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Published on: July 27, 2018
SNAP disruption during a government shutdown and implications for chronic disease self-management: a qualitative
Elizabeth Whidden1, Nicole Ellingson1, Charlotte Babbin1
1Department of Medicine (Infectious Diseases), University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
Introduction:
Government shutdowns expose safety-net programs to unplanned disruptions, but little is known about how unexpected benefit interruptions affect chronic disease management. In November 2025, a shutdown-related delay in Supplemental Nutrition Assistance Program (SNAP) benefit issuance disrupted food access for millions of Americans.
Methods:
We conducted semi-structured interviews with 20 SNAP recipients living with HIV, nested within a 54-person cohort with daily antiretroviral therapy adherence monitoring. Interviews explored monthly SNAP cycle experiences, food-HIV management connections, and the November 2025 benefit delay. Pre-shutdown adherence is reported across the parent cohort; during-shutdown adherence is reported across 9 participants whose monitoring extended into the disruption.
Results:
Four themes emerged: Routine food access required planning; the monthly SNAP cycle imposed cognitive and material burden affecting chronic disease self-management; the November 2025 disruption was qualitatively distinct because added uncertainty compounded burden and destabilized self-management; and community supports partially buffered consequences. Across the 54-person parent cohort, median pre-shutdown adherence was 72%; among 9 participants monitored during the disruption, median during-shutdown adherence was 40%.
Conclusions:
Unexpected benefit disruptions impose uncertainty that adds cognitive burden and upsets the routines essential for chronic disease management. Safety-net programs should prioritize benefit reliability alongside adequacy, with implications extending across chronic conditions that depend on daily self-management.
