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Strategies for Outreach to Children Eligible for CHIP or the Medicaid Program and Cost Issues

DATE:March 30, 1995
MEMO CODE:WIC Policy Memorandum #99-05
SUBJECT:Strategies for Outreach to Children Eligible for the New Children's Health Insurance Program (CHIP) or the Medicaid Program and Cost Issues
TO:Regional Directors
Supplemental Food Programs
All Regions

This memorandum addresses a broad range of issues regarding outreach strategies that WIC state and local agencies are encouraged to undertake to assist in identifying, educating, and referring uninsured children to and/or facilitate their enrollment in CHIP or Medicaid. It also defines allowable and unallowable WIC costs associated with these activities.

CHIP was created by PL 105-33, the Balanced Budget Act of 1997, as amended by PL 105-100 and PL 105-174. CHIP is intended to provide health insurance to uninsured, low-income children who are not eligible for Medicaid but have no health insurance. Since enactment of the legislation, many states have submitted and received approval from the Department of Health and Human Services (DHHS) to implement a children's health insurance program. States are designing their own unique programs. The legislation provides states with the option to implement CHIP via expansion of the state Medicaid program, creation of a separate child health insurance program, or a combination of the two.

In addition, the Food and Nutrition Service (FNS) has participated in an interagency workgroup with other federal Departments to identify how programs that serve children can assist in outreach efforts to uninsured children that may be eligible for CHIP or Medicaid. A report was sent to President Clinton in June 1998 which includes FNS strategies to assist in this outreach initiative. Some of the FNS strategies included in the report to the President include issuing this memorandum. communicating information about CHIP and Medicaid, and identifying the role the WIC community can play in outreach efforts to uninsured children. FNS strategies to assist in CHIP/Medicaid outreach and other current information about CHIP can be found on FNS Internet Web Site at: http://www.fns.usda.gov.

In general, DHHS defines CHIP outreach as a dynamic process that involves people in the public and private sector at the federal. state and local level in identifying, educating, and enrolling uninsured children in Medicaid or CHIP. Primarily, WIC's role in CHIP outreach at the federal, state, and local level will be to educate program staff about CHIP and Medicaid, identify uninsured children, educate parents/caretakers with uninsured children about the availability of free or low-cost health insurance coverage under Medicaid or CHIP, and refer them to these programs. Any decision to undertake CHIP/Medicaid outreach beyond these efforts requires approval by the WIC state agency director, based on a determination that WIC program goals and responsibilities will be accomplished. Some WIC agencies may be able to assist further by facilitating enrollment in CHIP/Medicaid. Such activities may include, for example, having CHIP/Medicaid eligibility workers onsite in WIC clinics or sharing common applicant information with Medicaid or CHIP in accordance with WIC confidentiality requirements. With agreements which include cost reimbursement, opportunities may exist for WIC agencies to become engaged in assisting state CHIP/Medicaid programs in their enrollment activities, e.g., presumptive eligibility determinations, thereby fulfilling CHIP/Medicaid program goals and responsibilities.

I. WIC'S ROLE AS ADJUNCT TO CHIP

As you know, the WIC program serves as an adjunct to health care and one of the benefits of the WIC program is referrals to health care. As such, the WIC program can play an important role in assisting in the CHIP/Medicaid outreach effort and help uninsured children who may be eligible for CHIP or Medicaid. The following discusses ways WIC program staff may be able to assist in this effort:

1. Educate/Reeducate WIC Program Staff at the State, Local and Clinic Level About CHIP and the Medicaid program

Educating/reeducating WIC staff at all levels is important to ensure that uninsured children are identified and referred for enrollment in either CHIP or Medicaid. WIC state/local agencies could educate WIC staff about the state's plan to implement a children's health insurance program and about its Medicaid program. In educating WIC staff, state and local agencies should consider strategies such as:

  • Coordinate discussions and presentations about CHIP/Medicaid at WIC state and local meetings and conferences and make available materials (federal and/or state-specific) about these programs. State CHIP/Medicaid representatives could assist in these presentations and provide state-specific materials;
  • Publish articles about the state's CHIP/Medicaid program in WIC state and local newsletters to WIC staff; and.
  • Apprise WIC staff when the state's CHIP Plan is approved by DHHS and of state specific implementation plans.
2. Coordinate with CHIP/Medicaid and Other Program Representatives

Coordination with Medicaid/CHIP representatives is critical in not only understanding how the state plans to implement CHIP but to discuss how WIC can assist in the CHIP/Medicaid outreach effort. Discussions with other program representatives such as Maternal and Child Health, Immunization, and Migrant and Community Health are encouraged to ensure a coordinated CHIP/Medicaid outreach effort is implemented where multiple programs serve children, or where multiple programs are co-located, in order to minimize duplication of effort. WIC agencies may wish to discuss/coordinate issues such as:

  • WIC participation in CHIP planning and implementation meetings;
  • Need for assistance in educating WIC staff at the state, local, and clinic levels about any changes in the state's Medicaid program and/or implementation of a children's health insurance program;
  • Strategies to minimize duplication of the CHIP/Medicaid outreach effort among programs serving children in the state or local area;
  • Outstation or establish offsite visits of CHIP/Medicaid eligibility workers at WIC sites;
  • Need for appropriate state-specific CHIP/Medicaid information materials such as brochures and posters to use in WIC clinics, provide to WIC applicants and participants, and educate WIC staff;
  • If feasible, incorporate a CHIP/Medicaid message on the WIC program toll-free hot lines/phone lines;
  • If feasible, incorporate CHIP/Medicaid eligibility as part of current or future joint application processes; and
  • If feasible, use WIC program staff to perform presumptive Medicaid/CHIP eligibility determinations so long as reimbursement is provided for making these determinations.
3. Identify, Educate, and Refer Children/Families to CHIP/Medicaid and/or Facilitate Enrollment in CHIP/Medicaid

Current WIC legislation and regulations require WIC agencies to provide written information about the Medicaid program and referrals to individuals who appear to be income eligible but currently not participating in Medicaid. Given WIC's role to identify, educate, and refer individuals who need health care or other social services, individuals should also be referred to a state's separate children' s health insurance program. Strategies, in addition to those already mentioned in section 2 above, which WIC agencies may wish to consider to educate children/families about CHIP/Medicaid and refer or facilitate their enrollment include the following:

  • Disseminate information about CHIP/Medicaid to individuals/families who may be potentially eligible for such benefits;
  • Display CHIP/Medicaid posters and materials in WIC clinics;
4. Medicaid/CHIP Presumptive Eligibility

Prior to enactment of the Balanced Budget Act of 1997, which established CHIP, states have had the option under Medicaid to grant limited Medicaid benefits to pregnant women based on preliminary information regarding income, before applying and being determined fully eligible for Medicaid. This process is known as presumptive eligibility determination.

The Balanced Budget Act, as amended, provides states the option under Medicaid to expand the use of presumptive eligibility determinations to include children (birth to age °19). In addition, the Act specifies the WIC program as one of several qualified entities that may make presumptive eligibility determinations. Under a separate children's health insurance program, states also have the option to provide presumptive eligibility determinations for children.

In states which opt to provide Medicaid/CHIP presumptive eligibility determinations, WIC state agencies may be asked, in some cases, to perform presumptive eligibility determinations on behalf of the state's Medicaid program and/or CHIP, and if feasible, coordinate this issue with state Medicaid/CHIP staff. As indicated above, WIC state agency directors must approve WIC agencies performing Medicaid/CHIP presumptive eligibility determinations, taking into consideration that WIC program goals and responsibilities must be accomplished and that reimbursement must be provided, as discussed below. state agencies should be aware that variations may exist from state to state on Medicaid/CHIP eligibility requirements, what information is collected to determine Medicaid or CHIP presumptive eligibility and other application and determination processes. Different processes and rules may also exist within a state between the eligibility requirements and data collected in the determination of presumptive eligibility under the state's Medicaid program and a state's separate child health insurance program.

If a WIC state agency director determines that WIC staff may perform Medicaid/CHIP presumptive eligibility determinations, a written agreement must be entered into with Medicaid/CHIP. Since Medicaid/CHIP presumptive eligibility determinations will entail the performance of activities that are above and beyond those necessary to fulfill WIC program functions and responsibilities, the agreement must specify that Medicaid/CHIP will reimburse the WIC program for activities performed on behalf of Medicaid/CHIP. Further guidance on this issue is provided below under "Cost Issues." As an alternative, WIC agencies may wish to pursue the possibility of Medicaid/CHIP eligibility workers being co-located or outstationed at WIC sites.

II. COST ISSUES
1. Allowable Identification, Education, and Referral Costs - Reimbursement Not Required

Allowable WIC costs for CHIP/Medicaid are limited to those costs related to the identification, education, and referral of potentially eligible WIC applicants and participants to CHIP or Medicaid. WIC applicants and participants who are potentially eligible for CHIP or Medicaid should be identified and referred to such programs as part of the traditional WIC certification process.

An example of a cost WIC may allow for CHIP/Medicaid outreach is sharing information that the WIC program must collect for its own use as long as WIC information is shared in accordance with WIC confidentiality requirements set forth in Section 246.26(d) of the WIC regulations. Additionally, personnel. mailing or faxing costs required to share such data may be allowed. Costs for WIC staff to participate in general coordination, information, planning and implementation meetings may be allowed. Provided the work station(s)/area will be otherwise occupied by WIC workers. WIC may allow outstationed CHIP/Medicaid eligibility workers to share an existing work station(s)/area within WIC clinic space to access WIC participants during clinic hours, without reimbursement or a cost sharing agreement. This is possible in situations where the CHIP/Medicaid workers will be on-site less than 100 percent of the time. All of the activities discussed in this paragraph are believed to be of the type that would result in little. if any, additional cost for the WIC program. However, if a WIC state or local agency determines that its funds are insufficient to support these costs, it may negotiate with CHIP/Medicaid to have these costs reimbursed.

Another example of an allowable WIC cost for CHIP/Medicaid outreach would be the cost of producing and distributing a referral pamphlet to WIC applicants and participants if sufficient copies of such pamphlets cannot be obtained from CHIP/Medicaid. A WIC designed referral pamphlet must contain information concerning the WIC program and be in a summarized or condensed format. For example, summary information, a paragraph each, concerning a number of programs that the individual might need, including CHIP/Medicaid, could be contained in a single pamphlet.

2. Unallowable Eligibility Determination and Enrollment Costs -- Reimbursement Required

CHIP/Medicaid state representatives may seek to involve other entities who serve uninsured children to assist in the outreach effort and provide multiple outlets for reaching uninsured children. Therefore, WIC agencies may be requested by state officials to provide staff, facilities and other resources to conduct CHIP/Medicaid eligibility determination and enrollment activities such as assisting individuals in completing CHIP/Medicaid applications or performing CHIP/Medicaid presumptive eligibility determinations. WIC state agencies may consider the feasibility of performing CHIP/Medicaid eligibility determination and enrollment activities. In these cases, one must consider that such CHIP/Medicaid functions may be more expensive and labor intensive than the WIC program is intended or funded to support.

As previously stated, if a WIC state agency director determines that WIC staff may perform Medicaid/CHIP presumptive eligibility determinations, or any other CHIP/Medicaid activities, as noted above, a written agreement must be entered into with Medicaid/CHIP. Since Medicaid/CHIP eligibility determination and outreach activities entail the performance of activities that are above and beyond those necessary to fulfill WIC program functions and responsibilities, the agreement must specify that Medicaid/CHIP will reimburse the WIC program for activities performed on behalf of Medicaid/CHIP. WIC cannot allow the cost of CHIP/Medicaid eligibility determinations and enrollments. But, the cost to identify and refer persons to CHIP/Medicaid are allowable WIC costs, because referral is a function of the WIC program. Identifying and referring persons to CHIP/Medicaid assists in reaching children who need health care and facilitates CHIP/Medicaid's efforts to assess eligibility and enroll individuals.

Costs associated with CHIP/Medicaid eligibility determination and enrollment activities are not allowable WIC costs. Examples of unallowable WIC costs include the cost of WIC staff: 1) attending training sessions to learn how to assist applicants in completing Medicaid/CHIP applications; 2) assisting with CHIP/Medicaid only data on application forms; 3) screening and verifying citizenship if required for Medicaid/CHIP eligibility; and,4) issuing CHIP/Medicaid notices of eligibility or identification/enrollment cards. However, the WIC agency may negotiate with CHIP/Medicaid to have these costs reimbursed.

As previously stated, an alternative to having WIC staff perform CHIP/Medicaid eligibility determination and enrollment activities would be to co-locate or outstation Medicaid/CHIP eligibility workers at WIC sites. The cost to provide full-time permanent office or clinic space for CHIP/Medicaid eligibility workers within space owned or leased by WIC is not an allowable WIC cost. If CHIP/Medicaid eligibility workers are to be placed on-site 100 percent of the time in space paid for by WIC, WIC needs to enter into a cost sharing or reimbursement agreement with CHIP/Medicaid that covers the cost of the space occupied by the CHIP/Medicaid eligibility workers.

Reimbursement must be provided at a level commensurate with the cost of the additional activities performed or resources provided. If reimbursement is provided as a fee per person enrolled, the fee negotiated must be sufficient to cover all CHIP/Medicaid costs that are unallowable as WIC costs. This would include the cost of all CHIP/Medicaid eligibility determination and enrollment activities performed by WIC staff such as attending CHIP/Medicaid application completion training sessions and unallowable resources provided such as full-time permanent office or clinic space. Therefore, employee time/activity and the agency's cost allocation records must accurately reflect activities that WIC staff perform that are Medicaid/CHIP eligibility determination and enrollment functions.

3. Reporting CHIP/Medicaid Reimbursement on FNS Reports

The reimbursements noted above would not be program income, because they are not new money earned. They would be refunds, recoveries of previous expenditures of WIC grant funds. They must, therefore, be collected for and offset expenditures of the fiscal year in which the original expenditures are made. Nutrition and administration services' (NSA) costs would be reported net of these reimbursements on the FNS-498 report. The FNS-227 is designed to capture allowable WIC program costs. It is not designed to capture costs of other programs that were initially paid by WIC, but have since been reimbursed. Therefore, gross NSA costs would be reported net of these reimbursements on the FNS-227 report. On the FNS-227 report, in the remarks section, the state may note that gross expenditures are net of CHIP/Medicaid reimbursements. The CHIP/Medicaid costs ultimately paid for with CHIP/Medicaid funds will be reported on the CHIP/Medicaid financial status reports.

