WIC, MEDICAID, AND SNAP: TEAMING UP TO IMPROVE THE HEALTH OF WOMEN AND CHILDREN
THE IMPORTANCE OF THE IMPORTANCE NWA’S MISSION MEDICAID FOR WIC OF SNAP FOR WIC PARTICIPANTS PARTICIPANTS The National The vast majority of WIC participants WIC benefits are not meant to cover WIC Association rely on Medicaid and/or the Children’s a full grocery basket of food each (NWA) provides its Health Insurance Program (CHIP)— month. Instead, targeted foods members with tools which provides coverage to uninsured address nutritional gaps in the diets of and leadership to children who are not eligible for pregnant women, new mothers, and expand and sustain Medicaid, but cannot afford private young children, For families lacking effective nutrition insurance—for healthcare coverage.3 resources to afford foods beyond the services for In addition to covering nearly half scope of WIC, SNAP plays a vital role. mothers and young of all births in the US, Medicaid A large body of research demonstrates children. provides a range of prenatal and that SNAP reduces the number of postpartum services that are key households facing food insecurity.7 8 to improving outcomes for WIC This is particularly true of households mothers and babies during these with children, with conservative vital periods.4 Most states’ Medicaid estimates attributing a reduction in OVERVIEW OF WIC programs cover access to prenatal childhood food insecurity of at least The Special Supplemental Nutrition vitamins, ultrasounds, amniocentesis, 8.1% to SNAP.9 Other studies assert Program for Women, Infants, and chorionic villus sampling (CVS) tests, that a mere six months of participation Children (WIC), the nation’s premier genetic counseling, breast pumps, in SNAP reduces the likelihood of public health nutrition program, has and postpartum home visiting.5 This food insecurity by one-third compared improved the health of women, infants, coverage plays a critical role in to similarly situated households.10 and children for 46 years. WIC serves guiding a safe pregnancy, identifying In addition, SNAP’s support has roughly 7.3 million participants per preventable risks, and promoting long-lasting effects, increasing the month through approximately 10,000 healthy practices like breastfeeding. likelihood of continuing food security in clinics nationwide.1 2 Without Medicaid coverage, these later years.11 services would be out of reach for A key component of WIC’s For families that qualify for both many WIC families, resulting in poorer effectiveness in improving nutrition programs, SNAP and WIC work best pregnancy and birth outcomes. and health outcomes is the program’s in tandem. WIC provides a healthy, strong partnerships with other Medicaid’s tailored assistance to tailored basket of foods, along with healthcare, nutrition, and social pregnant women complements nutrition education, breastfeeding service programs. On the federal level, WIC’s efforts to ensure positive birth support, and referral services, WIC’s primary partners are Medicaid outcomes and healthy children, and while SNAP allows families to and the Supplemental Nutrition participation in both Medicaid and WIC purchase enough food to meet their Assistance Program (SNAP). The US is shown to lead to greater healthcare macronutrient needs each month. Department of Agriculture (USDA) access for children and stronger and state and local WIC agencies linkages between families and the collaborate with national, state, and healthcare system.6 local Medicaid and SNAP agencies to ensure that WIC families are able to meet their nutrition and healthcare needs.
