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HEARING TO REVIEW FEDERAL NUTRITION 

PROGRAMS

HEARING

BEFORE THE

SUBCOMMITTEE ON DEPARTMENT OPERATIONS, 

OVERSIGHT, NUTRITION, AND FORESTRY

OF THE

COMMITTEE ON AGRICULTURE 

HOUSE OF REPRESENTATIVES

ONE HUNDRED ELEVENTH CONGRESS

SECOND SESSION

JANUARY 25, 2010, COLTON, CA

Serial No. 111–41

(

Printed for the use of the Committee on Agriculture 

agriculture.house.gov 

COMMITTEE ON AGRICULTURE 

COLLIN C. PETERSON, Minnesota, Chairman 

TIM HOLDEN, Pennsylvania, 

Vice Chairman 

MIKE MCINTYRE, North Carolina 

LEONARD L. BOSWELL, Iowa 

JOE BACA, California 

DENNIS A. CARDOZA, California 

DAVID SCOTT, Georgia 

JIM MARSHALL, Georgia 

STEPHANIE HERSETH SANDLIN, South 

Dakota 

HENRY CUELLAR, Texas 

JIM COSTA, California 

BRAD ELLSWORTH, Indiana 

TIMOTHY J. WALZ, Minnesota 

STEVE KAGEN, Wisconsin 

KURT SCHRADER, Oregon 

DEBORAH L. HALVORSON, Illinois 

KATHLEEN A. DAHLKEMPER, 

Pennsylvania 

ERIC J.J. MASSA, New York 

BOBBY BRIGHT, Alabama 

BETSY MARKEY, Colorado 

FRANK KRATOVIL, JR., Maryland 

MARK H. SCHAUER, Michigan 

LARRY KISSELL, North Carolina 

JOHN A. BOCCIERI, Ohio 

SCOTT MURPHY, New York 

EARL POMEROY, North Dakota 

TRAVIS W. CHILDERS, Mississippi 

WALT MINNICK, Idaho 

FRANK D. LUCAS, Oklahoma, Ranking 

Minority Member 

BOB GOODLATTE, Virginia 

JERRY MORAN, Kansas 

TIMOTHY V. JOHNSON, Illinois 

SAM GRAVES, Missouri 

MIKE ROGERS, Alabama 

STEVE KING, Iowa 

RANDY NEUGEBAUER, Texas 

K. MICHAEL CONAWAY, Texas 

JEFF FORTENBERRY, Nebraska 

JEAN SCHMIDT, Ohio 

ADRIAN SMITH, Nebraska 

ROBERT E. LATTA, Ohio 

DAVID P. ROE, Tennessee 

BLAINE LUETKEMEYER, Missouri 

GLENN THOMPSON, Pennsylvania 

BILL CASSIDY, Louisiana 

CYNTHIA M. LUMMIS, Wyoming 

PROFESSIONAL STAFF

ROBERT L. LAREW, Chief of Staff 

ANDREW W. BAKER, Chief Counsel 

APRIL SLAYTON, Communications Director 

NICOLE SCOTT, Minority Staff Director 

SUBCOMMITTEE ON DEPARTMENT OPERATIONS, OVERSIGHT, NUTRITION, AND

FORESTRY

JOE BACA, California, Chairman 

HENRY CUELLAR, Texas 

STEVE KAGEN, Wisconsin 

KURT SCHRADER, Oregon 

KATHLEEN A. DAHLKEMPER, 

Pennsylvania 

TRAVIS W. CHILDERS, Mississippi 

JEFF FORTENBERRY, Nebraska, Ranking 

Minority Member 

STEVE KING, Iowa 

JEAN SCHMIDT, Ohio 

CYNTHIA M. LUMMIS, Wyoming 

LISA SHELTON, Subcommittee Staff Director

(III)

C O N T E N T S 

Page 

Baca, Hon. Joe, a Representative in Congress from California, opening statement ...................................................................................................................... 1

Prepared statement .......................................................................................... 4

Costa, Hon. Jim, a Representative in Congress from California, opening statement ...................................................................................................................... 7

Fortenberry, Hon. Jeff, a Representative in Congress from Nebraska, opening 

statement .............................................................................................................. 5

WITNESSES

Pino, Lisa J., Deputy Administrator, Supplemental Nutrition Assistance Program, Food and Nutrition Service, U.S. Department of Agriculture, Washington, D.C. ........................................................................................................... 9

Prepared statement .......................................................................................... 11

Webb-Curtis, Christine, Chief, Food Stamp Branch, California Department 

of Social Services, Sacramento, CA .................................................................... 15

Prepared statement .......................................................................................... 17

Swanson, Nancy, Director, Department of Transitional Assistance, San 

Bernardino County Human Services System, San Bernardino, CA ................ 20

Prepared statement .......................................................................................... 22

Valenzuela, M.D., M.B.A., Guillermo J., Associate Medical Director and 

Chairman, Department of Women’s Health, Arrowhead Regional Medical 

Center, Colton, CA ............................................................................................... 33

Prepared statement .......................................................................................... 35

Wong, M.D., M.B.A., Webster A., Chief of Pediatrics, Arrowhead Regional 

Medical Center, Colton, CA ................................................................................. 36

Prepared statement .......................................................................................... 37

Sharp, Matthew, Senior Advocate, California Food Policy Advocates, Los Angeles, CA ............................................................................................................... 38

Prepared statement .......................................................................................... 40

Jessup, Edith C. ‘‘Edie’’, Program Development Specialist, Central California 

Regional Obesity Prevention Program, California State University Fresno 

Department of Health and Human Services, Central California Center for 

Health and Human Services, Fresno, CA .......................................................... 43

Prepared statement .......................................................................................... 44

Marsom, Matthew, Director of Public Health Policy and Advocacy, Public 

Health Institute, Oakland, CA ............................................................................ 48

Prepared statement .......................................................................................... 50

Page, Claudia, Co-Director, The Center to Promote HealthCare Access, Oakland, CA ................................................................................................................ 53

Prepared statement .......................................................................................... 54

SUBMITTED MATERIAL

Donatone, Lorna, Chief Operating Officer and Education Market President, 

Sodexo, Inc., submitted statement ...................................................................... 71

Submitted questions ................................................................................................ 74

(1)

HEARING TO REVIEW FEDERAL NUTRITION 

PROGRAMS 

MONDAY, JANUARY 25, 2010 

HOUSE OF REPRESENTATIVES, SUBCOMMITTEE ON DEPARTMENT OPERATIONS, OVERSIGHT, NUTRITION, AND FORESTRY

COMMITTEE ON AGRICULTURE, Colton, CA. 

The Subcommittee met, pursuant to call, at 10:00 a.m., at Arrowhead Regional Medical Center, Colton, California, Hon. Joe Baca 

[Chairman of the Subcommittee] presiding. 

Members present: Representatives Baca, Costa, and Fortenberry. 

Staff present: Lisa Shelton, Debbie Smith, Pam Miller, and 

Sangina Wright. 

OPENING STATEMENT OF HON. JOE BACA, A 

REPRESENTATIVE IN CONGRESS FROM CALIFORNIA 

The CHAIRMAN. The hearing in the Subcommittee on Department 

Operations, Oversight, Nutrition, and Forestry to review the effectiveness of implementing Federal nutrition programs will come to 

order. That sounds great, especially here in the Inland Empire. We 

are making history by having a hearing in the Inland Empire. To 

my knowledge, the Agriculture Committee has never had any kind 

of a hearing here. All of you that are here are witnessing history. 

I really want to thank two of my colleagues that are here. First 

of all, without any objections the gentleman from California, Mr. 

Costa, who is not a Member of the Subcommittee has joined us 

here today. I have consulted with the Ranking Member and we are 

pleased to welcome him to join the questioning of the witnesses. I 

would like to say welcome to Congressman Jim Costa from the 

Central Valley area. 

Then to my left is Congressman Jeff Fortenberry who is the 

Ranking Subcommittee chair. Welcome each and every one of you. 

We will officially begin the hearing by welcoming all of you to the 

43rd Congressional District. I want to give special thanks to Arrowhead Regional Medical Center for their wonderful hospitality including an opportunity for many of the individuals to give additional input earlier this morning at the reception. 

I would like to personally thank some of these individuals for 

their invaluable help in coordinating and making sure that we had 

this hearing. I would like to start by thanking Gary Obit, Chairman of the Board of ARMC; Josie Gonzalez who is the Vice Chair 

of the Board of Supervisors; Dr. Dev, Medical Director; Patrick 

Petree, CEO; George Valencia, Director of Business Development 

2

and Marketing; Susan Maruna who is the Administrative Assistant. Finally, my good friend Frank Reyes whom I have known for 

a long time and who is a resident of the Inland Empire and quite 

active. I want to thank all of them for being here. 

By the way, there is no applause in a Congressional hearing, so 

please hold your applause. We do not want to show favoritism towards one individual or the other, we are just addressing the 

issues. I want to set the rules. If anybody ends up speaking out of 

turn or are disruptive, you will be escorted out of the hearing just 

as we would do in Washington, D.C. 

With that, I want to thank all of you and I appreciate your patience. I appreciate all of you coming together for the historic hearing that we are having this morning. I say historic because, as I 

stated before, the House Agriculture Committee has never held a 

hearing in the 43rd Congressional District in San Bernardino 

County. 

As we get started I want to thank the leadership for all of their 

help. I especially want to thank the individuals that are here. I 

want to thank my two colleagues that are here, Congressman Jim 

Costa. I saved the Ranking Member from Nebraska, Jeff 

Fortenberry, for last, to thank him especially because it is coincidental, as you heard me say this morning, is that I happened to 

watch a movie yesterday, Extraordinary Measures. 

I do not know if any of you have seen the movie, but it is about 

a Dr. Stonehill who was from University of Nebraska. I was in Nebraska at a hearing and Congressman Fortenberry happened to 

take me to the university. As you drove up it says, ‘‘University of 

Nebraska.’’ 

There I met my good friend Tom Osborne whom I worked with 

in the past, an excellent football coach and now the Athletic Director for Nebraska. 

Congressman Fortenberry set a high bar for us to follow with his 

hearing in Lincoln, Nebraska because we actually held the hearing 

in a health facility. 

I figured, ‘‘Well, Jeff, you really had it at a nice health facility.’’ 

Then I said, ‘‘We have to have it at a hospital because if you have 

physical activities you have to tie in hospitals that provide assistance to a lot of our patients.’’ I want to thank Congressman Jeff 

Fortenberry, for his hospitality in Lincoln, Nebraska and having 

the hearing there. 

I look forward to working with him, not only now, but on a bipartisan basis along with my colleague Jim Costa in trying to make 

sure that we have related hearings. We not only want to have them 

in Washington, D.C. but throughout the United States. 

I would just like to say that some may have difficulty in seeing 

the connection between the Federal nutrition program and hospital 

settings. In fact, there is a very close and important connection. 

Over the past 4 years the Subcommittee, and the House Agriculture Committee as a whole, has built a record that links the importance of nutrition and health. They go hand in hand. 

In 2007, we held a hearing that demonstrated the importance of 

the food stamp program, called SNAP. We have to get used to the 

new name of the food stamp program called SNAP. There is the 

3

connotation that people do not want to be identified with food 

stamps, but would rather be identified with SNAP. 

We have a long ways to go to educate our communities about the 

change. By the way, I was the one that came up with the slogan 

SNAP to take the stigma away from the name ‘‘food stamp.’’ One 

of the reasons I did that in the farm bill is because I was actually 

on food stamps. I received food stamps when I was young. It was 

at a time my wife and I had a child and it was very difficult. 

During that period of time I did receive assistance and got food 

stamps. You know how embarrassing it is for those of us who have 

received food stamps? It is something you do not want to be dependent upon, but it was something that I needed during that period of time. 

I remember going to the grocery stores and people were looking 

at you as you are counting your food stamps and everybody says, 

‘‘Well, look at this guy and his wife. They are out here.’’ But I did 

not look at it from that point of view. 

I looked at it as the inability to feed my family, at that time I 

was a college student who could not afford it and did not have a 

good job, so I needed assistance. I know what it is like in terms 

of the stigma and being in line and being there. Now we have the 

debit card which looks like an American Express card or a Visa, 

which is nice that we have gotten away from coupons. That is why 

it is important that we have these kinds of hearings and look at 

what needs to be done. 

In 2008, the farm bill provided a record level of funding for nutrition and safety net programs like SNAP and food banks. We made 

important changes to promote healthy eating by funding vital programs that encourage consumption of more fruits and vegetables. 

We expanded the Fresh Fruits and Vegetables Snack Program to 

the entire nation providing children with access to education about 

healthy and fresh produce. 

In July of 2008, the Subcommittee heard testimony on the economic cost of hunger and nutrition in the United States, and that 

is one of the areas that we really want to address as we look at 

the actual cost of nutrition. I do appreciate today’s Sun Telegram’s 

story. ‘‘Many ignore food stamps or SNAP.’’ But, it is more than 

just this. I think California has got to look at it from the point of 

economics. 

There is $7 billion in revenue that could come back to this state. 

I think the paper missed one concept. It is good that we look at 

half of the people in the United States, or in California, that are 

not utilizing the SNAP Program. Yet, that means in revenue that 

would come back to the State of California it is approximately $7 

billion, and we are at a $20 billion deficit in the State of California. 

We just met with the Governor last week and Jim and I were 

there from the California Delegation in a bipartisan meeting, and 

he indicated that he needs $6 billion. Well, if we can get the $7 billion by making sure that we educate individuals about SNAP, it is 

not only about feeding them but it is also about the revenue that 

would come back to the State of California. 

Also at a Subcommittee hearing the testimony from California 

advocates demonstrated how the lack of participation in Federal 

nutrition programs means loss of revenue to California, as I stated 

4

before. In 2009 California’s poor participation in the SNAP Program lost $7 billion for the state. 

In March the Subcommittee took up the topic of obesity in the 

U.S. 

Experts from the Centers for Disease Control and Prevention testified that both nutrition education, and lack of access to healthy 

food contributes to obesity costing our nation between $80 to $120 

billion. 

We have established clear evidence of the link many tie between 

nutrition and health. Today we will take that conversation one step 

further. For some years I have wanted to hold a hearing in San 

Bernardino County and I am glad that we are able to do that now. 

I appreciate the bipartisan support that we received. 

[The prepared statement of Mr. Baca follows:]

PREPARED STATEMENT OF HON. JOE BACA, A REPRESENTATIVE IN CONGRESS FROM

CALIFORNIA

Good morning and thank you all for being here today in my favorite place, California’s 43rd Congressional District. 

Special thanks to our hosts today, Arrowhead Regional Medical Center, for their 

wonderful hospitality. I want to read the names of some of those who have been 

invaluable:

• Gary Obitt, Chairman of the Board of ARMC;

• Josie Gonzales, Vice Chair of the Board;

• Dr. Dev Gnanadeb, Medical Director;

• Patrick Petree, CEO;

• George Valencia, Director of Business Development and Marketing;

• Susan Maruna, Administrative Assistant;

• And finally, Frank Reyes, who is a long time friend and resident of this area.

I appreciate the effort and patience they have shown in working with the Committee to organize this historic hearing. 

I say historic hearing because as far as I know—this is the first House Committee 

hearing ever to be held here in the 43rd Congressional District and in San 

Bernardino County. 

Before we get started, I want to thank all the great leadership we have here at 

the local level. 

I especially want to recognize the work of the Rialto City Council, Mayor Grace 

Vargas, and Mayor Pro-Tem Joe Baca, Jr. 

I also want to say a special thank you to Congressmen Jeff Fortenberry of Nebraska; and Jim Costa from the Central Valley of California—for their willingness 

to be here. 

Jeff, Jim, and I share a strong interest in the connection between nutrition and 

health. 

In fact, it was my pleasure to chair a subcommittee hearing in Jeff’s hometown 

of Lincoln, Nebraska this past August. 

That hearing examined the innovative ways and economic benefits to communities 

and businesses in promoting healthful lifestyles. 

Congressman, I appreciate your continued interest in this important topic, and 

thank you again for your tremendous hospitality in Lincoln. 

I hope you enjoy your visit to California’s 43rd District as much as I enjoyed being 

in Nebraska’s First District. 

Mr. Fortenberry set the bar high for his hearing by holding it in the gymnasium 

of a beautiful health facility. 

So, we have followed his lead by holding this hearing in a health related location. 

Some may have difficulty seeing the connection between Federal nutrition programs and a hospital setting. 

But in fact, there is a very close and important connection. 

Over the past 4 years, this Subcommittee, and the House Agriculture Committee 

as a whole, has built a record that links the importance of nutrition and health. 

In 2007, we held a hearing that demonstrated the importance of the food stamp 

program (now called SNAP) to the overall health and long term success of children. 

5

Then, in the 2008 Farm Bill, we provided record levels of funding for nutrition 

for safety net programs like SNAP and food banks. 

We also made important changes that promote healthy eating, by funding pilot 

programs that encourage the consumption of more fruits and vegetables. 

And, we expanded the Fresh Fruit and Vegetable Snack program to the entire nation, providing children access to and education about healthy and fresh produce. 

In July of 2008, this Subcommittee heard testimony on the economic costs of poor 

nutrition in the United States. 

Researchers detailed that hunger costs our country $90 billion per year in lost 

work productivity, the need for special education, and other factors. 

Also, at that hearing, testimony from California advocates demonstrated how a 

lack of participation in Federal nutrition programs means lost revenues to California counties, compounding the costs of hunger and poor nutrition to communities. 

In 2009—California’s poor participation in the SNAP program was estimated to 

cost our state $3.7 billion in additional Federal funding. 

These funds would have led to an additional $6.9 billion in statewide economic 

activity. 

In March of 2009, the Subcommittee took on the topic of obesity in the U.S. 

Experts from the Centers for Disease Control and Prevention testified that both 

nutrition education and a lack of access to healthy foods contribute to the obesity 

epidemic—which costs our nation anywhere from $80 to $120 billion ever year. 

So, we have established a clear body of evidence linking the many ties between 

nutrition and health. 

Today, we take that conversation one step further. 

For some years, I have wanted to hold a hearing in San Bernardino County to 

point out the unique problems of our state’s cultural and economic diversity in improving health and nutrition. 

Sadly, the recession has only emphasized the problems that we have faced for 

many years. 

So we hold this hearing at one of the most critical times for California and its 

people. 

Why does California struggle with low participation rates in Federal nutrition 

programs? 

What does this mean for the physical and economic health of our communities—

especially as it pertains to the obesity epidemic? 

We will be looking for the answers to these and other questions from our outstanding witnesses today. 

This is a topic of great interest to me as a legislator, of course—but also as a husband, father, grandfather, and community member. 

Again—I want to thank everyone at Arrowhead Regional; and thank our witnesses for taking time from their busy schedules to be with us today. 

I now yield to our Subcommittee’s Ranking Member—my friend, Rep. 

Fortenberry.

The CHAIRMAN. With that, I would like to welcome and ask the 

Ranking Member Jeff Fortenberry for his opening statement, then 

I will call on Congressman Jim Costa for his opening statement. 

Congressman Fortenberry. 

OPENING STATEMENT OF HON. JEFF FORTENBERRY, A 

REPRESENTATIVE IN CONGRESS FROM NEBRASKA 

Mr. FORTENBERRY. Thank you, Mr. Chairman, for holding this 

hearing today and for honoring me with the invitation to attend, 

in your home State of California. Welcome to you all. I must say, 

coming from Nebraska, I am absolutely fascinated by the fact of 

seeing palm trees nestled against the backdrop of snow-covered 

mountains. That is very unique for me. I have, of course, been in 

California but not in this particular area. 

You have a lovely home here and I congratulate all of you for 

your attentiveness to community life here. It is very clear from our 

earlier meeting the level of commitment to public service and community input from a variety of areas, not only from the medical 

community but other leaders out there who are very interested in 

6

these questions: how nutrition relates to families, how nutrition relates to healthcare outcome, so thank you very much. 

I would like to let you all know it is a pleasure and an honor 

to serve alongside with Congressman Baca in the halls of Congress. 

As I mentioned earlier there can be quite a bit of rancor and divisiveness. There are strong philosophical divides in Washington, but 

the Agriculture Committee tends to pride itself on attempting to 

transcend those differences in creating a safe affordable food supply that helps feed this nation and the world. 

As you all know, Chairman Baca has served you in Congress 

since 1999. He is, of course, Chairman of this Committee. I am 

what is called the Ranking Member. I have admired Chairman 

Baca, as well, for his service in the U.S. Army, many of you may 

not know that, as a paratrooper from 1966 to 1968. Following his 

military service he came back to California and earned a degree in 

sociology. I understand you served both in the State Assembly as 

well as the State Senate so, again, thank you for hosting, Mr. 

Chairman. 

As you all are very much aware, we have been engaged in this 

very important debate about the future of our healthcare system in 

this country. The debate has been critical to the well being of families and small businesses and all of us throughout our great nation. 

My priority has been to focus on two essential questions. How do 

we actually improve healthcare outcomes and reduce cost while 

protecting vulnerable persons. 

I believe one important piece of this solution has been to understand the integral role that nutrition plays in the well being of our 

children and families. This is because a major driver of our everincreasing healthcare cost has been the rise of chronic diseases. 

Many of you are very aware of this and many of which are nutrition related. 

For instance, the average American is 23lb overweight. Obesity 

among young people has tripled since 1980. Obesity is a major factor that leads to the onset of chronic diseases like diabetes, heart 

disease, some cancers and even strokes. Chronic diseases are driving 75 percent of every healthcare dollar according to some studies. 

Consequently it is imperative to me that our healthcare system 

promote and incentivize healthy nutrition practices and wellness. 

We must all foster a culture of wellness and reward behaviors that 

reduce the onset of these diseases. I believe we could potentially 

save hundreds of billions of dollars if we could delay or reduce the 

onset of these chronic diseases. As responsible individuals and citizens I hope that we will personally implement wellness and preventative measures so that we all can thereby reduce our risk factors for these conditions. 

The food that individuals have access to and select often determines the quality of their overall health. The SNAP Program, the 

topic of our hearing today, enables persons in vulnerable circumstances to have access to a wide variety of nutrition selections. 

As we carefully allocate these resources an important topic of consideration should be the quality and health-promoting choices at 

the dinner table for families. 

This principle of healthy food combined with wide stewardship 

and personal responsibility should guide the goals of this program. 

7

I look forward to learning how these principles are currently being 

implemented and what recommendations our experts may propose 

to further this agenda. 

Again, Mr. Chairman, it is a great privilege to be here with you 

in the great State of California. Thank you. 

The CHAIRMAN. Welcome to the 43rd Congressional District. I 

would like to call Congressman Jim Costa. 

OPENING STATEMENT OF HON. JIM COSTA, A 

REPRESENTATIVE IN CONGRESS FROM CALIFORNIA 

Mr. COSTA. Thank you very much, Chairman Baca, and all of 

those who are here this morning, the witnesses on the first panel 

and the second panel. We applaud and commend your hard work 

and efforts and we look forward to hearing your testimony. 

Chairman Baca, I want to thank you for allowing me to be part 

of the Subcommittee hearing this morning, but I also want to convey to the constituents of the Inland Empire the tremendous work 

you do on their behalf in Washington. I know this to be a fact. I 

have had the honor and privilege to serve with Congressman Baca 

both in the State Legislature before I had this arctic blond and now 

in Congress. 

I want you to know he is a tenacious advocate on behalf of the 

people, not only in his Congressional district, but the people of 

California. He is always passionate and his tireless energy are hallmarks of his leadership. In the 2008 Farm Bill he truly wanted to 

ensure that the nutrition program was improved. As a result of his 

hard work and others in the Subcommittee, Congressman 

Fortenberry and others, I think we made progress in the food 

stamp program that Joe spoke of. 

It is important to note, as Congressman Fortenberry indicated, 

that the House Agriculture Committee is truly one of the more bipartisan committees that we have in Congress. I wished it were not 

the exception but the rule. 

The 2008 Farm Bill was, I believe, the only major piece of legislation that went through the entire hearing process. It had regular 

order. Went through the House and the Senate. Went to the Conference Committee. Had bipartisan support in both Houses. Actually was vetoed by the President and we overrode the veto, which 

really reflects the effort and the way all of you believe that we as 

your representatives ought to be acting to solve problems in this 

country. 

I think the 2008 Farm Bill, under the leadership of the Members 

of the Committee, both of them here—of course, I am on the Committee as well. Congressman Fortenberry and I are on the class of 

2004. He does a great job on behalf of his constituencies throughout 

Nebraska. We are pleased that you have come all the way out here, 

Jeff, to participate in this hearing. 

Mr. Chairman, let me give a brief statement about what we are 

dealing with here because your review of the Federal nutrition programs is timely. It is timely because we enacted the 2008 Farm 

Bill. It is timely because what has been part of the big discussion 

and debate over this last year, healthcare. We all know as children 

our parents taught us a long time ago that an ounce of prevention 

is worth a pound of cure. A lot of the focus in the healthcare bill 

8

has been on preventive healthcare. It is that ounce of prevention 

that is worth that pound of cure. 

Early childhood eating habits, good eating habits, are a key to 

ensuring and fostering that we live and eat healthy our entire 

lives. The nutrition program is an important component of that effort. It ties in the best aspects of America; reaching out to those 

who are less fortunate, but also taking advantage of our agricultural productivity which is second to none anywhere in the world. 

We all know that hunger and food insecurity in parts of our 

country, and in parts of our state unfortunately, continues to be a 

problem. One of the most devastating impacts of this economic recession that we have been in is that an increasing number of mothers and fathers find themselves no longer able to put dinner on 

their family’s table. 

My district has been especially hard hit. The recession coupled 

with four horrific droughts and a regulatory water crisis have left 

many of the hardest working people in this nation, who would normally be working to put food on America’s dinner table, in food 

lines. It is unacceptable in the richest nation in the world. 

How ironic it is that the most fertile agricultural regions of the 

country were forced to rely on food banks and the SNAP Program 

to feed these families. In my district we grow over 300 crops of 

which primarily are fruits and vegetable, that good nutrition we 

are talking about. Still many Valley residents rely on high-calorie 

fast foods and nutritionally deficient low-cost options because the 

healthy options are either unavailable or too costly to purchase on 

a family’s meager budget. 

Near Bakersfield, in the southern end of my district, we have 

what we call food deserts. They are not real deserts because we 

grow all this food, but what I mean is they are only occupied by 

fast food chains and convenience stores for miles. Almost 60 percent of my population is overweight. Nearly 30 percent of the population in each of these counties is considered obese. That is unconscionable. Nearly 30 percent of the population in some of the major 

cities I represent like Fresno are at the poverty level. Similarly 

these statistics are hardly a coincidence. 

I want to thank the Chairman. We have made great strides in 

providing more healthy options for needy families in the 2008 Farm 

Bill and the SNAP Program that he spoke of. We need to expand 

the use of farmer’s markets, the expansion of Fresh Fruits and 

Vegetables Snack Program to make a concerted effort to provide 

more healthy options for our food banks, which is important and 

through the TEFAP Program. We can and should do better. Mr. 

Chairman, I am looking forward to the testimony by our first and 

second panel to figure out how we can do a better job at the local, 

state, and Federal level. Thank you. 

The CHAIRMAN. Thank you very much, Congressman Costa and 

Congressman Fortenberry for your opening statements. As we indicated before, it is also about not only nutrition but prevention and 

intervention, as well. We need to look at the overall cost and the 

ability not only to use nutrition programs but as a cost to the state 

as well. 

I will just mention this because I mentioned the revenue is in 

terms of what we could potentially get to the State of California. 

9

In San Bernardino alone there is revenue that could be 

$508,960,781 and that is the amount that we are losing in terms 

of revenue because of people here in this county that are under-utilizing the nutrition program as well. 

That means that people are not putting food on their table and 

feeding their families, which means additional revenue that could 

come to this county alone. Then if you take LA County it is about 

$2 million that they are losing in revenue just in LA County, which 

is the surrounding county to that. 

With that we would like to begin with the panelists to begin to 

give us their testimony. Each of the panelists will have 5 minutes. 

There is a light in front of you so those of you who are new to this 

and have not seen this in Washington, D.C. there is a light that 

comes on. At first the green light will be on and then the yellow 

light tells you that you had better cut your statement off or the 

gavel is going to go off. 

The red means you are supposed to be done and your testimony 

will be heard during that period of time and then also we will take 

the written testimony. We would like to begin with our first panelist and that is Lisa Pino who is the Deputy Administrator for 

Food and Nutrition Service, U.S. Department of Agriculture in 

Washington, D.C. 

Ms. Pino. 