PATRICIA N. DANIELS
Director
Supplemental Food Programs Division

EO Guidance Document #
FNS-GD-1999-0007
Date
FNS Document #
WIC Policy Memorandum #99-05
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (2.24 MB)
No
Summary

This memorandum addresses a broad range of issues regarding outreach strategies that WIC state and local agencies are encouraged to undertake to assist in identifying, educating, and referring uninsured children to and/or facilitate their enrollment in CHIP or Medicaid.

Page updated: November 02, 2023

Strengthening Integrity in the WIC Certification Process

DATE: February 24, 1999
MEMO CODE: Final WIC Policy Memorandum #99-4
SUBJECT: Strengthening Integrity in the WIC Certification Process
TO: Regional Directors
Supplemental Food Programs
All Regions
I. Purpose

The purpose of this policy memorandum is to highlight and strengthen national program policy regarding integrity in the WIC certification process through existing regulatory requirements as well as through new legislative requirements mandated by PL 105-336 enacted Oct. 31, 1998. Many state agencies use a variety of measures to ensure integrity in the certification process and will find that they already comply with the provisions of this policy memorandum. Those state agencies that are not already in compliance must immediately begin implementation of the certification integrity issues addressed in this policy memorandum in light of the Oct. 1, 1998, effective date for the PL 105-336 provisions.

The two new requirements necessary to implement provisions of PL 105-336 are as follows:

  • Applicants not certified under adjunctive eligibility provisions must present documentation of income at certification.
  • Applicants must present proof of residency at certification.

The existing regulatory requirements which are being reemphasized are as follows:

  • To be certified as adjunctively income eligible for WIC, applicants must present documentation of current eligibility in one of the three allowable adjunct programs as evidence of income eligibility for WIC.
  • To be certified as automatically income eligible for WIC, applicants must present documentation of current eligibility in other means-tested programs.
  • Applicants must present proof of identity at certification; participants must present proof of identity at subsequent certification and at food or food instrument issuance.
  • State agencies must develop systems that detect and deter the receipt of dual benefits.

Implementation of this policy memorandum will necessitate state agencies taking appropriate action to educate applicants as to the type of documents they are required to bring to certification appointments to help determine eligibility. Practical approaches being used by some state agencies include reminders at food instrument pickup and messages on appointment reminders through mail, auto dialers or WIC help lines. Such actions ensure that applicants come to certification appointments with appropriate documents to facilitate the certification process.

For purposes of this policy memorandum, the term "applicant" refers to the individual for whom WIC benefits are being sought. The term "participant" refers to the individual currently receiving WIC benefits.

II. Background

Due to increased scrutiny and growing national interest on issues of integrity in the WIC Program, managers of the WIC Program at all levels are reexamining existing procedures and committing to increased management controls in the certification process.

As the WIC program has grown over the years, there has been increasing emphasis on ensuring that only persons who are both income eligible and at nutritional risk-receive WIC benefits. This concern is shared by Congress, the Department of Agriculture, and the WIC community. The U.S. General Accounting Office (GAO) report entitled, "Food Assistance: A Variety of Practices May Lower the Costs of WIC," released in September 1997, documents that more effort is needed to strengthen integrity. The report disclosed that some state agencies did not require applicants to provide proof of state residency while others did not require proof of identity at certification or at the time of food instrument issuance. While many state agencies required documentation of income, state policy sometimes allowed it to be waived. A few states agencies did not require documentation of income or allowed income documentation procedures to be determined individually by the local WIC agencies. The report concluded that Federal requirements pertaining to certification should be strengthened.

Given these integrity and accountability concerns, PL 105-336 was enacted which requires applicants to present documentation of either (a) family income or (b) participation in one of the adjunct programs--Food Stamps, Medicaid or Temporary Assistance for Needy Families. This new legislation also requires state agencies to implement systems to identify individuals who are participating in WIC at more than one site.

III. Proof of Residency and Participant Identity

Section 203(e) of PL 105-336 added Section l 7(t)(23) to the Child Nutrition Act of 1966 (CNA) (42 USC 1786(f)(23) to require each WIC state agency to implement a system to identify individuals who are participating at more than one site under the program. Program regulations already require state agencies to have systems in place to detect dual participation. In addition, current regulations require applicants to reside within the jurisdiction of the state (except for Indian state agencies) and that local agencies check an individual's identity at certification and when issuing food or food instruments. However, the regulations are not specific on how to meet these requirements. This policy memorandum serves to notify state agencies that proof of residency and identity are a necessary part of systems to detect dual participation and of the appropriate means to satisfy these requirements.

A. Proof of Residency
Section 246.7(c)(l) of the WIC regulations provides that all state agencies except Indian state agencies require applicants to reside within the jurisdiction of the state. Indian state agencies may establish a requirement for applicants to reside within their area of legal jurisdiction. state agencies also may establish a local service area residency requirement. However, by regulation, length of residency cannot be a prerequisite to receiving WIC benefits. FNS Instruction 803-1 provided that self-declaration of residency was sufficient to meet the regulatory residency requirements. However, self-declaration of residency is no longer an adequate means to prevent and detect dual participation in light of the added emphasis on detecting dual participation provided by PL 105-336. As a result, this memorandum, by requiring proof of residency, supersedes FNS Instruction 803-1, issued April 1. 1988, which permitted self-declaration of residency.

Proof of residency should be implemented in a manner that does not constitute a barrier to any applicant, particularly to a person who is mobile, such as a homeless person, a person in the military, or a migrant. It entails establishing the location or address where an applicant routinely lives or spends the night. For WIC purposes, it has no durational or formal legal aspect and need not represent a legal residence.

B. Proof of Identity
In addition, to further prevent dual or fraudulent participation or issuance of benefits, state agencies are reminded that Section 246. 7(1)(2) of WIC regulations requires that local WIC agencies check the identity of each applicant at certification and of each participant when issuing food or food instruments. For women participants with authorized proxies, this includes checking the identification of the proxies. For child or infant participants, this includes checking the identity of the parent, guardian or proxy picking up food or food instruments.

C. What Constitutes Reasonable Proof
In order to meet the intent of these legislative and regulatory requirements, state and local agencies must require applicants to present reasonable current documentation of personal identity and residency. Acceptable forms of proof of residency could include current utility bills, rent or mortgage receipts for lodging/housing, or a state/local document that can only be obtained through proof of current state or local residency. As per Section 246 7(1)(2) of WIC regulations, for an infant or child applicant, an immunization record, birth certificate, or other records that the WIC state agency considers adequate to establish identity shall be considered acceptable, as reflected in state agency guidance. For women applicants, optimal forms of proof of identity are a photo identification such as a current passport or driver's license, but acceptable forms include a work or school identity card, a health benefits or social services program card, pay stubs, a voter registration card, or other records that the state agency considers adequate. Persons seeking subsequent certification may use their WIC identification card for proof of identity. At state agency option, visual personal recognition by WIC staff at issuance of food or food instruments or subsequent certifications may be allowed once initial proof of identity and residency have been established.

When a WIC participant moves from one state to another, a valid Verification of Certification (VOC) card represents proof of nutritional risk and income eligibility. However, state agencies still need to subject the VOC card holder to a review of her identity and residency for enrollment in the system of the new WIC provider. The provisions of Section E. below, pertaining to "Applicants With No Proof of Identity and/or Residency.'' may be particularly relevant to VOC card holders.

D. Documenting Proof for Each Applicant
State agencies must require local agencies to record their determination of residency and identity. state or local agencies may wish to photocopy the actual documentation and place it in the applicant's case file. However, where state agencies deem this impractical. they must require that a notation be placed in the applicant's case file as to the type of documents (e.g., current driver's license, pay stubs, etc.) that were viewed which validated residency and identity. This notation may consist of simply checking off an appropriate annotated box on a form (paper or electronic). State agencies must establish appropriate protocols to facilitate and standardize the process among local agencies. These protocols and relevant forms must be reflected in the state agency's Policy and Procedure Manual.

E. Applicants with No Proof of Identity and/or Residency
An applicant with no proof of identity and/or residency, such as a victim of theft, loss, or disaster, a homeless individual, a migrant, or a person holding a VOC card, must sign a statement attesting to his/her identity and residency. In the situation where such a statement is used as the applicant's proof of identity and/or residency, the WIC staff must place in the applicant's case file the statement and a brief notation explaining why the applicant could not produce proof of identity and/or residency. State agencies must develop appropriate protocols to facilitate and standardize this process among local agencies, which may involve standard forms and documents. The state agency should also develop follow-up procedures to secure proof of identity and/or residency. These procedures and accompanying forms/documents must be included in the state agency's policy and procedure manual.

F. Efforts to Detect Dual Participation
PL 105-336 prompts us to reemphasize existing requirements to safeguard against dual participation. The new law reiterates existing WIC legislation and reinforces Section 246.7(1)(1)(i) and (ii) of program regulations. These regulations require each WIC state agency to implement a system to prevent and detect dual participation including within each local agency and between local agencies. Further. in states where WIC and CSFP operate in the same area, or where an Indian state agency operates WIC in the same areas as a geographic state agency, the regulations require that written agreements be entered into between the state agencies to prevent and detect dual participation.

In addition, WIC state agencies have the option to serve applicants outside their usual area such as shared areas or common borders. For example, an individual that lives in an adjoining state could be served by WIC in the state in which they receive health care. In such cases, however, WIC agencies must enter into written agreements to detect and prevent dual participation.

IV. Income Eligibility Determination

Section 203(a)(2) of PL 105-336 added Section l 7(d)(3)(D) to the CNA to require that an individual (except for those deemed adjunctively income eligible) seeking initial certification or subsequent certification for participation in the WIC program must provide documentation of family income, with limited exceptions such as for I) an individual for whom the necessary documentation is not available; or 2) an individual, such as a homeless woman or child, for whom the agency determines the requirement would present an unreasonable barrier to participation. Section 203(a)(3) of PL 105-336 added Section 17(d)(3)(E) which requires documentation of adjunct eligibility. The following interprets the legislation for practical application in WIC clinics.

A. Adjunct Income Eligibility and Documentation

1. Adjunct Provisions PL 105-336 requires that an individual seeking certification or subsequent certification for participation in WIC must provide documentation of adjunct eligibility. This legislative requirement reinforces Section 246.7(d)(2)(vi)(A) of WIC regulations which implements provisions of previous legislation enacted in 1989 (PL 101-147) that provided for adjunct income eligibility on the basis of an applicant's or certain family members' current eligibility to receive Food Stamps, Medicaid, or Temporary Assistance for Needy Families (TANF)--previously known as Aid to Families with Dependent Children. By law, persons and/or certain family members certified as eligible to receive benefits under any these programs at the time of their application to WIC are adjunctively income eligible for WIC, and consistent with Section 246. 7(d)(2)(vi)(C) of WIC regulations, are not subject to the income guidelines used for traditional WIC income eligibility certification discussed below in Section IV. C. Traditional Income Eligibility Screening. Because these programs generally document income, their use for WIC adjunct income eligibility determination purposes helps strengthen the integrity of the WIC eligibility determination process without undue burden to WIC. To the extent feasible, state agencies may wish to attempt to first certify an applicant on the basis of these adjunct provisions, as they are designed to expedite eligibility determinations, both for the applicant, as well as the WIC clinic.

2. Proof of Adjunct Eligibility Proof of adjunct income eligibility based on enrollment/eligibility in one of the three programs noted above must be confirmed at the time of application as required by current regulations and further reinforced by PL 105-336. When confirming an applicant's income eligibility for WIC on the basis of his/her own or a family member's current certification to receive benefits from one of these adjunct programs, state agencies are reminded that self-declaration has never been sufficient. Section 246. 7( d)(2)(vi)(A) of the WIC regulations requires documentation of eligibility for such programs. Such documentation must accurately represent current eligibility for participation in such a program. For food stamps, this may mean documenting membership in a family receiving benefits. Acceptable documentation could include a notification letter that identifies the respective program and the person's period of eligibility. We are aware that at least one WIC state agency has successfully negotiated with its food stamp counterpart to have all household members listed in the "Notice of Eligibility" letter. Documentation may be presented by the applicant, or alternately, the local clinic staff may use online or telephone access to adjunct programs to check an applicant's adjunctive eligibility. If documentation is not easily accessible, guidance in C.3. below, "Applicants Lacking Necessary Income Documentation at Certification Appointment," offers a variety of options. A Medicaid card with magnetic stripe or other electronic access provided to recipients, or an Electronic Benefit Transfer (EBT) card for food stamps and/or TANF, does not alone serve to verify current enrollment for purposes of establishing WIC adjunctive income eligibility.

B. Automatic Income Eligibility for Means-Tested Programs Other Than Food Stamps, Medicaid and/or TANF
In accordance with Section 246.7(d)(2)(vi)(B) of the WIC regulations, state and local agencies may continue to accept an applicant's documented participation in certain other means-tested programs as evidence of income eligibility for WIC. This is known as "automatic" income eligibility. Automatic income eligibility is applicable only if the programs: 1) routinely require documentation of income, and 2) have income guidelines at or below those of WIC. This ensures that persons being deemed income eligible for WIC on the basis of automatic income eligibility are only those who would have ordinarily been determined income eligible using WIC's traditional income screening processes discussed in Section IV. C. below. A federal program meeting these requirements is the Food Distribution Program on Indian Reservations.

At a minimum, documentation must show the participant's period of eligibility in an appropriate means-tested program. Again, acceptable documentation may include a notification letter that identifies the respective program and the person's period of eligibility.

C. Traditional Income Eligibility Screening
If an applicant is not adjunctively or automatically income eligible or the clinic worker is unable to substantiate adjunctive or automatic income eligibility with information provided, traditional income eligibility screening is required. State and local agencies are reminded that both family size and income levels are critical components of the income eligibility screening process. State agencies should review and, where necessary, strengthen the certification interview process to assure adequate prompts are used to elicit correct and complete economic unit size and income information from applicants. For example, a local agency certifier could ask the names of family members and their financial relationship to the applicant, their income sources, and financial arrangements they have with the persons with whom they live. This would assist in establishing a full understanding of the size of the economic unit and its financial resources. Both family size and income must be recorded in the applicant's case file.

Section 246.7(d)(l) of the WIC regulations allows local health care income guidelines for free and reduced price health care to be used to determine WIC income eligibility. However, state agencies are reminded that Section 246. 7( d)(2)(iii) further requires that such application of guidelines does not result in families, as defined below, with gross incomes above 185 percent of poverty, being rendered eligible for program benefits. The use of the state or local health care definition of "income" is not intended to extend income eligibility for WIC to those who otherwise would not meet WIC's income guidelines.

