Peer-reviewed article
Universal free school meals and Medicaid spending: evidence from linked education and claims data in Arkansas.
Sundell J, Kaur H, Lawson GM, Ma X, Martin BC et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined whether universal free school meal policies affect children's health care costs using linked education and Medicaid data from Arkansas. The researchers tracked 131,851 children on Medicaid before and after their schools adopted free meal policies. In the second year after adoption, Medicaid spending declined by 6.3%, with most savings coming from reduced inpatient and pharmacy spending for mental and behavioral health issues, even as outpatient mental health visits increased. The findings suggest that school nutrition policies may have broader health benefits beyond nutrition, particularly for children's mental health.
Key points
- Universal free meal adoption was associated with a 6.3% reduction in Medicaid spending in the second post-adoption year
- Spending reductions were concentrated in inpatient and pharmacy costs for mental, behavioral, and neurodevelopmental disorders
- Outpatient spending for mental and behavioral health increased, suggesting a shift toward less intensive care
- The aggregate effect across both post-adoption years was not statistically significant, but benefits emerged in year two
- The study used linked education and Medicaid claims data from Arkansas covering 2013-2020
Limitations
The study is limited to Arkansas Medicaid-enrolled children and cannot determine whether observed health spending changes reflect improved child health outcomes or simply shifts in care patterns. The mechanism explaining why nutrition policy affects mental health spending is not established.
Abstract
Introduction Universal free meal (UFM) policies provide school breakfast and lunch at no cost to all students, increasing participation, improving dietary quality, and reducing household food insecurity. Whether these policies affect children's health care spending is unknown. Methods Using linked Arkansas education and Medicaid claims data (2013-2020) and a stacked difference-in-differences design across 4 UFM adoption cohorts, we examined changes in Medicaid spending among 131 851 continuously enrolled Medicaid children before and after school-level UFM adoption. Results The aggregate effect across the 2 post-adoption years was not statistically significant (spending ratio 0.973; 95% CI 0.932-1.016). However, spending declined significantly in the second post-adoption year (spending ratio 0.937; 95% CI 0.889-0.987), a 6.3% reduction. Reductions were concentrated in inpatient and pharmacy spending for mental, behavioral, and neurodevelopmental disorders, alongside increased outpatient spending in these categories. Conclusions UFM adoption was associated with a delayed but significant reduction in Medicaid spending, driven largely by shifts in mental and behavioral health care utilization. These findings suggest school nutrition policy may influence health care spending among publicly insured children.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Universal free school meal (UFM) policy adoption providing free breakfast and lunch to all students
- Population
- 131,851 children continuously enrolled in Medicaid in Arkansas schools that adopted UFM policies
Key finding
Aggregate effect across 2 post-adoption years was not statistically significant (spending ratio 0.973; 95% CI 0.932-1.016)
J et al. · Europe PMC · 5 Aug 2026