STATEMENT OF LISA J. PINO, DEPUTY ADMINISTRATOR,

SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM, FOOD 

AND NUTRITION SERVICE, U.S. DEPARTMENT OF

AGRICULTURE, WASHINGTON, D.C. 

Ms. PINO. Good morning, Chairman Baca and distinguished 

Members of the Committee. I am Lisa Pino, Deputy Administrator 

of the U.S. Department of Agriculture’s Food and Nutrition Service. 

I am pleased and honored to join you here today to discuss the 

SNAP and how we can improve participation rates in SNAP, especially among difficult-to-reach groups and in California. 

The Federal food programs are critical components of our nation’s safety net for families in need. Our programs promote 

healthier food choices among the children and families they serve 

as crucial prevention components of our national public health 

strategy. 

The USDA is committed to making these programs as effective 

as possible in addressing our top priorities—ending childhood hunger and addressing the obesity epidemic. The setting for this hearing on hospital grounds is historic and reminds us of the vital connection between healthy eating and disease prevention. 

While SNAP is the largest food assistance program that FNS administers, it is still only one of our 15 nutrition assistance programs. They are all designed to combat hunger and promote nutrition. Congress is poised to reauthorize the Child Nutrition programs this year and the Obama Administration is committed to 

supporting ground-breaking improvements in these programs 

which includes school meals and WIC, a nutrition program especially for women, infants, and children. 

During this recession, SNAP proves its inherent value as the nutrition safety net for America each and every day. More than four 

10

million people have joined SNAP in the past 6 months alone. Nearly 38 million Americans receive SNAP benefits, which is a 22 percent increase over just 1 year ago. 

While record-high caseloads are an unfortunate indicator of the 

difficult times and the daily struggles of families across our nation, 

they are also clear evidence that SNAP is responding effectively, as 

it was designed to do during the economic downturn. 

In the past year, California has experienced a 25 percent increase in caseload from just 1 year ago consistent with national 

trends. Nearly three million Californians received SNAP benefits 

as of October 2009. The average California SNAP household received a monthly benefit of $325 or $137 per person in Fiscal Year 

2009. Still, California has a low participation rate relative to most 

states. According to the USDA’s annual report on state SNAP participation, California ranks 50 out of 51 state agencies including all 

states and the District of Columbia. 

In 2007, the most recent data available, California served 48 percent of those eligible to participate in SNAP, while the national average is 66 percent. Clearly a low participation rate means less 

healthy food at home for households in need, especially during such 

a tough economic time. 

But beyond SNAP’s nutritional benefit to households, SNAP is an effective economic stimulus. Every $5 in new SNAP benefits 

generate approximately $9.20 in total economic activity. That is almost double the benefit. 

If California were to increase its participation rate by just five 

percent, from 48 percent to 53 percent, participants would have 

more than $117 million in benefits to spend on healthy food generating more than $200 million in total economic activity. This is 

money left on the table that can flow into the state’s economy to 

help California get back on its feet with an influx of additional 

spending. 

We are working with the state to improve participation through 

three methods: better policies, better practices, and better outreach. We suggest such policies as simplifying client reporting, expanding broad-based categorical eligibility, and eliminating fingerimaging to prevent dual participation. 

USDA also offers states an array of policy waivers to increase 

participation in SNAP while reducing cost and administrative burden. As for better practices, we encourage all states, including California, to consider business process re-engineering, an approach to 

allow states to more effectively manage increasing caseload. 

In the area of better outreach one advantage is crystal clear. 

Good outreach increases participation in SNAP which brings even 

more Federal funding to the state and its residents. Currently California is reaching out to new participants through partnerships 

with food banks and we are working with all states, including California, to improve outreach to the under-served such as Latinos, 

legal immigrants, seniors, the newly unemployed, and the working 

poor or the under-employed. 

In closing, let me re-emphasize the Administration’s commitment 

to fighting hunger and improving the Federal nutrition programs. 

FNS has elevated nutrition and nutrition education as a top priority in all its programs. In addition to providing access to nutriVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00014 Fmt 6633 Sfmt 6601 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
11

tious food, FNS also works to empower program participants with 

knowledge of the link between diet and health. 

With our state partners, we look forward to working together to 

help bring more nutritious meals to those in need. I look forward 

to answering any questions you have and I thank you for your attention. 

[The prepared statement of Ms. Pino follows:]

PREPARED STATEMENT OF LISA J. PINO, DEPUTY ADMINISTRATOR, SUPPLEMENTAL

NUTRITION ASSISTANCE PROGRAM, FOOD AND NUTRITION SERVICE, U.S.

DEPARTMENT OF AGRICULTURE, WASHINGTON, D.C. 

Good morning, Mr. Chairman. I am Lisa Pino, Deputy Administrator of the U.S. 

Department of Agriculture’s Food and Nutrition Service (FNS). 

I am pleased to join you today to discuss the Supplemental Nutrition Assistance 

Program (SNAP) and how we can improve participation rates in SNAP especially 

among difficult to reach groups and in California. Before I get into those details, 

however, I want to step back and outline the U.S. Department of Agriculture’s priorities for the Federal nutrition assistance programs managed by FNS. 

These programs are critical components of our nation’s safety net for families in 

need. They currently touch more than one out of five Americans each year. Using 

their breadth and scope to promote healthier food choices among the children and 

families they serve is a critical prevention component of our national public health 

strategy. The U.S. Department of Agriculture is committed to making these programs as effective as possible in addressing our top priorities—ending childhood 

hunger and addressing the obesity epidemic. In support of these big picture outcomes, we are pursuing an ambitious agenda to strengthen program access, modernize operations, improve the effectiveness of nutrition education, and strengthen 

program integrity. We know that there are great challenges ahead of us, but with 

the aid of our state and local partners, we are determined to achieve these goals. 

We can achieve success in ending childhood hunger and improving the nutritional 

status of participants. 

This year Congress will reauthorize the Child Nutrition Programs. The Administration is committed to supporting ground-breaking improvements in these programs, including the school meals programs. In its Fiscal Year 2010 Budget, the Administration proposed a billion dollars each year in new funding for Child Nutrition, 

focused on priorities in reducing barriers and improving access; and enhancing nutritional quality and the health of the school environment. 

One important connection between SNAP and school meals is Direct Certification. 

This system enables states to utilize data from the SNAP certification process and 

directly enroll students in SNAP households for free school meals, eliminating the 

need for application paperwork. This is an excellent way to simplify the administrative costs while improving access to our hunger-fighting programs. A recent report 

shows that while schools have increased their use of direct certification, some direct 

certification systems are more effective than others. We will be working to promote 

and expand best practices in this area. 

During this recession, SNAP proves its inherent value as the nutrition safety net 

for America each and every day. More than four million people have joined SNAP 

in the past 6 months. Nearly 38 million Americans receive SNAP benefits, which 

is a 22 percent increase over just 1 year ago. In each month of Fiscal Year 2008, 

SNAP served approximately 6.3 million households with children, representing just 

over half (51 percent) of all SNAP households. 

While record-high caseloads are an unfortunate indicator of the difficult times and 

the daily struggles of families across our nation, they are also clear evidence that 

SNAP is responding effectively, as it was designed to do, to the economic downturn. 

SNAP participation increases when the need is greater and contracts in better 

times. While SNAP has been responsive in these difficult times, many eligible individuals remain unserved. 

FNS takes seriously its stewardship responsibilities for tax payer dollars through 

the quality control system and support for payment accuracy initiatives. Even as 

participation in SNAP continues to grow and benefits increase, FNS remains committed to program integrity, and the results are clear: In Fiscal Year 2008, SNAP 

achieved a record high payment accuracy rate. It is possible to achieve both high 

participation and high payment accuracy simultaneously. 

In the past year, California has experienced a twenty-five percent increase in 

caseload from just 1 year ago, consistent with national trends. Nearly three million 

12

1 Increases in food stamp (now named SNAP) benefits can stimulate additional economic activity. An increase in benefits raises spending by recipient households, which then stimulates 

production. Higher production boosts labor demand and household income. Increased household 

income triggers additional spending. Hanson and Golan (2002) estimate that an additional $500 

in food stamp expenditures triggers an increase in total economic activity of $920. See the Economic Research Service website at http://www.ers.usda.gov/publications/fanrr26/fanrr26-6/

fanrr26-6.pdf (See p. 2.) 

(2,998,851) Californians received SNAP benefits in October 2009. The average California SNAP household received a monthly benefit of $325, or $137 per person in 

Fiscal Year 2009. This is up from $259 per household and $105 per people in Fiscal 

Year 2007. 

Still, California has a low participation rate relative to many other states. According to the USDA’s annual report on state SNAP participation rates, California’s participation rate ranked 50 out of 51 including all the states and the District of Columbia. In 2007, the most recent data available, California served only 48 percent 

of those eligible to participate in the program. The national average was 66 percent. 

California’s low participation rate is a serious concern for many reasons. 

First, plain and simple, the low participation rate means less healthy food at 

home for households in need. It means that families lose the ability to stretch their 

food budgets to purchase more and healthier food. It means they go hungry instead 

of receiving nutrition benefits to which they are entitled. Second, SNAP is an effective economic stimulus. Every $5 in new SNAP benefits, 

if funded through emergency spending, has been estimated to generate as much as 

$9.20 in total economic activity.1 If California were to increase its participation rate 

among those eligible for benefits by just five percentage points, participants would 

have more than $117 million in benefits to spend on healthy food generating more 

than $200 million in total economic activity. This is money ‘‘left on the table’’ that 

could flow into the state’s economy and help the economy get back on its feet with 

an influx of additional spending. Almost all (97%) SNAP benefits are spent for food 

within 30 days. 

Because SNAP is an effective economic stimulus, Congress and the Administration worked together to build on the program’s strengths through the American Recovery and Reinvestment Act. The Recovery Act provided additional benefits for 

SNAP recipients nationwide, $80 for a household of four per month, starting in 

April 2009. These additional benefits have been very effective in getting food resources to families facing increased need as a result of the slow economy. In conjunction with the Mid-Session update to the President’s Fiscal Year 2010 budget, 

we estimate that over time, the increased benefits will total $48 billion. This figure 

will be re-estimated with the President’s Fiscal Year 2011 budget request and is 

likely to increase. The increased SNAP benefits were some of the first Recovery Act 

dollars to reach the wallets of needy people and the neighbors and businesses in 

their communities and made an immediate impact on the national economic situation. 

We recognize the extraordinary budget difficulties states, including California, 

face in this current economic crisis. To help address the growing strain on existing 

resources, the Recovery Act provided nearly $300 million in new administrative 

funds to states—funds that will not require a match—to help them serve the growing number of families seeking assistance. California’s share of these funds is $21.7 

million. The Defense Appropriations Act recently provided another $400 million to 

states for this purpose. 

USDA has offered all states an array of policy waivers to increase participation 

in SNAP while reducing cost and administrative burden and helping to more effectively manage the increasing workload. 

California has already made some steps in the right direction. For example, California has established broad-based categorical eligibility for families with children. 

They are doing telephone interviews at certification and recertification in some regions. There are online applications with electronic signature capability in some regions as well as change processing call centers in some regions. One important waiver that California is already using restores eligibility to households terminated for 

failure to provide reports if those reports are received within 30 days. These efforts 

represent a significant start towards improving participation. 

We are working with California to improve participation through three methods—

better policies, better practices and better outreach to those eligible for SNAP. 

First, better policies. There are several policies that California can implement to 

achieve significant savings and help to address its $20 billion budget deficit, while 

also improving access and service for clients. 

Specifically, we recommend the following approaches for California:

13

• First, simplify client reporting. FNS has asked the state to submit a plan by 

February 2010 to convert from the current quarterly reporting system to a simplified reporting system. Simplified reporting will require less frequent submission of report forms from clients, lead to longer certification periods for some 

households, and reduce the time and expense of acting on changes.

• Second, expand eligibility and reduce workload through broad-based categorical 

eligibility: Other states have eliminated asset requirements and are making use 

of higher income limits (up to 200 percent of the Federal poverty line) for all 

eligible households, not just those with children under 18 as in California. 

Broad-based categorical eligibility is an effective workload management tool for 

overburdened states workers and simplifies the application process for clients.

• Third, consistently offer telephone interviews in lieu of face-to-face interviews.

Many California counties have chosen not to use telephone interviews consistently or limit the criteria for waiving the face-to-face interview. Use of telephone interviews and tailoring interview length and questions to the specific 

circumstance of the case make the process more efficient and reduce as many 

burdens possible. Failure to fully utilize these telephone interviews to their fullest extent can make it more difficult for households to navigate the certification 

process, thereby discouraging participation.

• Fourth, eliminate finger imaging: While there is no hard data to establish that 

finger imaging prevents participation of eligible households, community-based 

groups have consistently reported that low-income groups (especially low-income 

legal immigrants) are often fearful of applying for SNAP because of the finger 

imaging requirement. As states look for ways to provide services in difficult fiscal times, the cost associated with finger imaging should be reconsidered. Most 

states satisfy the requirement to establish a system to prevent duplicate participation by matching names with Social Security Numbers, which is less costly 

than finger imaging and is also an effective deterrent. We need to make every 

dollar count by managing resources in the most efficient and effective manner 

possible. USDA is in the process of evaluating how finger imaging systems may 

impact cost and client participation.

• Fifth, expand call center change reporting and electronic applications. While 

these approaches are being used in some regions, participation and access could 

be enhanced if they were used statewide.

In the area of better practices, we stress the importance of customer service and 

better business processes. The more user friendly the application and related processes are, the more likely it is that access to the program will improve. We will continue to work further with the state to see where the application process can be improved or ‘‘reengineered’’ and whether there are waivers or other assistance we can 

provide to help counties move towards more efficient application processes. FNS encourages states to learn from each other and implement models that work. 

One critical customer service that must be addressed is application processing 

timeliness. Timeliness standards are set by law. Applications must be processed 

within 30 days or within 7 days for expedited cases where applicants have very low 

income. Despite current challenges, these standards must be met. People have a 

critical need for timely assistance. Every day matters when you’re hungry. 

Some states have persistent difficulty with timeliness with little improvement. 

California has experienced decreasing timeliness rates over the past 2 years. In 

2008, 79.6 percent of applications were processed in a timely manner in California. 

The national average is 85.6 percent. Record caseloads are challenging even those 

states with historically good timeliness rates. Yet there are states successfully maintaining timeliness rates despite rising caseloads. We encourage California to talk 

with such states and learn more about their business practices. 

The negative error rate, which is the rate of incorrect denials, suspensions or termination of benefits, is another critical customer service issue. California has a very 

high negative error rate. When negative errors occur, access is hampered and households face unnecessary hardship because households are removed from the program 

unnecessarily. Over the past several months, FNS has done in-depth reviews in the 

five largest states, including California, to learn why the negative error rate is going 

up and what we can do to help states reverse the trend. Results of this analysis 

are expected later this year. 

Like all states, California must promote accountability and make improved negative error performance as a priority. Policy, Quality Control (QC), and Corrective Action staff must work closely together on provided resources and tools to local county 

staff to promote improved performance in this measure. 

14

In the area of better outreach, the advantages are crystal-clear: due to economic 

multiplier effect I described earlier, increasing the number of eligible individuals 

participating in SNAP would bring additional Federal funding support to the state 

and its citizens. California is to be recognized for its statewide outreach plan that 

includes partnerships with food banks. We are working with many states, including 

California, to improve access and participation through innovative outreach and 

community partnerships, especially those designed to reach underserved populations, such as Latinos, the elderly, and the unemployed and under-employed. 

Nationwide, more than five million U.S. Latinos participated in SNAP in 2006, 

but nearly as many were eligible yet did not participate. SNAP served nearly 1.1 

million Latinos in California in an average month in 2006 (the latest year with data 

on race and ethnicity). The participation rate of eligible Latinos is just 56 percent 

nationwide, and in California is it just 43 percent. This means California is losing 

millions in federally-funded SNAP benefits to which their residents are entitled. 

Latino families are much more likely to live in poverty and experience food insecurity than white non-Latino households. More than 1⁄4 of all people eligible for 

SNAP benefits but not receiving them are Latino. According to USDA’s Economic 

Research Service, while fifteen percent of households in the U.S. are food insecure 

in 2008, the rate of food insecurity among Latino families was over 25 percent. This 

is not just a food security issue—it is a question of equitable program access across 

USDA’s diverse customer base. The Department is making a concerted effort to 

overcome barriers to program participation in a wide range of programs among 

Latinos and other traditionally under-served communities. We continue to seek 

ways to help all states develop strategies that increase participation among such 

target populations. 

Factors impeding Latino SNAP participation include confusion and misinformation about the issue of whether someone is considered a ‘‘public charge’’. In fact, receipt of SNAP benefits does not make one a public charge. Other factors impeding 

participation are the lack of awareness and understanding of the program and eligibility requirements, and limited delivery of that information in cultural and linguistically appropriate ways. 

For many years, the Food and Nutrition Service has worked to eliminate these 

barriers and reach out to underserved groups to raise awareness of the nutrition 

benefits of SNAP, including significant efforts to reach the Latino population. Our 

efforts include:

• Outreach to make sure that eligible clients, outreach providers, and other stakeholders are aware of Department of Homeland Security policy that clearly indicates that participation in SNAP does not make one a public charge.

• Radio advertisements in English and Spanish to promote the nutrition benefits 

of SNAP and educate non-participating eligible people have aired in multiple 

states for 6 years. We are in the planning stages for the seventh year. Radio 

advertisements have aired in California during each year to date.

• A web-based pre-screening tool in English and Spanish. Individuals using the 

prescreening tool receive estimates of their eligibility and benefit amounts. This 

tool is online at http://www.snap-step1.usda.gov.

• A national toll free number, 1–800–221–5689, provides information about the 

program in Spanish or English and includes the option to receive a packet of 

information by mail.

• Educational posters and flyers in English and Spanish which may be ordered 

for use in local outreach campaigns that can be used in promotional and informational materials. These resources are available at http://foodstamp.ntis.gov/

• A comprehensive Latino strategy outreach plan, now under development, to better reach and educate the Latino audience about the nutrition benefits of SNAP.

• A national SNAP Outreach Coalition to bring together national and local organizations working with low-income audiences. Coalition members share effective 

outreach strategies to educate eligible, non-participating, low-income Latino 

people about the benefits of SNAP.

• Participation grants for projects that look at ways that state partnerships can 

improve access, and make the application and intake process more user-friendly. Three of these grants have been awarded to organizations in California during the past 7 years.

• Outreach grants for small organizations to study the effectiveness of strategies 

to inform eligible low-income people about the program. Neighborhood and 

faith-based organizations in California have received nine outreach grants since 

2001.

15

Now, I would like to turn my attention for a moment to the role that SNAP plays 

in promoting healthy eating. Through the nutrition education component called 

SNAP-Ed, SNAP plays a critical role in helping recipients obtain a healthy diet, engage in physical activity and pursue healthy lifestyles within limited resources. 

SNAP-Ed nutrition education resources in English and Spanish such as Loving Your 

Family, Feeding Their Future can reach low-income mothers and motivate them to 

improve their families’ eating and physical activity behaviors. While SNAP-Ed can 

certainly be improved, it does play a key role in efforts to improve participants’ food 

choices. 

The Food Conservation and Energy Act of 2008—the 2008 Farm Bill—authorized 

$20 million for pilot projects to evaluate health and nutrition promotion in SNAP 

to determine if incentives provided to SNAP recipients at the point-of-sale increase 

the purchase of fruits, vegetables or other healthful foods. FNS refers to this effort 

as the Healthy Incentives Pilot. Through this recently launched pilot program, we 

released a competitive solicitation to encourage state applicants to test innovative 

ideas to improve the nutritional choices of SNAP participants. The Healthy Incentive Pilot is only one example of the agency’s efforts to provide grants and other incentives in the programs to advance nutrition. 

Increasing the number of farmers’ market authorized by SNAP is another priority. 

This effort not only creates access to healthy produce for our clients but it expands 

the customer base for local farmers. The number of farmers markets in SNAP increased 25 percent in Fiscal Year 2009 over the prior year. 

Know Your Farmer, Know Your Food is a new initiative launched by Secretary 

Vilsack and Deputy Secretary Merrigan to enhance the link between consumers and 

local producers. By successfully improving the link between consumers and local 

producers there can be new income opportunities for farmers and wealth can be generated that will stay in rural communities. There also can be a greater focus on sustainable agricultural practices and families can better access healthy, fresh, locally 

grown food. 

In closing, let me reemphasize the Administration’s commitment to fighting hunger and improving the Federal nutrition programs. I would like to thank the Committee for the opportunity to join you here to raise awareness, focus attention and 

motivate action to improve the effectiveness of SNAP and all Federal nutrition programs, both here and across the nation. Working together, we can strengthen our 

ability to ensure that, no matter what other hardships they experience in the face 

of economic disruption, low-income people need not experience food insecurity and 

hunger. I look forward to answering any questions that you may have.

The CHAIRMAN. Thank you very much, Ms. Pino. Thank you very 

much for sticking within the time limits because your light just 

went on. Just at the nick of time so thank you very much. I am 

glad you did not pick any of our habits—Members’ habits—I should 

say. 

Next I would like to have Christine Webb-Curtis who is the 

Chief, Food Stamp Branch for California Department of Social 

Services out of Sacramento. 

STATEMENT OF CHRISTINE WEBB-CURTIS, CHIEF, FOOD 

STAMP BRANCH, CALIFORNIA DEPARTMENT OF SOCIAL 

SERVICES, SACRAMENTO, CA 

Ms. WEBB-CURTIS. Thank you, Chairman Baca and Committee 

Members. My name is Christine Webb-Curtis and I am the Chief 

of the Food Stamp Branch—we are saying Food Stamps in California still—at the California Department of Social Services. Currently we have oversight of the Food Stamp Program and the 

Emergency Food Assistance Program. 

California’s Food Stamp Program is the second largest in the 

country, serving about three million persons with about $3 billion 

in food benefits each year. The most recent USDA report on participation, as Lisa mentioned, for 2007 indicates that we rank among 

those states with low rates. 

16

Although we have much work to do to increase participation, the 

data is 2 years old and doesn’t reflect the many state and county 

efforts to improve program access that have occurred over the past 

few years. Additionally, California’s ‘‘cash-out’’ of approximately 1.2 

million persons receiving SSI/SSP is a significant factor in our participation rate, as these families are not included in the calculation. 

Well before the recent economic slowdown, we had undertaken 

steps to increase public awareness about the program and improve 

access to these benefits. Along with our county parties we also pursued policy and operational changes to simplify and streamline the 

application process and the administration of the program. I would 

like to highlight some of those. 

The expansion of categorical eligibility makes households with 

minor children no longer subject to the resource test. Full implementation was completed the first of this month. The Governor’s 

budget includes funding to expand this policy to apply to all Food 

Stamp households, not just families which would add about 45,000 

households. 

In 2008 we received a Federal waiver to exempt most Food 

Stamp households from the face-to-face interview requirement. In 

2009 we received another waiver to exempt all households from the 

face-to-face requirement. This was recently implemented and is 

available at county option. In waiver counties fingerprint imaging 

can also be postponed for up to 1 year. 

Last year we provided instructions to counties to develop a simplified process that ensures that emancipating foster youth, about 

4,000 a year, will be given the opportunity to apply for this critical 

benefit prior to aging out of the Foster Care system. 

We are one of only four states to provide Restaurant Meal Allowance Program for homeless, elderly, and disabled Food Stamp recipients who may not have easy access to cooking facilities. This allows access to hot cooked meals at approved locations throughout 

the five counties which have implemented this option. 

A federally-approved restoration of eligibility waiver is about to 

be implemented to allow discontinued households to have benefits 

restored easily without the need for a new application if the reason 

is ‘‘cured’’ in the month following termination. 

Finally, we are working with our stakeholders including the California Food Policy Advocates to develop a new program name. We 

hope that the new name will go a long way toward eliminating 

some of the stigma associated with the Food Stamp Program, and 

provide an opportunity to outreach to potentially eligible families 

through the marketing of the new name. 

These efforts have played an important role in increasing participation in California from 2007 to 2009. We saw an increase of 31 

percent. 

We continue to explore ways to streamline the application process and enhance access to the program. Our phase two with Foster 

Youth would provide emancipated foster youth with the maximum 

benefits for their initial certification period. We are currently drafting a demonstration project proposal to be submitted in March to 

USDA. 

We are exploring a pilot for leveraging DMV information to assist in establishing identity, which may help decrease administraVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00020 Fmt 6633 Sfmt 6601 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
17

tive costs and provide a more public-friendly mechanism for detecting duplicate aid. We are one of five states with a biometric system 

for duplicate aid detection. States with a single automated eligibility system can more easily identify duplicate aid fraud. We have 

four systems, soon to be three. The Statewide Fingerprint Imaging 

System is the only statewide system, and having a statewide duplicate aid detection and prevention system is a Federal mandate. We received more than $22 million under the economic stimulus 

package and the Governor’s budget contains modernization proposals for additional administrative efficiencies and enhancements, 

including expansion of online applications in all three automation 

systems. These enhancements will benefit recipients and county 

welfare departments by expediting the application process and providing quicker handling of the cases. 

In 2009 we and the Department of Health Care Services were directed to develop a comprehensive plan for a single eligibility system for our programs. The work of this stakeholder group only recently began. The first meeting was January 21. We have greatly 

expanded our outreach efforts. For 2010 the outreach project doubled to 82 subcontractors operating in 43 counties with a budget 

of over $13 million. 

I will leave you to read our comments on the Emergency Food 

Assistance Program and just thank you for the opportunity to be 

here. California has more to do, but we have a solid basis for moving forward on increasing participation. We welcome ideas and opportunities and we will continue to do what we can. 

[The prepared statement of Ms. Webb-Curtis follows:]

PREPARED STATEMENT OF CHRISTINE WEBB-CURTIS, CHIEF, FOOD STAMP BRANCH, CALIFORNIA DEPARTMENT OF SOCIAL SERVICES, SACRAMENTO, CA 

Chairman Baca and Committee Members,

Thank you for bringing together this panel to discuss Federal nutrition programs 

in California. My name is Christine Webb-Curtis and I am the Chief of the Food 

Stamp Branch in the California Department of Social Services (CDSS.) 

I will briefly summarize for the Committee, the programs and some of the initiatives undertaken by my department and our county and stakeholder partners to address the food needs of low-income individuals and families in California. Currently, 

the Federal nutrition programs for which CDSS has oversight responsibilities are 

the Food Stamp Program (FSP) and the Emergency Food Assistance Program 

(EFAP). 

Food Stamp Program: 

The FSP is a Federal entitlement program that provides monthly benefits to assist low-income households in purchasing the food they need to maintain adequate 

nutritional levels. The California Food Stamp program is the second largest in the 

country, serving approximately three million persons and providing about $3 billion 

in food benefits over the course of a year. 

The most recent report on FSP participation, for Federal Fiscal Year 2007, released in November of 2009, by the United States Department of Agriculture, Food 

and Nutrition Service (FNS) indicates that based on Federal methodology, California still ranks among those states with low program participation rates at 48 percent. Although we acknowledge that we have much work to do to increase participation, the data is 2 years old and doesn’t reflect the many state and county efforts 

to improve program access that have occurred over the past couple of years. Additionally, California’s ‘‘cash-out’’ of approximately 1.2 million persons receiving SSI/

SSP is a significant factor in our low program participation rate as we are the only 

such ‘‘cash-out’’ state and these families are not included in the participation rate 

calculation. 

Well before the recent rise in food prices and the economic slowdown, CDSS and 

the California Office of Systems integration had undertaken steps to increase public 

18

awareness about the FSP and improve the access of eligible individuals and families 

to these benefits. CDSS and the County Welfare Directors Association (CWDA) also 

pursued policy and operational changes to simplify and streamline the application 

process and the administration of the FSP. Recently, CDSS has pursued several 

changes to enhance access to and participation in this important program with the 

assistance of our many partners. I’d like to highlight some of these changes.

• The expansion of categorical eligibility, pursuant to AB 433 in 2008, makes 

households with minor children no longer subject to the resource test for purposes of determining FSP eligibility. This option ensures that low-income families are not denied critical food benefits simply because they may have too many 

assets. Implementation was completed by January 1, 2010, for applicant households. The Governor’s Budget proposal, released on January 8, includes funding 

to expand this policy so it will apply to all Food Stamp households, not just families. This proposal would add an estimated 45,000 households to California’s 

Food Stamp Program.

• In 2008, CDSS received a Federal waiver to exempt most Food Stamp households from the face-to-face interview requirement at recertification, and for elderly and disabled households at both intake and recertification. These interviews will be conducted by telephone.