1. Family/Economic Unit Size
For WIC purposes, "family" is defined in Section 246.2 of the WIC regulations as a group of related or non related individuals who are living together as one economic unit ( except that residents of a homeless facility or an institution are not considered as members of a single family). Family members share income and consumption of goods and/or services. As stipulated in FNS Instruction 803-3, Rev. 1, for purposes of the WIC program, the terms "economic unit" and "family" can be used interchangeably, (although "economic unit" is probably the more appropriate terminology because it correctly conveys that familial relationship is not relevant to the determination of WIC family size and income).

It is reasonable to assume that persons (other than those living in institutional settings and homeless facilities) living in the residences of others, whether related or not, are likely to be receiving support and some commingling of resources which renders them members of the economic unit with which they live. However, it is possible to establish that more than one economic unit lives under one roof through appropriate questioning which helps to make a reasonable determination that there is general economic independence of the units, i.e., that financial resources and support are retained independently. For example, a pregnant woman who is sharing an apartment with her sister may be determined to be a separate economic unit from her sister if the certifier can reasonably establish that she has a source of income and is paying her proportionate share of household, living and personal expenses.

In accordance with Section l 7(d)(2)(C) of the CNA (as amended by PL 103-448, enacted November 2, 1994), when counting the number of persons in a family, it is important to note that a pregnant woman and her unborn child(ren) must be counted as two (or more) persons for determination of economic unit (unless the applicant has a religious or cultural objection which precludes this). In addition, in accordance with FNS Instruction 803-3, Rev. 1, a foster child is considered an economic unit of one as long as he/she remains the legal responsibility of a welfare or other agency. The payments made by the welfare agency or from any other source for the care of that child are considered to be the income of that foster child. An adopted child, or a child for whom a family has accepted legal responsibility, is counted in the size of that family.

Further guidance on family/economic unit size calculations can be found in FNS Instruction 803-3, Rev. 1, issued April 1, 1988.

2. Income Determination
Under PL 105-336, an applicant's income may no longer be self-declared; it must be documented. This provision took effect Oct. 1, 1998. State and local agencies may take the further step of requiring verification of income or other eligibility information as authorized by Section 246.7(d)(2)(v) of WIC regulations. Income generally means gross cash income earned or received by all members of the economic unit. Further guidance on what constitutes income for WIC eligibility determination purposes can be found in regulations under Section 246.7(d)(2)(ii) through (iv). In addition, FNS Instruction 803-3, Rev. 1, elaborates on income determinations, including on the use of current versus annual income. To assure full understanding of the new documentation requirement, a clear distinction is made between the terms "self-declaration," "documentation," and "verification." The implications of each of these are discussed below:

a. Self-Declaration - No Longer an Option "Self-declaration" means the reporting of income by an applicant without written documentation substantiating the information. This is no longer a permitted practice. except as specified below.

b. Documentation - Required
(i) "Documentation of Income" means presentation of written documents, such as current pay or unemployment benefits stubs, earnings statements, W-2 Forms with the corresponding income tax return, or other appropriate documents sufficient for establishing the current family income level of the entire economic unit. Documentation substantiating reported income for all members of the economic unit must be available.

(ii) As stated in Section 246. 7 ( d)(2)(ix) of the WIC regulations, valid VOC cards may serve as documentation of income eligibility for transferring participants and for instream migrant farmworkers and their family members. If a VOC card reflects that a migrant farmworker's certification period has expired, the VOC card may still serve as income documentation if the VOC card reflects that an income determination was made within the past 12 months.

c. Verification - Encouraged for Questionable Cases
(i) "Verification" means a process whereby the information presented, such as pay stubs, is validated through an external source of information other than the applicant. Such external sources include employer verification of wages, local welfare office verification, etc. state agencies must use their discretion in deciding when it is appropriate to verify, the information to verify, and the methods to use; and the need for applicant consent for such verification.

(ii) Section 246.7(d)(2)(v) of the WIC regulations authorizes (but does not require) the state or local agency to require verification of the information which it determines necessary to confirm income eligibility for program benefits (i.e., amount and source of income and number in family). FNS Instruction 803-3, Rev. 1, provides additional guidance on verification of income. FNS encourages verification of any questionable information.

3. Applicants Lacking Necessary Income Documentation at Certification Appointment
State agencies should establish guidelines to minimize the occurrence of the situation where applicants who do have proof of income fail to bring it to the clinic for review. For example. local WIC staff should routinely and clearly communicate to applicants the kinds of information they need to bring to their certification appointments. Nevertheless, for "walk-in" applicants and other applicants who do not bring necessary documentation to their certification appointment, state agencies may establish policies based on a number of options. These options, which also may be applied when the applicant fails to bring proof of adjunct or automatic income eligibility, include:

  • The local agency may inform the applicant of the necessary documents that are needed; make a new certification appointment within the timeframes for meeting certification processing standards; and certify only with income documentation.
  • The local agency may, if determined that an applicant meets all other eligibility criteria, screen for income eligibility based on self-declaration and, provide one month of food benefits and require that appropriate income documentation be brought in within 30 days. If the applicant fails to provide the documentation within the 30-day time limit, or provides the documentation and is found to be over WIC's income limit, the individual shall be determined ineligible. These cases should be treated as initial determinations. Thus, while the applicant must be given an opportunity to appeal this action, the WIC agency is not required to provide the 15-day advance notice of this action as generally required for actions affecting program participation. In addition, the individual may not receive WIC benefits while awaiting the fair hearing decision. Should the applicant return within the 30-day time period with the documentation and be found eligible, the applicant should be certified for the certification period beginning with the month benefits were initially provided.

4. Applicants with No Proof of Income
PL 105-336 provides for limited exemptions for situations which pose unreasonable barriers to participation. The House Report accompanying PL 105-336 reinforces that income documentation is required except in limited circumstances. To accommodate congressional intent, the following serves as guidance for instances where an applicant is in a situation unlikely to yield written documentation of income, such as for a homeless woman, child, migrant farmworker or person who works for cash. The state agency may, if it determines that requiring such an applicant to provide income documentation would present an unreasonable barrier to participation, allow the applicant to self-declare income, accompanied by the applicant's signature on a statement specifying why he/she cannot provide documentation of income. State agencies have the option to further require that such an applicant obtain a written statement from a reliable third party that has knowledge of the applicant's income. Reliable parties might include staff of a social service agency, church or legal aid society, or employers.

5. Applicants Reporting Zero Income
Given WIC' s definition of family size, which is a group of related or unrelated persons sharing financial and other resources, applicants declaring a zero income should be prompted to describe in detail their living circumstances and how they obtain basic living necessities such as food, shelter, medical care and clothing to properly apply WIC rules pertaining to family size and income. For example, an unemployed pregnant woman with no personal income living with a friend who is providing shelter, water, electricity and food to her in return for her care of the friends' two children may unwittingly and honestly report zero income as a family of two (the woman and her unborn child). In this example, the applicant should have been further prompted by a certifier to describe her situation more fully to draw a proper conclusion that she should be counted as a part of the larger economic unit, that is, a family of five with an income that is the friend's income. In cases where it is established that an applicant is truly with minimal ·or no resources, WIC agencies can offer invaluable links to crucial sources of aid and assistance.

D. How Proof of Income Eligibility Should Be Documented

State agencies must require that local agencies maintain a record of documentation used to establish an applicant's income eligibility. State or local agencies may wish to photocopy the actual documentation and place it in the applicant's case file. However, where state agencies deem this impractical, they must require that a notation be placed in an applicant's file of the specific type(s) of document that was viewed. This procedure applies whether an applicant is certified under adjunct, automatic. or traditional income eligibility determination processes. This notation may consist of checking off an appropriate annotated box on a state agency developed form (paper or electronic). Both income and family size must be recorded. When a certifier is satisfied that an applicant is legitimately reporting zero income, the applicant's signature on the application form will suffice as documentation.

V. Summary

This policy memorandum supersedes FNS Instruction 803-1, WIC Program Certification: Residency Requirements, by incorporating all its provisions, except self-declaration of residency, which is preempted by this policy memorandum. Implementation of the safeguards set forth in this policy memorandum will strengthen integrity in the income eligibility process by minimizing the potential for fraud and abuse of the Program and assuring optimal delivery of available benefits.

PATRICIA N. DANIELS
Director
Supplemental Food Programs Division

EO Guidance Document #
FNS-GD-1999-0005
Date
FNS Document #
Final WIC Policy Memorandum #99-4
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (4.24 MB)
No
Summary

The purpose of this policy memorandum is to highlight and strengthen national program policy regarding integrity in the WIC certification process through existing regulatory requirements as well as through new legislative requirements mandated by PL 105-336.

Page updated: November 30, 2021
Page updated: December 07, 2021

Evaluation Criteria for Infant Formula Rebate Contracts

DATE: October 14, 1998
MEMO CODE: Final Policy Memorandum #99-3
SUBJECT: Evaluation Criteria for Infant Formula Rebate Contracts
TO: Regional Directors
Supplemental Food Programs
All Regions

The purpose of this policy memorandum is to clarify federal statutory and regulatory limitations on the use of technical evaluation requirements for invitations for bid (IFB) for infant formula rebate contracts. Specifically, this memorandum addresses: (1) the statutory requirement that an infant formula rebate contract be awarded to the manufacturer "offering the lowest price" (42 USC 1786(b)(17)); and (2) that state agencies are prohibited by federal regulation from issuing IFBs or entering into contracts excluding "from consideration in the bidding evaluation any infant formula manufacturer in compliance with the Federal Food, Drug and Cosmetic Act (FFDCA) (21 USC 321 et seq.)" (7 CFR 246.16(0)(2)).

BACKGROUND

It has come to our attention that some state agencies included in their IFBs technical requirements that violate the Child Nutrition Act's (CNA) lowest price requirement. Specifically, the technical requirements used a subjective point evaluation system and/or a weight system that allowed scores for both the technical evaluation and cost evaluation. For example, the technical requirements under this subjective point evaluation standard included provisions such as rating marketing practices or organization size and structure, and/or requiring information on total shelf presence in a state or plant production capability. These types of technical requirements violate 42 USC 1786(b)(17) because they create the possibility of awarding an infant formula rebate contract to a manufacturer who has not offered the lowest price.

FEDERAL REQUIREMENTS

Several state agencies have indicated to us they are concerned about contract performance problems and believe evaluating technical requirements allows them to select a bidder that is the most able to provide benefits to the state. However, we must emphasize federal law explicitly requires state agencies to award infant formula rebate contracts to the bidder offering the lowest price to the state. This lowest price requirement appears in the CNA and is stated in unconditional terms; therefore, it is not subject to modification by the use of technical requirements such as those discussed above. This prohibition against using technical requirements to exclude lowest price bidders is buttressed by WIC regulations. As we have already stated, 7 CFR 246.16(0)(2) requires that "state agencies shall not issue invitations for bid or enter into contracts which exclude from consideration in the bidding evaluation any infant formula manufacturer in compliance with the Federal Food, Drug and Cosmetic Act." This regulatory language recognizes that compliance with the Federal Food Drug and Cosmetic Act demonstrates that a manufacturer satisfies all, subjectively evaluated, technical requirements relevant to whether the manufacturer is capable of providing infant formula for the WIC program.

FNS is not suggesting a state agency must totally exclude technical information from its IFB. A state agency may choose to require bidders to submit information of a technical nature in order to determine if a bidder is responsible and responsive. To be responsive, a bidder must submit a bid that conforms to the solicitation. To be responsible, the bidder must meet the eligibility requirements under the applicable statute and regulations, and be able to meet the requirements set forth in the IFB. For example, if a bidder meets applicable statutory and regulatory requirements, such as the requirement to register under the Food, Drug and Cosmetic Act, it should be deemed responsible.

However, if information is required, such information must be evaluated objectively. A state agency can only ascribe a pass or fail determination based solely on whether the bidder has submitted the required information and that the required information is relevant to the bidder's capability to provide infant formula products to the state agencies authorized retail vendors. In other words, technical information shall demonstrate factors which are either present or absent, and evaluation of the factors may not allow any subjective assessment.

Contract Provisions

Regarding state agency concerns about possible performance failure, we believe there are ways to provide the state agency with assurances via contractual provisions. To protect a state agency in the event the successful bidder cannot fulfill the terms of the contract, we suggest a clause in the contract that requires the successful bidder to continue to pay a rebate on another brand of similar infant formula issued to WIC participants in the event the contract manufacturer's formula is unavailable in grocery stores. Granted, this is not an easy solution; however, it does put bidders on notice that a rebate is required and it is in their best interest to have their infant formula readily available to WIC retailers. Also, contracts should contain provisions that allow the state agency to cancel the contract for non-performance issues such as failure to supply infant formula and hold the company liable for damages.

State agencies must also plan well in advance of the effective date of the contract to alert WIC retailers of an infant formula change to allow ample time to order an adequate supply of the new contract brand of infant formula. This will help ensure a smooth transition period, a critical time of the contract for infant formula supply. FNS strongly encourages that WIC state agencies also apply this memorandum, as appropriate, to IFBs for rebates on products other than infant formula.

Please advise your state agencies of this policy.

RONALD J. VOGEL
Acting Director
Supplemental Food Programs Division

EO Guidance Document #
FNS-GD-1998-0014
Date
FNS Document #
WIC 1999-3
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (909.53 KB)
No
Summary

The purpose of this policy memorandum is to clarify federal statutory and regulatory limitations on the use of technical evaluation requirements for invitations for bid  for infant formula rebate contracts.

Page updated: November 30, 2021

Approval of WIC EBT Systems

DATE:October 20, 1998
MEMO CODE:Final Policy Memorandum: #99-2
SUBJECT:Approval of WIC Electronic Benefits Transfer (EBT) Systems
TO:Regional Directors
Supplemental Food Programs
All Regions

This is to provide policy regarding federal approval requirements for state development and implementation of EBT systems for the WIC program. EBT systems in the WIC program encompass a wide spectrum of functions including the automation of the food benefit issuance and redemption process as well as exchange of client data. WIC EBT can be accomplished via magnetic stripe or integrated chip cards, or electronic transmission and processing of data, or a combination of all of these technologies as functions dictate. This memorandum discusses the objectives of EBT, not the technological method by which it can be accomplished.

