Opinion: Medicaid and SNAP cuts are exacerbating the intertwined problems of hunger and mental illness

OpinionFirst Opinion Medicaid and SNAP cuts are exacerbating the intertwined problems of hunger and mental illness Food insecurity leads to hospital visits — including for psychiatric emergencies Manage alerts for this article Email this article Share this article By Cole HansonJuly 16, 2026 Hanson is a dad, clinical dietitian, organizer, and journalist in St. Paul, Minn. The patient had come in for suicidal ideation. When I asked about his eating habits beforehand and access to food — routine for a psychiatric nutrition consult — he told me he’d lost his SNAP eligibility a few weeks earlier. It was something about a documentation deadline he hadn’t been notified about, or just another thing lost in the mix of making ends meet. Since then, he’d been getting by on what he could. He spent the last of his cash on a motel and dry cereal, which was all he ate for a few weeks. After his money and food ran out, he said, pretty simply, that the hospital made sense. He was hungry, thought through his options, and figured this was better than “Plan B”: ending his life due to hopelessness and a lack of food. As a clinical dietitian at a large urban hospital, part of my job is coordinating with social work and physicians of all stripes on nutrition support and food access: figuring out what patients need to eat, and occasionally what they’re going to eat after discharge. (Sidebar: We could all do worse than the Mediterranean diet.) Meals on Wheels referrals, pantry connections, SNAP enrollment support — the clinical and the logistical blur into each other because food insecurity doesn’t really stop at the point of discharge. Prior to my current role, I spent several years in public health dedicated to ending hunger and food insecurity for families. I’ve spent my career like the ferryman on the river: navigating hunger’s effects upstream, downstream, and working people across to something better.Advertisement And to no surprise, food insecurity and serious mental illness have a well-documented, bidirectional relationship. A 2023 systematic review with meta-analysis in the Journal of Psychiatric and Mental Health Nursing found high rates of food insecurity among adults with schizophrenia, bipolar disorder, and major depression — conditions overrepresented on any inpatient psychiatric unit. PLOS Mental Health went further in 2025, publishing research providing causal evidence that food insecurity directly produces anxiety and depression, not just correlates with it. An analysis of more than 2,300 emergency department patients.at a large urban public hospital found food-insecure patients significantly more likely to use the ED four or more times per year, with anxiety and depression as partial mediators of that pattern. None of this is surprising to anyone working in a psychiatric ward over the past few decades. Now the problem is getting worse, thanks to new federal government policies. Medicaid is the largest single payer of mental health and substance use treatment services in the country, covering a quarter of all behavioral health spending. The One Big Beautiful Bill, signed on July 4 last year, cut $863 billion from Medicaid over 10 years. The Congressional Budget Office estimated 10 million people will lose coverage directly. SNAP took $295 billion in cuts alongside it. Work requirements for SNAP now extend to age 64, up from 54. New documentation requirements for Medicaid eligibility redeterminations will hit every six months rather than annually; state agencies have said the administrative burden from delayed payments alone will push eligible people off the rolls.Advertisement The American Psychological Association noted the cuts will “disproportionately damage access to behavioral health services” as Medicaid enrollees are more likely to have behavioral health disorders than people with private insurance, and the program has no equivalent replacement in the legislation. The two programs most likely to keep someone fed and covered for psychiatric care were cut in the same bill, to the same population, at the same time. One out of five patients presenting to emergency departments screens positive for food insecurity across multiple urban studies. Unstable blood sugars, medication noncompliance when someone can’t afford food alongside prescriptions, psychiatric crisis when the chronic stress of hunger compounds an underlying condition — these are the mechanisms by which hunger produces increased hospital visits, including for mental health. And our cities often have greater concentration of these patients because of all the things that make urban living easier on people including access to basic care. Food-insecure patients show up more often, stay longer, and return sooner. The rural version of this is harder to fix, because rural communities are losing the infrastructure on both ends simultaneously. More than 300 rural hospitals are at immediate risk of closure due to financial instability. Forty-four percent of independent rural hospitals were already operating at negative net income in 2023, with Medicaid providing up to 63% of some facilities’ revenue. In more than half of states, Medicaid funding reductions for rural hospitals could exceed 20% of their current payments. The legislation includes a $50 billion Rural Health Transformation Fund, but KFF Health News reported it covers only 43% of what rural hospitals would need to offset the shortfall while also supporting rural clinics, community mental health centers, and federally qualified health centers competing for the same pot. When a rural hospital closes, there is no psychiatric ward down the street. More and more likely, there is often no food shelf, either. Meals on Wheels programs are facing growing demand and declining federal funding at the same time. Just recently I discharged another patient to their rural home where the nearest grocery store was an hour drive, and she was still another county away from Meals on Wheels. Anti-hunger advocates told a Capitol Hill briefing in April that charitable food systems are already stretched to their limits and cannot replace SNAP for the people losing benefits; SNAP provides nine meals for every one a food pantry can offer; and food pantries are already turning people away.Advertisement SNAP-Ed — the federal nutrition education program that helped SNAP recipients stretch their benefits and connected food pantries, schools, and community organizations to professional nutrition support — was eliminated in the same legislation, cutting roughly 12,000 jobs nationally. What was most crucial about it was that it put someone with nutrition training into rural communities and food deserts who could help people actually use what they had. It’s unclear whether health secretary Robert F. Kennedy Jr.’s plan to reheat the program via 6,000 public health officers will have the same impact. The hospital is not designed to be a food program, no matter where it’s built. No one built a psychiatric unit to solve hunger. The admission criteria, the billing codes, the length-of-stay targets — none of it accounts for the possibility that a patient’s primary presenting problem is not having enough to eat or a warm place to sleep. But the patient who walks in is the patient who gets admitted, and we will do what we can. When I do a nutrition consult, I’m looking at what the patient is eating and what that means for their medications, their stability, their recovery. But I’m also talking about what happens in four to seven days after they go home. The Meals on Wheels intake forms or phone calls are put on my calendar. SNAP reinstatement can take weeks after an appeal, which I won’t ever see but hope comes true. The food pantry is never close enough, car or bus. Our care coordinators and social workers document my referrals, but I’m not sure who will be left to close the gap. That’s the America my patients will be walking back into. If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: Call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or dial 711 then 988. Cole Hanson is a dad, clinical dietitian, organizer, and journalist in St. Paul, Minn. He writes about the connections between food, housing, politics, and public health for local, regional and national outlets. You can find more of his work at forksandfigures.org.Advertisement Mental Health, nutrition, Policy Submit a correction requestReprints Cole Hanson Newsletter The smartest thinkers in life sciences on what's happening — and what's to come Recommended First Opinion July 16, 2026 The growing fang-to-pharmacy pipeline First Opinion July 15, 2026 Why we still don’t know what foods are the source of the cyclospora outbreak Advertisement First Opinion July 14, 2026 It looks like your doctor and talks like your doctor. 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