• In 2009, just this past year, we received a Federal waiver to exempt all households from the face-to-face interview requirement. This waiver was recently implemented and is available at county option. In counties where face-to-face 

waivers are implemented, counties can also postpone the fingerprint imaging requirement for up to 1 year.

• CDSS provided instructions to counties this past year to develop a simplified 

process that ensures that emancipating foster youth will be given the opportunity to apply for the FSP prior to ‘‘aging out’’ of the Foster Care system. Food 

stamps at exit from Foster Care provide a critical benefit that helps stabilize 

foster youth at this critical juncture in their lives. Annually, about 4,000 foster 

youth statewide go through the emancipation process.

• California is one of only four states in the nation that provides counties the option to operate a Food Stamp Restaurant Meal Allowance Program for homeless, 

elderly, and disabled food stamp recipients who may not have easy access to 

cooking facilities. This option allows these household to have access to hot 

cooked meals at approved locations throughout the county. Five counties, accounting for 42 percent of caseload, have implemented this option.

• A federally-approved restoration of eligibility waiver is in the process of being 

implemented to allow discontinued households to have benefits restored quickly 

and easily without the need for a new application and interview if the reason 

for discontinuance is ‘‘cured’’ at any time in the month following termination.

• The Department collaborates with U.S. Department of Agriculture (USDA) on 

a regular basis across the spectrum of Food Stamp activities. As an example, 

CDSS partnered with the USDA Western Region Office and four counties (Los 

Angeles, San Diego, Fresno, and Tulare Counties) to implement a strategic 

planning process to increase Food Stamp participation. This plan utilizes a 

partnership with these counties, local community-based organizations, along 

with CDSS and USDA, to increase public awareness of the FSP and encourage 

eligible low-income working families to access FSP benefits.

• Finally, we are working with critical stakeholders, including California Food 

Policy Advocates (CFPA), the California Department of Public Health, and the 

counties, to develop a new name for California’s FSP. We are very appreciative 

that CFPA was able to secure funding through The California Endowment to 

employ research and marketing specialists to assist with development of the 

new name for the FSP. It is our hope that the new name will go a long way 

toward eliminating some of the stigma associated with the FSP and will provide 

a great opportunity to outreach to potentially eligible families through the marketing campaign that will support the launching of the new name.

All these efforts have played an important role in increasing California’s Food 

Stamp participation over the past few years. From Federal Fiscal Year 2007 to 

2009, California’s program participation has increased 31 percent or four (4) percent 

higher than the increase nationally. 

Future Policy Efforts 

In addition to the above efforts, CDSS continues to explore ways to streamline the 

Food Stamp application process and also enhance access to the program.

19

• Our phase two with Foster Youth would provide emancipated foster youth with 

FSP eligibility without regard to income or resources for a defined period of 

time to ensure their stability. Individuals eligible for this program will receive 

the maximum benefits for their initial certification period (up to 12 months). As 

a result of enacted state legislation (AB 719), CDSS is currently in the process 

of drafting a demonstration project proposal to be submitted to FNS no later 

than March of this year to put this proposal in place.

• CDSS is exploring options through a pilot for leveraging Department of Motor 

Vehicle information to assist in establishing identity for individuals in the food 

stamp program. This partnership may help to decrease administrative costs 

with counties and may provide a more public-friendly mechanism for detecting 

duplicate aid. Most states have a single automated eligibility determination system and can more easily identify duplicate aid fraud. However in California, 

there are four (soon to be three) automated welfare systems that do not talk 

to each other. California is one of five states that have a biometric system for 

duplicate aid detection. While there are several statewide automated systems 

that support our welfare programs, the Statewide Fingerprint Imaging System 

(SFIS) is the only statewide system that detects and prevents duplicate aid 

within our multiple eligibility systems; and having a statewide duplicate aid detection and prevention system is a Federal mandate. The only other state that 

has multiple automated welfare systems is New York. New York City requires 

fingerprint imaging and is on a different automated welfare system from the 

rest of the state.

• California received more than $22 million in administrative funding for the 

Food Stamp Program from the Federal FNS under the Economic Stimulus package. The Governor’s Budget contains modernization proposals for additional administrative efficiencies and enhancements, including an expansion/creation of 

online applications in all three automation systems as well as installation of 

document imaging capability in one automation system and Interactive Voice 

Response systems in the other two automation systems. These automation enhancements will benefit recipients and county welfare departments by expediting the application process and providing quicker handling on Food Stamp 

cases.

• Recent legislation in 2009, AB X4 7, directed the Department and the Department of Health Care Services (DHCS) to develop a comprehensive plan for a 

single eligibility process for the departments’ programs—Food Stamps, MediCal, and CalWORKs which is California’s Temporary Aid for Needy Families 

(TANF) program. The stakeholder workgroup includes representatives of advocacy organizations, county employees, county human services agencies, the California State Association of Counties, and legislative staff. The work of the 

stakeholder group has only recently begun, holding its first full meeting on last 

Thursday, January 21.

• Additionally, over the last 2 years, we have greatly expanded our outreach efforts in the Food Stamp Program. The Food Stamp Outreach Project involves 

partnering with the California Association of Food Banks, the Central Valley 

Health Network and other community-based organizations. These organizations 

are much closer to those families who are potentially eligible for the Food 

Stamp Program. They are able to reach out to them, explain the benefits of the 

program and assist them to apply.

» For 2010, the FS Outreach Project doubled and includes 82 subcontractors 

operating in 43 counties with a total budget of over $13 million. 

The Emergency Food Assistance Program (EFAP): 

• The second food-related program administered by CDSS is the Emergency Food 

Assistance Program, or EFAP. In FFY 2009, EFAP provided 109.5 million 

pounds of donated food to 49 local county food banks and over 2,300 distribution 

sites. The program serves approximately one million needy individuals monthly 

in low-income households. EFAP also provides a portion of the food used in soup 

kitchens throughout the state that daily serve thousands of homeless individuals. The food comes from two sources:

(1) USDA provides the bulk of the food distributed by EFAP. In FFY 2009, 

USDA allocated $27.7 million in ‘‘entitlement’’ commodities to California (45.8 

million pounds). In the same year, USDA also provided California with free 

bonus food comprised of surplus agricultural commodities valued at approximately $40 million and weighing 49.6 million pounds.

20

(2) In addition to these Federal commodities, the California Donate/Don’t 

Dump Program was established in 1995 to salvage fresh fruit and vegetables 

from farmers and growers throughout California and distribute them to needy 

Californians. EFAP collects and distributes to local county food banks over 14 

million pounds of fresh fruits and vegetables annually.

• Over the past several years, food banks have been reporting a steady increase 

in participation.

» Food banks are reporting an increase of more than 20 percent in participation rates. The food banks report that many of the new participants have lost 

their jobs and do not have enough money for food in addition to their bills.

» Soup kitchens that provide hot meals to the homeless have also cited a 12 

percent increase in meals served.

• Fortunately the 2007 Farm Bill increased funding for the EFAP Program. In 

FFY 2007 EFAP was provided $15.6 million for the purchase of food. In FFY 

2009, this was increased to $27.7 million. In addition, that same year, bonus 

commodities increased from less than $6 million to over $40 million. 

EFAP—American Recovery and Reinvestment Act: 

• In FFY 2009, the American Recovery and Reinvestment Act, or ARRA, provided 

approximately $12 million to EFAP for the purchase of food. In addition, ARRA 

provided approximately $3.1 million for administrative funds in FFY 2009 for 

California food banks, and California will receive an additional $3.1 million in 

FFY 2010. 

Fresno Drought Disaster Relief: 

• During 2009, Governor Schwarzenegger provided approximately $7.8 million to 

purchase and distribute food to provide relief to victims of the drought disaster 

in Fresno County. Distribution began in August 2009 and to date EFAP has 

provided food assistance to over 150,000 individuals and families. Disaster food 

commodities will continue through February 2010.

Thank you for the opportunity to share some of the many positive things that are 

happening in California to enhance access to this vital food and nutrition assistance 

program. California is moving in the right direction and many of the reforms and 

initiatives I have highlighted today will go a long way toward improving California’s 

Food Stamp participation. We have more to do, but we have a solid basis for moving 

forward. We are open to other ideas and opportunities, and will continue to do everything possible to ensure California’s needy households have access to these critical programs. 

Thank you.

The CHAIRMAN. Thank you very much, Ms. Webb-Curtis, for your 

testimony. 

At this time I would like to call on Nancy Swanson, the Director 

of the Department of Transitional Assistance from San Bernardino. 

Nancy. 

STATEMENT OF NANCY SWANSON, DIRECTOR, DEPARTMENT 

OF TRANSITIONAL ASSISTANCE, SAN BERNARDINO COUNTY 

HUMAN SERVICES SYSTEM, SAN BERNARDINO, CA 

Ms. SWANSON. Good morning, Mr. Chairman, and Members of 

the Committee. Thank you for having me here today. My name is 

Nancy Swanson and I am the Director of the Transitional Assistance Department for San Bernardino County. Our department administers all the Public Assistance Programs including the Food 

Stamp Program for the residents of San Bernardino County. Today 

I would like to share some important information on San 

Bernardino County’s continued efforts to increase public awareness 

and participation in the Food Stamp Program. 

I will be providing some statistical data on our Food Stamp caseload including recent growth and possible contributing factors; how 

we have worked with many agencies to assist the public with acVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00024 Fmt 6633 Sfmt 6601 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
21

cessing the Food Stamp Program; different constraints the county 

faces; and what counties need to increase Food Stamp participation 

rates. 

In 2009 San Bernardino County received 152,624 Food Stamp 

applications which is an average of 12,719 applications per month. 

Currently we have 105,044 active Food Stamp cases with a total 

of 270,468 individuals participating. Of those individuals participating, approximately 58 percent of them are 18 years old or 

younger. Approximately $38.2 million of benefits were issued per 

month. 

From January 2009 to December 2009 the Food Stamp caseload 

increased 46.1 percent, which is an average monthly change of 

about 3.5 percent. The economy is clearly driving the demand for 

services. A changing applicant is also being noted. Our two-parent 

family caseload has increased by 67.5 percent. County residents receiving public assistance increased from one in every five residents 

to one in every four residents. Recession has forced many working 

families to apply for government help who have never done so in 

the past. 

One avenue used to increase public awareness and streamline 

program access was to create an online application. This allows 

customers the flexibility to apply at anytime. In August of 2009, in 

conjunction with our County’s Consortia, C4Yourself was launched. 

Since inception we have received over 17,000 Food Stamp applications through our website www.c4yourself.com. San Bernardino County continues to reach out to provide important information on Food Stamps and eligibility requirements to 

community and faith-based organizations, the public, family agencies, and other county departments. We participate in many different outreach efforts including Inland Empire Economic Recovery 

Corporation Home Foreclosure Prevention Seminars, job fairs, senior events, veteran affairs events, and other health events. 

Our participants receive literature on the Food Stamp Program 

including general eligibility requirements, as well as nutritious 

food choices; how to choose an active lifestyle; and recipe cards to 

create healthy meals. At some of these events we have even been 

able to have staff on-site to take Food Stamp applications. 

We recognize our county’s geographic area as large and customers living below the Federal poverty level reside in all areas. 

To assist with program accessibility we continue to collaborate with 

the community-based organizations. To assist our customers living 

in remote mountain areas we recently relocated eligibility staff to 

an out-station office in the Big Bear area. In addition, we have eligibility staff located on-site at several schools to accept program applications and provide customer service. 

Last year in conjunction with Congressman Baca’s office we provided training to 224 participants from community-based organizations, county departments, and school districts. This training covered general program and eligibility requirements for Food Stamps, 

the C4Yourself website and how to access it, the online application. 

Participants were given user guides to assist them when they are 

helping members of the community. 

Many families and individuals do not apply for Food Stamp benefits due to the social stigma associated with receiving assistance. 

22

The public has a perception that benefits are too small to make a 

difference and the program is not easily accessible. A recent survey 

completed by the USDA indicates the most common reasons why 

a person does not apply for Food Stamps is perceiving oneself to 

be ineligible, avoiding dependency on government assistance, and 

difficulty of applying for benefits. 

I will let you read my further testimony. I would just like to conclude with saying that we continue to think of possibilities and 

ways of improving access such as improving online application 

processes, kiosks that could be put in schools and libraries and 

stores and hospitals so people would have the ability to go into 

their communities and apply for assistance. 

Call centers where people can call in to get general information, 

not only about the Food Stamp Program but if they are already receiving assistance, to get information about their case. I think that 

if we continue to work together with our Federal and state partners that we should be able to make some of these changes and 

streamline the technology with some eligibility processes to improve access to Food Stamps. Thank you. 

[The prepared statement of Ms. Swanson follows:]

PREPARED STATEMENT OF NANCY SWANSON, DIRECTOR, DEPARTMENT OF

TRANSITIONAL ASSISTANCE, SAN BERNARDINO COUNTY HUMAN SERVICES SYSTEM, 

SAN BERNARDINO, CA 

Good morning, Mr. Chairman, Members of the Committee. I am Nancy Swanson, 

Director of the Transitional Assistance Department for San Bernardino County. The 

Transitional Assistance Department administers Public Assistance programs, including the Food Stamp Program, for the residents of San Bernardino County. 

Today I would like to share some important information on San Bernardino County’s continued efforts to increase public awareness and participation in the Food 

Stamp program. 

I’ll be providing statistical data on San Bernardino County’s Food Stamp caseload, 

including recent growth and possible contributing factors, how we’ve worked with 

many agencies to assist the public with accessing the Food Stamp program, different 

constraints the county faces, and what counties need to increase the Food Stamp 

participation rate. 

Last year (2009) San Bernardino County received 152,624 Food Stamp applications, which is an average of 12,719 applications per month. Currently we have 

105,044 active Food Stamp cases with a total of 274,468 individuals participating. 

Approximately $38.2 million of benefits were issued per month. 

From January 2009 to December 2009 the Food Stamp caseload increased 46.1% 

(The average monthly change for this period is 3.5%). 

The Economy is clearly driving the demand for services. A changing applicant is 

also being noted.

• Two-parent family caseload increased by 67.5%.

• County residents receiving public assistance increased from one in every five 

residents to one in every four residents.

• Recession has forced many working families to apply for government help who 

have never done so before. 

Online Application—‘‘C4Yourself’’

One avenue used to increase public awareness and program access was to create 

an online application. This allows customers the flexibility to apply at anytime. In 

August 2007, in conjunction with the County’s Consortia, C4Yourself was launched. 

Since inception, we have received over 17,000 Food Stamp applications through 

www.c4yourself.com.

Outreach 

San Bernardino County continues to reach out to provide important information 

on Food Stamps and eligibility requirements to community and faith based organizations, the public, family agencies, and other County departments. We participate 

23

in many different outreach efforts including Inland Empire Economic Recovery Corporation Home Foreclosure Prevention Seminars, job fairs, senior events, and health 

events. Our participants receive literature on the Food Stamp Program, including 

general eligibility requirements, as well as nutritious food choices, how to choose an 

active lifestyle, and recipe cards to create healthy meals. 

We recognize our county’s geographic area is large and customers living below the 

Federal poverty level reside in all areas. To assist with program accessibility we 

continue to collaborate with many community-based organizations. To assist our 

customers living in the remote mountain areas we recently relocated eligibility staff 

to an outstation office in Big Bear. In addition we have eligibility staff located onsite at schools to accept program applications and provide customer service. 

Last year training was provided to 224 participants from community based organizations, county departments, and schools. This training covered general program 

and eligibility requirements, the C4Yourself website and how to access. the online 

application. Participants were given user guides to assist them in helping members 

of the community. 

Many families/individuals do not apply for Food Stamp benefits due to the social 

stigma associated with receiving assistance from the government. The public has a 

perception benefits are too small to make a difference and the program is not easily 

accessible. 

A recent survey completed by the USDA Food and Nutrition Services (FNS) indicates the most common reasons why a person does not apply for Food Stamps is 

perceiving oneself to be ineligible, avoiding dependence on government assistance, 

and difficulty of applying for benefits. 

Changes to the process to make applying for the program less intrusive and simplification of requirements would help to overcome some of these perceived barriers. 

We believe that our online application process, as well as our outreach efforts, is 

a step in the right direction in helping to reduce these barriers, as well as streamlining the application process. 

With the increasing caseloads salary and benefits costs have increased dramatically. The average employee cost increased by 68% from FY 2001–2002 to 2008–

2009. Program Administration funding has stayed relatively flat for the same period. As a result, staffing levels have dropped significantly. 

Additional funding is needed to serve our increasing caseloads and assist the families within our communities. 

It is important that we continue to collaborate with our state and Federal partners to ensure adequate funding—not only for the administration of the program 

but also to educate the public and reach out to those that may qualify. 

The Transitional Assistance Department is committed to increasing public awareness, accessibility and participation in the Food Stamp program. Working collaboratively with government and community partners, this goal is achievable.

The CHAIRMAN. Thank you very much, Ms. Swanson, for your 

testimony. I know that it is intimidating to pick up the gavel when 

someone says, ‘‘I’ve got to finish my statement.’’ We go through 

that when we are giving the 1 minute spiels on the floor back in 

Washington, D.C. and sometimes they cut us off immediately when 

we go beyond our 1 minute. I want to thank each of you for your 

testimony. 

We will begin with questions. I will begin with myself with some 

questions, I will then call on Congressman Fortenberry, and then 

I will call on Congressman Costa for questions. 

I will start my first question addressed to Lisa Pino, the Deputy 

Administrator. Ms. Pino, thank you for your testimony and for 

traveling here to Southern California on a beautiful day that we 

are now going to remark that you are in Switzerland as Mr. 

Fortenberry indicated out here. 

Mr. COSTA. Jeff, everyday is like that. 

The CHAIRMAN. During the summers it is like this. You just have 

to look beyond the smog. Thank you very much for coming here. 

Ms. Pino, given the audit in Texas, New York, and California 

casting doubt on the cost effectiveness of fingerprinting for food 

stamp applications to deter and detect fraud, given significant eviVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00027 Fmt 6633 Sfmt 6601 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
24

dence that fingerprinting deters and discourages eligible applicants, why does the USDA permit states to use Federal food stamp 

funds to operate fingerprinting imaging systems? 

Ms. PINO. We are currently evaluating the efficacy of finger-imaging, and actually states have the flexibility of choosing the structure of that option. That is why there are four localities in the 

country that do institute finger-imaging. However, we do take a 

strong stand and believe that finger-imaging is not the most costeffective means for detecting dual participation. It is very expensive to operate. 

We also have heard from many constituent groups and community-based organizations that it does act as a deterrent from participation among Hispanics, especially in immigrant communities. 

We think that there are alternative fashions of just doing a simple 

data match of name and Social Security Number. Finger-imaging 

isn’t very effective in terms of the cost and the investment needed, 

so we encourage California to consider suspending finger-imaging, 

possibly eliminating it altogether. 

The CHAIRMAN. The next question I have is: Can you explain to 

the Subcommittee USDA’s current plan for marketing and outreach 

for Federal nutrition programs like SNAP. 

Ms. PINO. Absolutely. I would be delighted to answer that question for you, Mr. Chairman. First, a little bit about marketing and 

outreach just to explain how it works for the benefit of all at the 

hearing. We do a 50/50 match with outreach initiatives, so whatever the state invests up front, we provide a 50/50 match. At this 

time, we have about 40 state outreach plans all together. States 

aren’t obligated to conduct outreach, but most of them do. 

In addition to state-level outreach, we also have national campaigns. We have a campaign of media involving radio and television. We have public service announcements. We do see a spike 

of activity and calls when those announcements are played. We 

have an 800 number and a call center. We also have an 800 number available to Spanish speakers. We have a lot of information in 

the form of educational materials that are available for download 

on the website in both English and Spanish. 

We also have an extensive national partnership network. Organizations such as the Catholic Charities are one among many of our 

partners. This is an area that we have dedicated serious attention 

to. With the new Administration, we are also working very hard to 

take the marketing and outreach plans that we do have, and more 

effectively coordinate a bigger more strategic plan so that we can 

better identify issues. One of the issues, as you have noted, Mr. 

Chairman, is that while caseload is increasing so quickly, we will 

need to bridge the gap with certain under-served communities such 

as Latinos, such as seniors, and most notably with the recession, 

the working poor. That involves an additional level of strategy and 

we look forward to working with California, as we look forward to 

working with many states during this time of crisis. 

I have also brought for your benefit some materials today. I have 

an oven mitt for you, Chairman Baca, for the next time you make 

a casserole at home. 

The CHAIRMAN. My wife would love that. She would love to get 

me to cook. 

25

Ms. PINO. Let give you one little example of how we are working 

hard to help states spread the good word of SNAP because, again, 

we cannot emphasize enough the economic value of this program. 

Traditionally, our retailers used to have a sign saying, ‘‘We accept 

SNAP benefits.’’ We are now encouraging them to advertise, ‘‘We 

welcome SNAP benefits.’’ That might seem like one little change, 

but to us and to retailers, it is paramount because it is taking 

SNAP out of the old perception, the old stigma and stereotype, and 

positioning it as nutrition assistance and inviting a new, fresh attitude that shows that SNAP is something that is a benefit to help 

people at a time of need. It is not anything that they should be 

ashamed of. 

The CHAIRMAN. Thank you. I know that my time is past. What 

we are going to do is we are going to have another go-around, but 

I am going to ask one final question. 

I think all of us agree that better education and nutritious foods 

and healthy lifestyles are essential to fight obesity. I understand 

that the SNAP-Ed Program plays a critical role in education. What 

does USDA plan to do in moving forward to improve the SNAP-Ed 

Program? You talked a little bit about that. Does the Department 

have any current plans to expand the program’s outreach? 

Someone mentioned that we used to have homemaking classes. 

Is that what needs to be done in terms of curriculum and our educational system so that our children understand the value of 

healthy food and living longer? We have cut back a lot of the physical education programs. Could you elaborate a little bit on that? 

Then I will turn it over to Mr. Fortenberry to ask the next question. 

Ms. PINO. Absolutely. My pleasure. First, let me say that we 

view the role of SNAP-Ed, not only in the context of SNAP, but 

also in the context of all of our 15 food programs. What is amazing 

about our programs is that they literally can span a person’s lifetime from birth to senior age. In the context of SNAP-Ed, we have 

legislation that authorizes us to use those funds for what is termed 

as ‘‘SNAP-eligible communities.’’ We understand that SNAP-Ed has 

to have somewhat of a focus in terms of targeting those who could 

be eligible for the program who are not aware of the program and 

who can benefit from learning about healthy eating and other good 

eating behaviors. 

Now, what is tricky about this question, and we are currently 

evaluating how we can expand SNAP-Ed, is that the more that you 

broaden the scope of that initiative, the more difficult it becomes 

to account for how you are going to track the outcome. How do you 

know that a specific initiative actually led to someone either enrolling in the program or changing their behavior? So, it’s not to say 

that we aren’t considering it. We are, but we are just currently 

evaluating it because it is very challenging. As you know, SNAP-Ed involves about $300 million. California is by far the largest player and has over $118 million, so we want 

to very carefully weigh the balance between using it as an effective 

tool and engaging education, promoting these early eating behaviors, while at the same time, trying to be very committed to the fiscal responsibility of ensuring that those monies are also leading to 

direct results. 

26

The CHAIRMAN. Thank you. 

Now I recognize the gentleman from Nebraska, Mr. Fortenberry, 

for 5 minutes. Please stay to 5 minutes. 

Mr. FORTENBERRY. With flexibility determined by the Chairman. 

Thank you, Mr. Chairman. 

Again, thank you all for your insightful testimony. I want to turn 

to you first, Ms. Pino, as well. You stated that low participation 

rates means less healthy food at home. I assume you mean that 

there is evidence that those who are benefiting from the SNAP Program are selecting healthy choices at the grocery store. 

Now, it is also my understanding that there is no evidence to 

suggest that obesity rates among children in the SNAP Program 

are lower than the population at large. Can you unpack what 

seems to be a conflict there. 

Ms. PINO. SNAP is termed the Supplemental Nutrition Assistance Program because, as you noted, it is a supplement. It is not 

meant to account for a household’s entire food budget. We do not 

see any link between SNAP participants and a higher rate or incidence of obesity. We are often asked why doesn’t SNAP restrict 

food purchases? How do you account for that these dollars are 

spent for healthy eating? 

The way we approach this conundrum is that we don’t view obesity or the lack of healthy eating at home as just an issue that pertains to low-income households. We see this as a broad cultural epidemic affecting the entire country, and we see it as something that 

is pretty analogous to smoking. It took decades of repeated messages and repeated work for smoking to become a rare instance, as 

it is today, and that really is a generational change. 

However, we very much believe in vehicles like SNAP-Ed to 

teach households not only about making healthy purchases but also 

about engaging physical in activity, about making purchases that 

are affordable. We want to use this vehicle in a constructive, positive light. We are very excited about our Healthy Incentives Pilot 

Program. We received $20 million, authorized by Congress, for this 

pilot which is to launch this year. We are in the request-for-proposal mode right now. 

The Healthy Incentives Pilot Program is to examine whether you 

can incentivize healthy purchases at the point of sale—if people 

buy more fruits and vegetables and if they receive a greater economic benefit for doing so, if incentives are going to change behavior because that really becomes the hardest connection to make. It 

is one thing to provide that education and to provide that option, 

but actually tracking whether it has really made a long-lasting impact in changing behavior is the most difficult obstacle to prove. 

But, it is one way of looking at it from a more constructive incentive than going down the road of restricting behavior and making 

people feel isolated for their purchases. 

Mr. FORTENBERRY. One of the inherent conflicts here is, and 

Chairman Baca alluded to this earlier, that in the initial formative 

stages of these programs the intent was to increase caloric intake. 

So, what we are all trying to do is change that culture. The difficulty of that, though, is foods high in caloric intake are less expensive, potentially, than the foods that would necessarily improve 

health outcomes. This is the tradeoff and dilemma. 

27

Ms. PINO. Just to add to that, Mr. Congressman, that is one reason why we are expanding our farmer’s markets and we are so excited about it, especially here in California. We want to also 

incentivize people to buy fresh fruits and vegetables. We also have 

other initiatives like Know Your Farmer, Know Your Food that 

talks about the important economic and health connection of buying locally. 

You are right that hunger and obesity do coexist. It is a paradox, 

but that is why we are more committed than ever to looking at how 

we can improve healthy eating patterns for families in all our programs. 

Mr. FORTENBERRY. Let me segue from what you said. This may 

be a little bit beyond your realm of expertise but if you and the 

panel want to comment on this as well. The Fresh Fruits and Vegetables Snack program was greatly expanded in the last farm bill 

to provide more low-income students with access. Can you comment as to how this program is working in California? 

Ms. PINO. I will just say very quickly, and I will let my colleagues answer, that the Fresh Fruits and Vegetables Snack program did begin in California as I understand it. We have about $5 

million apportioned for that. It has been, from my knowledge, very 

successful. What is great is that about 90 percent of the schools in 

the program are those that offer free and reduced-price meals, so 

that is very exciting to us. 

Ms. WEBB-CURTIS. I would not want to pretend that I can speak 

to it but I would be glad to get you information about it however. 

Mr. FORTENBERRY. Thank you. 

Ms. SWANSON. In San Bernardino County, it has just recently 

started up in the desert at a few local farmer’s markets. 

Mr. FORTENBERRY. I am finished for now. 

The CHAIRMAN. Thank you very much. It is a good question and 

one that we need to address. I know that we have school board 

members here changing their philosophy and looking at policies in 

using fresh fruits and vegetables. 

Now I would like to turn to the gentleman from the Central Valley, Congressman Jim Costa. 

Mr. COSTA. Thank you very much, Mr. Chairman. To both the 

Federal and state witnesses, I spoke of the challenges this last 

summer with the large unemployment and the food lines that I 

witnessed and participated in to help provide food in the areas 

where the droughts occurred. 

Since we have both the USDA and state witnesses here I would 

like to talk about the coordination of food banks. The food banks 

in a number of our areas indicated that they had come close, and 

we tried to be helpful, to the end of their food and administrating 

fund supply. During that period last fall we inquired to the USDA 

whether or not they were following up on this. They indicated they 

had purchased more than adequate supplies of food and supplied 

the state with administrative funds. 

Our food banks at the time were unclear and very fearful that 

there was going to be an end of that availability. Could you talk 

about how the USDA and State Department of Social Services determines what and when and how much food and administrative 

28

funds are provided? If you cannot provide the answers, I would like 

you to get back to me on those points. 

Ms. PINO. I do have some specific information about the 

amounts. I don’t know if you want me to actually go through all 

of the fiscal amounts right now. I can. 