EBT Vision

In November 1994, the Supplemental Food Programs Division published the WIC EBT Vision Statement, which served to establish key guidelines for future WIC EBT applications. In August 1997, the Food and Nutrition Service (FNS) submitted four-year goals to the Vice President's Reinvention Impact Center Initiative which included an increase in the number of state WIC electronic benefits projects from 1 in 1997, to 7 in 2000. In achieving the Vice President's year 2000 goal, the following guidelines are the cornerstone of the national WIC EBT initiative:

  • Include WIC as an integral part of the national strategy towards modernizing and streamlining business practices through electronic solutions.
  • Deliver WIC benefits and reconcile payments through an EBT system that is cost-effective at the statewide operational level.
  • Improve client services through simplified point-of-sale transactions and greater shopping convenience.
  • Increase accountability and streamline program monitoring for states.
  • Make WIC benefit redemption and payments more efficient for retailers.
  • Maximize the technological advantages for WIC in line with evolving commercial sector innovations.
  • Promote federal, state, and retailer partnerships in development and implementation of EBT systems for improved client benefit delivery and program integrity.

Pursuing this vision, through EBT technology, offers WIC two important opportunities for program improvement. First, the automation of the paper food package issuance and redemption process for WIC clients and grocers streamlines a labor intensive process, and at the same time enhances WIC's ability to track food items and food costs. Second, there is the opportunity to use EBT as the link for the WIC client to other programs and client services such as immunization tracing, Medicaid payments, and other health services.

Processing retailer payments for WIC is currently not a nationally uniform process. Most WIC state agencies currently have in place banking payment systems for WIC retailers. While electronic and expedited payments to retailers are advantageous, the EBT technology offers many other functional and efficiency advantages for grocery stores as well as the WIC program in general.

Retailers have reported to FNS that they are interested in solutions which will alleviate the burden of insuring that only WIC authorized foods are purchased at check out, expedite the food instrument payment process, and reduce the delays and the resources required to deal with returned food instruments which are denied payment. In WIC, improved service to both retailers and clients should focus on simplifying Point of Sale (POS) transactions so that retailer oversight responsibilities are minimized, and the client receives prompt and courteous service at the grocery store.

Because the WIC program transaction is complicated and time-intensive for grocery stores, the WIC program wishes to work in partnership with stores to automate this process. Further, it is expected that stores should share financially in order to implement this new technology to the extent it will reduce their current costs and is a sound business decision for grocers.

Other Program Linkages

WIC EBT will most likely involve partnerships with other programs such as Food Stamps, Medicaid, Head Start, TANF, and Immunization to share client data. The Food Stamp Program requires that its state agencies consult with WIC when planning an EBT system. It is anticipated that WIC state agencies will coordinate their plans with other state officials, including the Food Stamp Program and EBT Directors.

Through joint projects, WIC and FSP may be able to reduce costs by use of the same EBT contractor to do functions similar in both programs such as retailer settlement, bank processing, and help desk services. Integration of farmers' markets into states electronic benefit delivery plans is a challenge, and FNS has established a task force to work on resolving the problems presented by this unique type of integration.

Functionally, there are three points of intersection for the WIC program and the FSP: (1) shared benefit redemption at the retailer, (2) shared client population (up to 60 percent of WIC participants also receive food stamps in some states) and (3) shared goal to protect program integrity, achieved by facilitating the sharing of authorization and disqualification data on retailers to minimize fraud and abuse. Regarding the sharing of POS terminals at the grocery store, it is important to emphasize that WIC both delivers and measures its benefits differently than the FSP. WIC delivers a food package of specific, nutritious foods, targeted for the individual health needs of at-risk pregnant, postpartum, and breastfeeding mothers, infants and children. It is crucial that this part of the WIC program mission be addressed in EBT system plans and that grocery stores understand that WIC EBT will involve additional design features beyond those that enable the basic financial transaction used by the FSP.

Sharing client data is a special challenge, and it is the hope of FNS that EBT can serve as a catalyst to improve the exchange of client data between WIC clinics, FSP and other programs. The exchange of client data could be especially helpful in regard to WIC performing adjunct income eligibility determinations. However, it is understood that linking with other health and welfare data systems may present a challenge. Thus, while it is desirable to put WIC, FSP and other program client data on one EBT card, differences in each program's issuance systems may present integration difficulties.

Therefore, states should attempt to better integrate data, but FNS understands this objective is dependent on each state's circumstances and resources.

Finally, WIC and FSP have similar interests in ensuring the integrity of the grocery store transactions in our programs. While strengthened coordination is not a requirement of a WIC/FSP EBT project, it provides an opportunity for EBT to facilitate increased interaction and efficiency between both programs concerning retailer integrity responsibilities.

Funding for EBT

Funds to develop and implement EBT systems will come primarily from the same sources as current funding for ADP systems and other capital investments - state Nutrition Services and Administration (NSA) grants - including regional office discretionary funds, and the annual WIC multi-purpose grant. States are encouraged to share expenses through cost sharing agreements with EBT project partners (e.g., Food Stamp, TANF, Immunization) to the extent that this also benefits the WIC program.

EBT will offer additional benefits to the WIC program, however, these additional benefits carry a price. While the costs of implementing and operating EBT continue to decline, initial operational costs may exceed the current paper-based system. State agencies should understand that funding for the continued maintenance and operation of the state's EBT system will come primarily from its annual NSA grant.

EBT System Approval Policy for WIC

WIC regulations at 7 CFR 246. 14 require prior approval of the use of WIC funds for automation projects. States will need to obtain prior approval from FNS for all proposed expenditures for EBT projects by submission of Advance Planning Documents (APDs) consistent with the FNS Handbook 901. The WIC APD process for EBT systems should follow as closely as possible the regular process for submission of required documents for WIC ADP systems. However, the funding threshold levels which are considered when determining document requirements and the approval process for state automation projects will not be applied to WIC EBT. As EBT is a new technology for WIC, states should obtain prior approval from FNS for all proposed expenditures for EBT projects.

An Implementation Advance Planning Document (IAPD) is usually required for implementing an EBT system, even if the EBT project is just a component of a larger system redesign. In some cases, an Advance Planning Document Update (APDU) may be the only documentation required if the EBT project is an addition to an earlier APD. The Request for Proposal (RFP) and subsequent contract(s) for EBT development or services continue to be crucial elements in the approval process. RFPs may be submitted for review and approval at the same time as the APD or at another time, as appropriate to the state's procurement plans. For instance, at the discretion of FNS, states may be allowed to submit a partial or preliminary IAPD prior to the release of the RFP, or to submit the IAPD and RFP together for review. States should also be aware that if they are initiating projects which include procurements with the FSP, they will need to observe the FSP procurement rules which are more specific than WIC procurement requirements. As with APD approvals for other automation projects, regional offices should obtain from the state agency those documents appropriate for that state agency's unique situation.

For all EBT projects where the WIC program is the primary initiating program, the WIC state agency should submit copies of APDs and RFPs to their respective Regional Administrator (RA). Copies will be provided by the RA to the Supplemental Food Program Regional Director, who will provide copies to their designated regional WIC EBT coordinator, who will then transmit copies to their respective FNS EBT Account Executive. In order to adhere to the FNS agreement to provide a single point of contact to states for EBT approvals, state agencies may choose to send concurrent copies directly to the regional office and to the EBT Account Executive in headquarters. The FNS EBT Account Executive will then coordinate the Headquarters review and approval process with the Supplemental Food Programs Division (SFPD), the Information Technology Division (ITD), Financial Management (FM), and the Office of Analysis and Evaluation (OAE). In tum, FSP EBT planning documents which include a WIC component will be shared by the respective FNS EBT Account Executive with SFPD, regional program directors, and their respective W1C EBT coordinators.

While the above instructions are offered as guidelines to submitting documents for EBT systems approval, the process, sequence, and timetable for document submission should be viewed as flexible and sensitive to the system development needs and concerns identified by the regional office and state agency. Because EBT projects are likely to be multi-program ventures, FNS will be flexible in the documents needed. The state agency and FNS regional office should discuss plans and customize the documentation requirements for each state agency situation as early as possible in the planning stages.

FSP EBT Contracts with WIC Options

Many states have included WIC as an option in their FSP EBT system solicitation and contract. It is important to note that the approval of a contract for providing FSP EBT benefits and services does not automatically carry with it the approval for the expenditure of WIC funds for an EBT system. It is necessary to secure a separate FNS approval of funding to ensure the availability and encumbrance of WIC money for these joint projects.

There may be situations where, depending upon the approved contract language, it may be appropriate to add W1C services to an existing EBT contract. This is a procurement question, and will need to be addressed on a case-by-case basis, both in terms of individual state procurement laws and federal contract approvals. However, the legality of a contract or contract modification to add on these services is one issue; FNS's prior approval of the use of WIC program funds is another. Therefore, an APD/APDU or an IAPD will be necessary to obtain prior approval for WIC EBT systems, and the contract mechanisms the state wishes to use to procure such services should be addressed as a part of the APO.

EBT Functional Guidelines for WIC

The following is a general list of functions which FNS believes should be addressed in the design of an EBT system. Although state agencies may wish to introduce some functions in advance of others, such as the electronic transmission of the financial transaction settlement, this is discouraged unless the state can demonstrate that the overall costs of doing so would be cheaper than current check processing costs.

1. Ensure that the participant is able to purchase the full prescribed WIC food package, at their discretion within the valid period of issuance, and that the WIC food transaction afford the participant dignity and convenience.

Current paper food instrument systems restrict the number of shopping trips for the participant, and are cumbersome to transact. EBT should ensure the participant shops as other customers do, and has the flexibility to purchase the quantities of foods she needs whenever she wishes.

2. Ensure that the-participant is able to purchase only WIC authorized foods· and foods are not improperly substituted.

The current system of depending on the store cashier to screen participant purchases is burdensome and problematic. The main objective is to ensure only WIC authorized foods are purchased. In fact many large grocery stores have already incorporated features in their store scanning systems which deny an inappropriate WIC food choice. EBT should further facilitate this important integrity feature.

3. Provide data on the type, brand and cost of each food item so that state agencies can better control food costs through informed food package decisions and maximization of rebates on infant formula and other foods.

To improve WIC program administration, any EBT solution should better account for the types of food purchased, especially infant formula. Most state agencies rely on issuance records because multi-food item food instruments do not capture actual redemptions by food item. An EBT solution should provide for item-by-item tracking by UPC, quantity, dollar value charged, and redemption date, in order to give state agencies the necessary tools to produce accurate infant formula bills. In addition to using staff resources more efficiently and eliminating most billing disputes, a complete infant formula rebate billing system through EBT could help ensure more advantageous bids for states, since infant formula companies will not need to build the additional administrative costs and potential losses into their bids.

Additionally, beyond infant formula, similar data should be collected for other foods as well, at least on a sample or periodic basis to monitor costs and to support decisions on possible rebates on other foods or other cost control initiatives.

4. Ensure that WIC clients are charged no more than contract price or shelf price for food as other customers.

By gaining information from grocery store scanning and cash register systems, which automatically identify a food's price at check-out, WIC can be reasonably assured that it is paying no more than other customers for WIC purchases.

5. Enable the food retailer to complete the WIC transaction efficiently and properly and assure that the cost of the EBT system for a WIC transaction is reasonable for both the state and the retailer.

Currently, food instruments are rejected for a variety of reasons such as being over the price limit, outside-of date limits, altered, and so on. The automation of the food instrument transaction process to reduce the occurrence of such errors will save valuable grocery store and WIC staff time in screening for such errors and making payment adjustments. In developing the business case for implementing EBT, state agencies and grocery stores should consider their current, respective food instrument processing costs compared to costs under an EBT system.

6. Ensure that WIC food expenditure and rebate savings data, compiled by the state or outside entity, is accurate, provided promptly and in a timely manner, and allows the state agency to make better management decisions.

There is considerable disparity between states in the timeliness and accuracy of food expenditure and rebate savings data. In those states where informative food costs and rebate data is not provided in a timely fashion, EBT should facilitate easier production of cost and savings reports to enable the state to make more cost-effective food package management decisions. Among other uses, EBT transaction processing and redemption data should also be made available to facilitate program integrity monitoring by identifying irregular retailer and participant transactions, and to provide information regarding participant food purchasing patterns.

FNS hopes that this guidance is helpful to states in planning their EBT initiatives. If you have any questions, please contact the regional office.

RONALD J. VOGEL
Acting Director
Supplemental Food Programs Division
THOMAS O'CONNOR
Director
Benefit Redemption Division
EO Guidance Document #
FNS-GD-1998-0015
Date
FNS Document #
WIC 1999-2
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (2.21 MB)
No
Summary

This is to provide policy regarding federal approval requirements for state development and implementation of EBT systems for the WIC program. EBT systems in the WIC program encompass a wide spectrum of functions including the automation of the food benefit issuance and redemption process as well as exchange of client data.

Page updated: November 02, 2023

Impact of Participation in the WIC Program on Alien Status

DATE: March 19, 1998
SUBJECT: WIC Final Policy Memorandum #98-7
TO: Regional Directors
Supplemental Food Programs
All Regions

Attached is a letter we received from the Immigration and Naturalization Service (INS) expressing their position with regard to the impact of participation in WIC on an individual's alien status. As stated in the letter, INS confirms that use of WIC benefits does not render an alien a public charge, that benefits should not be denied to aliens who have used WIC, and that INS should not request that aliens repay any WIC benefits received. In addition, based on meetings and discussions, it is INS and the State Department's position that receipt of WIC benefits will not have any effect on an individual's application for immigration or citizenship benefits or result in a determination that an alien is a public charge. However, the receipt of WIC benefits does not shield an individual from compliance with other requirements under the immigration law. For example, an applicant would be ineligible for a visa or adjustment of status if some other ineligibility applied such as a conviction for a crime, violation of immigration status, or if the applicant could not meet overall public charge requirements.

As noted in INS' letter, they are nearing completion of a memorandum to INS field officers which will formally clarify this issue for the WIC program and a number of other federal programs. It is our understanding that the issuance of INS' policy will trigger the State Department to release guidance to its U.S. consulates consistent with INS since both agencies' guiding rules are the Immigration and Nationality Act.

In the interim as we await the issuance of INS policy guidance, please share a copy of the attached letter with your state and local agencies. They may wish to use the INS letter in clarifying this issue with WIC applicants and participants and in cases where other entities indicate policy which is inconsistent with the attached INS letter. As soon as INS and the State Department formally issue policy, we will share that information with you. At that time we, in concert with INS, will ensure wide dissemination of the policy information to program applicants, participants, entities that handle/deal with immigration cases, and entities such as universities that advise aliens about their status so that a consistent message reaches the community.

