A Systematic Review: The Impact of COVID-19 Policy Flexibilities on Supplemental Nutrition Assistance Program and Women, Infants, and Children Programmatic Outcomes.

In response to the coronavirus disease 2019 (COVID-19) public health emergency (PHE), the federal government deployed policy flexibilities in food and nutrition assistance programs including the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) to meet the needs those experiencing economic hardship. Emergent literature evaluates the impact of these flexibilities on program outcomes. The objective of this study was to explore the impact of policy flexibilities deployed during the COVID-19 PHE on access, enrollment/retention, benefit utilization, and perceptions of SNAP and WIC. Keyword searches were performed in November 2023, February 2024, and August 2024. The search included peer-reviewed literature from 2020 to 2024, following Johanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, resulting in 37 eligible articles. Twelve studies evaluated policy flexibilities in SNAP only, 21 in WIC only, and 4 in both programs. Across these, 12 studies explored program access, 7 enrollment/retention, 13 benefit utilization, and 15 program perceptions. JBI critical appraisal tools were used to assess risk of bias. The reviewed articles show that although SNAP and WIC participants identified challenges to access, there were increases in enrollment/retention due to policy flexibilities enabling remote services and reducing administrative burden in both programs. Benefit increases led to greater purchase of preferred foods in SNAP and greater access to fruit and vegetables in WIC. Overall, participants were satisfied with the flexibilities and reported most were beneficial for their households. Some implementation challenges were identified by participants and staff. A few studies showed potential risks of bias, including selection bias and confounding bias. COVID-19-related policy flexibilities in SNAP and WIC demonstrated significant improvements in selected program outcomes; however, challenges communicating policy flexibilities to authorized vendors and participants created difficulties to benefiting from the flexibilities. Findings from the evaluations of these flexibilities can inform future program enhancements and long-term regulatory changes. This study was registered in PROSPERO (CRD42023493302).