Mr. COSTA. For the sake of brevity why don’t you provide that 

in a written statement because I have some other questions I want 

to ask. 

Ms. PINO. I will provide that later. Okay. 

Mr. COSTA. Ms. Webb-Curtis, you care to add anything to that? 

Ms. WEBB-CURTIS. I also have information about amounts but I 

can’t speak to that. 

Mr. COSTA. Also, because I worked with the Schwarzenegger Administration and folks, in some of these food lines, sadly in the 

most productive agricultural region in the world, I noticed that 

there were canned vegetables that were purchased from China. I 

mean, talk about nonsensical. While you have the option the preference is to buy American food products and they said they were 

going to correct that. Would you please let us know about that? 

Ms. WEBB-CURTIS. I will look into that. 

Mr. COSTA. Number two, it was spoken earlier by Congressman 

Fortenberry about the importance of fruits and vegetables and obviously we want to encourage that. We know they are more costly 

under the SNAP program than, say, potato chips. Do you believe 

it is worthwhile providing additional incentives to purchase more 

healthy food options like fruits and vegetables? You talked about 

some of the things that you were doing when he asked you the 

question earlier. What are some of the logistical barriers to providing the system? Like Safeway provides bonuses in their purchasing. Can you comment, please? 

Ms. PINO. Well, I think that overall, and I would like to actually 

make a quick note about food banks as well, but overall the tricky 

part is the coordination from the local level, the state level, and the 

Federal level. At the same time, more than ever, we need to be engaging partners whether they are community-based organizations, 

faith-based organizations. We are here at a hospital today. We 

have to more effectively engage the health and medical community 

because they really serve as vital links to that coordination. 

Mr. COSTA. I want to get to that point but if you could——

Ms. PINO. I would just say, for instance, food banks serve as a 

front line. 

Mr. COSTA. Right. 

Ms. PINO. The more that we can have those front lines distributing information, building awareness, engaging partners. For instance, with our farmer’s markets and some localities there are additional incentives so that when people buy fruits and vegetables, 

they also can receive an additional incentive so those fruits and 

vegetables become more affordable. 

Mr. COSTA. Some of our areas have been innovative, and it gets 

back to the point that the Chairman was raising a moment ago in 

terms of access and taking advantage of all those who potentially 

can qualify. Some of our areas have been innovative and they have 

one-stop-shops that include nutrition assistance for health, where 

health clinics also provide funding for WIC, Women and Infant 

29

Children, as well as SNAP depots. What are you folks doing to further incentivize or encourage that collaboration, one-stop shopping? 

Ms. WEBB-CURTIS. I am not sure whether you are directing that 

at me. 

Mr. COSTA. To you, please, Ms. Webb-Curtis. 

Ms. WEBB-CURTIS. I cannot speak to the one-stop shopping. I can 

tell you that there is a lot of enthusiasm in California for the incentive program. We don’t have it up and running but there are 

people——

Mr. COSTA. Is the state providing any funding for clinics to colocate some of the sign-up process? 

Ms. WEBB-CURTIS. Not to my knowledge but that may be the 

case and certainly I will find out. 

Mr. COSTA. Why don’t we look at that? It seems to be that would 

be helpful because I have one county, Kern County, that does that, 

it is very innovative. I have another county, Fresno County, that 

doesn’t. The differential between those that sign up and those that 

don’t in the two counties is distinct. 

My time has expired. Thank you very much. 

Ms. SWANSON. Congressman Costa, could I just share with you 

that in San Bernardino County we are working on an integrated 

health initiative that includes our Behavioral Health Department, 

our Public Health Department. I also have eligibility staff that will 

work at these clinics to ensure that Medi-Cal applications and Food 

Stamp applications are taken at the time people come in for services. We are really very excited about it. I think it is going to be 

a very promising venture. 

Mr. COSTA. Good for you. Congratulations. 

Ms. Webb-Curtis, that other aspect with regards to where you 

are purchasing your food from, I do want to stay on top of that. 

Ms. WEBB-CURTIS. Oh, yes. I have made a note. 

Mr. COSTA. That is an embarrassment. Thank you. 

The CHAIRMAN. Thank you very much, Mr. Costa, for your statement and your question, especially as it pertains to the one area. 

I think both the Minority Ranking Member and I are very much 

interested in looking at what we might do from a national perspective in terms of policy to make sure that we do buy products that 

are made right here in the United States for a multitude of different reasons. A lot of the products that come from another country do not have the food safety requirements that are required here 

in the State of California, especially as it pertains to pesticides, 

and the impact it could have on children, and other individuals. 

We will begin a second round of questions and I will begin the 

first one. I will ask Ms. Webb-Curtis first. The Committee recognizes that California has increased enrollment in Food Stamps for 

SNAP in recent years. As we all know the current economic downturn is the primary reason for this. What efforts has CDSS undertaken to identify the level of needs in our states, Number one? 

Number two, how does CDSS adjust policies and practices to respond to the increased need during difficult times like these? 

Ms. WEBB-CURTIS. I think I will answer your second question 

first and that has to do with adjusting policies. We have worked 

very closely with many of the partners in this room including the 

counties, California Food Policy Advocates, and other communityVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00033 Fmt 6633 Sfmt 6601 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
30

based organizations to look at how we can do things better to address the needs of those whose nutrition needs to be improved. 

In addition, we work with our partners in public health to manage the outreach program and the nutrition education programs. I 

think I might have explained our increase in outreach efforts over 

the last year which were considerable. I have tried to communicate 

that we have really done a lot of work in areas that I think you 

and your Committee Members would be happy about, in terms of 

our modified category for eligibility. For example, to allow individuals to apply and not be subject to the resource test. It is something that we work at all the time. We are bound by certain state 

statutory requirements, and we work with our legislative partners 

as well, to make changes that are beneficial to this population. 

The CHAIRMAN. Thank you. The next question I have is how 

much does finger imaging cost the state? Do you believe this is cost 

effective? In today’s article there is a constituent in the area that 

says finger imaging has deterred a lot of individuals from even 

going and applying. 

Also, what type of information is gathered. I stated at the beginning that we had problems in privatizing collection of some information in Texas and in Indiana. A lot of people are very much concerned when you look at all of the data and information, especially 

now, as you look at identity theft. 

Or individuals may say in filling out the application, ‘‘They are 

asking for too much information and a lot of that is available. I 

don’t want the IRS to find out I didn’t pay my $10 payment at Target.’’ I was going to mention another store but I better not mention 

that one. This presents a problem. Can you elaborate on that, 

please? 

Ms. WEBB-CURTIS. Well, first, let me tell you that I cannot tell 

you how much the fingerprint imaging cost the state, but I can certainly provide that information to you. 

The CHAIRMAN. Thank you. 

Ms. WEBB-CURTIS. As Ms. Pino mentioned, the information that 

we have available to us through a study indicated that one of the 

most important reasons that individuals do not apply for the program is that they don’t know that they qualify, and that they are 

afraid of the administrative burdens. The fingerprint imaging 

didn’t appear to be an issue in that particular study. 

Be that as it may, California does have a system of determining 

eligibility that is done through four automation systems, soon to be 

three, that essentially don’t talk to each other at the moment. In 

other states that have a single eligibility system, of course there 

are other ways of detecting duplicate aid that would be simpler. In 

California it is not so simple. That is where we are on the fingerprint imaging. 

The CHAIRMAN. Okay. Ms. Swanson, given your experience, what 

are the most serious barriers to better SNAP participation that we 

face here in San Bernardino County? 

Ms. SWANSON. I think a lot of those barrier are things that we 

talked about, the perceptions or misperceptions people have about 

the program. People don’t necessarily want to go to the Welfare Department. They don’t necessarily see Food Stamps as a nutrition 

31

program. They kind of lump it in as an entitlement program with 

the CalWORKs benefits. 

I also think from comments that we have heard from our community, members that come in and do apply, that the finger imaging 

is indeed a concern for many of them. At times that is one of the 

first questions that they do ask. Sometimes we take an initial application and then when we explain they are going to have to wait 

to be finger imaged they leave our offices. That is why I really 

think that our online application process and going to the phone 

interviews is really going to improve access in San Bernardino 

County. 

The CHAIRMAN. Thank you. 

Mr. Fortenberry. 

Mr. FORTENBERRY. Yes, Mr. Chairman. I do want to return to my 

earlier question and further unpack this issue as to seeing if there 

is any evidence of a change of buying patterns yet. As you know, 

the farm bill provides significant resources and is attempting to institutionalize cultural changes towards more healthy choices in this 

program, as well as your outreach efforts. 

The stimulus program dumped huge amounts of new resources 

into the SNAP program. Has that provided evidence of any change 

of buying patterns toward more healthy food selections? 

Ms. PINO. I think the Healthy Incentives Pilot really will serve 

as the first paramount in-depth examination of that query. It will 

probably take a couple of years to really accumulate all that information, which doesn’t seem like too long of a time—in the world 

of research that is a pretty reasonable time. It cost $20 million which sounds like a lot of money, but because 

we are going to do such in-depth research and comparing shopping 

patterns ‘‘before’’ versus ‘‘after,’’ I think that examination will really 

give some specific information about what the potential impact is, 

the connection between changing food pattern consumption, how 

that links to better health, how that can also lead to increased 

physical activity and promote better health in the realm of disease 

prevention and promotion. I think the HIP Pilot really will serve 

to do this. 

Mr. FORTENBERRY. I think you understand what I am driving at 

given my earlier testimony in the opening statement as is related 

to healthcare outcomes, as well as prudence around governmental 

budgeting. Because, we will pay to fix or cut or prescribe in the 

healthcare system but not incentivize prevention and wellness and 

this is one of the cost drivers in our system that is leading to 

chronic diseases. There is linkage between nutritional outcomes. 

In that regard I appreciate your commentary on local farmer’s 

markets, Know Your Farmer, Know Your Food. Reconnecting the 

urban and the rural, the farmer to the family is not only a growing 

trend because, given the fragmentation in our society, people are 

looking for that sense of connectedness from a sociological perspective but it has real potential power to improve healthcare outcomes 

as we move better nutritional selections directly to the table. But, 

it also creates local economies, the revival of local economies. 

There are a multitude of opportunities here. It is a bit ironic that 

this is the way we used to do things. This is not new. We are returning to something traditional. My family was engaged heavily 

32

in the Cooperative Extension Service. My grandfather was a county 

agent, my mother an extension educator, 4–H agents they used to 

be called. I loved looking at the old pamphlets that aren’t that old. 

Many of you may remember growing up with them. Congressman 

Costa had mentioned he was in 4–H and so was I. Were you in 4–

H? You missed that chapter of life. 

This was a part of the USDA’s effort to acculturate through the 

land-grant system in the classrooms directly, as well as in family 

education, this common sense essential aspect of balancing healthy 

lifestyles by focusing primarily on nutrition. We are trying to recapture something that is old. I would go dust off all of those old 

extension pamphlets if I was you that are a bit anachronistic. 

Ms. PINO. No, it’s funny that you say that because actually my 

colleagues and I——

Mr. FORTENBERRY. They are very interesting. 

Ms. PINO. Yes, absolutely. We were recently at the Smithsonian 

in Washington. They just opened a gallery of food stamp artifacts 

and we were looking at the old food stamp coupon books. The back 

of those books, even if they were 10 or 20 or 30 years old, they still 

had the same information that we are preaching today, like portion 

size and fruits and vegetables and take 15 minutes to exercise. It 

really is nothing new. 

On your point, Mr. Congressman, about the connection of localism, as you noted aside from the amazing economic impact, because 

when you purchase something that has been grown locally it has 

such a higher magnitude of economic stimulus. What is really exciting in the Know Your Farmer, Know Your Food initiative is to 

see the impact on children. Today, children think food comes from 

the supermarket. 

When you ask them where does food come from, they think it 

comes from plastic-wrapped containers. They really don’t know 

enough about how food is grown. It is exciting to encourage that 

respect and understanding because the more that you do that, 

what is amazing is you will see how children will start changing 

their behavior and then they act as ambassadors at home. I visited 

a school in Vermont not that long ago and it was amazing to see 

that the food prepared and distributed at the school was grown in 

a garden that used to be a desolate lot. How the kids loved going 

to the garden. 

They are so excited to eat fruits and vegetables now because they 

have met the farmer who grew them. They have seen how they are 

grown. They have nurtured those plants. Having that emotional 

connection, especially with children at such a young age, we think 

that is a very significant and empowering means of helping to develop adults with good eating behaviors for life. 

The CHAIRMAN. Thank you. I would like to thank each of the 

panelists for being here. I would like to call the next panel, panel 

two, to the table. I would like to just state that originally when the 

farm bill was done there were 38 million people who were going 

hungry and that is before we went into the big depression that we 

are in, so it is even higher than that in terms of hunger in the 

United States. 

We still have a lot of work ahead of us in marketing and reaching out to assure that not only do we reach needy individuals, but 

33

at the same time look at it from a cost effectiveness view. With 

that we would like to thank each of the panelists for being here. 

We would like to call our next panelists to the table. While they 

are coming up, I will have at the very beginning Congressman Jim 

Costa introduce a constituent, an individual from his area, and 

then I will introduce the other panelists. 

We will begin if we can have your attention, please. If you would 

be silent so we can begin the second panel. I would like to welcome 

the panel up here. I will introduce a couple of the individuals right 

now. Dr. Guillermo Valenzuela who is one of our panelists. We 

have Dr. Webster Wong from Arrowhead Medical Center here in 

Colton, California. We have Matthew Sharp, Senior Advocate, California Food Policy Advocates from California. We have Matthew 

Marsom, Director of Public Health Policy and Advocacy from Public 

Health Institute in Oakland, California. Then we have Ms. Claudia 

Page, Co-Director of The Center to Promote HealthCare Access to 

Oakland, California. 

I will let the gentleman from Central Valley, Mr. Costa, introduce one of his constituents. 

Mr. COSTA. Thank you very much, Mr. Chairman, and thank all 

of you. This second panel is very exciting and I appreciate the expertise that all of you provide for us. Unfortunately the Chairman 

has been very kind to me. Not that that is unfortunate. I appreciate that but unfortunately I have to leave. I won’t be able to stay 

for the entirety of the second panel because I have another hearing 

at 1:00 in downtown Los Angeles. 

Edie Jessup is the Central Valley Regional Obesity Prevention 

Program Director. She has a wealth of experience. She is a pistol 

as you will find out in her testimony. She grew up in Porterville 

in Tulare County and has been working in a host of efforts in advocacy and direct service work with neighbors that happen to be poor 

and, thereby, hungry, homeless and some without access to 

healthcare. 

She has focused on advocating there with the State University of 

Fresno. Go Bull Dogs. Go Dogs. We appreciate her good work with 

Fresno Metro Ministry, Girl Scouts, the youth county homeless 

shelters and the Sanford Public Library for Adult Literacy Programs. Mr. Chairman, you have a good panel here, the second 

panel, and I am really pleased to hear. I won’t be able to hear all 

of you but I have your statements and I have read them and I will 

have some questions if I am not able to remain and submit them 

after the testimony. 

The CHAIRMAN. Thank you very much, Mr. Costa, for the introduction. 

At this time we would like to begin with Dr. Valenzuela. Please 

begin. You have 5 minutes. 

STATEMENT OF GUILLERMO J. VALENZUELA, M.D., M.B.A.,

ASSOCIATE MEDICAL DIRECTOR AND CHAIRMAN,

DEPARTMENT OF WOMEN’S HEALTH, ARROWHEAD

REGIONAL MEDICAL CENTER, COLTON, CA 

Dr. VALENZUELA. Mr. Chairman, thank you for inviting me to 

talk. Since you have my statement I will just talk a little bit about 

what I consider important in this area of obesity in general. You 

34

know, if you have ever seen a Chihuahua date a German Shepherd 

you realize that if the female is a Chihuahua that she cannot use 

the gene that come from the German Shepherd or huge dogs. The 

mother controls the size of the baby in utero and in that way she 

is able to have puppies. They will grow really rapidly thereafter 

using the genes of the father. The important part of this is that in 

utero we determine a lot of what will happen given the rest of our 

life. 

For instance, if the mother is overweight and eats a lot, or the 

mother is underweight and the baby weighs very little, 50 years 

later or way before we have myocardial infarction, diabetes, hypertension. Because of the mother’s environment regardless of your 

genes it can make things a lot worse. 

I think that in order for us to deal with the problem of obesity 

or undernutrition we are going to have to look at a lot of other factors, not just telling children to eat this or eat that. I think this 

is great what you guys are doing with the SNAP program and so 

on. However, I personally feel that many times a child is told at 

school to do this or do that. They go home and they get Cheetos 

and they get cheese and they get a big hamburger or whatever depending on the socioeconomic factors and that is what they will eat. 

So recently here we started a program trying to intensively teach 

pregnant women how to eat right apart from what the state is 

doing and to see how big the problem is. For instance, we have 80 

women that we were trying to do intensive counseling, a group of 

40 and another we work with. We do so much counseling. The BMI 

of these pregnant women was 40 or there about. We had a pregnant woman who weighed 680lb. We had multiple pregnant women 

with severe problems. 

If you think of those children, they are condemned for life because it is already going to start with insulin resistance at birth. 

They will have a much higher chance of being obese. If the parents 

are obese, there is a much higher chance for them to be obese. The 

problem I think that we are going to have, and we are trying, is 

to face it from a cultural point of view. 

For instance, here in the capital Mr. Petree have set up Find the 

Feet that people come and walk around, go up and down stairs. 

They have a running competition. 

Dr. Wong is working in another area with children. What we are 

trying to do in pregnancy is try to get these women support during 

pregnancy, and when they go back to their community to try to 

work with community-based organizations so we can provide support. Diet and exercise program success is very limited, for 2 years. 

In every place that they have done any studies they have shown 

that after 2 years everything goes back to normal, it is only when 

you change the whole culture of a group. Right now there are studies showing that children are watching 7 hours a day between 

video games, the TV or whatever. You have any type of food, even 

a pretty healthy food, and you eat a lot of pretty healthy food and 

you don’t do anything you are going to get fat anyway. 

Personally I like the theory of pregnancy because I blame my 

parents on my 23 pounds that I am overweight. But the point is 

that I think the city needs to design places where children can 

35

safely run and play and teach the parents the same thing. This is 

what we are starting to do here. 

First we start with the pregnant women and then we are trying 

to get back into the community with the help of Supervisor Gonzalez to try to see if we can interact with community-based organizations in order to provide support to these women and trying also 

with the schools and children in other areas. This is what we are 

trying to do here. I think it is important that we take this program 

to multiple places from exercise and education, not only to the children but the parents and affecting the expecting mother. That is 

what I would like to say. 

[The prepared statement of Dr. Valenzuela follows:]

PREPARED STATEMENT OF GUILLERMO J. VALENZUELA, M.D., M.B.A., ASSOCIATE

MEDICAL DIRECTOR AND CHAIRMAN, DEPARTMENT OF WOMEN’S HEALTH,

ARROWHEAD REGIONAL MEDICAL CENTER, COLTON, CA 

The relevance of addressing obesity as a major health problem is the projected 

$147 billion in costs related to healthcare. 

The causes for obesity are multi-factorial. The process begins in utero. We know 

that if a baby is born whom weighs less or more than he should for the gestational 

age he is born at, a higher rate of insulin resistance is more likely. Barker in England demonstrated the relationship between birthweight and diabetes, heart disease, insulin resistance and obesity. Later, other investigators have added the metabolic syndrome. If the mother undergoes gastric bypass surgery, children born after 

the surgery tend to have a lower prevalence of obesity. 

Animal studies show that a mother’s weight and health influence her child’s birthweight and size. Generally, if one of the parents in the household is obese, the child 

is two to three times more likely to become so. 

Evidence also points to ethnicity as a factor. For example, childhood obesity is 

more common amongst American Indians, non-Hispanic blacks and Mexican Americans than in non-Hispanic whites. Clearly, there are socioeconomic factors as obesity 

is more common amongst low-income populations. 

Public perception of criminality, drugs, urban violence, etc. in residential areas are 

a factor. They have made neighborhoods unsafe for children to play and traverse 

(walking, running, bicycle); therefore, decreasing considerable ‘‘public space’’ and 

limiting outdoor physical activities. 

Gender also affects obesity. 80% of teenage girls that were obese as children, remain obese, versus only 30% of males under the same circumstances. Furthermore, 

in recent years there is a decrease in physical activities both at home and at school, 

increase in usage of video games, increase in time spend watching TV (up to 7 

hours/day), high-caloric snacks (very popular with younger teen); all of these factors 

are associated with increase incidence in obesity. 

Complicating the solution, is that choices confronting care-givers, schools, etc. are 

defined also by cost-effectiveness in the food selection. The cost of food with good 

nutritional value is higher, while food with high-calorie and fat content is subsidized 

and thus cheaper and very abundant. 

Many studies examine obesity in adults and children and evaluate the treatments 

of diet, exercise and use of medication and surgery. This research shows that treatment of obesity successes are very limited in the long-term (2 years), except for surgery. As for the last option, even though the risks of surgery have been decreasing 

significantly with time, there are still major obstacles. These include financial cost 

and the risk of morbidity/mortality to treat a significant portion of the society. 

Any solution will require an integrated system, utilizing portions of prenatal care, 

to be sure that women gain a healthy amount of weight during pregnancy. It will 

require a community effort to address multiple causes such as awareness of the impact of a mother’s weight on her child’s, opportunity and encouragement for exercise 

for children and adults and access to adequate nutrition at schools. The bottom line 

is to positively influence a change in obesity trends and work together on multiple 

levels to address the problem.

The CHAIRMAN. Thank you very much, Dr. Valenzuela. 

Next we have Dr. Wong. 

36

STATEMENT OF WEBSTER A. WONG, M.D., M.B.A., CHIEF OF

PEDIATRICS, ARROWHEAD REGIONAL MEDICAL CENTER, 

COLTON, CA 

Dr. WONG. Thank you very much, Congressman Baca, distinguished guests, Congressmen. My name is Dr. Webster Wong. I am 

Pediatric Chair of Arrowhead Regional Medical Center. What we 

are looking at is calculated by some experts to be a $147 billion 

price tag per year that America spends on obesity and obesity-related illnesses. Some experts will also say that price tag will go up 

to $1 trillion by 2030. For kids, Medicaid kids who are obese cost at least $6,700 per 

year for obesity-related issues and across the nation, even here in 

San Bernardino, upwards of 18 to 25 percent of all adolescents and 

children are obese or are overweight. Seventy percent of those kids 

will be obese adults. 

Not only are issues of obesity-related diseases affecting kids but 

also other issues such as school performance. Upwards of four 

times the number of school problems occur in obese kids and upwards of 30 percent of kids will have more thoughts of suicide, depression, and feelings of hopelessness. There are many reasons for 

issues of obesity, namely socioeconomic problems, the urbanization 

of America. Kids are more concerned about safety rather than 

going to their playgrounds or their local parks. 

The technology factor that Dr. Valenzuela alluded to: there is 

more TV time. There are more computers and more video games 

to deflect and defray the kids away from physical activity. Also, the 

family unit is a bit affected. There are more single-parent families. 

Also there is a de-emphasis on family mealtime, too. 

Obesity disease states, when it comes to pediatrics, include many 

things and with long-standing consequences. Namely, type 2 diabetes. Back 20 years ago this was named adult onset diabetes, but 

we are seeing patients who are 7, 8, 9 years of age who qualify for 

diabetes. That along the lines will contribute to issues of heart disease, atherosclerosis, stroke, and also asthma and certain cancers. 

Depression is also an issue with regards to these obese kids. 

Certainly this affects their productivity not only from a school 

standpoint but from a worker standpoint as they get into the workforce. Obesity has caused some issues with discrimination. Obese 

people earn less and undergo a lot of discriminatory actions against 

them. 

The SNAP program is a valuable program, as we all know. However, studies show that moms who are primary food buyers and 

food preparers really don’t like to engage in certain behaviors that 

increase cleanup time. Certainly they are not always around their 

kids when mealtime occurs. So, therefore, kids have poor role models. Many families are struck with obesity not only with their kids 

but with parents, too. 

Serving-size issues and, again, no family mealtime leading to increased TV time all contribute to obesity. 

Studies also show that lower-income families, kids, 70 percent 

eat less grains, 50 percent eat less fruit and there is certainly a 

lower amount of vitamin E, zinc, and calcium levels in those diets, 

too. Everyone has a face to obesity. My face is a 14 year-old Hispanic female by the name of Gabriella, one of the 24,000 visits that 

37

1 Cynthia L. Ogden; Margaret D. Carroll; Lester R. Curtin; Molly M. Lamb; Katherine M. 

Flegal. Prevalence of High Body Mass Index in U.S. Children and Adolescents, 2007–

2008. JAMA, 2010; 0 (2010): 2009. 2012. 2 Benchener M. Obamacare’s Impact On Obesity, Liberty, And Cost. 2009. The Philadelphia Bulletin. Available at: http://www.thebulletin.us/articles/2009/08/10/commentary/opeds/doc4a8064c80fd5f937691673.txt. Accessed August 2009. 3 Ibid.

4 American Academy of Child and Adolescent Psychiatry, May 2008, Number 79. 

we see here at Arrowhead Regional Medical Center Pediatric Clinic 

per year. 

She is 300 pounds and 5′4′′ and she has a debilitating hip issue 

called SCFE, slipped capital femoral epiphysis, which limits her 

ability to move and that increases her downward spiral of hypertension, of obesity, of depression. She really doesn’t have the ability 

to get herself out of this spiral affect. 

Her mother is obese and both of them, although they understand 

the message, lack the motivation to be able to get her to lose 

weight. As a provider we are all overwhelmed with access issues, 

and we all have issues in trying to get a concerted message out to 

try to fight obesity through adequate nutrition. 

At Arrowhead, we are poised to deliver that concerted message. 

We have three mobile clinics. We already have existing relationships with schools and we are able to see patients right there in 

schools. We have our FHCs, our family health clinics, and pediatric 

specialists. Ultimately we look forward to being part of the solution 

and we look to our leaders to show us the way so that we can address this pervasive problem. Thank you very much. 

[The prepared statement of Dr. Wong follows:]

PREPARED STATEMENT OF WEBSTER A. WONG, M.D., M.B.A., CHIEF OF PEDIATRICS, 

ARROWHEAD REGIONAL MEDICAL CENTER, COLTON, CA 

Pediatric obesity and its related conditions are serious consequences to an increasingly unhealthy lifestyle in the United States. Poor awareness, cultural and socioeconomic factors, genetic predisposition and educational deficiencies contribute to 

this widespread problem. 

Obesity is measured by a Body Mass Index (BMI) of over the 95th percentile. 

Overweight children are defined by a BMI between the 85th and 95th percentile. 

Obesity in children has a direct causal effect on the development of various disease states: diabetes, cardiovascular compromise, hypertension, musculoskeletal ailments and cancer. Recent studies show that American children are fatter, more sedentary and prone to lifelong illnesses than international children. Statistics bear out 

these observations: The percentage of overweight and obese children has tripled 

since the 1975. More than 10% of infants and toddlers and nearly 18% of adolescents are obese.1 More than 70% of them will be obese adults. Furthermore, 1⁄3 of 

U.S. children eat fast food every day. Those that do stand to gain about 6 pounds 

each year. In addition, Hispanic and African American teens are more at risk than 

other ethnicities. 

The annual cost of obesity related problems has been estimated at $147 billion. 

If unchecked, experts calculate that the yearly expenditures will top $1 trillion by 

2030.2 The cost for healthcare for an obese child is three times that of an average 

child. Mean annual healthcare costs for an obese child are $3,700 for insured and 

$6,700 for Medicaid plans.3 More than 300,000 deaths each year are attributed to 

obesity.4

Psychosocial issues as a result of obesity influence mental health, employment, 

and school performance. Obese children and adolescents plan or contemplate suicide 

32% more often and are 20% more likely to have thoughts of hopelessness than 

healthy adolescents. Roehling described that overweight workers were stereotyped 

with negative traits and as socially/emotionally handicapped, which resulted in 

38

5Schwimmer, Jeffrey B., Tasha M. Murminkle and James W. Varni, ‘‘Health-Related Quality of Life in Severely Obese Children and Adolescents,’’ Journal of the American Medical 

Association, vol. 298, No. 14, April 9, 2003. 

lower wages and benefits. School performance is negatively affected four times 

greater than healthy-weight students.5

Culturally, widespread obesity can be linked to America’s societal evolution over 

the past 3 decades. As a whole, Americans have embraced a culture of fast, poorly 

nutritious food, increasing divorce rates, urbanization, sedentary activities, and skyrocketing medical costs. Fast food is more accessible and easier to prepare compared 

to cooking at home. The rates of children raised in broken and dysfunctional homes 

are steadily rising, leading to a de-emphasis on healthy eating. More children are 

unable to exercise in cities where parks and playgrounds are unsafe or unavailable. 