INS and the State Department continue to work with us on a case-by-case basis, as necessary, to resolve specific problems related to the WIC program as they arise. If you become aware of specific problems involving WIC participation, please provide us with sufficient details concerning the problem. To thoroughly investigate a problem, INS needs the INS office/officer's name, the applicant/participant's name, date of birth, current alien status, status being sought, and alien number that begins with the letter "A" followed by eight numbers, e.g., #A 76543210. In order for our office to share such information with the INS, a WIC applicant/participant must provide written consent authorizing the WIC program/FNS to share her name (or that of her participant children, where appropriate), date of birth, and alien identification number with the INS for the purpose of INS investigating the appropriateness of the action taken by its officers. When requesting investigation of a problem, please provide us with a copy of the written consent, so that we are assured authorization has been granted to us by the individual.

RONALD J. VOGEL
Acting Director
Supplemental Food Programs Division

 
Attachment
EO Guidance Document #
FNS-GD-1998-0006
Date
FNS Document #
WIC 98-7
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (901.66 KB)
No
Summary

The Immigration and Naturalization Service  confirms that use of WIC benefits does not render an alien a public charge, that benefits should not be denied to aliens who have used WIC, and that INS should not request that aliens repay any WIC benefits received.

Page updated: November 30, 2021

Documentation of FSP Participation in an EBT Environment

DATE: February 5, 1998
MEMO CODE: WIC Policy Memorandum: #98-4
SUBJECT: Documentation of Food Stamp Program Participation in
an Electronic Benefits Transfer (EST) Environment
TO: Regional Directors
Supplemental Food Programs
All Regions

This policy memorandum provides guidance on acceptable forms of documentation which confirm current participation in the Food Stamp Program (FSP) for WIC adjunctive income eligibility purposes.

As you may know, the FSP is under a mandate by Congress to convert all benefit delivery to EST by the year 2002. Many states have already done so, eliminating the traditional FSP card, and issuing a plastic card, usually with no name and no eligibility date printed on it. This can present a dilemma for the WIC program because local agencies are accustomed to seeing certain paper documentation as proof of FSP participation in determining adjunctive income eligibility for WIC. Section 246.7(d)(vi)(A)(1) of the WIC regulations requires that applicants document their participation in the Food Stamp, Medicaid or Temporary Assistance for Needy Families (TANF) Program in order to be deemed adjunctively income eligible. Self declaration of participation in one or more of these programs is not acceptable documentation.

The increasing use of EBT by states to provide FSP benefits as well as other program benefits such as TANF, has raised questions concerning the appropriateness of an EBT card as proof of adjunctive income eligibility, since an individual's current participation in the FSP cannot be determined by visual examination of the EST card. Therefore, WIC clinic staff shall not accept an EBT card as proof of current FSP or other adjunctive program participation, unless the card contains the period of eligibility. However, by regulation, the FSP still issues a paper notification of eligibility, which includes the certification period. This paper notification, as well as on-line access data systems that are available to WIC clinic staff are acceptable forms of documentation of FSP participation. WIC clinic staff must record in the participant's case file the type of documentation that was used to document participation.

WIC state agencies should provide policy information to their local agencies about the new card and notice prior to FSP conversion to EBT, to ensure that no WIC applicant is rejected due to lack of appropriate documentation. WIC clinic staff should instruct applicants to bring appropriate documentation to their certification appointment so applicants are enrolled expeditiously when there is no on-line mechanism to verify current FSP participation.

It is in WIC's best interest to meet early with state FSP project planners to advise them about the need for documentation to facilitate verification of FSP eligibility. It would certainly be advantageous for WIC if the FSP would agree to inform their clients of the paperwork requirements for WIC adjunctive eligibility purposes. As an extra measure to ensure this communication occurs, we suggest that WIC state agencies make fact sheets available to the FSP explaining the paperwork required to document current FSP participation in an EST environment. The fact sheets could be easily distributed in FSP offices (as well as any other programs which issue benefits via an EBT card) making the information readily available to potential WIC applicants.

RONALD J. VOGEL
Acting Director
Supplemental Food Programs Division

EO Guidance Document #
FNS-GD-1998-0003
Date
FNS Document #
WIC 1998-4
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (601.63 KB)
No
Summary

This policy memorandum provides guidance on acceptable forms of documentation which confirm current participation in the Food Stamp Program for WIC adjunctive income eligibility purposes.

Page updated: November 30, 2021

Non-Computer Equipment Purchases Less than $25,00

DATE: January 6, 1998
MEMO CODE: WIC Final Policy Memorandum 98- 3
SUBJECT: Non-Computer Equipment Purchases Less Than $25,000
TO: Regional Directors
Supplemental Food Programs
All Regions
Regional Directors
Financial Management
All Regions

Federal awarding agencies may waive the requirement to obtain the awarding agency's prior approval of capital expenditures for equipment, other assets, and improvements which materially increase the value or useful life of equipment or other capital assets (7 CFR 3016.22). Therefore, this policy memorandum authorizes WIC state agencies to purchase or allow their local agencies to purchase non-computer equipment with a unit cost less than $25,000 without prior approval from FNS. The exception is that regional offices maintain the authority, with written notice, to continue to apply a lower cost threshold for a state agency and its local agencies, if the region determines that an equipment purchase having a unit cost of $5000 to $24,999 would represent a significant amount or percentage of that state agency's Nutrition Services and Administration (NSA) grant or if the state agency is high-risk for financial or program management deficiencies based on its current or historical performance.

The objective of this policy is to relieve WIC state agencies of the requirement to submit requests to FNS for prior approval of relatively small state and local level noncomputer equipment purchases which have traditionally been accepted to be reasonable and necessary to conduct WIC program operations such as copiers and vehicles. This policy memorandum is applicable only to non-computer equipment. Computer equipment purchases are governed by FNS Handbook 901 , Advanced Planning Document and require the state to either obtain written prior approval from FNS or notify FNS of the purchase according to the guidance provided there. Computer equipment purchases include hardware such as personal computers, monitors for individual work stations, printers, modems, keyboards, etc., whether used alone or as part of a distributed system or a centralized system. Therefore, all equipment purchases are governed either by this policy memorandum or FNS Handbook 901, Advanced Planning Document.

This policy simply raises the cost threshold for non-computer equipment purchases which require prior approval from FNS. Equipment costs determined, by audit or otherwise, not to meet other requirements or tests for allowability, provided in program regulations and policy and 0MB Circulars, such as reasonableness and necessity, may still be disallowed. Therefore, regardless of cost, if a state agency has any question concerning the allowability of an item of equipment, the FNS regional office should be contacted for assistance in making this determination. Further, equipment acquired with federal WIC grant funds must still be used, managed (property records maintained, inventories conducted, etc.) and disposed of in accordance with guidance provided in 7 CFR 3016.32. Finally, WIC state and local agencies must continue to follow state and local agency procurement policies and procedures. As such, WIC state agency procurements, which no longer require prior approval from FNS, may continue to require prior approval from state agency officials. WIC local agency procurements, which no longer require approval from FNS, may continue to require prior approval from local and/or state officials.

Purchases of other capital assets such as buildings, land and improvements to buildings or land that materially increase their value or useful life, costing more than $5000, continue to require prior approval from FNS. regional offices will use the guidance provided in FNS Instruction 813-1, dated May 5, 1993, to assess these requests.

BARBARA HALLMAN
Acting Director
Supplemental Food Programs Division
LOU PASTURA
Director
Grants Management Division

 

Attachment
EO Guidance Document #
FNS-GD-1998-0001
Date
FNS Document #
WIC 1998-3
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (1.65 MB)
No
Summary

This policy memorandum authorizes WIC state agencies to purchase or allow their local agencies to purchase non-computer equipment with a unit cost less than $25,000 without prior approval from FNS.

Page updated: November 30, 2021

WIC Vendor DQs Resulting from Permanent Disqualification from the FSP

DATE: December 8, 1997
MEMO CODE: Final WIC Policy Memorandum: #98-2
SUBJECT: WIC Vendor Disqualifications Resulting from Permanent Disqualification from the Food Stamp Program
TO: Regional Directors
Supplemental Food Programs
All Regions
Regional Directors
Food Stamp Program
All Regions

The purpose of this policy memorandum is to provide clarification regarding the effective date of Special Supplemental Nutrition Program for Women, Infants and Children (WIC) vendor disqualification's that result from the permanent disqualification of a vendor from the Food Stamp Program (FSP).

Section 845 of PL 104-193. the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. generally known as the Welfare Reform Act, requires that permanent disqualification of a firm from the FSP be effective from the date of receipt of the notice of disqualification. As such. the disqualification becomes effective before an administrative or judicial decision is rendered. The law further provides that if the FSP disqualification is reversed through administrative or judicial review, USDA is not liable for the value of any revenues lost during the disqualification period.

This change in the FSP law raises new issues for the WIC program regarding the effective date of a reciprocal WIC vendor disqualification based on a disqualification from the FSP. In the past. this has not been an issue for WIC because the WIC disqualification always occurred after all FSP administrative appeal rights have been exhausted.

The FSP retailer disqualification process involves two written communications from the Food and Consumer Service (FCS) field offices- a charge letter and a letter of determination. In the past. the letter of determination did not actually effectuate the permanent disqualification since the effective date of the FSP action to disqualify a firm was held in abeyance pending the possibility of administrative appeal. Now. however, the letter of determination issued b\' FCS field offices effectuates the permanent disqualification. The retailer may appeal the action to permanently disqualify the firm, and, upon winning the appeal. be reinstated for participation in the FSP. but the actual disqualification takes effect upon receipt of the determination letter.

WIC state agencies which have implemented Section 246.12 (k)(l)(iii) of the WIC program regulations. which allows disqualification from WIC because of disqualification from another FCS program. should proceed with caution on reciprocal WIC disqualifications based on a FSP permanent disqualification because there are no WIC legislative protections from liability for the value of lost revenues. As such, the WIC reciprocal disqualification should not take effect until all FSP appeal actions have been exhausted and a final decision upon administrative or judicial review has been rendered.

If an appeal has been filed by the vendor, no WIC action can be taken until all administrative or judicial appeal rights have been exhausted. The FCS field office will notify the WIC state agency of the final administrative or judicial decision at which time the state agency may take action as appropriate.

If an appeal has not been filed within 10 days of the date of the determination letter, the determination letter will be forwarded to the WIC state agency notifying them that this firm has been disqualified.

Those state agencies which have not implemented the option at 246.12(k)(l)(iii) of the WIC program regulations cannot disqualify the vendor from WIC solely on the basis of the FSP disqualification. Although the Welfare Reform Act contained a provision requiring the disqualification of WIC vendors who have been disqualified from the FSP, we must first establish criteria in WIC program regulations before implementing this provision. The proposed rule establishing such criteria is currently in clearance.

BARBARA HALLMAN
Acting Director
Supplemental Food Programs Division
THOMAS O'CONNOR
Director
Benefit Redemption Division, FSP
EO Guidance Document #
FNS-GD-1997-0021
Date
FNS Document #
WIC 1998-2
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (630.27 KB)
No
Summary

The purpose of this policy memorandum is to provide clarification regarding the effective date of Special Supplemental Nutrition Program for Women, Infants and Children vendor disqualification's that result from the permanent disqualification of a vendor from the Food Stamp Program.

Page updated: November 30, 2021

Caseload Management

DATE:May 5, 1997
MEMO CODE:Final WIC Policy Memorandum: #97-7
SUBJECT:Caseload Management
TO:Regional Directors
Supplemental Food Programs
All Regions

This policy memorandum addresses the basic tools of WIC caseload management. This document consolidates key provisions of previously issued Food and Consumer Service (FCS) policy on all components of caseload management -- from food cost savings strategies and food package design, to certification strategies -- into a comprehensive scheme. This policy memorandum is intended to summarize. reinforce and clarify these strategies and their critical interrelationships.

WIC managers at all levels know that one of the most challenging aspects of WIC program management is finding the right blend of strategies to successfully manage caseloads and funds obligations. Prudent caseload management and integrity in operations is an ongoing responsibility of WIC managers. The basic goal of caseload management in WIC is to deliver, within available resources, appropriately prescribed packages of benefits to a maximum number of persons most in need.

Financial data accounting and management systems which accurately and reliably forecast project and track funding, expenditures, and obligations are essential to effective caseload management. Accurate and timely data are critical to the early detection of potential over- or under-spending, the magnitude of the problem, and the effectiveness of measures taken to remedy the problem. A sound data system also can trigger an early response to allow gradual and systematic reduction in caseload. which always is preferable to precipitous drops in caseload. Finally, accurate reporting of expenditures to FCS enables timely recovery and reallocation of funds to support responsive management of WIC caseload and funds nationwide.

In addition to a financial management system which permits timely and accurate tracking of revenue and expenditures, there are numerous other tools and strategies that state agencies may use to manage funds and caseload on both a routine, ongoing basis. and when funding resources become limited.

Efficient, proactive and effective funds and caseload management can be achieved through the following ongoing management actions:

  • Maximizing cost savings through rebate management and other cost containment activities such as prudent management of food delivery systems.
  • Making appropriate and allowable food package administrative adjustments.
  • Targeting benefits to those most in need on the basis of eligibility criteria that clearly and credibly identify and prioritize income eligible persons at nutritional risk.

Numerous tools and strategies are also available to further reduce costs, decrease caseload. or simply change the mix of clients served to those at highest risk. Such tools are for use when the ongoing management strategies listed above are insufficient to deal with increased demand or decreased resources, either anticipated or unanticipated. They are presented in a general preferred order of application:

  • Making additional allowable administrative adjustments to food packages.
  • Establishing shorter certification periods on a participant case-by-case basis, or discontinuing new certifications of lower-priority participants, or in extreme cases, discontinuing new certifications of all applicants,-while implementing applicant waiting lists.
  • Discontinuing or temporarily suspending benefits during a certification period.

This is a last-resort measure, to be avoided if possible and used only in extreme circumstances when other more acceptable strategies are not adequately responsive to funding shortages.

The following is a discussion of these major tools and strategies, with particular emphasis on their use for general management as well as for effecting cost reduction and gradual caseload reductions and in avoiding precipitous caseload drops. State agency managers may create a mix of appropriate strategies from among those allowable to manage caseload within the parameters of these guidelines and other relevant regulations and policy. State agencies are encouraged to apply the strategies for caseload reduction as equitably as possible on a statewide basis to all local agencies so that participants within a state have approximately equal program access relative to their priority level, consistent with WIC policy memorandum #93·8 of July 26, 1993. This policy memorandum highlights key items; it does not include every detail of all pertinent policy. Thus, regulations. instructions and the policy memorandum cited in this memorandum should be consulted as state agencies develop caseload management strategies. For convenience, a grid of the referenced policy and instruction documents are attached.

