gov/assets/operations/downloads/pdf/pmmr2024/2024_pmmr.pdf., accessed April 2024.

[11] New York Health Foundation. (2023). “A Critical Safety Net: New Yorkers’ Experiences with Food and Nutrition Programs.” https://nyhealthfoundation.org/resource/a-critical-safety-net-new-yorkers-experiences-with-food-and-nutrition-programs/, accessed April 2024.

[12] The City of New York, Mayor Eric L. Adams. (2024). “Preliminary Mayor’s Management Report.” https://www.nyc.gov/assets/operations/downloads/pdf/pmmr2024/2024_pmmr.pdf., accessed April 2024.

[13] Secretary Thomas J. Vilsack, United States Department of Agriculture, to Governor Kathy Hochul. February 8, 2024. https://fns-prod.azureedge.us/sites/default/files/resource-files/NY-SNAP-Performance.pdf.

[14] The City of New York, Mayor Eric L. Adams. “Mayor’s Management Report.” September 2023. https://www.nyc.gov/assets/operations/downloads/pdf/mmr2023/2023_mmr.pdf

[15] The City of New York, Mayor Eric L. Adams. “Preliminary Mayor’s Management Report.” January 2024. https://www.nyc.gov/assets/operations/downloads/pdf/pmmr2024/2024_pmmr.pdf.

[16] NYHealth. “Equity Advocates,” https://nyhealthfoundation.org/grantee/equity-advocates-2/, accessed April 2024.

[17] New York Health Foundation. (2022). “NYHealth Survey of Food and Health”  https://nyhealthfoundation.org/resource/nyhealth-survey-of-food-and-health-2022/, accessed March 2024.

[18] NYHealth. “Equity Advocates,” https://nyhealthfoundation.org/grantee/equity-advocates-2/, accessed April 2024.

[19] Thomas, M.M.C.; Miller, D.P.; Morrissey, T.W. (2019). Food Insecurity and child health. Pediatrics. 144(4).

[20] Kimbro, R.T.; Denney, J.T. (2015). Transitions into food insecurity associated with behavioral problems and worse overall health among children. Health Affairs. 34(11).

[21] Fox, M.K.; Gearan, E.; Cabili, C.; et al. “School Nutrition and Meal Cost Study, Final Report Volume 4: Student Participation, Satisfaction, Plate Waste, and Dietary Intakes,” U.S. Department of Agriculture, Food and Nutrition Service, Office of Policy Support; 2019. https://fns-prod.azureedge.us/sites/default/files/resource-files/SNMCS-Volume4.pdf, accessed April 2024.

[22] Kinderknecht, K.; Harris, C.; Jones-Smith, J. (2020). Association of the Healthy, Hunger-Free Kids Act with Dietary Quality Among Children in the US National School Lunch Program. Journal of the American Medical Association. 324(4), 359-368.

[23] New York Health Foundation. “NYHealth Survey of Food and Health,” August 2022.  https://nyhealthfoundation.org/resource/nyhealth-survey-of-food-and-health-2022/, accessed April 2024.

[24] New York Health Foundation. “NYHealth Survey of Food and Health,” August 2022.  https://nyhealthfoundation.org/resource/nyhealth-survey-of-food-and-health-2022/, accessed April 2024.

[25] Cobbs, E.; Ford, M.M.; McCarthy, J.; Barrett, A.; Havusha, A.; and Sandman, D. (2024). “Still Hungry: Food Insufficiency in New York State 2020-2023,” New York Health Foundation, New York, NY. https://nyhealthfoundation.org/resource/food-insufficiency-in-new-york-state-2020-2023/, accessed April 2024.

[26] Cobbs, E.; Ford, M.M.; McCarthy, J.; Barrett, A.; Havusha, A.; and Sandman, D. (2024). “Still Hungry: Food Insufficiency in New York State 2020-2023,” New York Health Foundation, New York, NY. https://nyhealthfoundation.org/resource/food-insufficiency-in-new-york-state-2020-2023/, accessed April 2024.

[27] Poole, K.M.; Fleischhacker, S.E.; Bleich, S.N. (2021). Addressing Child Hunger When School Is Closed — Considerations during the Pandemic and Beyond. New England Journal of Medicine. 384(10).