In exchange, kids are adopting non-active lifestyles filled with video games, television and computers. 

These factors are felt no more acutely than in poor, working class communities. 

Parents struggle with maintaining income causing their parenting skills to suffer. 

Nutrition education seems to be a distant priority and obesity envelopes the family 

unit. Medical costs are too high and access is too limited to halt the long term consequences of obesity. The downward spiral of these communities continues. 

Many possible solutions are being considered to reverse these staggering statistics. Successful programs must rely on changing the culture of obesity by involving 

the family unit, community resources, education, healthcare and government. Children and their families should benefit from a comprehensive effort to guide and to 

re-educate dietary and exercise choices, with continued contact with healthcare providers. 

By combining a comprehensive medical program utilizing measurable outcomes 

and a socioeconomic, culturally based educational component to drive home specific 

methods to combat obesity, a program can answer many questions. ‘‘How can we 

facilitate better recognition of obesity before problems arise?’’ ‘‘What is needed for 

a basic pediatric obesity work-up that will demonstrate health improvements over 

time?’’ ‘‘How can we involve the whole family unit to combat this pervasive problem?’’ With specific answers to these complex issues, a recipe for dealing with one 

of the most dangerous epidemics of our time can be created. 

As stated, the road to obesity is multi-factorial. Aside from genetic proclivities, 

many of the key elements to develop an obese child can be addressed effectively, 

yielding to a suspension and perhaps reversal of the devastating results from obesity.

The CHAIRMAN. Thank you very much, Dr. Wong. 

Mr. Sharp. 

STATEMENT OF MATTHEW SHARP, SENIOR ADVOCATE, 

CALIFORNIA FOOD POLICY ADVOCATES, LOS ANGELES, CA 

Mr. SHARP. Good morning, Chairman Baca, Ranking Member 

Fortenberry, Representative Costa. My name is Matthew Sharp. I 

work with California Food Policy Advocates. We are a statewide 

nonprofit organization whose mission is to improve the health and 

well being of low-income Californians by increasing their access to 

nutritious and affordable food. 

Since the mid-1990s I have had the privilege of working with this 

organization to try and make various changes in both policies and 

programs in California communities, I work in Los Angeles primarily, to improve health and well being. 

We are focused on the Federal food programs, both food stamps 

as a recession fighter and an anti-hunger tool, and the broad range 

of Federal food programs as tools to help prevent childhood obesity. 

I’ll talk extensively about some of the strategies that might assist 

with reducing the obesity epidemic, but today I was invited to 

present just a few brief remarks on steps that might improve participation in the food stamp program. 

39

First a few numbers to help set the context. Unemployment in 

California has increased over 140 percent in the last 24 months. 

That is an astronomical increase in need among households, among 

families. Here in San Bernardino County nearly 14 percent is the 

official unemployment rate. 

According to UCLA there are possibly 3.1 million California 

adults that are suffering food insecurity and several million additional children in those households. The suffering is real. The increase in households seeking emergency food assistance and help 

from a variety of charitable sources has skyrocketed remarkably 

during the course of the recession. 

As you’ve just heard from the two distinguished doctors here at 

the hospital, the rate of childhood obesity has increased dramatically. We do a lot of work in the school setting. Forty percent of 

the 9th graders in the low-income schools are overweight and unfit, 

so we have an enormous and complex problem to solve. 

What I wanted to do was to highlight for you a couple numbers 

about food stamps and a couple of things that you might do about 

it. From this report that Chairman Baca quoted earlier; Lost Dollars, Empty Plates we analyze a number of data sources and estimate that nearly 2.9 million Californians are likely eligible for food 

stamps but not participating. Today that has translated to about 

$3.5 million of lost Federal benefits. 

As the Chairman pointed out, this is nearly $7 billion in lost economic activity but the number you haven’t heard yet is that it is 

also analyzed that there is $150 million in lost state and local sales 

tax revenue due to the lost economic activity that might be in these 

communities if benefits were more fully utilized. So, there are a 

number of ways that food stamps will contribute to a recovery from 

the recession, and to mitigate the nutrition and food insecurity 

problems that too many households face. 

A few quick highlights of some changes that will make a difference. First of all, Congress and USDA should ensure adequate 

funding for benefits preserving the increase in the amount of food 

stamps allotted that was enacted as part of the Recovery Act in the 

winter. There needs to be an increase, a better formula for the administration of the program because of the local hiring freezes at 

the state level in the other states. In California it is a county-level 

problem. 

There is a difficulty in ensuring the local governments can respond to the increased demand in terms of resources. Additionally, 

of significant concern this winter is the Governor’s proposal for the 

2010 budget which proposes to eliminate 35,000 persons who are 

legal permanent residents paid for by the state. Illegal immigrants 

are supposed to be cut off from the program. Certainly we are talking about various forms of Federal fiscal relief and this would be 

a population that would be reasonable for USDA and Congress to 

take on to the Federal roles in light of the state budget crisis. 

A couple more: California ought to move quickly to 6 month reporting which is basically the way of keeping people on the program by obligating them to send in fewer forms to the county to 

retain their benefits. All the other states have moved to this system. California has been asked by USDA to do so and ought to be 

expected to move very quickly to 6 month reporting. 

40

Couple of other ones that I think you will find intriguing. California and USDA could do a better job of connecting health insurance to Food Stamps by combining the application processes and 

the reporting processes. There are one million children in California that receive public health insurance but do not receive Food 

Stamps. Their households were willing to fill out forms, fill out paperwork, go through the system but they have not been imported 

into the Food Stamp Program despite their probable eligibility for 

nutrition benefits, which is obviously a key way to integrate the 

nutrition message into the delivery of healthcare. 

The states and the counties need to work together much better 

to ensure that local operations are similar in all 58 counties. The 

way the system works today there are a number of different operations, different computer systems. Options have been made available to do fewer in-person interviews. There are options to do activities online to optimize customer services practices. All this 

ought to be the same for applicants in each county and to establish 

those will improve participation. 

Last, it is important that you get more data. As Representative 

Fortenberry asked earlier about what do we know about food 

stamps and nutrition. It is a good question. We ought to talk a little more about it. We have very little information about those who 

applied for benefits and have not succeeded in the application process. We need more data about your customer population. Thank 

you. 

[The prepared statement of Mr. Sharp follows:]

PREPARED STATEMENT OF MATTHEW SHARP, SENIOR ADVOCATE, CALIFORNIA FOOD

POLICY ADVOCATES, LOS ANGELES, CA 

Introduction. Good morning. My name is Matthew Sharp. I work for California 

Food Policy Advocates, in the Los Angeles Office. CFPA is a statewide nonprofit organization whose mission is to increase low-income Californians’ access to nutritious, affordable food. Since the 1990s, I have worked with CFPA to increase the 

use of Federal nutrition programs, particularly food stamps given its tremendous potential, by pursuing state and Federal legislation, as well as local policy changes. 

I’ve also coordinated food stamps advocacy and outreach with a dozen Los Angelesarea community partners to increase awareness and ease accessibility to these valuable nutrition benefits. This winter we are focused on blunting the impact of the 

severe state budget crisis on low-income Californians and on ensuring Congress invests new resources for Child Nutrition and WIC Reauthorization. 

This morning I will share with you the progress we’ve made in California to 

strengthen food stamps policy and accessibility. I will identify the key data points 

indicating that more changes are needed to expand participation further and I will 

provide a few recommendations for action. 

Background. Food stamps and the child nutrition programs have offered a nutrition safety net for millions of needy families and children since the day they started. 

The nation’s deep recession makes these programs more important than ever. With 

childhood food insecurity and obesity escalating at rates that reflect steeply increased unemployment and poverty, the healthy meals and snacks that the programs provide, the measurable gain in students’ academic performance, and the savings that strapped families can realize with five less breakfasts and lunches to supply each school week are among the many extremely valuable benefits that the child 

nutrition programs can deliver. 

The food stamp program, the nation’s most important anti-hunger program, helps 

very low-income Americans to afford a nutritionally adequate diet. Unlike most 

means-tested benefit programs, which are restricted to particular categories of lowincome individuals, the food stamp program is broadly available to almost all households with very low incomes, making it an important resource for families with limited income. More than 75 percent of all food stamp participants are in families with 

children; nearly 1⁄3 of participants are elderly people or people with disabilities. The 

41

1 Based on CBPP analysis of food stamp quality control administrative data, available at: 

http://www.fns.usda.gov/ora/menu/Published/SNAP/SNAPPartHH.htm.

Federal Government pays the full cost of food stamp benefits and splits the cost of 

administering the program with the states, which operate the program. Food stamp 

eligibility rules and benefit levels are, for the most part, uniform across the nation, 

but states have flexibility in the procedures and requirements that low-income families face for application and ongoing receipt of benefits, as long as states meet certain Federal service-delivery standards. 

Food stamp households receive their benefits on electronic benefit transfer (EBT) 

cards, which can be used only to purchase food. The average household received 

about $133 a month (or $4 a day) for each household member in the second half 

of Fiscal Year 2009. The food stamp benefit formula targets benefits according to 

need. Very poor households receive more food stamps than households closer to the 

poverty line since they need more help affording an adequate diet. In Fiscal Year 

2008, ninety-five percent of food stamp benefits went to households with income 

below the Federal poverty level, and more than half went to households with income 

below half of the Federal poverty level. 

The share of households that receive food stamps and have no other income is on 

the rise, from about eight percent in 2000 to almost 16 percent in 2008, and likely 

a higher level currently because of the economic downturn.1 This trend is the result 

of two factors: first, many low-wage unemployed workers cannot qualify for Unemployment Insurance, and second, the cash assistance available to unemployed workers through TANF and state general assistance programs has eroded over time. As 

a result, food stamps may be the only federally funded safety net program available 

to many families who have lost jobs during this recession. 

Current Data. Unfortunately, despite increased enrollment in recent years, the 

Food Stamp Program misses an unsettling number of eligible, needy Californians. 

This underutilization is neither acceptable nor necessary. The numbers are sobering. Three million Californians received food stamp benefits worth $5.4 billion during 2009—only half those who are eligible. While this reflects an increase of 35% 

more persons receiving benefits since 2007, the increase in need has been far greater.

• Unemployment in California has increased by 140% since 2007, reaching nearly 

13% statewide.

• Demand at food banks and emergency shelters has increased 46%

• According UCLA’s Center for Health Policy Research (http://

www.healthpolicy.ucla.edu/pubs/Publication.aspx?pubID=225), among the 3.1 

m adults struggling with food insecurity, 77% do not receive food stamps.

• According to USDA’s Program Access Index (http://www.fns.usda.gov/OANE/

menu/Published/SNAP/FILES/Participation/Reaching2007Summary.pdf), 

only 46% of eligible Californians participated in 2007.

Low participation means lost dollars (http://cfpa.net/ldep/ldep2009.pdf) for all. 

Because, as USDA says, each dollar of food stamp benefits generate $1.84 in economic activity, low participation adversely impacts not only hungry families but a 

variety of sectors of the California business community. If all eligible Californians 

participated, California would receive $3.7 billion in additional nutrition benefits, 

generating $6.9 billion in statewide economic activity and $153 million in state and 

local sales tax revenue. Increasing food stamps participation will help California 

families put food on their table—and it also will help California rebound from the 

recession. 

Improvements. A few recent changes represent significant progress since the 

2008 Farm Bill reauthorized (and re-named) the food stamp program.

• More money. As part of the American Recovery and Reinvestment Act, Congress 

provided a 13.6 percent temporary boost in the maximum food stamp benefit 

in Federal Fiscal Year 2009. This provision was included as a fast and effective 

economic stimulus measure that could help to push against the tide of economic 

hardship that low-income individuals are facing. Additionally, ARRA provided 

$300 million in additional administrative funds to states to handle larger caseloads. The 2010 appropriations bill provided an additional $400 million for food 

stamps administration.Q02

• More application options. Through local partnerships with community organizations, health clinics and WIC centers, as well as recent state policy changes to 

eliminate in-person interview requirements (and, hopefully, office visits), Californians will have more convenient opportunities to apply for food stamps closer 

42

to their home or workplace or to manage their benefits by phone—and maybe 

even someday, online.

• More flexible rules. State legislation eliminated the asset test. When fully implemented in 2010, this will allow families to seek nutrition help before spending down their entire savings.

• Rebranding. State legislation triggered a market research project to gather information from non-participants about potential names and logos that might reposition food stamps as an attractive program. Terms like ‘‘fresh’’ and ‘‘modern’’ 

will be considered as the state selects a new name this winter.

Action Steps. While numerous changes are needed at a Federal, state, county 

and community level to respond to the myriad reasons why hungry families do not 

receive food stamp benefits, I wanted to draw your attention to the top policy 

changes that may make the most difference to non-participants. You will hear today 

about technological innovations, outreach initiatives and important connections between food stamps and healthier eating. We support all those endeavors. Here are 

our recommended priorities: 

Ensure adequate funding for nutrition benefits and administration.

• Congress should ensure sufficient funding for food stamps by preserving the 

13.6% increase in benefits enacted in the American Recovery and Reinvestment 

Act of 2009 and establish a mechanism to increase administrative funding more 

nimbly to respond to the state and local budget cuts and hiring freezes.

Modernize the program by moving to simplified (6 month) reporting. USDA denied 

California’s request (http://www.cfpa.net/USDAltr6month.pdf) to continue quarterly reporting for 4 more years, but the state and counties have not yet implemented this important change.

• California should quickly transition to simplified reporting.

Provide benefits to needy Californians who are fully eligible but for the repressive 

welfare restrictions enacted in the 1990s. Many legal immigrants do not receive Federal food stamp benefits, many unemployed adults without children are subject to 

outdated work requirements and SSI recipients are not eligible to participate in 

California. Federal legislative changes are needed to provide benefits to each of 

these populations (USDA and Department of Homeland Security changes are needed to enroll immigrants), with state changes needed to carve out SSI recipients that 

would benefit from food stamps. In order to close the state’s budget deficit for 2010–

2011, the Governor proposes to eliminate the California Food Assistance Program, 

which provides food stamp benefits to legal immigrants with state funds—a good example of where Federal fiscal relief is needed, since these are immigrants who were 

once eligible for Federal food stamps.

• Congress and USDA should pursue legislative changes to ensure all needy populations are eligible for valuable food stamp benefits. Congress should expand the 

pool of legal permanent residents eligible for food stamp benefits.

Connect food stamps and health insurance. Approximately one million MediCAL 

recipients—already means-tested and certified eligible for Federal health benefits—

do not participate in food stamps.

• California should implement policy and technological changes to ensure that 

low-income households receive nutrition insurance alongside health insurance.

Eliminate fingerprinting. Nine years since California implemented its biometric 

system to detect multiple-aid fraud, two state audits (http://www.bsa.ca.gov/reports/summary/2001-015) and the fraud detection systems of 46 other states have 

demonstrated that the system is not cost-effective for the state and counties—and 

that it is ineffective at detecting multiple benefits, the system’s supposed purpose. 

Fingerprinting also discourages applicants by adding stigma and an obligatory trip 

to the welfare office—undermining out-of-the-office enrollment efforts.

• USDA should prevent states from using fingerprinting systems as a condition of 

eligibility or issuance of benefits. USDA should cease co-funding California’s fingerprint imaging system.

Strengthen local operations. With 58 counties administering food stamps across 

California, applicants in some counties benefit from the availability of office visit 

waivers (http://www.cfpa.net/PhoneInterviewsCalifornia.html), speedy processing of 

benefits and limited paperwork requirements. However, other applicants in other 

counties are not as fortunate, as demonstrated by several pending lawsuits regardVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00046 Fmt 6633 Sfmt 6621 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
43

ing failure to provide timely benefits and excessive requests for verification of application documents, as well as wide variations in enrollment rates.

• USDA and California should improve monitoring of local customer service practices and timely issuance of benefits to ensure best practices become the norm.

Significantly more resources are available at www.cfpa.net. 

I am happy to answer any questions you might have.

The CHAIRMAN. Thank you very much, Mr. Sharp. 

STATEMENT OF EDITH C. ‘‘EDIE’’ JESSUP, PROGRAM

DEVELOPMENT SPECIALIST, CENTRAL CALIFORNIA

REGIONAL OBESITY PREVENTION PROGRAM, CALIFORNIA 

STATE UNIVERSITY FRESNO DEPARTMENT OF HEALTH AND 

HUMAN SERVICES, CENTRAL CALIFORNIA CENTER FOR 

HEALTH AND HUMAN SERVICES, FRESNO, CA 

Ms. JESSUP. Thank you for this opportunity to speak to you. My 

name is Edie Jessup. For the last 10 years I worked with a nonprofit agency on a hunger and nutrition project in Fresno, California. That included monthly meetings with the county Food 

Stamp Director and staff and over 25 community-based organizations who work with low-income residents needing food. 

I now work regionally with the Central California Regional Obesity Prevention Program on food access and policy issues. I am also 

co-chair of the Roots of Change working on a sustainable food system for California by 2030. 

I see the Federal nutrition programs as health programs, as violence prevention programs, and I see food as a human right. There 

is no scarcity of food. However, there is a political decision not to 

feed people in the United States. I am witnessing the great unraveling in my fragile community. The nation expects affordable fruits 

and vegetables from the Valley where people are hungry and food 

giveaways run out of food. 

In any other day or time these people in line would be considered 

good hardworking people. The number one agriculture producing 

county in the United States, Fresno, is also the Congressional district with the highest poverty in the United States. 

Full Food Stamp enrollments by eligible families linked to other 

U.S. nutrition programs is the quickest program and economic 

stimulus for my community. Food stamp enrollment would solve institutionalized poor diet for poor people that has created racist outcomes in poor health by diet. Prior to 1996 there was enough food 

on the shelf in the United States to feed our country for a year. 

We have disinvested in Federal purchase of surplus food and the 

consequences are seen in the emergency nature of incompetent food 

provision and disasters. 

Charity is not sufficient to supply and distribute food to the increasing poor and under-employed. This leads to the ever-unmentionable food system issue of what the Federal Government subsidizes. The USDA needs to subsidize food and farming that is 

healthy for all people. You must lead states and local governments, 

from the health and environmental perspective, in making healthy 

food access a high priority through integrated and linked Federal 

programs. 

Full Food Stamp enrollment by all eligible would benefit my 

neighbors so hungry families could purchase food, but it is not hapVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00047 Fmt 6633 Sfmt 6601 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
44

pening. The fed, states, and counties blame each other and in 10 

years of my community identifying major barriers to Food Stamp 

enrollment again and again leadership to solve the issue has not 

happened. 

In addition to the recommendations of my colleagues, I advise 

the following to overcome the 50 percent under-enrollment in Food 

Stamps in California and nationally. Number one, on the issue of 

immigration and fair public charge: I call on your to request ICE 

and USDA to jointly sign a clarifying directive to states, counties, 

and the public that immigrant families will not be denied a change 

in their legal status because of accessing food programs for which 

they are eligible. 

Number two, customer service. Simplify enrollment and link Federal food programs. I have to report that the county’s cultural competence is poor. People are treated poorly and do not feel welcome 

at Food Stamp offices. People I have surveyed feel their treatment 

is racially and class motivated. The USDA and Congress must require better service practices. 

Number three, privatization and inefficiencies. Each state should 

engage one computer system for food stamps, not the four nonintegrated systems as allowed in California. The administrative reimbursement for counties should be based on caseload to encourage 

enrollment. USDA should monitor, track, and publicly report the 

cost of having banks run the Food Stamp system compared to federally run programs. 

EBT help centers should be located in the state administering 

food stamps, not overseas. 

What if we fed people? The Federal nutrition programs can and 

should be made available to all who qualify. There is plenty of food 

and we can assure through food stamps and other programs that 

all those eligible are enrolled. Thank you. 

[The prepared statement of Ms. Jessup follows:]

PREPARED STATEMENT OF EDITH C. ‘‘EDIE’’ JESSUP, PROGRAM DEVELOPMENT

SPECIALIST, CENTRAL CALIFORNIA REGIONAL OBESITY PREVENTION PROGRAM, 

CALIFORNIA STATE UNIVERSITY FRESNO DEPARTMENT OF HEALTH AND HUMAN

SERVICES, CENTRAL CALIFORNIA CENTER FOR HEALTH AND HUMAN SERVICES, 

FRESNO, CA 

Food Stamp Participation and Outreach in the Central Valley of California 

Thank you for the opportunity to testify on the condition in the San Joaquin Valley of California, and the need for full enrollment in the Federal nutrition programs 

by more than a majority of residents, in a dignified, equitable, and sustainable 

way—very quickly. I see this as urgent, not something that we need to analyze 

more. If Food Stamps are to fulfill their intended outcome of a healthy population 

ready to work and learn, you need to make Food Stamps work at once. 

I will set the stage, with short comments on need for Federal nutrition programs, 

and then provide you with seven specific issues that the Federal Government can 

and should address to assure full Food Stamp/SNAP participation from constituents 

in the Valley. 

My name is Edie Jessup. For the last 10 years I worked with a nonprofit agency 

on a Hunger and Nutrition Project in Fresno, Ca. I am now working regionally with 

the Central California Regional Obesity Prevention Program as a Program Development Specialist. I am also co-chair of Roots of Change, working on a sustainable 

food system for California by 2030. 

I see the Federal nutrition programs as health programs, as violence prevention 

programs, and I see food as a human right. There is no scarcity of food. I also appreciate that agriculture is the meeting point tying health outcomes, access to healthy 

food, and, a revived agricultural economy in the Central Valley. 

45

However, there is a political decision not to feed people in the United States. 

I negotiated a meeting where the state and Federal Partnership on the San Joaquin Valley were willing to make Food Stamps their priority last year, and encourage businesses and other state and Federal agencies to promote and support enrollment in Food Stamps. The county, state, and Federal offices started squabbling, and 

the offer to work to increase enrollment by the business community was taken off 

the table. The Chair said ‘‘Clearly you people (county, state, Federal) do not want 

people eligible to be enrolled in food stamps for the betterment of their health, and 

the health of our local economy. There is no point in my sitting through any more 

of this, and wasting my time.’’ Advocates tried to link up rural municipalities in 

places like Tranquility, and San Joaquin with the county Food Stamp office, to take 

applications at the city offices via computer. The County would not accommodate 

that because of fear they could not manage new cases of food stamp applicants if 

people were not in their office in Fresno, 80 miles away, in person. People do not 

have transportation, nor can they take a day off work to come into the county center. But they are hungry, and do qualify for food stamps. 

I understand that prior to 1996; there was enough food ‘on the shelf’ in the U.S. 

to feed our country for a year. We have disinvested in storing for hard times and 

emergencies, and the consequence is seen in obesity and malnutrition in the Central 

Valley, and is seen in the ‘emergency’ nature of incompetent food provision in disasters (Katrina, the California Central Valley drought, or Hati). Charity is not sufficient to supply the need for food by the chronically under wage households in California. It is apparent in the Central Valley the poor quality and safety of food provided for our school food programs, the fact that accessing the Child Care Food Program is nearly impossible for child care providers, and is inadequate. 

I am witnessing the ‘great unraveling’ in my community. For the last 10 years 

I have worked with Ca. Food Policy Advocates statewide, and with my county Department of Employment and Temporary Assistance, and the local school district to 

raise SNAP enrollment from the 50 % eligible but not enrolled low income families 

and individuals. The story in the Valley is the same. Low income wages at best, agricultural seasonal work, immigration raids and splitting families by deportation of 

our labor force. We know the eligibility is there because in the Fresno School District 83% of all children are eligible for free lunch, and most rural towns have Provision two schools—where all children are at least getting lunch. They report school 

lunch as the one meal daily they can count on during the week. Breakfast needs 

to be the first lesson of the day for every child in every school, and School Districts 

should be required to do this so that that Breakfast is truly accessible to kids. Their 

learning will improve. And Summer Lunch, a righteous program to provide food 

during time off from school, needs to be required by all school districts who serve 

over 50% free/reduced during the school year. The problems of summer lunch need 

to be solved by funding community based organizations to serve summer lunch, and 

schools should be required to provide and transport summer lunches to where kids 

are—whether neighborhood schools, or parks, or apartment building complexes, or 

churches in neighborhoods. 

The population in the San Joaquin Valley is fragile. The conservative power structure’s ‘‘blame the victim’’ mentality results in institutionalized racism that determines who eats, and results in poor health outcomes. 

That attitude of scarcity preserve the poverty and ill health of the very people assuring the rest of the nation access to healthy food. I currently work with the Central Valley Regional Obesity Prevention Program, directly working on environmental change and policy change to give people access to healthier food and safe 

physical activity. In Mendota, where so much public attention has been drawn to 

the drought’s impact on a town, nearly completely unemployed, 37 of 80 Head Start 

children are obese as a direct result of diet. The local store carries junk food and 

poor parents take food bank commodities or donated top-ramen as the primary food 

on their table. Their health will be on our Hospital doorstep, and the chronic treatment for diabetes in these children will lead to impaired lives, and is now creating 

poor learning in our schools. We have created this monster of a human problem. 

Our Public Health Officer in Fresno County says that he can tell how many generations an individual has been here by the decline in health status; the biggest public 

health issues in Fresno County are asthma, obesity, and diabetes. Chronic disease 

by diet, and our food system practices. 

Federal nutrition programs would bring in over $170 million yearly in Food 

Stamp benefits to my county if all were enrolled. That is to purchase food, our number one business in Fresno and the Valley. But it is not happening. The feds blame 

the state, the state blames the feds, and in 10 years of the major barriers to enrollment being identified again and again, no one cares to do anything. The USDA 

Western Regional Office wants to assist, the state would like to turn this around, 

46

the counties in the Valley, because of reimbursement formulas that do not support 

the administration of food stamps try to do what they can, while struggling with 

caseloads of 500 families/worker, and feel under the gun by USDA for sanctions if 

they make an error. 

Most concerning to me is the institutionalization of poor diet, the lack of fresh, 

healthy food in neighborhoods, and because of deep poverty, and the fact that 

unhealthy food is the cheapest, large numbers of folks truly have no access to 

healthy food. Taking on the industry of food has to happen, and the Federal Government must engage (from the health and environmental perspective) states and local 

governments in making food access a high priority in zoning, ordinances, and assuring equitable access to affordable food. Grocery Stores decide to pull out of low income neighborhoods, leaving food deserts, and populations at risk in ill health. 

This leads to the ever unmentionable issue of who and what the Federal Government subsidies in the food system. It is your watch. Painfully we need to subsidize 

food that is healthy for all people. We must cease subsidizing farmers not to farm. 

We must undergird small farmers who are raising our food in sustainable ways. 

We must subsidize and favor food that is not polluted with corn syrup, fat, and 

salt, because we are producing unhealthy generations who will not be able to live 

without extreme and long term medical support. Or, they will die from diet that 

leads to diabetes, heart disease, cancer. 

Meanwhile, the economy has created devastation in towns throughout the Valley, 

and drought that has displaced farm workers, and local businesses. 

The nation expects fruits and vegetables to feed the nation from this very place 

where people are hungry. It is a fragile place at best, filled with what in any other 

day or time would be considered good, hardworking people. 

These are the seven recommendations that would create increased enrollment in 

Food Stamps.

1. In the Valley, families need linked enrollment, without repeated applications 

for Food Stamps, WIC, School and Child Care food programs, and USDA Commodities. If poor families cobble together all these programs they might have 

enough to eat for a month. The programs could be linked and tiered so when 

times were better, or income improved, individual programs could be dropped 

as a benefit. None of these Federal food programs, by themselves, is adequate 

for hungry families.

2. I call on you to require ICE and USDA to jointly sign a clarifying letter that 

acknowledges that immigrant families will not be denied a change in their legal 

status because of accessing food programs for which they are eligible.

We have mixed immigrant families from all over the world in Fresno, over 100 

languages spoken in our school district, afraid to apply for Food Stamps, and afraid 

that if they allow their children to eat school lunch or summer lunch, for which 

their citizen children are eligible, their family will be split by deportation, or, that 

they will be ineligible for legal status or citizenship. Both Immigration and Customs 

Enforcement (ICE) and USDA say that there is no Public Charge issue, but they 

refuse to sign a joint letter and directive that clarifies this.

3. Families are definitely afraid to apply for food stamps given that even though 

parts of their family are eligible because all adults have to be fingerprinted and 

photographed to apply for EBT by California rules.