ONGOING STRATEGIES TO MANAGE, CONTAIN AND CONTROL COSTS:
1. Cost Containment

Examining and aggressively pursuing rebates and other food cost savings should routinely be a first step to stretch food dollars to serve a maximum number of eligible participants. Section 246.160) of the WIC regulations requires each state agency to examine and, as appropriate, initiate cost containment measures. Rebate savings currently annually support about 1.5 million participants. State agencies should strive to secure the most lucrative rebates and should ensure that rebates are accurately billed and collected in a timely manner. If feasible, rebates on products such as special formula and other foods in addition to infant formula should be considered. Implementing effective food delivery management measures can also contribute significantly to food cost containment. They include selecting the most economical vendors through strategies such ns competitively selecting vendors on the basis of food costs. Alternative delivery systems, such as direct distribution of special infant formula, also can reduce costs. Other ideas include but are not limited to: selecting vendors with a strong compliance history; developing training programs that ensure vendors understand program intent, rules and operations; monitoring vendors on a regular basis; and sanctioning vendors as appropriate.

2. Food Package Design

Food package design is one of the most powerful tools available to achieve cost economies. The regulations at Section 246.10 and FCS Instruction 804-1 provide guidance on the principles of food package design which permit food cost efficiencies while at the same time maintaining nutritional integrity. When assessing food package design, state agencies need to consider the costs of implementing and enforcing changes in food packages. including the training of both vendors and participants. The following list summarizes the basic principles pertaining to food package design in FCS instructions. regulations and policy:

  • Regulatory quantities may be reduced. but only for sound nutrition reasons based on the participant's age, nutritional risk condition, dietary needs, and personal food preferences. The term ''nutrition tailoring" is reserved solely for quantity reductions for nutrition reasons. Reduction of the Federal regulatory quantities of W[C foods for other than nutrition reasons, even to accommodate anticipated or imminent food over-obligations, is not an acceptable caseload management strategy.
  • Nutrition tailoring may be directed to individuals or to categories of individuals with similar nutritional needs.
  • Nutrition tailoring represents a serious commitment to long-term implementation, until a change occurs in the science and nutrition rationale upon which the food package modification is based. As such, nutrition tailoring is intended to respond to changes in scientific knowledge and the nutrient needs and food preferences of participants, not changes in funding availability. Therefore, nutrition tailoring must not be done for cost reasons, although lower costs may be an incidental result.
  • Types and forms-but not quantities-of allowable WIC foods can be designated by state agencies for cost reasons and are called "administrative adjustments." These adjustments can significantly reduce food package costs. There are innumerable effective and allowable administrative adjustments such as selecting the least expensive brands and the most economical container sizes or packaging. The attachment to this memorandum, as well as FCS Instruction 804-1. provide relevant examples. (Please note, however, that Exhibit A of the Instruction contains obsolete information about infant formula reconstitution in item I.A.)
  • State agencies should consider administrative adjustments as routine cost containment procedures when designing food packages, while keeping in mind the critical importance of participant acceptance and appeal.
  • Exercising the full potential of all allowable administrative adjustments is an effective response to meet caseload demands that may exceed anticipated resources. State agencies can develop strategies in which more aggressive administrative adjustments may be imposed as needed to contain costs and maximize or maintain participation.
  • In making any nutrition tailoring or administrative adjustments, state agencies must adhere to the following two principles:
    • at least one food from each WIC food category must be offered in every food package unless medically contraindicated or refused by the individual participant. consistent with Section 246.1 0(b)(2)(i); and
    • the maximum quantities stated in Section 246.10 must be made available to individual participants needing that level of nutritional support. based on their health status. nutritional needs and risk conditions .as per FCS Instruction 804-1. State agency nutrition tailoring policy must not totally preclude regulatory maximum quantities of foods for certain individuals who need them.
  • State agencies are encouraged to prorate benefits for those participants whose eligibility is effective late in the monthly issuance cycle or who are late in picking up food instruments. While nutrition tailoring, as noted above. is based on individual nutrition needs and preferences, proration is appropriately apportioning the amount of food a participant is entitled to receive based on the remaining days/weeks in the month or issuance cycle. Container sizes may influence the amount of foods provided in prorated packages. Thus, for practical reasons, state agencies should plan to provide participants with more rather than less of the prorated amount of foods, especially infant formula.
  • Food package changes must be reflected in the state Plan/Procedure Manual and must be approved by FCS prior to implementation.
3. Benefit Targeting

Targeting benefits is an underlying principle of the WIC Program which has contributed to its longstanding success. Section 246.7(e)(4) of the WIC regulations and FCS Instruction 803-12 provide guidance on benefit targeting. Nutritional risk criteria and income guidelines which facilitate objective distinctions among applicants on the basis of relative but legitimate financial and nutritional risk and need also are crucial tools for routine management of program participation and costs. Nutritional risk criteria used by state agencies should appropriately identify those applicants with nutritional or medically-related nutritional conditions that can be addressed, assisted or controlled through participation in WIC. Benefit targeting assures that applicants are categorized into appropriate priorities, so that benefits can be provided to those most needy. and discontinued for those least in need at times when demand exceeds resources. Through effective targeting, WIC can continue to assure that persons at-highest relative need have first access to available benefits. The nutritional risk criteria used by a state agency should be considered a general caseload management tool to be used as a routine, ongoing measure to assure benefits are directed only to at-risk persons throughout the year and that persons are classified appropriately into relative priorities of need in anticipation of possible caseload reduction. Appropriately established legitimate nutritional risk criteria thus should not be changed solely for the purposes of reducing the pool of eligibles as a caseload management tool. This also is applicable to income guidelines. However. creating subpriorities within priorities of participants on the basis of relative income or nutritional risk are effective ways to target benefits based on relative need.

STRATE GIES FOR FURTHER COST REDUCTION:
4. Limiting Certification/Waiting List Management

State agencies should make sure they have fully maximized cost economies through food package administrative adjustments, rebates and other cost containment efforts. and the routine management measures discussed above. State agencies still needing to reduce costs or caseloads after taking those more modest measures have some options: They may certify certain short-term lower-priority applicants for predetermined shorter certification periods (see section S below). They may cease certifying applicants in the lower priorities and certify only high-priority applicants. In extreme situations, state agencies may stop certifying all applicant priority categories. Applicants who cannot be served must be placed on waiting lists as per Section 246. 7(f)(l) to allow natural attrition of existing caseload to occur. See FCS Instruction 803-6, Certification: Waiting Lists for Additional Information. Judicious waiting list management allows an orderly, systematic and gradual caseload decrease and/or a "rebalancing" of caseload composition towards higher priority applicants. It encompasses the following principles:

  • When demand exceeds available caseload slots in some but not all clinic locations within a state agency's jurisdiction, it should consider reallocating caseload slots from local agencies not using their assigned caseloads to those with greater demand or growth capacity in an effort to balance benefit availability to approximately the same priorities of participants statewide.
  • State agencies may continue to certify and provide service to new applicants at higher priorities. while placing lower priority applicants on waiting lists.
  • State agencies are encouraged to establish procedures which will ensure that applicants are scheduled for WIC appointments in a manner that generally conforms to the priority system. so that higher priority applicants are seen and served as soon as possible. This means that state agencies may use an essentially categorical priority system for scheduling appointments that proceeds from pregnant or breastfeeding women to infants to children to non-breastfeeding women.
  • Waiting lists must be imposed starting with the lowest priorities and working upward without skipping priorities or subpriorities within priorities.
  • In accordance with FCS Instruction 819~2, within 20 days of requesting benefits, individuals must be notified of their placement on a waiting list and their right to a fair hearing. The request may be made in person to the local agency. or at state agency option, by telephone,
  • The waiting list shall include the applicant's name, address or phone number, status (e.g., pregnant, breastfeeding, age of applicant), and the date he or she was placed on the waiting list.
  • State agencies may also wish to take actions to pre-screen waiting list applicants for eligibility to the extent practical. For example. state agencies could conduct a quick income review on applicants to assure their potential eligibility, automatically eliminating over-income applicants." Also, state agencies may wish to categorize income-eligible applicants by priority if nutritional risk information is available so that when caseload slots do become available, they can move persons off waiting lists in an orderly, logical. and expeditious fashion based on relative need.
  • State agencies may subprioritize within priorities. See FCS Instruction 803-2 for examples.
  • State agencies need not place lower priority applicants on waiting lists if there is no reasonable expectation of service to them (unless they request such placement.
  • State agencies can minimize the potential deterrent effect of waiting lists on future applications by clearly informing applicants and those making referrals to WIC as to the likelihood of receiving service at a later time given the funding situation.
  • As resources become available through attrition, the waiting list is a ready source of persons to be served. Staff must offer service to highest priority persons first, then work systematically down the list in priority order.
5. Establishing Shorter Certification Periods

One option. with limited utility, allowed on a participant case-by-case basis as per FCS Instruction 803-4, is to certify certain persons for periods that are shorter than a normal certification. FCS Instruction 803-4 limits this option on a case-by-case basis only to persons with "temporarily low income" (persons such as strikers. for instance). While FCS Instruction 803-4 does not address the appropriateness of shorter certification periods to deal with funding shortages, it is logical to extend this option to such purposes. If state agencies wish to use this strategy, they must seek prior approval from FCS. State agencies also should establish procedures for use by local competent professional authorities. to ensure consistency and fairness of application statewide. Upon certification, state agencies must assure that affected participants clearly understand the length of their certification period, and the need to reapply for benefits at the completion of the certification period. Assigning a shorter certification period is not considered an adverse action and thus, it is not appealable. Therefore, this strategy eliminates costs associated with appeals and required benefit delivery during any resultant appeals. The primary effect of this strategy is to allow state agencies to change their caseload mix to higher priorities. using the faster attrition rates of shorter certification periods. It may have little effect on food costs savings, however, state agencies contemplating such a measure should consider that shorter certification periods are likely to increase administrative costs associated with additional certifications in the long run.

6. Mid-Certification Benefit Discontinuation

Notwithstanding all existing tools and strategies available to state agencies to 1nanage resources discussed above, if further caseload reductions are still needed. State agencies may discontinue benefits to certain participants during a certification period. Unlike shorter certification periods discussed above in number 5, where a participant is informed at certification exactly when his/her benefits will specifically end, mid-certification benefit discontinuation constitutes an unanticipated break in the delivery of services prior to the time a participant expected services to end. Because mid-certification discontinuation or disruption of benefits is a broken commitment, and thus an "adverse action", it must be considered only as a last resort. State agencies never should plan to use mid-certification discontinuation or disruption of benefits as a strategy to routinely manage caseload. Regulations at Sections 246.7(h)(2). (h)(J). (j)(6), and (j)(9), as well as FCS Instruction 803-9, govern mid-certification discontinuation of benefits. Discontinuation of benefits before the end of a certification period may be imposed in one of two forms: Suspension of benefits for a group of participants with the expectation of resuming benefit provision when funds/caseload slots become available; and disqualification of a group of persons when it is unlikely that funds/slots will become available. Key points. which apply to all situations of mid-certification benefits discontinuation (both suspension and disqualification) follow:

  • Due to the sensitive nature of such adverse actions, state agencies must notify FCS in advance of planned service disruptions.
  • If the funding problem is temporary, state agencies may wish to suspend benefits, rather than disqualify participants. Suspension can be used for temporary benefit disruption, whereas disqualification is a permanent measure which requires reapplication and certification. Suspension may be preferred by state agencies as a more moderate and temporary means to reduce food expenditures without causing undue negative alarm among participants. It also avoids the administrative costs of additional new certifications associated with disqualifications.
  • Mid-certification discontinuation of benefits should be applied in an equitable manner, to the minimal number of lowest priority persons necessary to bring caseload under control.
  • In imposing discontinuation of benefits, state agencies are not relieved of their obligation to follow proper "due process" procedures required by regulations.
  • State agencies must provide affected participants with a written notification of such adverse action l 5 days in advance of such disruption, the reasons for the action, and the offer of a right to appeal, as per regulations at 246. 70)( 6) and (9). Should the participant accept the offer of an appeal within mandated timeframes, benefits must be continued at the current level until a hearing decision is rendered or the certification period ends, whichever occurs first (246.9(g)). Given these constraints, mid-certification benefit discontinuation, even as au emergency measure, is not a particularly effective tool for realizing immediate cost savings.
  • No applicants -- in any category or priority -- may be certified during a period in which a state agency is employing mid-certification adverse actions, as per 246.7(h)(3) of regulations and FCS Instruction 803-9.
  • State agencies may wish to minimize the potential deterrent effect of benefit disruption on future applications by clarifying to affected persons that benefits may be available at a future date, as appropriate.

Using the techniques, tools and strategies discussed above, state agencies should plan well in advance so as to maintain a relatively stable participation level, minimize service disruption, and avoid precipitous end of year caseload reductions. In the event a state agency finds it must take action to reduce costs, the state agency must notify the FCS regional office of its intended actions. The regional office will continue to work with the state agency to refine its forecast of funding, validate its caseload projection, and customize available tools and strategies to the anticipated needs of the state agency to minimize the deterrent or negative impact on participants.

STANLEY C. GARNETT
Director
Supplemental Food Programs Division

 

Attachments
EO Guidance Document #
FNS-GD-1997-0008
Date
FNS Document #
WIC 1997-7
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (4.24 MB)
No
Summary

This policy memorandum addresses the basic tools of WIC caseload management. It consolidates key provisions of previously issued FCS policy on all components of caseload management -- from food cost savings strategies and food package design, to certification strategies -- into a comprehensive scheme. 

Page updated: November 02, 2023

WIC Program – Immigration Participation in the WIC Program

DATE:January 13, 1997
MEMO CODE:WIC Policy Memorandum 97-3
SUBJECT:WIC Program - Immigrant Participation in the WIC Program
TO:Regional Directors
Supplemental Food Programs
All Regions

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (the Act), restricts participation in most food assistance· programs based on citizenship and alien status. The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is specifically exempted from these restrictions, however, states have the option to limit participation to citizens and qualified aliens. Qualified aliens include:

  1. aliens who are lawfully admitted for permanent residence under the Immigration and Nationality Act;
  2. aliens who are granted asylum under section 208 under the Immigration and Nationality Act;
  3. refugees who are admitted to the United States under section 207 of the Immigration and Nationality Act;
  4. aliens who are paroled into the United States under section 212(d)(5) of the Immigration and Nationality Act for a period ·or at least one year;
  5. aliens whose deportation is being withheld under section 243(h) of the Immigration and Nationality Act;
  6. aliens who are granted entry pursuant to section 203(a)(7) of the Immigration and Nationality Act (as in effect prior to April 1, 1980); and
  7. certain battered aliens and aliens with battered children determined by the Attorney General to be in need of program benefits.