MARCH 2019 Please direct all questions to NWA at 202.232.5492 HOW IS WIC LINKED TO 1. REFERRALS SNAP AND MEDICAID? Local WIC agencies actively engage AS AN ADJUNCT TO HEALTHCARE, a wide range of community partners WIC PROVIDERS SCREEN EVERY 1. WIC CLINIC STAFF REFER in referral networks to address CHILD UNDER TWO FOR UP-TO- PARTICIPANTS TO THESE issues unique to young parents and DATE IMMUNIZATION SCHEDULES PROGRAMS. In fact, referral services their children. WIC clinics screen are one of the four cornerstones of WIC, participants for food insecurity, AND PROVIDE REFERRALS TO along with the healthy food package, healthcare coverage, immunizations, IMMUNIZATION SERVICES FOR nutrition education, and breastfeeding access to dental care, tobacco use, THOSE WHO NEED THEM. STUDIES postpartum depression, opioid promotion and support. In this way, HAVE FOUND THAT PARTICIPATION WIC serves as a gateway to crucial addiction, and other health issues, healthcare services and additional and provide appropriate referrals IN WIC SIGNIFICANTLY nutrition support. to Medicaid, SNAP, Head Start, IMPROVES RATES OF CHILDHOOD pediatricians, dentists, mental health IMMUNIZATION AND OF HAVING A 2. WIC PERMITS WOMEN AND providers, and other programs and CHILDREN TO ENROLL BASED ON services. The low-income families REGULAR SOURCE OF MEDICAL THEIR CURRENT PARTICIPATION participating in WIC benefit fro a CARE.13 IN SNAP OR MEDICAID, THROUGH holistic, integrated approach that can A PROGRAM CALLED ADJUNCTIVE help prevent medical or dietary risks ELIGIBILITY. Adjunctive eligibility, from escalating into serious chronic established in WIC in 1989, enables conditions. applicants to be automatically income- 2. ADJUNCTIVE eligible for WIC by showing proof of ELIGIBILITY participation in these programs as In 2016, nearly 75% of WIC participants well as the Temporary Assistance for CASE STUDY were adjunctively eligible for Needy Families (TANF) program and WIC.14 For the remaining 25% of other programs as determined by each CCI HEALTH & WELLNESS WIC participants who must provide state.12 Permitting applicants to enroll SERVICES IN MONTGOMERY income documentation, the process of in WIC in this way helps to simplify and demonstrating eligibility for WIC can streamline the WIC application process COUNTY, MARYLAND, be time-consuming and cumbersome. and reduces documentation burdens ESTABLISHED A RESOURCE Income documentation requires for potential WIC participants and NAVIGATOR PROGRAM participants to find and bring a variety current participants undergoing the re- SEVERAL YEARS AGO. THE of documents to the WIC clinic: pay certification process and administrative RESOURCE NAVIGATORS stubs for the last 30 days, tax returns, costs for WIC agencies. CONNECT WIC CLIENTS income-verification letters, utility bills, WITH HEALTHCARE AND and/or rent receipts. Enrolling in WIC 3. STATE AND LOCAL WIC PREVENTIVE SERVICES through income documentation can AGENCIES PARTNER DIRECTLY BY EDUCATING THEM sometimes require several trips to WITH MEDICAID AND SNAP the WIC clinic and in some instances AGENCIES TO STREAMLINE ABOUT THEIR OPTIONS, HELPING THEM SCHEDULE may take several days. Evidence ENROLLMENT AND CONDUCT suggests that bringing in income and In the APPOINTMENTS, AND TARGETED OUTREACH. residency documentation for initial same way that WIC refers participants ENCOURAGING THEM and subsequent WIC certifications may to Medicaid and SNAP, WIC works TO ATTEND THEIR cause some families to drop out of the to ensure that Medicaid and SNAP APPOINTMENTS. program or choose not to participate in agencies are referring to WIC, both the first place.15 16 in-person and online. WIC agencies also partner with Medicaid and SNAP agencies to identify participants in these programs who are eligible for WIC but not currently participating. This allows WIC agencies to conduct targeted outreach to individuals and groups who are not currently accessing WIC benefits.