I would ask that in order to enroll all eligible people in the Federal food stamp 

program, you create Federal legislation that bans using finger-imaging in connection with food stamps. The purpose of the move to EBT was to eliminate any 

fraud by Food Stamp clients. It has worked, and redundant, pejorative continuance of photography and finger imaging as if applicant families were terrorists 

is untenable and costly in California.

Prohibit California from requiring fingerprinting as, it costs over $11 million, 

is revealing no fraud, and blocks families from Food Stamp participation.

4. If we are providing fresh, safe affordable produce for the rest of the nation, 

it seems that the purpose of Federal agriculture programs should accrue to 

those in need, who are providing the labor for feeding America, other than by 

standing in lines and convincing people how poor they really are for a hand out 

of food that is making them ill with diabetes and obesity. My recommendation 

is to provide a Federal waiver and enroll in Food Stamps everyone standing in 

too infrequent commodity distributions in food stamps, and sort out eligibility 

later, within the first 6 months. And if they really do not qualify, drop their 

enrollment.

47

5. I have to report that though the counties try pretty hard, their cultural competence is poor, and people are treated poorly, do not feel welcome in Food 

Stamp offices. People I have surveyed feel their treatment is racially and class 

motivated. Food Stamp workers feel overworked. The USDA and Congress could 

address the public sense that Food Stamps are for people who do not deserve 

food.

6. Some of the reasons for low enrollment are the facts of poverty, and the complexity of rules, difficulty in enrolling, multiple trips to the County office to 

qualify, county refusal to take options like face-to-face waivers that are allowed, 

etc. Clearly, a simple sheet of paper or online version of the application is preferable to the complex, nearly impossible to translate into 100 languages that 

we now have. Honestly, Hmong neighbors have told me that my County calls 

in the Janitor to interpret for applicants, or the 10 year old children are the 

family representatives. This is truly crazy. Increase the administrative Federal 

share, so that services offered can be rendered to eligible families.

7. Last, require California to enroll elders in Food Stamps. The irony is that 

some 40 years ago, California took some ‘options’ offered by USDA and they are 

still in place, although most all other states have rejected and reformulated 

their Food Stamp/SNAP rules. Federal Legislation calls out that California SSI/

SSD recipients cannot receive food stamps, even though they qualify by income. 

So, we have elders (about to grow into a larger poorer group because of the 

Baby Boomers) not eating in order to keep their home, or pay for medications 

and transportation, or because they are feeding their grandchildren, and becoming ill. I request that you see that the Federal exception for California is taken 

out of the Federal register, and require the State of California to directly enroll 

all SSI/SSDI recipients automatically, now.

What if we fed people? What if we saw to it that the bounty of what we produce 

gets eaten, through normal channels, like purchasing at the store? The clear distance between producer and consumer has become larger, more bloated, and the inbetween distribution and processing is taking the money and seeing to it that the 

farmer does not get enough to farm, and the consumer pays too high a price for 

unhealthy, over processed food. The Federal nutrition programs can and should be 

made available to all who qualify. If people are fed reliably and healthily they can 

pay their rent, and begin to address work and education, and be contributing citizens. There is plenty of food, and we can assure through Food Stamps and other 

programs that all those eligible are enrolled. Thank you. 

Additional Federal Nutrition Issues 

Breakfast, lunch, summer lunch: School districts need adequate Federal reimbursement. 

Quality of food in school programs must be improved and funded adequately, and 

incentivize local purchase. 

In California, Counties are allowed one of four computer systems that do not communicate with each other. Each state should engage one computer system for Food 

Stamps. 

Elevate Federal nutrition programs to the status of Health Care, because Federal 

nutrition programs are Health Programs. Perhaps, a joint initiative with HHS? Or 

National Institute of Health? 

Incentivize EBT purchase of fruits and vegetables with bonus added to EBT for 

such purchases. 

Sustainable food system: Local and regional distribution should be priority, and 

replace current commodity structures in the USDA. This will re-create vibrant farm 

to table and institution results, and economic viability in the agricultural areas of 

the country. 

Require Farmers to overtly support all USDA programs, including SNAP as part 

of their subsidy acceptance.

The CHAIRMAN. Thank you very much. At this time I am going 

to let Congressman Jim Costa make a quick comment because he 

has to leave to attend another hearing in LA. 

Mr. COSTA. Yes. I want to thank all the witnesses and I want 

to thank you, Mr. Chairman and Congressman Fortenberry for 

bringing this very important hearing to California. Edie, I want to 

take up your challenge so let us set up some time back in Fresno, 

let us bring the people together. Let us see if we can make progress 

48

in stopping the finger pointing and maybe take advantage of some 

of your suggestions and see if we can implement them. 

Ms. JESSUP. Thank you. 

Mr. COSTA. Thank you very much, Mr. Chairman. 

The CHAIRMAN. Thank you. 

At this time we will continue with Mr. Marsom. 

STATEMENT OF MATTHEW MARSOM, DIRECTOR OF PUBLIC 

HEALTH POLICY AND ADVOCACY, PUBLIC HEALTH

INSTITUTE, OAKLAND, CA 

Mr. MARSOM. Good morning. My name is Matthew Marsom, Director of Public Health Policy with the Public Health Institute. PHI 

is an independent, nonprofit organization dedicated to promoting 

health, well being and quality of life for people across the nation 

and around the globe. 

I want to thank Chairman Baca and the Members of the Committee for providing PHI with the opportunity to testify today regarding the Federal nutrition programs. For more than 20 years 

PHI has partnered with the California Department of Public 

Health to implement a series of programs and initiatives focused 

on nutrition education and obesity prevention. This includes the 

state SNAP-Ed Program. Recently we were successful in securing 

funding from the Kaiser Permanente Foundation to help the state 

get ready for its Healthy Incentive application to USDA. 

In the time I have this morning I would like to focus my remarks 

on SNAP-Ed, a Federal-state partnership that provides matching 

reimbursement funds to support nutrition education for low-income 

persons currently and potentially eligible for SNAP. In California 

SNAP-Ed is overseen by the California Department of Social Services and delivered through an inter-agency agreement with the Department of Public Health and the University of California. The 

state’s largest SNAP-Ed initiative, the Network for a Healthy California, targets an estimated seven million SNAP-Ed eligible children and parents in this state alone. 

I would like to outline some specific steps that we believe would 

help position SNAP-Ed as a central pillar in our effort to confront 

the twin threat of obesity and hunger that threatens the health of 

our children. We have already heard today about the impact of obesity in the United States. I won’t dwell on that again other than 

to say that Food Stamp recipients live in the most under-served 

communities where environments make healthy choices challenging 

if not impossible. 

In the context of these environments SNAP-Ed programs work to 

improve the likelihood that program participants will make healthy 

choices. It is important to say that throughout the United States 

SNAP-Ed programs are doing tremendous work to promote healthy 

behaviors and help families make a healthy choice. However, the 

program can do so much more than that. SNAP-Ed programs can 

be a lynchpin linking together other Federal nutrition programs 

and initiatives to address access to healthy food while addressing 

hunger and obesity. 

Unfortunately, however, current USDA program guidance restricts allowable SNAP-Ed activities to focus primarily on tradiVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00052 Fmt 6633 Sfmt 6601 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
49

tional educational approaches, which when used alone are often inefficient, outdated, and a poor use of limited resources. 

The program rules established during the prior Administration 

significantly limit the use of effective and proven environmental 

and system change approaches and social marketing approaches 

learned from business and the private sector. This is despite a wide 

body of research that illustrates the power of these methods to deliver sustainable improvements in eating habits and other lifestyle 

changes. 

Quite simply, the present program guidance makes it cumbersome, costly, or impossible to successfully execute state and 

local programs. 

USDA can take immediate and no-cost steps to unlock the potential of these programs and allow them to play a greater role in 

helping to address childhood hunger. Specific actions are as follows: 

First, SNAP-Ed programs should be encouraged to use their existing Federal share to support population-based, evidence-driven 

targeted interventions including social marketing, mass communications, and environmental and policy change approaches that 

reach the audience where they live, where they work, where they 

go to school, where they pray, and where they make their food and 

physical activity choices 

Second, state and local programs must be able to take advantage 

of techniques that support healthy behavior change at the individual level by addressing social, environmental and community 

factors that currently limit their healthy choices. 

Third, USDA should allow state and local agencies to use SNAPEd reimbursement funding to conduct marketing campaigns that 

increase participation in the Federal nutrition programs, especially 

in SNAP, but also school breakfast, summer meals, after-school 

snack, and the Child and Adult Care Food Program. 

Finally, Congress and USDA should allow SNAP providers to 

conduct counter-marketing campaigns that address the marketing 

of unhealthy foods and beverages, particularly marketing to children, learning a lesson from the strategies and innovations that 

work so well for tobacco control here in California and elsewhere. 

These efforts should be accompanied by education and promotion 

to increase demand for healthier food including fresh fruits and 

vegetables. 

By empowering parents and their children to make healthy 

choices, SNAP-Ed can and must play a greater role in improving 

dietary and physical activity practices, while helping to increase 

community food security, prevent obesity and reduce the risk of 

chronic disease for low-income Americans. 

We have welcomed the willingness of the new leadership at 

USDA under the direction of Secretary Vilsack and Under Secretary Concannon to engage with those of us who are seeking these 

changes. However, to date we have yet to see any specific proposals 

to undo the harmful and costly rules that were instituted during 

the prior Administration. Thank you very much for the time. I can 

answer any questions. 

[The prepared statement of Mr. Marsom follows:]

50

PREPARED STATEMENT OF MATTHEW MARSOM, DIRECTOR OF PUBLIC HEALTH POLICY

AND ADVOCACY, PUBLIC HEALTH INSTITUTE, OAKLAND, CA 

Introduction: Good morning. My name is Matthew Marsom, Director of Public 

Health Policy with the Public Health Institute (PHI). PHI is an independent, nonprofit organization dedicated to promoting health, well being and quality of life for 

people across the nation and around the world, and one of the largest and most comprehensive nongovernmental public health organizations in the nation. 

I want to thank Chairman Baca and the Members of Subcommittee for providing 

PHI with the opportunity to testify today regarding the Federal nutrition programs. 

We are pleased to have the opportunity to provide our perspective and recommendations on this important topic. 

For more than twenty years, PHI has partnered with the State of California to 

assist the California Department of Public Health (CDPH) implement a series of 

programs and initiatives focused on nutrition education, obesity prevention, and 

chronic disease surveillance, including the statewide SNAP-Ed program. This close 

working relationship and our decades of experience in program implementation provides PHI with a unique perspective on the status of the Federal nutrition programs 

in California, and specifically in regard to their impact on public health and food 

insecurity. 

The impact of the obesity epidemic confronting the United States is not news to 

any of us here today. Obesity is linked to increased risks for many serious diseases, 

including type 2 diabetes, heart disease, stroke, and some cancers. The costs in 

healthcare, disability, workers compensation, and economic losses from lost worker 

productivity are matched by the personal toll on individuals and their families. 

People with low incomes, including those in households eligible for food stamps, 

are at highest risk for chronic disease resulting from poor eating and inactive lifestyles. Food stamp recipients live in the most underserved communities, environments where making healthy choices can be challenging, if not impossible, due to 

a lack of safe, well-equipped and well-maintained places to walk and play; lack of 

nearby retail stores and other services within walking or biking distance; inadequate access to supermarkets and reliance on local corner stores; and a higher concentration of fast-food outlets. 

In these circumstances, food stamps can provide an essential resource for low-income families, helping to ensure that very-low-income Americans can afford a nutritionally adequate diet. Good nutrition underpins public health, education and work 

productivity, and food security is a fundamental social determinant critical to community well being. 

However, despite the tremendous need and the importance of the program, still 

too many eligible Californians are going without the benefits to which they are entitled. According to recent data from UCLA, among the 3.1 million adults in California struggling with food insecurity, 77 percent do not receive food stamps. California is second to last in the nation for overall participation in the Food Stamp Program and last in the nation for participation amongst the working poor. The need 

has only increased due to the current economic crisis, making these figures all the 

more alarming. Although the Federal nutrition assistance entitlement programs are 

designed as a nutrition safety net, many are under-used and operate in silos. 

Today, I would like to describe a series of recommendations that we believe would 

help to enhance SNAP and other Federal nutrition programs and ensure that they 

can better help to confront the twin threat of obesity and hunger that threatens the 

health of our children. 

Program Participation and Outreach:

1. Congress and USDA should establish cross cutting national participation targets for all Federal programs and reduce penalties and sanctions for errors in 

eligibility, instead providing stronger, non-competitive incentives to state and 

local agencies that increase program participation. For waivers or mandates intended to increase participation but which require new administrative costs or 

expensive retrofitting of computer systems, USDA should provide administrative supplements to offset the initial costs of system upgrades. USDA should institute monitoring and evaluation systems that report to the public regularly on 

rates of food insecurity and progress of Food and Nutrition Service (FNS) program access and participation.

2. USDA should revise Federal program requirements to ensure that barriers 

to full participation are minimized:

• Index eligibility criteria to actual cost of living: To end childhood hunger successfully, income eligibility criteria should not exclude children whose families 

happen to live in high-cost states. To extend eligibility to all families facing 

51

food insecurity, USDA should index income criteria for food assistance program eligibility to local or regional cost of living, such as the ACCRA Cost 

of Living Index or other recognized measure, rather than the nationally-applied Federal Poverty Level (FPL).

• Improve access and reduce stigma to food assistance program participation 

and implement Electronic Benefits Transfer (EBT) for delivery of the Women, 

Infants and Children’s Nutrition Program (WIC) to mirror SNAP.

• Reduce administrative barriers to full participation in child nutrition programs, for example:

—Allow state WIC agencies the option to certify children for a period of 1

year, aligning with the current policy for other participants and ensuring

the availability of resources for nutrition services; and

—Align WIC screening for iron-deficiency anemia with lead and substance

abuse protocols by referring to medical care when verbal screening criteria

are met and removing the requirement to document blood tests.

—Use SNAP and Temporary Assistance for Needy Families (TANF) categorical eligibility to qualify all school-aged children in families for free meals,

not just individual students.

—Eliminate the current tiered system in the Child and Adult Care Food AtRisk Snack Program to encourage greater participation by family daycare

homes.

3. USDA should mobilize its resources to establish technical assistance networks for community food security that can be available to help states and localities with adapting, implementing and taking to-scale successful techniques, 

methods, and initiatives from throughout the country. Topics and activities that 

could be part of such technical assistance networks for the nation include: community food system assessments, Electronic Benefits Transfer (EBT) in farmers’ 

markets, corner store conversion projects, community-supported agriculture, 

farm-to-fork sourcing, state or local food policy councils, agricultural preservation, small farm and new farmer programs, and community/school gardens. This 

low-cost network might be established using grants or cooperative agreements 

with nonprofit public health, anti-hunger and food security organizations; the 

existing Cooperative Extension system; FNS programs; partnerships with other 

sectors like foundations, nonprofit health plans, insurers and hospitals; and sister Federal agencies like the Centers for Disease Control and Prevention (CDC), 

Department of Transportation, Department of Education, and Housing and 

Urban Development.

4. In SNAP, USDA should modify the use of the Thrifty Food Plan as the fiscal 

base for SNAP and increase the benefit value to accommodate the generallyhigher prices of healthy food and regional variability in cost of living, allow retailers to offer EBT customers sale—and promotional prices for healthy foods 

such as fruits and vegetables and push for higher standards for retailers to provide for the availability of fresh foods in all four food categories. This would 

have the benefit of increasing the availability, accessibility and—possibly—

lower the price of healthy food in many low-income communities.

Supplemental Nutrition Assistance Program Education (SNAP-Ed):

One Federal nutrition program that is a lynch pin, linking together opportunities 

to address access to healthy food, while addressing hunger and obesity, is SNAPEd. 

SNAP-Ed is a Federal-state partnership that provides matching reimbursement 

funds to support nutrition education for low-income persons currently and potentially eligible for SNAP. Prior to the renaming of the food stamp program in the 

2008 Farm Bill, SNAP-Ed was known as Food Stamp Nutrition Education, or 

FSNE. SNAP-Ed programs improve the likelihood that SNAP participants will make 

healthy choices within a limited budget and choose active lifestyles consistent with 

the current Dietary Guidelines for Americans and MyPyramid.gov.

In California, SNAP-Ed is overseen by the California Department of Social Services (CDSS) and delivered through interagency agreements with the CDPH and the 

University of California. CDPH has established the Network for a Healthy California (Network) which supports a comprehensive statewide nutrition and physical 

activity campaign, working through diverse channels and hundreds of local programs to target an estimated seven million SNAP-Ed eligible parents and children. 

Throughout the United States, SNAP-Ed programs are doing tremendous work to 

promote healthy behaviors and help low-income families understand the importance 

of a healthy choice. However, current USDA FNS program guidance restricts ‘‘allowVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00055 Fmt 6633 Sfmt 6621 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
52

able SNAP-Ed activities’’ to focus exclusively on traditional approaches which, when 

used alone, are often inefficient, outdated and a poor use of limited resources. 

The rules, established during the last Administration, significantly limit the use 

of effective and proven social marketing interventions and disallow the use of environmental and system change approaches despite a wide-body of research that illustrates the power of these methods to deliver sustainable improvements in eating 

habits and other lifestyle changes. The present guidance makes it cumbersome, costly or impossible to successfully execute state and local programs. 

The current USDA guidance also restricts state programs from effectively reaching large proportions of their target populations. In California over half of the SNAP 

population lives outside USDA approved SNAP-Ed Census tracts and the figure is 

as much as 90 percent in some rural states. 

Congress has already acted to address these problems and provided direction in 

the Manager’s report that accompanied the 2008 Farm Bill, stating that ‘‘The Secretary will support and encourage implementation of the most effective methods for 

nutrition education . . . consistent with recommendations of expert bodies. Dietary 

and physical activity behavior change is more likely to result from the combined application of public health approaches and education than from education alone’’. 

We have welcomed the willingness of the new leadership at USDA, under the direction of Secretary Vilsack and Under Secretary Concannon, to engage with those 

of us who are seeking these changes to the program. However, we have yet to see 

specific proposals to undo the harmful and costly rules that were instituted during 

the prior Administration. Timing is critical to make changes to the USDA SNAPEd guidance so that state programs can most effectively use the state and Federal 

dollars currently being spent on nutrition education. 

USDA can take immediate no cost steps to unlock the potential of SNAP-Ed and 

allow state and local programs to play a greater role in helping to address childhood 

hunger and prevent obesity Specific actions are as follows:

1. SNAP-Ed programs should be encouraged to use existing Federal share to 

support population-based, evidence-driven public health interventions—including community-based social marketing, mass communications, and environmental and policy change approaches—that reach the target audience where 

they live, work, go to school, and make their food and physical activity choices.

2. State and local programs must be able to utilize approaches that enable and 

support healthy behavior change at the individual level by addressing social, 

environmental and community factors that limit healthy choices.

3. USDA should allow state and local agencies to use administrative funds and/

or SNAP-Ed reimbursement to conduct marketing campaigns that increase participation in the Federal nutrition programs, especially in SNAP, school breakfast, summer meals, after-school snack, and the child and adult care food program.

4. Congress and USDA should encourage all nutrition assistance programs, including SNAP-Ed, to conduct counter-marketing campaigns to address the marketing of unhealthy foods and beverages, learning a lesson from the strategies 

and innovations that worked so well for tobacco control here in California and 

elsewhere. In addition, where food is sold a` la carte or in vending machines, 

programs should take other steps such as increasing the prices of competing 

foods like soft drinks, other sweets, salty snacks, and deep fried foods to help 

lower the prices of healthy foods like fresh fruits and vegetables, low-fat milk 

products, whole grain products, lean and vegetarian protein sources. These efforts should be accompanied by education and promotion that increase demand 

for healthier food, including fresh fruits and vegetables.

By empowering parents and their children to make healthy choices, SNAP-Ed can 

and must play a greater role in improving dietary and physical activity practices, 

while helping to increase community food security, prevent obesity and reduce the 

risk of chronic disease for low-income Americans. 

PHI welcomes the opportunity to work Congress and USDA to identify measures 

that can identify and remove obstacles limiting the reach, impact and effectiveness 

of the Federal nutrition programs, including SNAP-Ed, and create sustainable 

healthy change in underserved communities. We believe these programs are a central pillar in a concerted effort eliminate childhood hunger and provide the opportunity to address poverty, a root cause for health, social and economic problems that 

affect a growing number of Americans. In many cases, the simplest solutions have 

little or no cost and may in fact generate considerable savings over the long-term. 

In addition, many of the recommendations I have outlined here and echoed by others testified today can help to simultaneously address the scourge of obesity and 

53

overweight in children and adults that leads to ill health and perpetuates the cycle 

of poverty. 

Thank your for your time and consideration of our recommendations. I am happy 

to answer any questions you might have.

The CHAIRMAN. Thank you very much, Mr. Marsom. 

At this time I would like to call on Ms. Claudia Page. 

STATEMENT OF CLAUDIA PAGE, CO-DIRECTOR, THE CENTER 

TO PROMOTE HEALTHCARE ACCESS, OAKLAND, CA 

Ms. PAGE. Good morning and thank you for the opportunity to 

share some comments. I am the Co-Director of a nonprofit organization that is focused on using technology to connect low-income individuals with public and private benefits for which they may be 

eligible. We created a system called One-e-App. It stands for One 

Electronic Application. It is a web-based system that screens individuals for a variety of programs such as Medicaid, food stamps, 

SCHIP, Earned Income Tax Credit, low-income energy subsidies, 

and more. It is used in California, Arizona, Indiana, and Maryland 

as one channel, and not the only channel, to connect families with 

benefits for which they may be eligible. 

In those states it is used both by the individuals who help families who work at community-based organization and clinics and 

hospitals and food banks. It is also used by families themselves in 

some locations. In the State of Arizona consumers themselves go 

online and apply and in several places in California that is happening. 

The goal of One-e-App is to bridge the silos that exist between 

all of these various programs. We know that food stamps and Medicaid, Earned Income Tax Credit and all of these programs live in 

silos whether it is around the financing streams, the administration of those programs, the systems, or the application forms. What 

One-e-App has done is create a front-end that is modeled somewhat 

on Turbo Tax®, asking questions that are relevant, error checking 

the data, making sure that data is complete. On the back-end, and 

wherever possible it is delivering that data electronically for final 

determination. 

We have integrated fully in the State of Arizona so that when an 

applicant is applying for Medicaid, food stamps, TANF, the data 

goes directly into the state system and disposition is returned. In 

California that journey is different, mostly because of the county 

variation and the presence of 58 different county systems. 

We have been successful in that integration and that integration 

is one of the most important factors in terms of deficiency for the 

administrators in preventing manual data entry of all these paper 

forms, and for the consumer because the loop is closed more fully 

when their data gets there electronically. We have screened, to 

date, 3.3 million people using One-e-App and we have generated 

applications for over six million different programs. 

In terms of Food Stamps, Food Stamps is a relative newcomer to 

One-e-App in California, but we have some important pilot efforts 

underway including: a partnership with Los Angeles unified school 

district to test public kiosks; and a partnership with the California 

Association of Food Banks, with whom we built a fast track in Onee-App to assist in applying for Food Stamps. 

54

In Arizona, where One-e-App is available statewide, in the last 

calendar year 230,000 households representing 625,000 people submitted Food Stamp applications, 70 percent of them without assistance and 70 percent of those applications were approved. 

We are sort of on a journey that some have called radical 

incrementalism. We started with the health programs. We realized 

quickly that once you ask a family the questions you need for Medicaid there is not a lot left to ask a family. Certainly when you 

combine Food Stamps and Medicaid you have an incredibly rich set 

of data that can be used to see if people qualify for really important 

programs like Earned Income Tax Credit which also brings important resources and helps with fiscal stability of communities and 

local communities. 

This work is not without challenge. Systems reform is incredibly 

difficult. Our success is only because we have had important visionary leaders and partnerships with our states and counties. I just 

wanted to mention a couple of the challenges and some things that 

have been mentioned today that can help to overcome those. 

Using technology to have systems talk to one another is incredibly important. Back-end data matches help to reduce cumbersome 

documentation requirements; and linkages between programs, 

other means-tested programs. While the systems may exist in silos, 

an individual’s need does not exist in a silo and their eligibility and 

need for one program usually suggest their need for additional 

services. 

Some of the other recommendations you heard here today, removing mid-year reporting requirements, increasing the use of innovations like telephonic signatures, removing fingerprinting in 

interviews. Those are the kinds of barriers that make technology 

not as efficient as it can be and that, ultimately, prevent people 

from becoming more seamlessly involved in the programs for which 

they are eligible. 

I will be happy to talk about some of the pilot projects underway 

and answer any questions. Thank you very much for your attention 

to this important issue. 

[The prepared statement of Ms. Page follows:]

PREPARED STATEMENT OF CLAUDIA PAGE, CO-DIRECTOR, THE CENTER TO PROMOTE

HEALTHCARE ACCESS, OAKLAND, CA 

My name is Claudia Page and I am a Co-Director at The Center to Promote 

HealthCare Access (The Center), a nonprofit technology solution provider improving 

quality of life by connecting people to needed public benefits. The Center’s signature 

solution is One-e-App, an innovative, one-stop, Web-based system for connecting 

families with a range of publicly funded health and human service programs. My 

comments today on participation in Federal nutrition programs will be offered 

through this One-e-App lens. 

The Center works with a variety of states, including the State of California and 

15 California counties, to use One-e-App software to screen and support enrollment 

of families in programs ranging from SNAP (i.e., Food Stamps) and WIC to Medicaid 

and Earned Income Tax Credit (EITC). Nationally, adoption of the One-e-App technology is increasing. To date, One-e-App, has been used to screen more than 3.3 million people, generating roughly six million applications for more than 20 programs. 

Food stamps (SNAP) was implemented less than 2 years ago in Arizona and more 

recently in a couple of California counties. In this short time, more than 627,500 

of these people were screened potentially eligible for Food Stamps through One-eApp and applications were submitted for final determination to states or counties. 

The opportunity to provide testimony on this topic is timely and important. While 

technology is not a cure-all for the myriad enrollment challenges families face, it is 

55

a critical component in bridging the ‘‘silo phenomenon’’ and improving the enrollment process for Federal nutrition and other health and social services programs. 

Further, conversations around Federal healthcare reform provide a potential opening to promote broader enrollment reform, with improved systems development, 

data sharing and a more thoughtful way to support families and make sure they 

do not fall through the cracks as major new enrollment changes are rolled out. 

I will focus my comments on discussing the ‘‘silo’’ phenomenon and missed opportunities to connect needy individuals with assistance and the One-e-App experience 

in bridging the silos created by complex disconnected enrollment processes. I will 

also provide suggestions for overcoming challenges related to using technology to 

improve access and participation. 

Context and the Silo Phenomenon 

If there was ever a time to focus attention on the efficiencies of the screening and 

enrollment process for low-income families into public benefits, now is that time. 

Hundreds of thousands of Americans have lost and continue to lose their jobs, their 

homes and their savings as a result of severe economic stress at both state and national levels. 

For county and state governments this means increased demand for government 

sponsored programs such as Food Stamps and Medicaid. Governments are facing 

the largest budget crisis in recent history and have cut and furloughed staff, with 

additional cut backs likely in coming months. Government cannot afford to do business as usual under these circumstances. Technology offers promise in redeploying 

the workforce to focus on high-value tasks like answering substantive questions 

about benefits programs instead of tasks like manually entering data from paper 

forms, denying applications when hand writing cannot be deciphered, correcting 

common errors, dealing with duplicate applications and rescheduling missed appointments. 

For applicants, the current process of applying for programs for which they may 

be eligible in the current environment means waiting in long lines (sometimes snaking outside offices along sidewalks), completing multiple paper forms (supplying 

much if not all of the same information each time), traveling to different locations 

sometimes multiple times and navigating an incredibly complex maze of referrals 

and programs. Imagine a single mother trying to hold on to a low-wage job, who 

cannot pay for child care and who’s car has been repossessed; applying for the very 

help that may change her situation has become nearly impossible. Ultimately, this 

siloed approach results in missed opportunities for assistance because there is no 

one place to be screened for all programs. 

One-e-App was created to not only bridge silos between programs but to equip 

community support networks and families with channels and tools to do more for 

themselves and to relieve pressure on already constrained state and county social 

services and Medicaid departments. The goal is to help communities and government better serve individuals and families. 

One-e-App Solution 

One-e-App is essentially like a ‘‘turbo-tax’’ for public and private benefits: it is 

available online, the system is intuitive and asks only relevant questions, data is 

error checked and complete, data is stored and retrievable and the system can 

transmit data and documentation electronically where needed for final dispositions. 

