Health is not just about the time one spends in a doctor’s office. It is impacted by innumerable factors, including food, mental health, shelter, financial security, and support. These social determinants of health must be addressed for patients to achieve true health. For example, food insecurity is a prevalent issue in almost every community. This article aims to highlight the need to expand access to Supplemental Nutrition Assistance Program (SNAP) resources within federally qualified health centers (FQHC), such as Church Health, to address food insecurity and provide lasting health.

Church Health is a clinic for uninsured families in Memphis, Tennessee. Not only does Church Health address medical needs but also they also seek to address the various social determinants of health (SDoH) that affect the lives of patients. One specific area of focus is food insecurity, and it is being addressed by connecting patients with resources like SNAP. Moving forward, Church Health hopes to create its own SNAP clinic to support patients seeking these necessary benefits.

SNAP is a federally funded program that provides nutrition benefits to supplement a family’s food budget so they can purchase healthy food. The number of benefits received is based on income and household size. Additionally, applicants must meet other requirements: a U.S. citizen or a U.S. national or qualified alien and employment if between the ages of 16-59. The application requires information on their income, expenses, and resources as well as required documents, such as a Social Security Number and bank statements. In addition to applying, an interview must be completed before applicants can be approved. Clearly, the application and interview process are complex, and many people could likely benefit from extra support. The Tennessee Justice Center (TJC) demonstrates the benefits of providing this support by showing how utilizing SNAP benefits correlates to better health outcomes and reduced rates of poverty.1 By establishing a SNAP clinic at Church Health, patients can receive SNAP support in the same place they are coming for their health care.

The need for social programs like SNAP is great in Memphis and Shelby County as a whole. To be eligible to receive SNAP benefits, households must be under 130% of the Federal Poverty Guidelines (FPG).2 In Memphis, 22.6% of people are living in poverty.3 Simply based on income eligibility requirements, many of the people in this category are likely eligible to receive SNAP benefits. Even though people are eligible, they do not always access these resources, possibly due to the barriers previously discussed. Based on data from Shelby County from 2017-19, 38.5% of individuals were eligible for SNAP but of the eligible individuals, only 74% accessed SNAP benefits.3

Before moving forward in establishing a Church Health SNAP clinic, information was gathered from previously established clinics in the state. There are already SNAP clinics that are helping connect patients to these resources. The SNAP clinics help individuals understand the application process and sometimes assist with completing the application. Additionally, organizations such as the TJC are also able to pre-screen individuals for eligibility and provide support if they are wrongfully denied access to benefits. Since the SNAP application process is so complex, it will likely be beneficial to have a Church Health SNAP clinic. To establish a SNAP clinic within Church Health, there would need to be an effective flow from the patient-provider interaction to the patient-SNAP connector interaction.

As Church Health works to address the social determinants of health (SDoH), it will be necessary to implement systems that streamline and clarify patient needs. Moving forward, Church Health clinics plan to begin using ICD-10 codes related to the SDoH to identify patients in need and to refer them to appropriate support resources. The ICD-10 codes pertaining to SDoH issues are categories Z55-Z65.4 For example, issues specifically related to food insecurity can be recorded using the code Z59.4 which identifies patients with a “lack of adequate food and safe drinking water.”4 Z-codes could be used to get patients from the exam room with the physician to the office with the social worker. Additionally, Z-codes could allow clinicians and social services to document SDoH issues in a standardized way. Other potential benefits to using Z-codes for SDoH issues are the format is already used for insurance requests, and the codes can provide a way to keep track of patient needs. The utility of Z-codes extends beyond addressing food insecurity as they can be applied to other non-medical needs patients have.

To address the issue of food insecurity experienced by many of their patients, Church Health in Memphis, Tennessee, is working to establish a SNAP clinic. By creating these resources and relationships, Church Health will be able to address food insecurity by providing patients with the necessary support and assistance needed to receive benefits. In the future, Church Health hopes to expand this model to other social determinants of health that are impacting the lives of patients.

References

  1. Tennessee Justice Center. SNAP Outreach Toolkit. https://www.tnjustice.org/wp-content/uploads/2021/10/SNAP-Toolkit.pdf. Accessed April 15, 2023.
  2. Tennessee Department of Human Services. Supplemental Nutrition Assistance Program (SNAP), Income Update. https://www.tn.gov/content/dam/tn/human-services/documents/Tn.gov_Income_Update%20FY23.pdf. Accessed April 15, 2023.
  3. United States Census Bureau. Memphis city, Tennessee. https://data.census.gov/cedsci/profile?g=1600000US4748000. Accessed April 15, 2023.
  4. John Hopkins Medicine. Provider update. https://www.hopkinsmedicine.org/johns_hopkins_healthcare/providers_physicians/resources_guidelines/provider_communications/2021/PRUP135_ICD10-km.pdf. Published February 2020. Accessed April 15, 2023.

Issue

Topic

Clinical Practice, Health Equity, SGIM, Social Determinants of Health

Author Descriptions

Ms. Walls (cwalls5@uthsc.edu) is a second-year medical student at the University of Tennessee Health Science Center. Mrs. Moore (moores@churchhealth.org) is the manager of nutrition services at Church Health. Dr. Jackson (cjacks67@uthsc.edu) is associate professor of medicine and senior associate program director for curriculum at the University of Tennessee Health Science Center (UTHSC) Internal Medicine Residency.

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