[28] Abt Associates, Inc. “Summer Electronic Benefit Transfer for Children (SEBTC) Demonstration: Summary Report.” U.S. Department of Agriculture, Food and Nutrition Service. May 2016. https://fns-prod.azureedge.us/sites/default/files/ops/sebtcfinalreport.pdf, accessed April 2024.

 

Winding Up New York’s Medicaid Unwinding

For the past year, New York State has made substantial investments to make sure as many people as possible stay enrolled in health insurance, including Medicaid and other public coverage options. The 2023 rollback of a pandemic-era federal policy that prohibited states from terminating Medicaid enrollees’ health insurance requires that states recertify all Medicaid beneficiaries. Known as the “Medicaid unwinding,” it’s meant that New York has been reassessing eligibility and renewing coverage for all eligible Medicaid, Essential Plan, and Child Health Plus enrollees since last May, through the end of next month.

I previously wrote about how some states saw the end of the continuous coverage requirement as a welcome opportunity to shrink their public health insurance rolls. In contrast, New York saw it as a moment to go all-in on preserving coverage for millions of New Yorkers.

I’m proud of how New York has fulfilled its promise. As of March of this year — the latest data available, about three-quarters of the way through the total unwinding period — New York had initiated more than 5 million coverage renewals. Overall, 82% of eligible New Yorkers’ coverage has been renewed — 79% of adults and 91% of children. New York has been among the top five states for keeping kids covered. An Urban Institute analysis of unwinding data through last November shows New York had the 10th-lowest rates of coverage disenrollment among states. KFF’s latest data tracker shows similar relative performance as of March, with New York ranked 12th best among states.

What’s been the secret to New York’s success? A few things:

  • Flexibility through Federal Waivers: The State has applied for and received numerous federal waivers that have allowed for additional flexibility in maintaining coverage for eligible enrollees. For example, New York can renew Medicaid eligibility for people whose income is verified to be at or below the federal poverty level, without requiring additional paperwork. Another waiver allows for streamlined reenrollment into the Children’s Health Insurance Program (CHIP) for individuals who receive Supplemental Nutrition Assistance Program (SNAP) benefits. Cutting some of that red tape has been a big boon to New York’s enrollment numbers.
  • Robust Outreach and Communication: The State has sent out roughly 7.5 million e-mails, 4.5 million text messages, and 3.7 million consumer notices alerting people of the need to recertify to stay covered. The New York State of Health call center has answered more than 4.5 million inquiries (with an average wait time of less than 2 minutes — pretty impressive!). And the State has developed a communications toolkit that includes shareable resources like how-to videos, sample social media posts and infographics, fact sheets, posters, and more. This library makes it easy for the State’s partners to consistently use tested messages and language.
  • Cross-sector Partnerships and Support: The unwind has been the single largest outreach and enrollment effort since the passage of the Affordable Care Act. State government stepped up and led but recognized that success would require additional support and coordination beyond government. I’m proud that the New York Health Foundation was one of numerous philanthropic partners to support on-the-ground outreach efforts to keep New Yorkers covered. Led by the Community Service Society, a network of community-based organizations across the State have had more than 44 million touchpoints to educate and engage eligible New Yorkers and get more than 54,000 people reenrolled so far. These organizations serve as trusted messengers, reaching people through conversations, social media posts, advertisements, and flyers in the language they speak. And they’re connecting with people where they are — libraries, schools, doctors’ offices, places of worship, citizenship classes, community festivals, museums, and food pantries — to maximize their reach.

There’s always more work to do, always an imperative to reach people who may still be falling through the cracks as they’re required to renew their health insurance coverage. At a meeting earlier this week, New York State officials made clear they’re not resting on their laurels. New York is in the homestretch of this recertification period and is pulling out all the stops to maximize renewals. It is improving enrollment and renewal systems and opening new channels for submitting applications, including options for easy enrollment via smartphones and other devices.

One of the few silver linings of the pandemic is that New York achieved record high insurance coverage rates. So much work has occurred to preserve those gains. It’s easy to get caught up in the numbers, the comparative data, the benchmarks, but ultimately this year has been about the millions of New Yorkers who can maintain the peace of mind that comes with having health insurance. New York should take a bow, and keep it up.

By David Sandman, President and CEO, New York Health Foundation
Published on Medium on May 23, 2024

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