Referrals for Food Assistance at Health Resources and Services Administration Health Centers

Importance Approximately 47 million individuals in the US experience food insecurity. Food insecurity adversely impacts treatment and prevention of diet-related health conditions (DRHCs). Health systems are increasingly screening for food insecurity and referring individuals with food insecurity to food assistance. Many people experiencing food insecurity seek care in Health Resources and Services Administration (HRSA) health centers. Objectives To evaluate the frequency of referrals to food assistance from HRSA health centers and to examine the demographic, socioeconomic, and clinical characteristics of patients who received them. Design, Setting, and Participants This cross-sectional survey study used data from the 2022 HRSA Healthcare Patient Survey, which included 3616 English- or Spanish-speaking adult patients with at least 1 visit to a HRSA health center from 2021 to 2022; this weighted sample represented 19.6 million patients. Analyses were conducted from August to December 2025. Exposures Food insecurity and presence of a DRHC. Main Outcome and Measures Patient report of ever receiving a referral from their health center to food assistance or of receiving Supplemental Nutrition Assistance Program (SNAP) or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) within the past year. Results The sample included 3616 respondents; in the weighted sample representing 19.6 million patients (49.8% aged 18-44 years; 62.9% women and 37.2% men), 42.4% reported an income below the federal poverty level. In addition, 24.7% reported food insecurity, 64.4% reported at least 1 DRHC, and 6.8% reported ever receiving a health center referral to food assistance. Food insecurity was significantly associated with referral (11.1% vs 5.5%; P = .001). Among patients with food insecurity, 7.9% reported receiving both SNAP or WIC and a referral to food assistance, 3.2% reported receiving a referral to food assistance but not SNAP or WIC, 50.9% reported receiving SNAP or WIC but not a referral to food assistance, and 38.1% reported neither. Care through the Health Care for the Homeless program (adjusted odds ratio, 6.44 [95% CI, 3.09-13.42]) or a Migrant Health Center (adjusted odds ratio, 4.47 [95% CI, 1.48-13.49]) was associated with greater odds of referral than care through a community health center. There was no evidence of racial and ethnic, language, or rural disparities in referrals. Conclusions and Relevance In this study of HRSA health center patients, more than one-third of patients with food insecurity did not receive either SNAP or WIC or a referral to food assistance. With ongoing cuts to SNAP, the need for food assistance will likely increase. HRSA health centers should strengthen systems for screening and referring patients to food assistance.