MARCH 2019 Visit nwica.org Enrolling in WIC through adjunctive 3. DIRECT eligibility, on the other hand, takes WIC WORKS BEST IN TANDEM about one minute and simply requires PARTNERSHIPS a WIC client to present their Medicaid Many state and local WIC agencies WITH SNAP AND MEDICAID. card or demonstrate receipt of SNAP partner directly with Medicaid and TOGETHER, THESE THREE or TANF benefits. This makes the SNAP agencies and providers to PROGRAMS IMPROVE PUBLIC process much easier for participants improve outreach, eligibility, and and the WIC clinic. enrollment processes. WIC agencies HEALTH AND HELP TO Reducing paperwork and time spent work with Medicaid and SNAP PREVENT CHRONIC DISEASE on administrative tasks also cuts agencies to strengthen referrals to down on administrative costs for WIC by providing WIC promotional IN PREGNANT WOMEN, NEW WIC. One state estimated that income materials, encouraging agencies to MOTHERS, INFANTS, AND screening involving pay stubs or include a question about WIC eligibility YOUNG CHILDREN IN OUR financial documents costs $12.50 per on Medicaid and SNAP application participant, whereas the administrative forms, and asking agencies to reach COUNTRY. costs for an income screening with out directly to the WIC office when they adjunctive eligibility is only $3.75 identify a client who could be eligible per participant.17 The additional time for WIC. Many state and local WIC and funding freed up as a result of agencies also use data from SNAP this practice is used by WIC staff to and Medicaid agencies to identify and WIC: EMPOWERING focus on delivering WIC’s mission— reach out to potentially eligible WIC FAMILIES, healthy foods, nutrition education, recipients and/or to identify geographic breastfeeding support, and referrals. areas where there are large numbers STRENGTHENING of potential WIC participants who are not yet enrolled. Finally, a number of COMMUNITIES states have explored universal online Please direct all questions applications that permit an individual to NWA at 202-232-5492. CASE STUDY to apply for or be pre-screened for multiple benefit programs at one time, THE CALIFORNIA STATE including WIC. WIC AGENCY HAS 1 United States Department of Agriculture, Food and BUILT AN ADJUNCTIVE Nutrition Service (2018) WIC Program Data. Accessed ELIGIBILITY CHECK INTO online: https://www.fns.usda.gov/pd/wic-program. ITS WIC MANAGEMENT 2 United States Department of Agriculture, Food and CASE STUDY Nutrition Service (2015) About WIC - WIC at a Glance. INFORMATION SYSTEM Accessed online: https://www.fns.usda.gov/wic/about-wic- (MIS), THE DIGITAL wic-glance. THE NEW HAMPSHIRE 3 INFORMATION SYSTEM Thorn B, Kline N, Tadler C, Budge E, Wilcox-Cook E, DEPARTMENT OF HEALTH Michaels J, Mendelson M, Patlan KL, Tran V. (2018) WIC USED FOR PROCESSING Participant and Program Characteristics 2016. Alexandria, AND HUMAN SERVICES WIC VA: U.S. Department of Agriculture, Food and Nutrition AND TRACKING WIC PROGRAM WORKED WITH Service. Available online at: https://fns-prod.azureedge. BENEFITS AND SERVICES. net/sites/default/files/ops/WICPC2016.pdf. THE NEW HAMPSHIRE SNAP 4 WITH A SIMPLE CLICK, Galewitz P (2013) Nearly Half of U.S. Births Are Covered AGENCY TO ESTABLISH A By Medicaid, Study Finds. Kaiser Health News. Accessed FRONTLINE WIC STAFF DATA-SHARING AGREEMENT online: https://khn.org/news/nearly-half-of-u-s-births- CAN CHECK PARTICIPATION are-covered-by-medicaid-study-finds/. AND DESIGN A WIC 5 Gifford K, Walls J (2017) Medicaid Coverage of Pregnancy IN MEDICAID, SNAP, AND/ DASHBOARD WITHIN THE and Perinatal Benefits: Results from a State Survey. Henry OR CASH ASSISTANCE. J. Kaiser Family Foundation. Accessed online: https:// SNAP ONLINE APPLICATION www.kff.org/womens-health-policy/report/medicaid- THIS MAKES CHECKING TOOL. THROUGH TELEPHONE coverage-of-pregnancy-and-perinatal-benefits-results- FOR ADJUNCTIVE from-a-state-survey/. OUTREACH ACTIVITIES, 6 ELIGIBILITY QUICK AND Buescher PA, Horton SJ, Devaney BL, Roholt SJ, Lenihan NEW HAMPSHIRE WIC’S AJ, Whitmire JT, Kotch JB (2003) Child Participation in SEAMLESS, IMPROVING WIC: Medicaid Costs and Use of Health Care Services. GOAL IS TO USE THE DATA American Journal of Public Health. Accessed online: THE EXPERIENCE THEY RECEIVE FROM THE https://ajph.aphapublications.org/doi/full/10.2105/ FOR BOTH STAFF AND AJPH.93.1.145. SNAP AGENCY TO INCREASE 7 PARTICIPANTS.18 United States Department of Agriculture (2013) THE NUMBER OF FAMILIES Measuring the Effect of Supplemental Nutrition Assistance Program (SNAP) Participation on Food Security. Accessed ENROLLED IN WIC. online: https://www.fns.usda.gov/measuring-effect-snap- participation-food-security-0.