Each WIC state agency receives funds based on an allocation formula which calculates a state's fair share allocation by estimating its percent share of all individuals nationally who meet the program income eligibility guidelines (up to 185 percent of the federal poverty level).· These estimates are based on all federally-eligible individuals including qualified and non-qualified aliens. In order to maintain funding equity among the states, the Food and Consumer Service (FCS), under existing regulatory authority, will adjust downward that state's estimated WIC-eligible population by the number of aliens the state declares ineligible.

I also wanted to advise you that in accordance with the Agriculture and Related Agencies Appropriations Act for fiscal year 1997, FCS will be reviewing and evaluating all states' participation and expenditure performance so that more frequent analysis and redistribution of available resources can be made. If a state's participation decreases and food funds are not expended, for what ever reason, including the exclusion of certain categories of immigrants, FCS may need to execute its regulatory authority to recover funds during the year from the state in question.

Please do not hesitate to contact me if you have any questions concerning the above information.

STANLEY C. GARNETT
Director
Supplemental Food Programs Division

EO Guidance Document #
FNS-GD-1997-0001
Date
FNS Document #
WIC 1997-3
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (231.45 KB)
No
Summary

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, restricts participation in most food assistance programs based on citizenship and alien status. WIC is specifically exempted from these restrictions, however, states have the option to limit participation to citizens and qualified aliens. 

Page updated: November 02, 2023

WIC Infant Formula Rebate Reviews

DATE:March 12, 1996
MEMO CODE:WIC Final Policy Memorandum 96-6
SUBJECT:WIC Infant Formula Rebate Reviews
TO:Regional Directors
Supplemental Food Programs
All Regions
Regional Directors
Financial Management
All Regions

The purpose of this policy memorandum is to provide guidance concerning a state's responsibility to properly conduct rebate billing and collection activities and provisions which should be included in a state agency's request for proposals (RFPs) or Invitation for Bids (IFBs) and contracts for infant formula rebates to avoid rebate billing discrepancies. Guidance is also provided concerning procedures being allowed on a one-time basis to address a current problem. That is, how WIC state agencies are to account for and report rebates and federal food outlays when rebates billed are withheld or disputed as a result of infant formula manufacturers' recent reviews of rebate billings made under existing contracts. For purposes of this memorandum, all Requests for Proposals and Invitation for Bids are hereafter referred to as IFBs.

INFANT FORMULA REBATE BILLING AND COLLECTION

The billing process for infant formula rebates is a key component of a successful cost-containment initiative. The need for tight control over billing procedures is imperative. When a state agency fails to collect all earned rebates, the federal cost of operating the WIC program increases dollar-for-dollar by the amount of rebates uncollected. Likewise, when a state makes an error(s) that causes it to bill and collect more rebates than it earned, this can lead to disputes which are very difficult to resolve. The following are situations which are not acceptable cost-containment practices.

( 1) Failure to properly bill and collect infant formula rebates due to a state agency.
FCS believes that a state agency's failure to collect rebates earned is clearly contrary to congressional intent. State agencies are required to have infant formula rebate contracts in place and are expected to collect all earned rebates due to the state agency. The state agency must abide by billing procedures stipulated in its infant formula rebate contract and bill the infant formula manufacturer for the entire amount to which it is entitled.

Any deviation will be handled on a case-by-case basis. For example, FCS will consider mitigating or unusual circumstances beyond the state agency's control.

(2) Billing Discrepancies.
The accuracy of a state agency's billing process is an important aspect of infant formula rebates. There have been occasions when a manufacturer has withheld current year earned rebates when overbilling errors from previous years were discovered. Correct rebate amounts must be credited to the fiscal year account initially charged with the infant formula cost. Therefore, the IFB and contract must provide specific procedures for handling billing discrepancies for both the state and manufacturer. The IFB and contract should state a reasonable time period in which each party must alert the other to any billing discrepancies. Because a state agency's unspent funds are recovered and reallocated to other states, there is no guarantee that prior year(s) funds will be available to pay understated prior year(s) food costs resulting from rebate overbilling(s) that occurred in the prior year(s). Therefore, all discrepancies must be settled by closeout of the fiscal year related to the rebate savings. This provides a reasonable time for both parties to review records and resolve disputes.

AVOID BILLING DISCREPANCIES THROUGH IFS/CONTRACT PROVISIONS

The requirement to recover and reallocate unspent funds effectively forestalls the accumulation of prior year funds to pay prior year costs. Therefore, states must have the following specific procedures in their IFBs and contracts for infant formula rebates to minimize the risk of billing discrepancies, and to handle those discrepancies that do occur:

( 1) Contractor must pay invoice within timeframe stipulated in contract (usually 30 days).

(2) Contractor must notify state agency of any dispute or error in rebate invoice within a time period stipulated in contract. If contractor misses deadline, any requirement to return funds to the contractor as a result of a dispute or overbilling error is waived.

(3) All disputes must be settled by closeout of the fiscal year in which dispute occurred.

(4) Contractor must not be allowed to withhold any rebate payments due states under any circumstances.

(5) If an overbilling error occurs, state agency must make every effort to validate .. Independent reviews of the records stipulated in the contract are encouraged, if necessary.

(6) Upon resolution of dispute, state agency will promptly disburse any funds due to appropriate party.

(7) State agency and contractor must meet as often as necessary, e.g., quarterly, to review progress and performance of contract. During these meetings any concerns regarding billing procedures must be addressed.

(8) The IFB and contract should identify the records to which the contractor has access. The only records which the contractor should have access to are those directly related to monthly billings. This must be made clear in the contract.

(9) The IFB and contract should clearly identify the billing procedures, i.e., which data will be used and how these data will be gathered and used to prepare infant formula rebate billings.

Please note that states will have no recourse against FCS for understated prior year food costs associated with prior year rebate overbillings which occur under new contracts, those entered into on or after Oct. 1, 1995, as this problem should be eliminated through the issuance of new contracts containing the foregoing provisions. states implementing new infant formula contracts on or after Oct. 1, 1995 have been advised through FCS's IFB and contract review process to include the foregoing provisions, thereby eliminating the current rebate billing problems. The rebate reporting procedures outlined in this memorandum are provided on a one-time basis to assist states with rebate billing discrepancies that have or could occur under contracts implemented prior to Oct. 1, 1995.

We recognize that many states have contracts in place which will not expire for several years (latest expiration date for existing contracts is December 1998), and are therefore unable to immediately incorporate these provisions into a new contract. However, states must also take action under existing contracts to avoid billing errors and disputes. This may be accomplished by strengthening internal controls over the rebate billing process, e.g., reforming the method(s), to the extent possible without requiring a contract amendment, for implementing contract provisions such as how data are gathered and used to bill for infant formula rebates. If a contract provision concerning the billing process is found to contribute to billing errors, the state should seek a contract amendment.

REPORTING PROCEDURES FOR BILLING DISCREPANCIES ASSOCIATED WITH EXISTING CONTRACTS

Based on ongoing coordination, we believe the Office of Inspector General (OIG) will agree to the following reporting procedures on a one-time basis, i.e., these procedures are limited to withheld or disputed rebates associated with existing rebate contracts. Please be reminded that states which fail to add the foregoing provisions to their future rebate contracts will have no recourse against FCS for rebate withholdings or disputes.

These procedures can only be applied for those state agencies for which it can be demonstrated through prior year closeout records that their cumulative federal WIC funding over the fiscal years in question would have been the same, had they billed their rebates correctly and exercised available spending options to cover the resulting prior year food costs. However, states will not be required to submit amended closeout reports.

States which have undergone infant formula manufacturers' rebate reviews and are cited in the report of the review as having received rebates in excess of that earned during the closeout and/or prior year(s) will likely be in one of the following situations at closeout:

  1. Rebates earned by the state during the closeout year have been withheld by the infant formula manufacturer to recover excess rebates previously paid to the state for the closeout year and/or prior year(s) .
  2. The state is currently negotiating the amount refundable to its infant formula manufacturer as the result of a rebate review, but the manufacturer has not withheld any or has withheld only a portion of the amount it considers refundable from rebates earned by the state during the closeout year.

In either situation, the state will report the amount of rebates actually received from rebate billings for the closeout year on Line 5, Rebates Billed, of the FNS-498 and on Line 10a, Rebates, of the FNS-227. Rebates actually received from the infant formula manufacturer for rebates billed for the closeout year will be reported even if the amount received is net of manufacturers' withholdings to recover prior year(s) excess rebates, or if some portion of the amount received is still in dispute and may have to be returned to the infant formula manufacturer after the dispute is resolved.

States will also identify the amount of rebates withheld from rebate billings for the closeout year to recover prior year(s) excess rebates, and whether negotiations are final or ongoing in the remarks section of the final FNS-498. This information will provide an official record to track the status of rebate billing disputes.

In the latter situation, the amount of rebates received from rebate billings for the closeout year which may have to be refunded to the infant formula manufacturer at the conclusion of review negotiations will be reported as unliquidated food obligations. This will be accomplished by adding the dollar value of rebates in dispute to Line 4, Actual Food Outlays, of the final FNS- 498 and to Line 9, Column (A), the Food Cost Category for Gross Outlays and Unliquidated Obligations for Report Year Program Cost, of the FNS-227. The dollar value of the disputed rebates will also be reported as unliquidated food obligations in the remarks section of the final FNS-498 and on Line 21, Column (A), the Food Cost Category for federal Unliguidated Obligations Against the Formula Grant, of the FNS-227. States must also indicate in the remarks section of the Final FNS-498 whether or not the dollar value of unliquidated food obligations represent disputed rebates. Again, this information will provide an official record to track the status of rebate billing disputes. Reporting disputed rebates as unliquidated food obligations prevents WIC Output Reports generated at closeout from the FNS-498 and FNS-227 from overstating the amount of unspent funds available for recovery and reallocation. It also enables FCS to hold the funds necessary to fund the obligations.

We caution states to be very accurate in reporting unliquidated food obligations. Unliquidated food obligations must be sufficient to cover all rebate amounts which are still in dispute and may have to be returned to the infant formula manufacturer. If they are understated, the understated amount will be recovered and reallocated, and thus become unavailable for restoration to the state agency in the event the infant formula manufacturer prevails. On the other hand, if unliquidated food obligations are overstated, it will result in funds needlessly being made unavailable to fund current program costs. This is due to the fact that unliquidated food obligations are withheld from the reallocation process, and if subsequently de-obligated, end up in the expired appropriations account.

The following are examples of the type of information concerning rebate billing disputes which may need to be reported in the remarks section of the final FNS-498 to provide an official record of the status of rebate billing disputes:

1 ) Rebates have been withheld:

          $50,000 (rebates withheld - ongoing), or
          $50,000 (rebates withheld - final)

2) Rebates have not been withheld, but are in dispute and may have to be returned to the infant formula manufacturer:

          $40,000 (disputed rebates)
      + $ 1,000 (other unliquidated food)
           $41,000 (total unliquidated food), or

          $40,000 (total unliquidated food - disputed rebates)

When a state's negotiations have reached a final determination of the amount refundable to the infant formula manufacturer, the state will request the necessary funds to make this payment from the funds held by FCS for the state for this purpose by submitting Form SF-270, Request for Advance and Reimbursement, with attached letter stating that this is the final settlement. If the letter states that the final settlement is an amount less than that set aside for the state for this purpose, FCS will de-obligate the balance of these funds. If it is determined that the infant formula manufacturer is not due a refund, the state must notify FCS by letter stating that this is the final settlement, so that FCS may de-obligate the entire amount held for the state for this purpose. And finally, if it is determined that the infant formula manufacturer must pay the state some or all of the rebates withheld, the state will return these funds to FCS by submitting Form SF-270, Request for Advance and Reimbursement, with attached letter stating that this is the final settlement.

STANLEY C. GARNETT
Director Supplemental
Food Programs Division
LOU PASTURA
Acting Director
Grants Management Division
EO Guidance Document #
FNS-GD-1996-0002
Date
FNS Document #
WIC 1996-6
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (2.06 MB)
No
Summary

The purpose of this policy memorandum is to provide guidance concerning a state's responsibility to properly conduct rebate billing and collection activities and provisions which should be included in a state agency's RFPs or IFBs and contracts for infant formula rebates to avoid rebate billing discrepancies.

Page updated: November 02, 2023
Page updated: December 02, 2021

Non-Birth Mothers Certified as Breastfeeding Women

DATE: October 4, 1995
MEMO CODE: Final WIC Policy Memorandum: #96-1
SUBJECT: Non-Birth Mothers Certified as Breastfeeding women
TO: Regional Directors
Supplemental Food Programs
All Regions

The purpose of this policy memorandum is to clarify that women who breastfeed infants that they did not give birth to ("nonbirth mothers"), may be certified to participate in the WIC program as breastfeeding women at state option.

WIC regulations define breastfeeding women in Section 246.2 as "women up to one year postpartum who are breastfeeding their infants." Although this reference clearly indicates a biological maternal relationship, it was not the intent of regulations necessarily to exclude women who are breastfeeding infants to whom they did not give birth from being certified as WIC breastfeeding women. The Food and Consumer Service (FCS) would be in favor of a broader interpretation of the WIC regulations to achieve the breastfeeding and nutritional goals of the WIC program. However, it is a WIC state agency's decision whether to implement this policy.

Nutritional and medical research has shown that there is no better food than breast milk, a major source of nutrition for a baby's first year of life. Human milk, even if it is not from the natural mother, is generally recognized as the optimum source of nutrition for young infants , as it provides the ideal balance of nutrients, enzymes, immunoglobulins, anti- inflammatory substances, hormones, and growth factors.

Therefore, we do not intend to preclude the WIC certification of an otherwise eligible non-birth mother as a breastfeeding woman, if she is providing her breast milk for the nourishment of a WIC infant. some examples of a non- birth mother would include: a wet nurse; an adoptive mother; and a foster mother. However, this does not include women who donate breastmilk to a milk bank.