Created in 2002 to support enrollment in a variety of health programs, over the 

last several years the system has evolved to include a range of government and nongovernment health and social services programs. The following programs are currently available in One-e-App. 

Programs: 

• Food Stamps.

• TANF (Temporary Aid to Needy Families).

• Medicaid.

• SCHIP.

• Early Periodic Screening Diagnosis and Treatment (EPSDT).

• School Lunch Medicaid (known as Express Lane Eligibility (ELE—a School 

Lunch and Medicaid linkage) in California.

• County Indigent Care and Coverage Expansion Programs (for adults and children).

• Kaiser Permanente Child Health Program.

• Kaiser Permanente Bridge Program.

56

• Medicare Cost Sharing.

• Sliding Fee and Charity Care Programs.

• Family Planning.

• Cancer Detection (Breast, Cervical and Prostate).

• Supplemental Nutrition for Women, Infants and Children (WIC).

• Earned Income Tax Credit (EITC).

• Voter Registration.

• General Assistance.

• Discount Utility Programs.

• Low Income Auto Insurance.

• Child Tax Credit.

• CalKIDS Health Programs.

• Pharmacy Discount Programs.

• Hospital Charity Care Programs.

• Work Force Investment Programs (under development).

• And other local programs.

One-e-App integrates with other systems to electronically deliver applications and 

supporting documentation and signatures for many of these programs. Electronic 

interfaces have been built from One-e-App to state systems in Arizona and state and 

county systems in California. In addition, Maryland is in the process of building an 

interface from its version of One-e-App to the state system for Food Stamps, Medicaid and other programs. One-e-App also interfaces with a variety of other entities 

including PG&E, Kaiser Permanente, health plans, patient management systems, 

electronic health records, U.S. Postal Service for address verification, and more. 

Innovation and Impact 

One-e-App is currently used in Arizona, California, Indiana and Maryland by 

state and county workers and community-based assistors in hospitals, clinics, 

schools, health plans and other locations. With local and state partners, The Center 

is testing new approaches to streamlining access to nutrition and other programs. 

Activities include: 

Bridging the Silos—Full Integration to State Systems: 

In Arizona, One-e-App has been fully integrated with the state systems enabling 

applicants to apply across a range of programs. Applications and supporting documents can be delivered and shared via a fully electronic approach. Disposition data 

is provided so applicants know the outcome of their application. This fully integrated approach is the first of its kind in the nation. Maryland is also going to be 

adopting this model and One-e-App, known there as Health-e-Link, should be fully 

integrated across all state and local programs by the end of 2010. 

Public Access:

• In Arizona and California (and soon in Maryland) One-e-App is publicly accessible, which means applicants themselves go online (at home, libraries, school 

computer labs, work) to complete and submit applications.

• Publicly accessible One-e-App (called Health-e-Arizona in AZ) launched in Arizona on December 15, 2008, and at the end of 2009 nearly 230,000 households 

submitted Food Stamps applications electronically to the state. This represents 

almost 626,000 individuals applying for benefits. Of the applications submitted, 

68% were approved or benefits were retained (some applications are renewals 

or change reports.) The approval rate would likely be over 90% had the applicants followed through with interviews and provided verifications (75% of denials are for failing to follow through). Of the 230,000 Food Stamps applying 

households, more than 217,000 (almost 95%) had at least one individual likely 

eligible for Medicaid.

• In Los Angeles, One-e-App is available via public kiosks located at school enrollment sites where families can complete the application process themselves, or 

with assistance from on-site counselors. In Fresno, applicants can apply from 

home, libraries and other locations. 

Fast Track for Food Stamps: 

In California, the One-e-App system also provides a newly created ‘‘Fast-Track for 

Food Stamps’’ that allows Food Banks to assist with the Food Stamps application 

57

process while a community partner completes the application process for additional 

programs, using the electronically stored data and documentation from the Food 

Stamps application as the starting point. This approach allows resource-strapped 

Food Banks to more effectively assist with Food Stamps applications while 

leveraging the effort to assist families with other programs. Pilot initiatives are underway in Humboldt, San Diego and soon in Alameda and Fresno. 

Impact of Missed Opportunities to Reach and Enroll in Public Benefits 

As you will have heard from others providing testimony, low uptake in benefits 

programs results not only in missed support for families, but also in missed revenue 

for local economies. 

Earned Income Tax Credit (EITC) program: One-e-App screens for EITC and calculates the projected refund families will likely receive, based on data provided. To 

date, One-e-App has referred users to roughly $1.8 million in EITC credits. It is important to note that we did not add a single question to the system to be able make 

this preliminary calculation for EITC; the questions asked of the applicant to calculate eligibility for other programs is sufficient to make the EITC calculation. This 

means no added work for assistors helping families, but significant opportunity for 

families to be connected with what is considered to be the most powerful anti-poverty tool, and one of the most underutilized. The dollars received by families 

through the EITC program make their way back to the local economy, thus supporting local economic activity. 

Food Stamps: Missed participation in Food Stamps results in lost revenue for 

local economies. With each dollar of food stamp benefits generating $1.84 in economic activity, in Arizona alone, connecting households to Food Stamps through 

One-e-App has put $50 million into local economies. 

Health Coverage: It is difficult to put a dollar amount on the enormous impact 

of uninsured and lack of health coverage. As an uncompensated Emergency Room 

visit costs a hospital $1,200 to $1,900, frequent utilizers of uncompensated Emergency Room care are therefor costly. Further, the downstream impacts of missed 

preventive care and lack of timely treatment are also costly (physically and emotionally for families who worry about children getting sick, or getting sick themselves.) 

Food insecurity does not exist in a silo. Those challenged to put food on the table 

are also likely struggling with health coverage, paying bills, keeping their homes 

and more. And the numbers are significant—on average, roughly 13 million people 

nationally are eligible but not enrolled in Food Stamps, nearly 3.1 million California 

adults are not receiving benefits and 645,000 residents in Riverside County alone 

suffer from food insecurity (data sources respectively: USDA, UCLA Center for 

Health Policy Studies, California Food Policy Advocates). In addition, nearly one 

million Medi-Cal recipients in California are also likely eligible for Food Stamps 

based on their eligibility for Medi-Cal, yet there is no linkage or connection for these 

families. 

So while hunger is a powerful indicator of need, when food insecurity is addressed 

as a stand-alone concern, we miss opportunities to more fully help families with 

other issues related to poverty. Similarly, when access to health coverage is addressed in a silo, we miss opportunities to connect eligible individuals with food assistance. There is an entrenched national history of creating silos around specific 

benefit programs, such as Food Stamps and Medicaid. These means-tested programs 

have separate financing streams, administrative oversight, technology systems and 

eligibility rules. 

Opportunities for Closing the Participation Gap 

The following suggestions for removing barriers would permit technology to be 

more effective at closing the enrollment gap in food and other assistance programs:

• Support development (create financing opportunities) of systems like One-e-App 

and create incentives to encourage states to permit data exchange in the way 

Arizona has done (with appropriate securities and safeguards). Similarly, to the 

extent appropriate, provide access to Federal systems (e.g., IRS, Federal IEVS, 

Federal housing programs). Experience in Arizona points to immediate opportunities to break down the silos through a community based tool that exchanges 

data in this way.

• Provide guidance to states on conducting data matches to establish linkages for 

other means tested programs such as Medicaid and Free and Reduced School 

Lunch. Conduct deemed eligibility for programs where a match is identified.

• Provide a mandate to state and counties to find secure and safe ways to accept 

applications electronically through a ‘‘One-e-App’’ or similar tool so that applicaVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00061 Fmt 6633 Sfmt 6621 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
58

tions can be received and processed electronically, thereby extending reach in 

the community and efficiency for administrators.

• Continue to promote ways to reduce the number of in-person meetings required 

to complete an application, including eliminating the fingerprinting requirement 

in California and other states requiring fingerprinting.

• Promote broader awareness and utilization of telephonic signatures and other 

innovations to streamline the enrollment process.

These recommendations do not have to be something that happen in the future; 

they can happen immediately. One-e-App has demonstrated success in bridging the 

silos and while broader systems reform is ultimately called for, modernizing enrollment in public benefits is complex and disruptive and will take years to accomplish. 

It is critical to start with immediate wins and ready partners while more integrated 

systems reform takes place through healthcare reform and driven by economic realities of maintaining outdated, disparate systems. 

The Center to Promote HealthCare Access is happy to provide more information 

or to connect interested stakeholders with One-e-App users. Thank you for the opportunity to share these comments and experience today and for your leadership on 

this important issue.

The CHAIRMAN. Thank you very much, Ms. Page. 

I want to thank all of you for your testimony. At this time we 

will begin with some of the questions, and I will begin myself by 

asking Dr. Valenzuela: 

Obesity is a major health crisis for our entire nation but, as the 

saying goes, the journey of 1,000 miles starts with the first step. 

I believe that we must tackle this issue not just from the Federal 

perspective, but head on at the local level. As someone who has 

vast experience in this field, what do you think is the key to obesity prevention at the community level? 

Dr. VALENZUELA. I believe that the only way that we can deal 

with this problem, especially in low socioeconomics, is through support in the community for the people’s effort and reinforcement. 

For instance, we recently told all our doctors to tell the patients, 

‘‘You need to do some exercise.’’ Reinforce exercise after each meal. 

But that patient as they go back into the community they don’t 

have any reinforcement support, they are going to go their own 

way. I think this has to be very important in order to succeed. 

The CHAIRMAN. Thank you very much. Part of the problem is 

that you as doctors can only see so many individuals and how do 

we then get educational institutions, the communities and others 

at the local level to do what needs to be done? USDA can only do 

so much in terms of marketing, whether it is TV or whether it is 

through other media, public broadcasting, or radio, or whatever 

else needs to be done. 

Dr. VALENZUELA. I think that you need to get involved with community-based organizations. If we educate and there are some 

funds in order to coordinate the effort, but it has to be coordinated 

through school and teaching by way of many institutions of higher 

education to provide some system. We can educate all the medical 

community, but it is very rare that you confront the patient being 

obese. 

It is an unpleasant conversation to have with a patient. It is difficult to actually bring up the issue and, therefore, it is something 

that we have to do and accept as a change in the culture in the 

community. I think we have to be with the doctors, be in the 

churches, be in the community-based organizations and everywhere 

in the schools, too. 

59

The CHAIRMAN. Thank you. I guess all of us realize we have a 

lot of work in partnership and collaboration. We all need to work 

and try to communicate throughout our communities, because we 

are looking at the effects. The cost is going to be on taxpayers. The 

consumers ultimately will pick up the cost in the era of obesity for 

everyone else if we don’t begin to address it. 

Dr. Wong, I thank you for your testimony on the obesity epidemic 

and its powerful impact on America’s children. The figures that you 

threw out, the expenditures on obesity topping $1 trillion by the 

year 2030, that is very alarming to a lot of us. Sometimes we don’t 

look at them, but we need to look at it because ultimately we are 

going to pay and people are not going to live longer. 

When you combine the losses in work productivity that obesity 

and chronic disease can produce, we need to really understand that 

obesity can literally bankrupt our society. I don’t think we really 

understand that yet. We have not come to grips with that yet and 

we need to. 

I think that is what we are trying to do now. The hearing that 

Congressman Fortenberry had in Lincoln, Nebraska, began to look 

at the importance of this issue, and its impact. With that what 

kind of role do you think nutrition education should play in our 

schools and why, Dr. Wong? 

Dr. WONG. It is a significant role that nutrition education should 

play because essentially what we are doing is re-educating the 

masses. We are going for a culture change. We have to use and utilize all of the means that we have available, systems issues, technological advances, and the collaboration of everyone in the community. 

However, what I feel is important is that we must rededicate 

ourselves to the family unit, rededicate ourselves to getting the 

message across to parents, because essentially parents are the role 

models for their children. Right now, unfortunately, children have 

many other role models that are not as nurturing. For instance, the 

television and movie industries and whatnot. 

Unfortunately, we have somewhat lost our way in my opinion. I 

think that with the aid of the medical community I have seen in 

my practice where parents actually listen to their medical providers with greater emphasis than, say, for instance other people 

in the community. I think that is a benefit that we need to explore. 

However, what we need to do is get down and talk to the parents 

and be able to avail themselves of some time to spend with their 

kids so that they can be role models again. 

The CHAIRMAN. Okay. Thank you. I know that there will be a 

second round of questions and I would like to follow-up. I know 

that my time has expired but I would like to ask Mr. Sharp. Again, 

thank you for your testimony. We are all aware of the tremendous 

impact that the current economic conditions have had on the demands for SNAP and benefits, but can you give us a better picture 

of how our budget crisis in the State of California is affecting the 

Administration’s nutrition programs like SNAP, WIC, and school 

lunch? I have the article by Arnold Schwarzenegger that says they 

are cutting back and 150 families may lose Food Stamp benefits. 

Mr. SHARP. Each of the Federal nutrition programs depends on 

a partnership at the state and local level that involves the adminisVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00063 Fmt 6633 Sfmt 6601 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
60

trative funding. For example, the state budget crisis that reduced 

funding for public schools in California by $4 billion in 2010 over 

2009 evidently makes it far less probable that nutrition education 

and physical education will be expanded. So it is within that context that there are a variety of challenges associated with expanding these programs. 

At the county Welfare Office level where these programs are administered, generally, in all 58 counties there are a range of hiring 

freezes and budget cuts. The Federal SNAP program has responded 

to that by providing an influx of additional administrative funds 

both in the Stimulus Act in February, as well as again this fall as 

part of the appropriations bill. There are a range of additional challenges associated with making one-time investments in the technology upgrades that you heard about from Ms. Page. 

There are a number of one-time investments needed to modernize the program that will ultimately generate savings but it is 

a time of extraordinary fiscal deficit. In Sacramento it is very difficult for policy makers to invest in these kinds of short-term improvements, even if they will pay long-term dividends. Identical is 

true with both WIC and the Child Nutrition Programs. 

The CHAIRMAN. Thank you. I know that we are looking at technology and I know Ms. Page made reference to it, but part of what 

I have heard, too, is that we are not talking to one another and 

we are not communicating in terms of the technology. 

Which is the best method and what do we need to do, for the 

most cost effective set of programs that can speak to one another, 

and at the same time provide the needed services? You can develop 

the new technology and the new programs, but with different programs within each county it presents a problem. 

Mr. SHARP. When food stamps was really expanded 40 years ago 

there was a strong Federal commitment to establish a minimum 

level of access in all the counties across the country. That sort of 

became a Federal program. Ever since then the USDA has put a 

great deal of attention towards trying to understand the different 

variations and participation. 

There is an extraordinary amount of evidence on this as well as 

on nutrition and health habits among participants. The challenge 

is to try and translate those components of knowledge and learning 

into different practices. That is very difficult given the multiple jurisdictions involved. The Federal Government has a clear established role, and in some of these cases it may need to be extended 

in order to ensure and establish new minimum floors in each of the 

program areas. 

The CHAIRMAN. Okay. One final question since Jim Costa is not 

here and I can ask the additional question. Of course, my colleague 

here can too. 

In your expert opinion what is the most important thing that we 

can do, and I state, what is the most important thing that we can 

do to increase SNAP or Food Stamp outreach in California in 

under-served communities? There are a number of them right here 

in this area. 

Mr. SHARP. There are a number of initiatives that are underway 

right now. Given the enormous scale of the under-served population which, as we mentioned earlier, is three million persons, 

61

there is not one strategy that is going to effectively engage all three 

million nonparticipating households. Many of those households will 

have had contact with either the Medicaid system, as I pointed out 

in my remarks, or have already applied for SNAP benefits and 

have been turned down or discouraged during the process. The single most effective strategy is to keep people on this program, or in 

the program, who have indicated an interest and desire in the government. 

The second would certainly be to ensure that the confusion that 

exist among Latino and immigrant households is clarified regarding the eligibility for these programs in a way that reassures families, particularly households that have immigrant parents and citizen children that their eligibility for this program is unaffected by 

the immigration status. I think those two areas, both ensuring a 

more seamlessly integrated application process that captures everyone that shows interest, as well as clarifying confusions regarding 

eligibility among immigrants. 

The CHAIRMAN. Thank you. I now recognize the gentleman from 

Nebraska for 5 minutes plus the additional time he needs to ask 

to make sure that we are working bipartisan. 

Mr. FORTENBERRY. You are all about fairness. This doesn’t happen in Washington by the way. Thank you, Mr. Chairman. Thank 

you all again for being here and for your insights and excellent testimony. Let me make a few comments that I think encapsulates 

some of what you said, Ms. Page, and what some of the doctors 

were referring to. 

One of the frustrations of being in public service, an elected official, is you inherit a big pipeline of institutional processes and procedures and you refer to silos. There is not an Administration that 

hasn’t come into office that says we are going to reduce the duplication. We are going to make systems talk to one another. We are 

going to ensure that if there is a nutrition program that existed 40 

years ago that is diminished that is in one department, it is simply 

not going to be replaced by the advent of another one. 

Sometimes, though, we ask questions in silos as well. We have 

a problem with hunger. We have a problem with assistance or people properly accessing assistance who deserve assistance. I think 

this comes back to the commentary that the doctors gave on the 

sociological problems here, the fragmentation in society. 

Dr. Wong, I think you did an excellent job, a courageous job in 

attacking that. You see this first hand because you doctors are 

more highly trusted than politicians. Well, not here maybe. So 

there is an honesty and a transparency in those relationships. You 

are clearly evaluating what is happening, not only in individual 

lives, but in seeing it over and over again you can generalize the 

broader difficulties that we are having societally in terms of family 

disintegration, in terms of poor role modeling that is out there, particularly in the media, the pervasive media, the problems of crime 

and community deterioration which prevent a child from playing 

outside which was normal for us, or walking to school. We may 

have to come up with a program that kids have to walk 30 minutes 

in school. This was unthinkable 40 years ago. You just walked to 

your school. 

62

These are some of the hard realities that are out there in addition to the pressures on educators who have to produce outcomes. 

These older interests of life skills and the rest of it are taking a 

second place as we are dealing with the emergency needs that appear to be before us. This is what is frustrating at this level because you have a responsibility to deal with both; an emergency to 

put out the fire, but what is causing this societal fragmentation in 

the first place. 

In that regard, though, given the prestige and trust that does 

exist with medical doctors particularly, one thing that I am concerned about is, again, and I hinted at it earlier, is the way in 

which we reimburse for services, the way in which you are paid. 

You have to make a living. You have huge opportunity cost in your 

own education and it takes a long time to get some place where you 

have a stable income. 

There is pressure on you, particularly given the supply meeting 

the demand, more and more demand, that you move someone along 

as quickly as possible with that which is, of course, efficacious but 

that which is also reimbursed. How do you reimburse for your time 

sitting down with a family and say, ‘‘You know, what the difficulty 

here is, you really need to try to get along. Your children need you. 

The consequences of this are habits that are being inculturated 

that are going to lead to disasters for your own children,’’ and such. 

That is a hard thing to do, I understand, but, again, you being 

on the front line of this social difficulty, I think it is something we 

can drive back to. As I was suggesting earlier, in terms of the way 

in which we reimburse, because if you saw someone that you know 

you could give some drugs or treatment to and be reimbursed. But, 

it would be better simply if they embraced some sort of lifestyle 

change that became disciplined around healthy foods or exercise or 

just simply personal interrelations. That could lead to better outcomes and reduce the pressures that we are feeling on this end, potentially, in the long term. That is probably a hearing in and of 

itself. 

It is the frustration that Congressman Baca and I see when we 

have real people in real pain and you have to put out a fire, but 

how do we get underneath this and change directions so that people are truly interconnected in communities, of affirmation where 

they live out life in hope and love with others. That is ultimately 

what the human heart is longing for. When you have that guess 

what happens? Health improves. It really does. That is a demonstrable fact. Mr. Sharp, you are clearly an expert on statistics. I 

think you would agree there is a direct correlation there. 

Mr. SHARP. Absolutely. 

Mr. FORTENBERRY. I just gave a speech. I was supposed to ask 

a question. Anyway, what do you think of that? 

Mr. SHARP. That was a very complicated question. Notwithstanding from a provider standpoint reimbursement is a major concern. From a pediatric standpoint historically we do not get reimbursed for anticipatory guidance or spending more time in educating families and trying to get families on board. 

Mr. FORTENBERRY. That’s true. 

Mr. SHARP. However, we do get reimbursed through other programs like pay for performance programs based upon outcomes 

63

management. Also we want our kids, our patients, to be well and 

we want out families to be well, or else we would not have been 

in this business in the first place. 

However, I think that one way to try to refocus on this particular 

issue is to really engage providers on early recognition. Some certain quantifiable aspects that we can recognize patients early, very 

early, and be able to direct them to community resources. We need 

a collaborative effort with other people in the community to be able 

to get the message out even when we won’t be able to get out that 

message because of time constraints. 

I think that physicians need to speak with one voice on this particular subject. Unfortunately, physicians don’t have a habit of 

doing that. However, it is important and physicians do recognize 

that. It is just another aspect to healthcare reform that we need 

to approach. 

Mr. FORTENBERRY. Thank you, Mr. Chairman. 

The CHAIRMAN. Just a quick comment in reference to Dr. Wong’s 

question. It is a good question that the gentleman from Nebraska 

asked about the reimbursement. You mentioned that we get reimbursed in other ways. I think that is what we have to address as 

well. When you start looking at oversight accountability, transparency, then we begin to ask questions why is so and so getting 

billed for A, Y, and Z when they provided something else out here. 

That is where we have the difficulties in Washington, D.C., when 

we are trying to look at dollars that are coming back into the area. 

So, we have to be very careful when we turn around and say we 

get reimbursed in other ways and not bill someone for something 

else when you actually provided the guidance during that period of 

time out here. 

I have a question for Ms. Jessup and this is not a question from 

me. This comes from Congressman Jim Costa and I told him that 

I would ask you. He told me to make sure I asked you this question. He says, ‘‘Thank you for being here representing Fresno. Your 

experience in the nutrition and hunger programs is much appreciated here. You mentioned that the county had concerns about 

rural municipalities transmitting data back to the county. What 

was the primary concern—errors on the forms?’’

Ms. JESSUP. This is in reference to trying to find ways to enroll 

people who live 80 or 100 miles away from where they have to 

apply for Food Stamps. Last summer in the midst of the real crisis 

around the food and the droughts in communities that have 40 to 

80 percent unemployment right now, I proposed that the county 

allow the municipalities to act as a place where people could apply 

for food stamps rather than trying to apply for them standing in 

110° heat while they were collecting not enough food. 

The county, I believe, is just worried about error rate. They are 

worried about having their hand spanked for enrolling somebody 

who maybe they find out later didn’t quite apply or didn’t have all 

the information, all the documentation that was required. It ended 

up not working out. It could have been a first step for folks, but 

it didn’t happen because they are afraid. They are afraid of making 

a mistake and that overwhelms the actual intent of the program 

and people aren’t enrolled. 

64

The CHAIRMAN. Thank you. He had an additional two questions 

and I am just going to submit for the record and I will give these 

to the staff here. As you mentioned in your testimony it makes it 

clear that you have seen firsthand the inefficiencies that can arise 

when Federal, state, and county authorities get into jurisdictional 

fights? How can all of these different levels best work together on 

an issue like nutrition education, and obesity prevention? 

Ms. JESSUP. Okay. I would particularly like to address the obesity prevention issue. Nutrition education, there is plenty of it and 

it is out there, and it isn’t the issue. I am very concerned in terms 

of the spectrum of prevention looks at things like individual behavior change and the kind of care that the physicians are talking 

about. At the other end, the end of policy and environmental 

change, is really a causal factor and it is multi-sectored, and it 

really is the area that we have to say, ‘‘This is not right and we 

can’t do it anymore.’’

I know that sounds pretty harsh but we really are moving into 

a difficult situation. 

The program I work with works in about 12 different sectors to 

create environmental change so that when the physician says, ‘‘You 

have to do better with your diet and physical activity,’’ they go 

back into a community where the zoning is such that there is food 

access for them that is healthy. That the parks are open and available and have safe places for people to be. 

Mr. FORTENBERRY. Can I interject, Mr. Chairman? 

The CHAIRMAN. Yes. 

Mr. FORTENBERRY. This is a very interesting point that we have 

unpacked in previous hearings. The actual access to healthy foods 

is another issue, not just retraining of habits. 

Ms. JESSUP. Yes. And so you can say that——

Mr. FORTENBERRY. Particularly in dense urban communities. It 

may be a little different where you are. 

Ms. JESSUP. Well, no. In dense urban communities and in the 

rural areas where there may only be a liquor store and that is 

where people get their food. Until we make those changes and create incentives for the business community to really—you spoke before about having to go back. Our distribution systems, the place 

in between the food and the person are broken, and we really do 

need to go back to that. Those are big environmental and policy 

issues around that. 

Fresno, the city, we made a policy change that will allow farmer’s markets in Fresno. Prior to that change they were not allowed, 

so we didn’t have farmer’s markets on every corner which is what 

you would expect. 

The CHAIRMAN. I think that is part of the problem we tried to 

address in the ag bill with fresh fruits and vegetables in the Snack 

program. 

Ms. JESSUP. Fresh fruits and vegetables, yes. Looking at those as 

our valued crops and relooking at subsidies, which I mentioned in 

my testimony. Otherwise, I would say that it really is the community, but that physicians may need to write prescriptions for food 

stamps or for school meals. It is an environmental change. It is an 

environmental change that we need to have happen. 

65

The CHAIRMAN. Mr. Fortenberry, you wanted to interject something? 

Mr. FORTENBERRY. This is clearly what I was driving at earlier, 

rethinking some of the frameworks in which the medical system 

interacts with patients, particularly if we have drawn the correlation between nutrition and healthcare outcomes. They have to be 

paid. I mean, they can’t do it and so they get paid for certain behaviors and not paid for others. 

These gentlemen are good public servants in the sense they are 

clearly on a mission because their patients want to be well, but 

changing the institution to incentivize that, particularly through 

reimbursements, is something we have to think through. I think 

that, again, is a way in which we do two things as I said at the 

beginning, improve outcomes and we reduce cost as they manifest 

themselves in the healthcare system and other poor outcomes like 

you were talking about depression, family disunity and the rest. 

Ms. JESSUP. I think that is so important. The California Medical 

Association has an obesity prevention program and is encouraging 

physician champions to actually talk to the wider public. It is op 

eds about the issue of what you are seeing. 

The CHAIRMAN. On that note, let me go on to ask Mr. Marsom 

a question as well. 

Can you give us some examples of effective marketing and outreach techniques for Federal nutrition programs that you have 

seen in communities across the United States and what makes 

these programs effective? 

Mr. MARSOM. That is the big question. I think there is one that 

we always like to share which started here in California. It was a 

local program that has now been expanded around the state which 

is Good Harvest of the Month. It is a program funded through 

SNAP-Ed. What happens in the schools and communities, where 

this program is taking place, is that they choose a different fresh 

fruit and vegetable every month and while that is seasonally and 

locally available they promote that in schools. 

These are low-resource, low-income schools. What happens is as 

they engage with the teachers and the students and also then with 

the parents. We have worked with retailers who are actually showing those products are selling out in the stores because the children 

come out of the classroom, they go home, they are in the grocery 

store with their parents and they say, ‘‘Oh, look. There is the blueberry. There is the squash that we talked about in the classroom 

today.’’ 

What we have been able to do at the state level with the SNAPEd funding is have a program that is comprehensive. I think the 

point that Edie raised is it is not enough just to do the education 

alone. I think, certainly, there are many families that need to have 

that basic one-on-one education, but what has been shown time 

and time again to work whether it be an obesity issue or smoking 

is you need to have a comprehensive approach in all aspects of people’s lives. At the faith community when people are at church they 

hear about healthy eating from their pastor or from the clergyman. 

When they are in the grocery store at the point of sale they can 

see the Five a Day message or the healthy eating message. 

66

When they are at school or when they are at work we have worksite promotional messages. What unfortunately is limiting the program’s success are the extremely burdensome administrative requirements which, while we understand the need and the importance of targeting, there comes a point where the expense of the 

administration of the program is turning away many local dollars, 

local funding that could be puts towards this to draw down Federal 

dollars into the state. 

It is unfortunate that Congressman Costa had to leave because 

as a result of the USDA rules I have referenced in my testimony 

Fresno County actually withdrew from the Federal program. They 

didn’t want to see their local dollars matched against the Federal 

dollars for more traditional one-on-one education. They realized 

that to address obesity to help the Food Stamp families they need 

to address the spectrum of prevention that Edie referenced so you 

are addressing the individual, you are addressing the interpersonal 

in the community, and you are addressing that norm. 

