Food Stamps Training Clinical Partners in Advocacy La Rabida Children’s Hospital

1. Food Stamps Training Clinical Partners in Advocacy La Rabida Children’s Hospital Friend Family Health Center May 2008

2. Presentation Objectives • Recognize the connection between food insecurity and child health • Understand the basics of food stamps in Illinois and common barriers • Understand ways to connect patients with resources for food security

3. Food Insecurity • Defined as “limited or uncertain access to enough nutritious food.” • Food insecurity among children leads to: • Poor health  More emergency hospitalizations • Nutrient deficiencies  Learning and developmental deficits • Emotional/behavioral problems • Heat vs. Eat: Increased $ spent on energy/gas leads to decreased $ spent on food. The Greater Chicago Food Depository found that 41% of their clients had to choose at least once between paying for food OR utilities. Also, over 26% had to choose between paying for food OR medicine/medical care.

4. What is the Food Stamp Program? • According to C-SNAP, physicians and medical researchers think the FSP is one of America’s best medicines to prevent and treat childhood food insecurity. • America’s first line of defense against hunger. Foundation of our national nutrition safety network. • Federal entitlement program, administered locally by the Illinois Department of Human Services (DHS). • Enables low income families to buy food in authorized retail stores. Food Stamp benefits are issued in an electronic debit card called a “Link Card.” Source: “Food Stamps as Medicine: A New Perspective on Children’s Health” Children’s Sentinel Nutrition Assessment Program (C-SNAP), February 2007

5. Why Food Stamps Matter for Children’s Health: What Research Shows • Children receiving food stamps are 26% less likely to be food insecure than eligible children not receiving food stamps. • Latino children whose family food stamp benefit was sanctioned were more than twice as likely to suffer from food insecurity as those whose food stamp benefit was unchanged. • Food Stamp Program participation has beneficialeffects for children on non-nutritional outcomes, specificallyacademic learning during the first 4 years of school. • Food security can affect two generations: mothers’ psychological well-being and positive behaviors with their infants. Sources: “Food Stamps as Medicine: A New Perspective on Children’s Health” Children’s Sentinel Nutrition Assessment Program (C-SNAP), February 2007; “Food Security During Infancy: Implications for Attachment and Mental Proficiency in Toddlerhood” Child Trends, March 26, 2008’; “Food Stamp Program Participation Is Associated with Better Academic Learning among School Children,” Journal of Nutrition, April 2006.

6. Who Participates in the Food Stamp Program? • 25.7 million Americans receive food stamps every month. • In 2006, 1,198,000 people (9.3% of population) received food stamps in Illinois – about half (589,000) were children. • In Cook County, alone, 658,000 people were enrolled. Children were in 50% of these households and received 74% of benefits. • In Illinois, 67,000 citizen children living with noncitizens receive food stamps. Sources: “Characteristics of Food Stamp Households: Fiscal Year 2006.” USDA. September 2007; “Food Stamp Access in Urban America: A City-By-City Snapshot." Food Research and Action Center. October 2007.

7. Food Stamp Participation is Increasing: An Expected 28 Million Recipients in FY 2009

8. Who Is Missed By the Food Stamp Program in IL? • Food Stamp participation is increasing but the program (in 2005) still only reached 77% of the eligible population in Cook County and 74% in Illinois (up from 62% in 2003). • In Cook County, alone, an estimated 183,993 persons were eligible for food stamps but did not participate. • This translates into a loss of $161,670,118 in federal food stamp benefits for the state. • Among children, children of immigrant parents fare worse. • Young low-income children of U.S. citizens are twice as likely to receive food stamps than are young low-income children of immigrants. Sources: “Food Stamp Access in Urban America: A City-By-City Snapshot." Food Research and Action Center. October 2007. “Reaching Those in Need: State Food Stamp Participation Rates in 2005,” USDA. October 2007. “The Health & Well-Being of Young Children of Immigrants,” The Urban Institute, 2004.

9. How Health Care Professionals Can Help Address Barriers to Food Stamp Access

10. Food Stamp Program Basics: Who is Eligible? Family of 4 could earn up to $26,856 per year to qualify. That’s 130% of the federal poverty level.