As with any breastfeeding woman, the breastfeeding non-birth mother must meet the eligibility requirements of residency, income, and nutritional risk. She may have her own independent nutritional risk, or be at nutritional risk because the infant she is breastfeeding is determined to be nutritionally at risk. If a non-birth mother has a nutrition risk condition that contraindicates her breastfeeding an infant (i.e . , substance abuse, HIV Infected), the guidance and education provided to her should be the same as that provided to a birth mother. A woman's health status could determine whether her breastmilk is the healthiest source of ·nourishment. for an infant. In this instance, however, a state agency is not obligated to certify a woman as breastfeeding.

If a state agency chooses to exercise the non-birth mot her option, they should establish written policies and procedures for certification. The state agency is reminded that a postpartum birth mother who meets eligibility criteria is eligible to receive postpartum benefits even if her infant is being breastfed by a certified non- birth mother. Under this scenario, only one woman can be classified in a breastfeeding status. The other woman must be classified in a non-breastfeeding postpartum status.

In determining income eligibility, the breastfed WIC infant does not necessarily have to reside with the non-birth breastfeeding mother. The household size should be determined by either the birth mother or non-birth mother claiming the infant in that household. The breastfed infant cannot be included in the family size of both the birth mother and nonbirth mother.

For purposes of determining the appropriate allowable timeframe for duration of certification as a breastfeeding non-birth mother, the age of the infant should be the determinant. As with natural birth mothers, a non-birth mother's status as a breastfeeding woman ends when she stops nursing the infant .at least once per day or at the infant's first birthday, which ever occurs first.

STANLEY C. GARNETT
Director
Supplemental Food Programs Division

EO Guidance Document #
FNS-GD-1995-0012
Date
FNS Document #
WIC 1996-1
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (738.81 KB)
No
Summary

The purpose of this policy memorandum is to clarify that women who breastfeed infants that they did not give birth to ("nonbirth mothers"), may be certified to participate in the WIC program as breastfeeding women at state option.

Page updated: November 30, 2021

WIC Allowable Costs and Additional Issues with a Dietetic Supervised Practice Program or Other Out-of-Service Training Program

DATE: September 28, 1995
MEMO CODE: WIC Policy Memorandum: #95-22
SUBJECT: WIC-Allowable Costs and Additional Issues-Associated With a Dietetic Supervised Practice Program or Other Out-of-Service Training Program
TO: Regional Directors Supplemental Food Programs All Regions

The attached policy memorandum clarifies the requirements WIC agencies must meet to spend federal WIC grant funds on a dietetic supervised practice program or other out-of-service training program for WIC staff and eligible in-kind staff. WIC agencies that incurred WIC-allowable training costs during the period Oct. 1, 1994 through Sept. 30, 1995 may charge these expenses to their fiscal year 1995 federal WIC grant.

The Food and Consumer Service (FCS) also developed the accompanying technical guidance document to offer optional suggestions, which WIC agencies may adopt at their discretion, to help them implement the policy. Further, attached are two additional relevant resources to share with all WIC state agencies. One is the American Dietetic Association (ADA) publication, entitled Developing a Dietetics Education Program, and the other is a packet of information and fact sheets on dietetic supervised practice programs that was duplicated by FCS with permission from ADA.

The former ADA publication serves as a guide for interested WIC agencies on how to develop an ADA-approved/accredited dietetic supervised practice program and on the procedures for writing a related self-study. FCS originally intended to develop a prototype self-study to make it easier for WIC agencies to design their own dietetic supervised practice programs. However, ADA recently published the attached handbook which provides excellent guidance on this process.

Therefore, in lieu of developing a similar guide, FCS purchased a copy of Developing a Dietetics Education Program for each WIC state agency's reference. The attached packet of ADA information includes an order form for WIC agencies to use if they wish to purchase more copies of this publication.

STANLEY C. GARNETT
Director
Supplemental Food Programs Division

 
Attachments
EO Guidance Document #
FNS-GD-1995-0011
Date
FNS Document #
WIC 1995-22
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (2.36 MB)
No
Summary

The attached policy memorandum clarifies the requirements WIC agencies must meet to spend federal WIC grant funds on a dietetic supervised practice program or other out-of-service training program for WIC staff and eligible in-kind staff. WIC agencies that incurred WIC-allowable training costs.

Page updated: November 30, 2021

Coordination Initiative: WIC and Medicaid Programs that Utilize Managed Care Providers

DATE: June 30, 1995
SUBJECT: Coordination Initiative: WIC and Medicaid Programs That Utilize Managed Care Providers
TO: Regional Directors
Supplemental Food Programs
All Regions

Attached is Policy Memorandum: #95-20 regarding the above subject. On May 11, we transmitted a memorandum to you on the same subject. Subsequently, as we notified you by cc: mail, a revision to paragraph one of the memorandum was necessary. After incorporating the revision, we determined that it was appropriate to incorporate this memorandum into the WIC policy memorandum system. Therefore, attached is the revised version of the subject memorandum and attachments for transmittal to your state agencies.

STANLEY C. GARNETT
Director
Supplemental Food Programs Division

 

Attachment
EO Guidance Document #
FNS-GD-1995-0008
Date
FNS Document #
WIC 1995-20
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (1.47 MB)
No
Summary

PL 103-448 requires coordination between the WIC program and state Medicaid programs that use coordinated or managed care providers under contract or under waiver authority as permitted under the Social Security Act. 

Page updated: November 30, 2021

Allowable Costs for Immunization

DATE: April 26, 1995
MEMO CODE: WIC Policy Memorandum: #95 -16
SUBJECT: Allowable Costs for Immunization
TO: Regional Directors Supplemental Food Programs All Regions

This memorandum provides policy clarification about WIC allowable costs for activities related to immunization promotion in the WIC program.

Background

Since 1978, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has had a legislative mandate and, consequently, regulatory responsibility to coordinate with immunization services. Section 246.4(a) (8) of the WIC program regulations requires each state agency to describe its policies and procedures for coordinating with and referring participants to a variety of allied nutritional and primary health care services. Among the services that must be addressed in this regard are immunization services.

Using this legislative history as a base, at a minimum, WIC is required to refer participants to available immunization services. An assessment of each participant's immunization status at the time of certification and subsequent referral to appropriate immunization services, if needed, is a responsible and appropriate way in which to respond to program regulations in this area. While sophisticated client immunization need assessments enhance the effectiveness of referrals and are encouraged where possible, the assessment process and emphasis may vary based on local WIC resource availability.

The WIC program and the Centers for Disease Control and Prevention's (CDC) National Immunization Program have initiated a cooperative effort to increase immunization rates among preschool- age participants in the WIC program. Because of this increase in immunization promotion, many questions have arisen regarding the allowability of costs for activities related to immunization promotion in the WIC program.

Allowable WIC Costs

The costs of WIC participant immunization assessment, referral, education, and caseload management are allowable WIC costs. For example, the cost of developing and printing educational materials could be an allowable WIC cost if the publication were targeted to and used for WIC's population. If such a publication is also intended for use in programs other than WIC, those programs should pay a fair and equitable share of the costs. A cost sharing plan between programs (at the state or local level) would help formalize the financial commitments of all involved programs.

WIC funding is not generally intended to duplicate available services from other programs. While WIC may fund the above cited costs for WIC participants, it may first wish to use other available resources to conserve its own for other WIC purposes. Other federal and state resources available to support immunization services for WIC participants include Title V Maternal and Child Health grants; the Early Periodic Screening, Diagnostic, and Treatment Program; immunization grants, including Immunization Action Plan (IAP) funding, provided by CDC; and state and local appropriated funds for these purposes.

IAP funding is intended to provide support to communities to improve their vaccine delivery infrastructure and help communities create networks to provide access to and improve the quality of immunization services, aiming particularly at children in their earliest years. The funds are to be used to ensure that vaccines are available and administered to children less than 2 years of age. The funding assists states and localities in the following: removing barriers to immunization; reducing missed opportunities to vaccinate; measuring immunization coverage rates; raising awareness among the public, parents, and providers; and stimulating innovative approaches to improving immunization levels in vulnerable children. It is important to note that CDC funding may be used for a variety of WIC immunization services and activities including, but not limited to, immunization assessment, referral, education, caseload management, and the purchase and administration of vaccines.

Non- allowable WIC Costs

WIC funds may not be used for purchasing vaccines or administering vaccines. In no instance are the costs, which are associated with the delivery of acute or primary health care services, such as purchasing and administering vaccines and medical equipment (i.e., oxygen units, syringes, etc.), allowable WIC expenditures.

Cost Distribution Methodologies

To assure that WIC can effectively serve as a catalyst for the shared health goal of promoting immunizations, qualified medical professionals working in WIC local agencies may be used to administer vaccines to WIC participants if a mutually agreed upon arrangement is made for full reimbursement from non-WIC sources. Determination of an appropriate level of reimbursement to WIC can be accomplished in a number of ways. One concept, known as "fee-per-shot," is a negotiated arrangement between WIC and immunization programs at the state and local levels. The "fee" is the cost to state or local immunization programs to equitably reimburse the WIC program for the full cost of administering vaccines. This permits vaccines to be administered with non-WIC funding sources within the framework of the typical WIC clinic visit as a convenience and service to WIC participants. This is particularly desirable if alternative vaccine delivery systems are inadequate or nonexistent. State and local agencies must, however, assure that the fee continues to be fair and reasonable over time, with regular renegotiations as necessary. Additionally, WIC agencies must assure that WIC services are not adversely affected if WIC staff are assigned to do non-WIC (albeit reimbursed) activities.

Assurance of a reasonable basis for determining fair and full reimbursement does not imply intensive time/cost allocation data systems. Rather, systems must be in place that indicate the salary, benefit, and other direct costs that are charged to WIC. The appropriateness of these charges can be established through a variety of mechanisms that, again, should be described in state/local agency agreements (e.g., time studies, cost-sharing agreement, time and use plans, job descriptions, etc.). State or local health agencies should develop policies which clearly delineate immunization activities to be paid with WIC funds and those to be paid with other federal or state funds. Because immunization assessment, referral, education, and caseload management could be paid by WIC as well as other programs, the policy should fairly allocate the payment of services among all potential funding sources.

FCS has an obligation to ensure that any expenditure of WIC funds is an appropriate WIC cost. At the same time, however, the WIC program should not lose sight of its larger mission to promote the health and well-being of its participants. State and local agencies are encouraged to use the WIC program as an important means of access to health care. For many participants, the WIC program may be their only consistent point of contact with public and private health services.

STANLEY C. GARNETT
Director
Supplemental Food Programs Division

EO Guidance Document #
FNS-GD-1995-0007
Date
FNS Document #
WIC 1995-16
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (1.26 MB)
No
Summary

This memorandum provides policy clarification about WIC allowable costs for activities related to immunization promotion in the WIC program.

Page updated: November 30, 2021

Infant Formula Rebate Contracts Provisions Restricting Competition

DATE: April 6, 1995
MEMO CODE: WIC Final Policy Memorandum #95-14
SUBJECT: Infant Formula Rebate Contracts Provisions Restricting Competition
TO: Regional Directors Supplemental Food Programs All Regions

In the course of reviewing Invitations for Bids (IFB) for infant formula rebate contracts, the Food and Consumer Service has noticed that certain provisions may preclude some infant formula manufacturers from bidding. One example is provisions requiring multiple manufacturing facilities which are intended to insure continued delivery of formula in the event of plant shut-downs, natural disasters or other unpredictable occurrences. Although such provisions are intended to achieve legitimate state agency purposes , they are often too broad and may result in restricting competition by precluding bidding by otherwise qualified manufacturers.

Such provisions violate the spirit of Section 246.16(Q) (2) of the WIC program regulations, therefore restricting competition. The regulations state that "State agencies shall not issue invitations for bids or enter into contracts which  exclude from consideration in the bidding evaluation any infant formula manufacturer in compliance with the Federal Food, Drug and Cosmetic Act (FFDCA). 11. Therefore, the Department will not approve future IFBs or contracts that include provisions that erroneously restrict competition for WIC infant formula rebates.

If the goal is to prevent interruptions in supply, this can be accomplished by an "insufficient quantities provision, " requiring a contractor who is unable to supply the contracted quantity of formula to pay a rebate for non-contracted for mu l a (and any resulting increased costs to the state agency) until the contracted formula can be supplied again. In lieu of a requirement that a contractor have multiple manufacturing plants, such a provision would adequately protect the state agency's interest without precluding bidding by an otherwise qualified manufacturer.

Please inform your respective state agencies of this policy. If you have any questions, please contact us.

STANLEY C. GARNETT
Director
Supplemental Food Programs Division

EO Guidance Document #
FNS-GD-1995-0006
Date
FNS Document #
WIC 1995-14
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (493.18 KB)
No
Summary

In compliance with the Federal Food, Drug and Cosmetic Act, the Department will not approve future IFBs or contracts that include provisions that erroneously restrict competition for WIC infant formula rebates.

Page updated: November 30, 2021

Sharing WIC Data and Information with State/Local Immunization Programs

DATE: March 3, 1995
MEMO CODE: WIC Final Policy Memorandum : #95-10
SUBJECT: Sharing WIC Data and Information With State/local Immunization Programs
TO: Regional Directors
Supplemental Food Programs
All Regions

The purpose of this memorandum is to transmit the attached WIC Final Policy Memorandum #95-10. It is important to note that this policy memorandum is simply a clarification of general WIC program confidentiality principals delineated in Section 246.26(d) of the Program Regulations and FCS Instruction 800-1 with special emphasis on provisions which affect immunization promotion activities. The same principals apply in similar situations with other programs (e.g., Maternal and Child Health Programs, Healthy Start, etc.). The policy memorandum assumes that states have copies of both the WIC program regulations and FCS Instruction 800-1. If this is not the case, regional offices should provide states with these resources.

The comments which regional offices provided which were not included in this policy memorandum will be used to develop a future policy memorandum regarding the larger more comprehensive picture of data/information sharing and automated data processing systems in WIC. Thank you for providing very helpful comments on this policy memorandum. We hope this information is helpful in establishing strong and lasting relationships between state\local WIC and immunization program counterparts. 

STANLEY C. GARNETT
Director
Supplemental Food Programs Division

 

Attachment
EO Guidance Document #
FNS-GD-1995-0004
Date
FNS Document #
WIC 1995-10
Resource type
Policy Memos
Guidance Documents
Resource materials (Drupal)
Policy Memo (1.86 MB)
No
Summary

This policy memorandum is simply a clarification of general WIC program confidentiality principals delineated in  the Program Regulations and FCS Instruction 800-1 with special emphasis on provisions which affect immunization promotion activities.

Page updated: December 17, 2021
Page updated: December 07, 2021
Page updated: June 14, 2023