MARCH 2019 Visit nwica.org 8 Ratcliffe C, McKernan S-M (2010) How Much Does SNAP Reduce Food Insecurity? The Urban Institute. Accessed online: https://www.urban.org/sites/default/ files/publication/28506/412065-How-Much-Does-SNAP- Reduce-Food-Insecurity-.PDF.
9 Kreider B, Pepper JV, Gunderson C, Joliffe D (2012) Identifying the Effects of SNAP (Food Stamps) on Child Health Outcomes when Participation is Endogenous and Misreported. Journal of the American Statistical Association, Vol. 107, Issue 499.
10 Mabli J, Worthington J (2014) Supplemental Nutrition Assistance Program Participation and Child Food Security. Pediatrics. Vol. 133, Issue 610.
11 Vericker T, Mills G (2012) Childhood Food Insecurity: The Mitigating Role of SNAP. Urban Institute. Accessed online: https://www.urban.org/sites/default/files/ publication/25936/412681-Childhood-Food-Insecurity- The-Mitigating-Role-of-SNAP.PDF.
12 Child Nutrition and WIC Reauthorization Act (1989) Pub. L. No. 101-147.
13 U.S. Department of Agriculture, Food and Nutrition Service (1987) The National WIC Evaluation: An Evaluation of the Special Supplemental Food Program for Women, Infants, and Children. Vol. 1: Summary. Alexandria, Virginia: U.S. Department Agriculture.
14 Thorn B, Kline N, Tadler C, Budge E, Wilcox-Cook E, Michaels J, Mendelson M, Patlan KL, Tran V. (2018) WIC Participant and Program Characteristics 2016. Alexandria, VA: U.S. Department of Agriculture, Food and Nutrition Service. Available online at: https://fns-prod.azureedge. net/sites/default/files/ops/WICPC2016.pdf.
15 Huynh, D (2013) Women, Infants, and Children (WIC) Awareness, Experience, and Access: A Study Conducted for the Minnesota Department of Health WIC Program. Wilder Research. Accessed online: http://www.health. state.mn.us/wic/wilder/report.pdf.
16 Jacknowitz A, Tiehen L (2010) WIC Participation Patterns An Investigation of Delayed Entry and Early Exit. United States Department of Agriculture Economic Research Service. Accessed online: https://www.ers.usda. gov/webdocs/publications/44781/8018_err109.pdf?v=0.
17 National WIC Association (2015) WIC State Directors Value Medicaid Adjunctive Eligibility. Available online: https://s3.amazonaws.com/aws.upl/nwica.org/medicaid- adjuctive-eligibility-study.pdf.
18 Neuberger Z (2017) Modernizing and Streamlining WIC Eligibility Determination and Enrollment Processes. Center on Budget and Policy Priorities. Available online: https://www.cbpp.org/research/modernizing- and-streamlining-wic-eligibility-determination-and- enrollment-processes.
MARCH 2019 Visit nwica.org