11. Food Stamp Program Basics • A household’s net income has bearing on whether or not it is eligible for food stamps and if so, how much per month. • Asset Limits • $3000 limit for households with a member who is elderly or disabled. • $2000 limit for households without member who is elderly or disabled. • A home, a car and/or jewelry does not count as an asset.

12. Who is Eligible: Immigration • US Citizens • Refugees • Lawful permanent residents (green card holders) over 18 who have had a green card for 5+ years • Lawful permanent residents (green card holders) under 18 (no 5 year limit) • Families with eligible children can apply for kids without disclosing parents’ immigration status.

13. How much can IL families receive in Food Stamp benefits? Source: “Fact Sheet on Resources, Income and Benefits.” United States Department of Agriculture, Food and Nutrition Service. 4 Oct. 2007. 10 Nov. 2007. http://www.fns.usda.gov/pd/18fsavgben.htm

14. Case Study • Meet the Ramirez Family – Carlos and Veronica have two young children – Christian (4) and Angel (2). • Carlos works full time as a custodian at a rate of $9/hour (Monthly = $1560 / Annually = $18,720) while Veronica stays home to take care of their children. • The family has $1600 in checking and savings. • Their monthly rent is $700 and they currently receive energy assistance (LIHEAP). • The Ramirez Family qualifies for $339 in Food Stamp Benefits each month.

15. Other Examples • Teenage girl living with her mother and her baby. • Undocumented immigrant parents living with three citizen children. • Single, childless adult. • Examples from Health Center Staff?

16. The Application Process • Where can patients apply? (Family Help Desk, DHS Office, Chicago Public Schools, SSA Local Offices if SSI-Only Household, CBOs) • Where are applications submitted? • Illinois Department of Human Services Local Office • How long does it take to receive a LINK card? • Complete and submit application to DHS along with verification information/documents • Within 20 days, receive a letter regarding an interview with a case worker (phone or in-person) • Within 30 days of application an eligible person should receive a letter stating the amount of benefit • With that letter, a person can pick up their Link card from DHS (may designate a representative to pick it up) • Most people must renew their eligibility within 6 months to a year

17. Miscellaneous • What if patients need food immediately? • Ask for “expedited food stamps” • What happens if my patient is denied benefits? • Refer them to the Chicago Medical Legal Partnership for Children • How do food stamp participants re-certify? • When should food stamp participants contact DHS? • Change in address • Increase in rent • Decreased income • Additional Child

18. Other Food Resources • Illinois Hunger Hotline: 1-800-359-2163 • Food pantries. Go to “Need Food?” at http://www.chicagosfoodbank.org/ and search by zip code. • Chicago Public Schools: Children & Families Benefits Unit (773.553.KIDS) or http://www.cps.k12.il.us • Illinois’ Women Infants and Children (WIC) Program http://www.dhs.state.il.us/ • After School and Summer Feeding Sites (Go to Illinois State Board of Education website): http://webprod1.isbe.net/NutSvc/ • Illinois DHS Office Locator http://www.dhs.state.il.us • Indiana Food Stamp Department http://www.in.gov/fssa/dfr/3674.htm • Families in SSI-only households can apply for food stamps at SSA local offices:https://secure.ssa.gov/apps6z/FOLO/fo001.jsp

19. Summary of Key Points • Food insecurity has a direct impact on children’s health, behavioral and academic outcomes. • Food stamps provide vital income support for families to purchase nutritious food. • Health care professionals play a critical role in addressing food insecurity. • Direct patients to the Family Help Desk for food stamp application assistance. • Refer food stamp application denials to CMLPC La Rabida Family Help Desk Coordinator: Paige Cowles pcowles@uchicago.edu 773-256-5719 Desk Hours: Mondays, 12:30-4:00 PMTuesdays, 12:30-3:00 PMFridays, 12:30-4:00 PM Friend Family Health Center Help Desk Coordinator: Elizabeth Van De Graaf ejvdg@uchicago.edu 773-702-7756 Desk Hours: M-F, 1-5 pm

20. Thank you! Alicia Huguelet – Greater Chicago Food Depository (773) 843-6706 ahuguelet@gcfd.org Stephani Becker – Health & Disability Advocates (312) 265-9072 sbecker@hdadvocates.org Emily Brice – Project HEALTH(773) 256-5746 chicago@projecthealth.org Amy Zimmerman – Chicago Medical Legal Partnership for Children (312) 265-9075 azimmerman@hdadvocates.org