On any approach, to answer your question again, it has to be a 

comprehensive approach using media, using technology with the 

kids these days using online tools and resources as well, rather 

than just simply handing someone a brochure and saying, ‘‘Go out 

and eat healthy.’’

The CHAIRMAN. Thank you very much. I think we have to look 

at it from the positive point of view, especially as we look at fresh 

fruits and vegetables. For us adults we are trying to eat a lot more 

blueberries now because some of us can’t remember what we did 

on the last hole when we play golf. I would love to have that person 

jump back in, to remember. It goes right back to education as well 

saying, ‘‘This is what it does for the mind.’’ 

I am kidding. When we look at a child, if, in fact, they start eating those kinds of fresh fruits and vegetables perhaps their ability 

to think, their ability to act would improve their ability in the 

classroom. I think we have to approach it from that perspective as 

well, and not just from the perspective of saying, ‘‘Hey, I want to 

remember what I scored last time I swung the club.’’ The golf club 

that is on the golf course. I want to make sure I clarify that for 

the record. On the golf course, not anywhere else. Somebody had 

stories about being swung somewhere else, but I don’t want to 

mention where they were swung but on the golf course. 

Ms. Page, I would like to ask you a question: In your testimony 

you mentioned that a few California counties have already adopted 

the One-e-App process for SNAP. Which California counties have 

already adopted that process? That is question one, and question 

two, what do the results look like for these California counties? 

Ms. PAGE. Sure. The first county was Fresno County and the 

process isn’t just to flip the switch. Conversations had to take place 

with the county agency to discuss how applications would be received, because there is not an interface between One-e-App to the 

county system in Fresno. That is really one of the single biggest 

challenges. 

It is the same challenge faced in Los Angeles, which also includes Food Stamps and their version of One-e-App, but there is no 

interface between One-e-App and the county Social Services Agency. It means you have to have conversations about will the applicaVerDate 0ct 09 2002 09:12 Mar 22, 2010 Jkt 041481 PO 00000 Frm 00070 Fmt 6633 Sfmt 6601 I:\DOCS\111-41\55427.TXT AGR1 PsN: BRIAN
67

tions be mailed? Are you going to require that they be delivered in 

person? Would you permit a fax receipt? 

Those details are part of what we have been working out in both 

Los Angeles and Fresno and so the numbers, frankly, are kind of 

low as we have launched only in the last several months with both 

of those counties. We will now be able to start to analyze what kind 

of impact we have, and more importantly, look at why the impact 

isn’t greater in part looking at the integration issue. 

The other counties are—Humboldt County is going to launch in 

the next couple of weeks and there are organizations in Sonoma 

and Napa who also use the system, but it is not county wide. There 

are several other organizations and counties that will be coming 

onboard. 

I just want to say one thing about the adoption of food stamps 

which is that our journey really began with the health programs 

with a lot of our partners. This is the other challenge, that it was 

a bit of a paradigm shift to have traditional health organizations 

take on the responsibility of doing the screening and assessment 

for Food Stamps, Earned Income Tax Credit Programs, those other 

programs. It is going to be incremental, but the inroads that we are 

making and having a system that makes it more rational to do that 

screening is going to be critical to making a food bank that never 

does an assessment for a health program be willing to take that 

on. 

The CHAIRMAN. Okay. 

Mr. Fortenberry. 

Mr. FORTENBERRY. Just one more quick question. You well know 

how particularly in this state, but also at the Federal level, the resource constraints that we’re under. Are there ways to improve nutritional outcomes and participate in the paradigm shift, as you 

well stated, without expenditure of additional resources? 

The CHAIRMAN. This is open to any of the panelists. 

Mr. FORTENBERRY. That is my last question. 

Mr. SHARP. Let me do one that hadn’t come up yet at all which 

is that the dietary guidelines for Americans spell out a roadmap on 

how to live. There is a very slow process underway to align all the 

Federal nutrition programs to not only serve food that exemplifies 

the dietary guidelines but actually teaches those lessons. The most 

cost effective thing you can do within the current resources are to 

ensure that the programs are teaching the healthy habits that are 

intended. 

In 2004, you required the WIC program to update its food package accordingly and you need to establish the same expectations for 

the Childcare Food Program. There is a process underway with 

school lunch now to do that. As in the context of the previous panel’s discussion about this pilot program to incentivize, that would 

be a promising long-term direction within the limited fiscal constraints to try and target the benefits of SNAP more effectively. 

Unlike childcare and WIC there has not yet been a demonstration project to test out the cost and benefits of relative approaches. 

That is the general direction that public health is going is to restructure the guidelines, the meal patterns, the standards in order 

to both encourage the healthy habits, so that the healthiest choice 

68

is also the easiest choice and that is the best way to teach the lesson. 

Mr. FORTENBERRY. That is an interesting concept because the 

healthiest choice is not always the easiest choice right now, particularly, because of a lot of factors you pointed out, all of you 

pointed out. 

Ms. JESSUP. I would like to offer a suggestion of a joint initiative 

with Health and Human Services between the Department of Agriculture, which has the food, and the SNAP and nutrition programs. 

At that high level put the two together to weed out some of the 

silos between the two and to really make the point of the obesity 

issue real for the rest of the country. 

Mr. FORTENBERRY. Thank you. 

Mr. MARSOM. So quickly on the cost question. I mean, one of the 

unique and wonderful aspects about SNAP nutrition education, of 

course, is that it is a shared cost between the Federal Government 

and the states. But we also know, and elected officials are often especially aware of this, is the mass media is an extremely powerful 

way of reaching individuals and changing perceptions. However, it 

can be very costly. 

What we found in recent years in California where the state had 

tried to use mass media to reach the target population USDA had 

called us because when you are reaching an audience with mass 

media there are going to be people they use the term ‘‘incidental 

outreach.’’ There are people who are going to be watching or listening to a radio station who are not necessarily going to be eligible. 

They are going to be low income but perhaps not in the program. 

Headquarters USDA required that the state narrow the target to 

show that the maximum number of people who are reached are eligible. That actually cost a great deal more money. Consequently 

they actually reached fewer of their actual target population and 

that to me is where we get some fuzzy math going on. 

If we understand that the outcome is to reach the greatest number of the target population, and if we can show that using the 

types of evidence and media targeting that is available in the private sector, we on the public program should be using those types 

of expertise, that type of information. That way we can actually in 

the long-term reduce those costs. 

Another point specifically, we believe that if states were today allowed to use their existing Federal share to include some of these 

public health approaches, they could do so without increasing the 

actual Federal share of the program because that is how they draw 

it on the match. If they use the existing Federal money and just 

include maybe 20 or 30 percent of that to support public health approaches, we believe there could be some tremendous results in 

terms of addressing obesity and hunger. 

Mr. FORTENBERRY. Thank you. 

Ms. PAGE. From a systems perspective, on the cost front with the 

precious resources that are being invested, it is incumbent upon 

the Federal financing streams to be funding the integration and 

the interoperability. So that Federal financing comes with a requirement that investments in systems that the states are only 

using those dollars to build systems that can talk to one another, 

that they are building them in the right architecture and on the 

69

right platforms. The Federal Government might look at the investment in a state like California in four separate systems that do not 

talk to one another, and how much longer does that meet the criteria in this fiscally constrained environment. 

Mr. FORTENBERRY. Thank you. 

The CHAIRMAN. Thank you. Before we adjourn, I would like Mr. 

Fortenberry to make his closing remarks and then I will make my 

closing remarks before we dismiss the panel. 

Mr. FORTENBERRY. Great. Well, again, thank you all for the investment of time today. Thank you all who have stayed with us 

through the whole time. I am very impressed by your willingness, 

again as a community, to come out and listen to this. I hope this 

has been helpful to you. These types of hearings are always very 

helpful to us as we try to unpack the implication in real time the 

policies that we have made in Washington, D.C. 

I want to thank you and congratulate you on the excellent spirit 

that I perceive in your community of both cooperation but real intensity of care. You are, of course, using resources well, but are 

taking community-based approaches to real complex problems that 

are a convergence of a lot of factors. 

Interestingly today our hearing unpacked a lot of those social 

complexities in the one manifestation of it in terms of hunger and 

nutrition-related healthcare problems. I think this has been very 

helpful and I am really grateful to Chairman Baca again for the 

privilege of being here with him but the honor of the invitation as 

well. Congratulations, sir, on a great hearing. I appreciate, again, 

the opportunity to be here with you. 

The CHAIRMAN. Thank you very much. Before we adjourn I would 

also like to thank each of the panelists for being here today and 

for your thoughtful testimony and your knowledge and your participation. I hope Congress will find the best policies and solutions to 

meet the challenges to our national health problem including from 

nutrition, obesity, and cost effectiveness. 

I think when we have hearings like we are having here right 

now we actually get to hear from each and everyone of you prior 

to and in this hearing itself. It was helpful to hear you express 

some of the problems that we are having, and some of the solutions, some of the directions, and some of the suggestions. I think 

if we had been back in Washington, D.C. we probably wouldn’t 

have heard as much as we have heard right here. 

Maybe that is a warning to us to say that we should have more 

hearings out in communities throughout the states, because we actually have the ability to hear all of your thoughts and your inputs 

other than your written testimony. When we are back in Washington, D.C. I believe the bell goes off and at that time we are on 

a time schedule for us to get back in and vote, and then trying to 

get back into a hearing and trying to pick up where we left off. 

This was very fruitful for us to have this kind of a hearing and 

get the kind of input that will look towards policies across our nation. It is always worthwhile to come home anyway and get local 

perspective on our national legislation and how we can best implement these policies. I want to thank Congressman Fortenberry, 

Congressman Costa again. A special thanks for both of you for 

traveling to the Inland Empire. 

70

Last but not least, also I want to thank Arrowhead Regional, all 

the individuals that were involved, my good friend Frank Reyes 

who has been wandering around to make sure that everything was 

done. Also to Dr. Dev who was here as well and making this hearing happen and making history right here in the Inland Empire. 

This is a historical moment. Hopefully we can go on and do the 

same things, another time. 

Again, thank you very much, panelists, for being here. With that 

I would like to state under the rules of the Committee the record 

of today’s hearing will remain open for 30 calendar days to receive 

additional materials and supplementary written responses from the 

witnesses and any question posed by Members. This hearing of the 

Subcommittee on the Department Operations, Oversight, Nutrition, 

and Forestry is now adjourned. 

[Whereupon, at 12:48 p.m., the Subcommittee was adjourned.] 

[Material submitted for inclusion in the record follows:] 

71

SUBMITTED STATEMENT BY LORNA DONATONE, CHIEF OPERATING OFFICER AND

EDUCATION MARKET PRESIDENT, SODEXO, INC. 

Mr. Chairman and distinguished Members of the Committee, thank you very 

much for giving me the opportunity to provide input on innovative practices adopted 

by Sodexo to improve child nutrition. I am pleased to describe for the Committee 

examples of programs that Sodexo has found successful in increasing the consumption of healthy and nutritious meals by students. We know that access to good nutrition benefits children not only in their health and wellness but also in their ability 

to achieve academic success. 

Sodexo is the leading provider of integrated food and facility management services 

in the United States with roughly 110,000 employees in 6,000 locations across the 

country. Through our School Services Division, we are privileged to serve 2.8 million 

school meals each day to students in more than 470 school districts across the country. 

In California alone, we provide student nutrition services at over 65 public school 

districts throughout the state. In those districts, which range from large city systems like the San Jose Unified School District, to small rural systems, we provide 

wholesome meals that meet or exceed all USDA nutrition guidelines for schools. 

Sodexo is focused on the overall well-being of the students we serve and we are 

committed to delivering effective programs that help students, teachers, parents and 

employees understand nutritional concepts and allow them to make informed decisions that support a healthy lifestyle. Experience has shown us that persuading 

children to eat more nutritiously is an evolving process that requires new and creative methods that make healthy foods more acceptable to children. Permit me to 

outline several specific parts of the Sodexo approach which we have found to be especially effective in California. 

Sodexo looks for opportunities to make healthy food fun and interesting to 

childing. For example, Sodexo organized a special fruit and vegetable booth for the 

Romoland School District health fair in Homeland, California. The booth included 

fresh fruits and vegetables, along with recipes and informational flyers about the 

produce. The real highlight of the event was exotic foreign fruits including star fruit, 

passion fruit, kiwi, kumquat and loquat. These fruits were both cut into pieces for 

tasting and left whole so students could touch and see them. Another example is 

the San Ysidro School District Waffle Breakfast Bar—a promotion that encouraged 

healthy eating by using fresh toppings like unsweetened strawberries, blueberries 

and bananas. The promotion has been a major hit with students, and the school district has seen a 50% increase in breakfast participation on promotion days. On the 

days following the promotions, participation in the school breakfast program also 

has increased, so we know that these promotions and programs are working to encourage children to eat healthy breakfasts at school. 

However, it is still an unfortunate fact that many students who qualify for free 

and reduced price school meals do not take advantage of those services. Sodexo’s research shows that a variety of reasons contribute to this including failure to complete the application, social stigma associated with subsidized school meals or, in 

the case of breakfast, extenuating factors that impact the child’s ability to be in 

school in a timely fashion 

Sodexo supports school districts by encouraging families to complete and submit 

the meal benefit application. Completing the application is the first step to ensuring 

that all students have the opportunity to enjoy healthy meals everyday. Sodexo 

works with our school district partners to find new ways of getting that message 

to students and parents and encouraging them to sign up for the federally-funded 

program. In Rhode Island, Sodexo works with a local radio station on an annual 

promotion that provides rewards and incentives for students at ten high schools 

throughout the state who complete free and reduced program applications. The promotion, which started in 2005 and was created to increase participation in the program, while also removing the stigma associated with free and reduced meals, has 

been an overwhelming success and has produced a 15% increase in applications and 

a 25% increase in meal participation during school. 

The next step in the process is developing new, creative solutions and opportunities for students to access meals. An excellent example of Sodexo’s efforts in this 

area comes from our operations in Atlanta Public Schools where we found that students were not eating breakfast at school, despite the fact that we offer free breakfast to all students in the district. In an effort to get more students the nutrition 

they need to succeed, Sodexo and its partner Jackmont Hospitality started a program that delivers breakfast directly to students in their morning classroom or distributes nutritious breakfast foods at special kiosks as students enter the building 

at the start of the school day. The ‘‘desk-side’’ breakfast program, which Sodexo 

72

launched last school year, has increased breakfast participation at schools by 200 

percent and school officials report that attendance figures have increased over that 

same period of time. School district officials also report fewer behavioral problems 

and increased punctuality as a result of the innovative breakfast program. 

Giving children a ‘‘second chance’’ to have breakfast during AM recess in CotatiRohnert Park in Sonoma County, CA has also proven extremely effective. The ‘‘second chance breakfast’’ was implemented in January 2009. Cotati had previously offered traditional breakfast at 7:45 a.m. before the start of the school day and the 

participation in the traditional program was minimal. Students were not able to get 

to the cafeteria at the early time of 7:45 and many of the free and reduced students 

were hungry and not receiving their much-needed breakfast. The pilot at an elementary school was a huge success allowing Sodexo to roll the program to the remaining 

breakfast sites in the following months. As of September 2009, the before-school program was eliminated; breakfast is now only available as the ‘‘second chance’’ program at recess. The results for the first quarter of the 2009–2010 school year show 

an increase in participation by 22,413, a 60% increase over the same period last 

year. 

Creating Pleasurable Food Experiences Add More Impactful Information 

About Our Programs To Encourage Healthy Eating 

Along with ensuring that students have access to nutritious school meals, our goal 

is to provide children with affordable meals that they enjoy eating. In order to meet 

the desires and needs of students, Sodexo has a team of experts including executive 

chefs and registered dietitians who monitor student insights and trends and also reviews and evaluates evolving studies on student nutrition. We have discovered that 

children tend to eat with their eyes first, so the food we serve must be colorful, visually appealing and familiar. Sodexo has been working closely with its vendor-partners to source food that meets high nutritional standards while also being attractive 

to kids—both in flavor and visual appeal. 

Sodexo strives to find innovative ways to serve healthier versions of the foods and 

beverages children love. For example, in California, Sodexo switched to a sucrosebased chocolate milk as a healthier alternative to the high fructose corn syrup 

version in 2010. This change is happening at all Sodexo districts across the state. 

In a school district in Hopewell Valley, NJ, the block shaped wax-coated milk cartons that traditionally have brought milk to schoolchildren have been replaced with 

eye-catching, pear-shaped, recyclable plastic bottles that feature tasty low fat milk 

in regular, low-fat chocolate and strawberry flavors. In addition, the school provides 

a number of milk-based promotional items such as magnet, buttons, rubber wrist 

band and the like. In other school settings, milk machines have been moved to high 

traffic areas and the distinctive ‘‘Got Milk’’ posters are used to attract student attention. In all cases, we are pleased to report that milk consumption has increased and 

recent studies support the fact that offering a variety of milk choices sustains student consumption of milk. In a recent study, when flavored milks were removed 

from schools, there was an observed reduction in milk purchase consumption for all 

grades (K–12). This reduction ranged from 37 percent in high school to 62 percent 

in the lower elementary school grades. This reinforces the fact that milk needs creative packaging and variety so that students benefit from the additional calcium 

and vitamin D afforded by milk. 

In addition to the examples provided above, we also have increased healthy eating 

through the utilization of age appropriate educational programs. At the K–12 level, 

Lift-Off is Sodexo’s school ambassador and this character is presented in a variety 

of fun and engaging ways to entice students to aim for better nutrition and physical 

activity. 

In an effort to make good nutrition fun, we partnered with Martha Montoya, the 

Los Angeles-based cartoonist behind the nationally-syndicated ‘‘Los Kitos’’ comic 

strip. The partnership brought popular ‘‘Los Kitos’’ cartoon characters like Pikito, 

Mima and Solito to elementary school cafeterias across the United States with a 

monthly comic strip. Sodexo’s nutrition mascot Lift-Off, joined the ‘‘Los Kitos’’ characters in entertaining and educating students through comic strips about valuable 

topics such as the importance of breakfast, daily exercise, gardening, planning balanced meals and taking care of the environment. To help celebrate the nationwide 

program launch, Lift-Off was joined by Montoya and Mima from ‘‘Los Kitos’’ to bring 

a special health and nutrition message to students at William McKinley Elementary 

in the Burbank Unified School District. During this visit, Montoya taught students 

to draw cartoons during a classroom educational session while a registered dietitian 

also taught students about healthy eating and then lead the class through an engaging activity session. The cartoons have been so popular with students that we were 

73

asked to convert the comic strips into coloring pages so students could bring the cartoons to life with their creativity. 

For middle school, we offer Performance Zone and at the high school level we offer 

Balance Mind Body and Soul. Both programs highlight nutritional content of meals, 

offer monthly promotional messages through brochures, posters and signage, and 

offer vibrant, age-appropriate signage to motivate students to make healthier lifestyle choices. Students have access to a variety of wholesome menu choices with 

pizza made from whole grains and low-fat cheese, and fresh salads and deli options. 

Along with our base nutrition programs, Sodexo has special initiatives and promotions designed to teach students about the importance of balanced nutrition and 

making healthy choices in the cafeteria, at home and throughout life. 

Sodexo’s A to Z Salad Bar program offers students a chance to learn about a wide 

variety of fruits and vegetables by providing a produce item for each letter of the 

alphabet on a cart. Sodexo encourages students to try all of the items and gives 

them information about why fresh fruits and vegetables are an important part of 

a balanced diet. 

The Produce of the Month program is another example of Sodexo’s commitment 

to nutrition education. Not only does Sodexo highlight a specific produce item each 

month, but the company also creates informational materials for students and parents, including nutritional facts, educational games and activities and recipes to try 

at home, to encourage healthy eating away from school. 

Building Cross-Community Coalitions To Encourage Healthy Eating 

We have also discovered that it is essential to involve varied members of the educational community is influencing the food choices of children. In many instances, 

we have formed Nutrition Teams, comprised of parents, teachers, food service directors, dietitians, students, school nurses and physical education teachers to develop 

healthy meals and to coordinate and integrate educational messages at home, in the 

classroom and on the playground. Our chefs and registered dietitians have been invited into classrooms to teach nutrition and culinary skills, and have offered afterschool programs, such as cooking demonstrations on creating healthier meals at 

home. Other school communities have begun to build school gardening programs 

with the assistance of Sodexo managers and chefs. Registered dietitians and school 

managers work with parents and nursing staff to ensure students with diabetes and 

food allergies are properly accommodated. And most recently, we have signed a very 

important agreement with the Alliance for A Healthier Generation to ensure beverages and snacks served to students in all grade levels meet specific nutritional 

criteria. By serving snacks and beverages with a healthier nutrient profile in ageappropriate portion sizes we hope to visually educate students, parents and teachers 

about better food choices. 

Access To Healthy Foods Is Critical in Fight Against Childhood Obesity 

At Sodexo, we know that children who don’t have access to healthy foods are more 

likely to suffer from childhood obesity—a condition that will create other devastating health problems for life. Recently, Sodexo joined First Lady Michelle 

Obama in her National Fight Against Childhood Obesity Initiative, named ‘‘Let’s 

Move’’, to positively impact students nationwide in the next school year. The agreement will affect 135,000 students in the 2010–2011 school year alone. In addition, 

representatives estimate a potential increase of 18,700,000 meals conforming to 

standards outlined in the Healthier U.S. School Challenge. The school lunch providers expect to reach two million families with nutrition information. 

Under the agreement, Sodexo and industry partners have agreed to support the 

First Lady’s Initiative by including more fruit, juice, vegetable, whole grain and 

milk options in reimbursable lunches. Sodexo also agreed to increase nutrition education efforts aimed at students and parents, as well as encourage broader participation in the USDA’s Healthier U.S. Schools Challenge by providing technical assistance and facilitating paperwork requirements for the schools they serve. 

Sodexo also commits to working closely with the White House, and to continue 

to work with Federal and state agencies, local school districts and others in the private sector to achieve the First Lady’s goal to eliminate chilldhood obesity in this 

generation. 

Conclusion 

Mr. Chairman and Members of this distinguished Committee, these are brief 

highlights of the many ways in which we strive to increase student access and interest in school meals, and thus, promote consumption of a healthier diet. 

At a time of great need, increasing access to these vital programs would benefit 

millions of American children. A recent survey conducted by the Alliance to End 

Hunger showed that half of likely voters in America live from paycheck to paycheck. 

74

Too often when families are in a hand-to-mouth situation, children’s nutritional 

needs suffer. We believe the foodservice Sodexo provides to 470 school districts 

across the country can be an even greater solution to this current problem. 

Thank you for allowing us this opportunity to share our story. We look forward 

to working with this Committee to inform the policy discussions surrounding access 

to healthy food and ways to encourage healthy eating in the Federal school lunch 

programs. 

SUBMITTED QUESTIONS

Response by Claudia Page, Co-Director, The Center to Promote HealthCare 

Access 

Questions Submitted by Hon. Jim Costa, a Representative in Congress from California 

Question 1. You mention that the One-e-App is being used in Fresno. When was 

this system started and what sort of success rates have you seen in terms of enrollment? 

Answer. One-e-App was originally launched in Fresno in September 2005 with a 

focus on children’s health coverage programs. Over time, Fresno has increased the 

range of programs and the channels through which applicants get connected to coverage. 

Food Stamps was added to Fresno’s version of One-e-App in 2009 but is still in 

a pilot phase. Progress has been slow in part due to challenges in working with the 

County Social Services Agency on the process for accepting Food Stamps applications originating from One-e-App. 

The collaboration of the state or county agency(ies) responsible for final eligibility 

determination is a critical success factor for systems like One-e-App that are aiming 

to streamline and improve the efficiency of eligibility and enrollment processes. The 

presence of this collaboration in the State of Arizona has resulted in a streamlined 

process that has generated Food Stamps applications on behalf of nearly 628,000 

people. In Arizona, One-e-App interfaces with the state system to electronically deliver applications and supporting documentation and signatures for Food Stamps 

and other programs. Similarly, in California’s San Diego County, county agencies 

are supporting and funding the creation of an electronic interface with One-e-App 

to better facilitate Food Stamps applications in that county. There is no similar 

‘‘pipeline’’ to deliver applications to the county agency in Fresno. 

In California, in addition to Fresno and San Diego, One-e-App also facilitates 

Food Stamps applications in Los Angeles, Sacramento and Solano (and soon in Napa 

and Sonoma). California’s delegation of Food Stamps eligibility determination to 

counties means that implementation of a system like One-e-App happens incrementally on a county-by-county basis, a slower and more resource-intensive process than 

in states (such as Arizona, which uses One-e-App for Food Stamps) where eligibility 

is centralized.

Question 2. What are the primary barriers to expanding this program nationwide? 

Answer. There are a number of barriers to expansion, including competing demands for scarce resources, variable program administration across states, and resistance to change in general and to technology in particular. The current economic 

recession and national and state budget crises have resulted in a perfect storm of 

competing priorities where government agencies are confronted with a growing population of people in need of food support and other health and social services at the 

same time that they are facing layoffs and sharply restricted budgets. Though the 

environment calls for the need to improve the efficiency of outdated processes, it can 

be challenging to commit the up-front costs needed to set change in motion. 

Compounding the scarcity of resources, the current national focus (and the majority 

of available resources) are focused on clinical IT rather than on enrollment solutions. 

National expansion is also complicated by the lack of consistency with which the 

food stamps program is administered across and within states. Program rules and 

business processes can vary significantly in different regions, requiring different 

configurations and customizations for One-e-App. Further, IT systems are often old 

and outdated, making electronic data exchange challenging. 

Finally, there is often resistance to breaking down the walls between programs 

to make the enrollment process for all health and social services programs more integrated and efficient. Programs such as food stamps and Medicaid often operate in 

silos, and it can be difficult to forge collaboration and partnership among agencies 

and stakeholders that have not historically worked together. Adding technology into 

75

* There was no response from the witness by the time this hearing went to press. 

this mix can create a further challenge. In spite of these challenges, since 2006 Onee-App has screened more than 3.3 million people in four states and generated roughly six million applications for a broad range of health and social services programs.

Question 3. What is the cost associated with starting up a program like this? 

Where is your primary source of funding? 

Answer. Costs to implement One-e-App cover a range of activities, including requirements assessment, system development and configuration, training, hosting 

and maintenance, ongoing user support, and system enhancements to keep pace 

with changing program rules and new technologies. Launching One-e-App in a new 

state requires an assessment of business processes, system requirements, existing 

IT systems, and local programs. Costs depend on the number of programs included 

in the system, the number and types of users, the number of interfaces to other systems, and other functional requirements. 

One-e-App has two cost-structure models: (1) a customized One-e-App implementation, enhancement and maintenance agreement available to states and jurisdictions; or (2) a California Statewide Subscription Agreement (currently available in 

California only). For the customized implementation, which would be typical for new 

County or state agencies interested in implementing One-e-App, the pricing is developed based on a requirements analysis of the client agencies’ programs and business 

processes, number of interfaces, etc. For a statewide subscription agreement, the 

pricing is based on the type of organization, number of sites, and number of users. 

The Center is happy to discuss pricing in more detail for interested parties. 

In terms of funding, different localities have raised funding in different ways. 

Sources have included Federal grants, foundation contributions, local and statewide 

First 5 funds, Federal matching funds, and contributions from health plans, hospitals, and clinics and county funds. 

Response by Edith C. ‘‘Edie’’ Jessup, Program Development Specialist, Central California Regional Obesity Prevention Program, California State 

University Fresno Department of Health and Human Services, Central 

California Center for Health and Human Services * 

Questions Submitted by Hon. Jim Costa, a Representative in Congress from California 

Question 1. Did the rural municipalities that you dealt with have the administrative capabilities to perform this function, or would they require additional administrative staffing andfunding?

Question 2. Thank you for mentioning the bonus reward on the EBT cards as a 

way to incentivize people to by more healthy fruits and vegetables. We discussed 

this during the last Farm Bill, but concerns were raised over administrative obstacles. Since you have a great deal of experience dealing with low-income communities 

and obesity, can you talk a bit more about why you believe this incentive structure 

would be helpful?

Question 3. I agree that health and nutrition go hand in hand and that agriculture has a tremendous role to play in improving our nations health. 

Each of you mentioned the need for increased partnerships between the health 

and nutrition communities. With budget issues at the state, local and Federal level, 

what types of new partnerships do you believe would be the most effective in increasing the likelihood that low-income populations will be able to access and will 

choose healthier options In other words—where is our biggest obstacle—in education? Access? Funding?

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