Assessing Your WIC Certification Practices

Is there an online screening tool to assess WIC eligibility?

Screening tools that are easy to find, with clear instructions about what information to enter and what steps to take to apply for WIC, are most useful. Many state and local WIC agencies combine a self-screening tool with a search tool that allows an applicant to enter an address to get the name, address, and telephone number of a nearby local agency or clinic. Other screening tools automatically forward an applicant’s contact information to a local agency or clinic for follow-up. Many state agencies include a link to the USDA Food and Nutrition Service WIC Pre-screening tool on their websites.

Can applicants schedule an enrollment appointment using a digital tool?

Some digital tools allow an applicant to enter contact information so that WIC staff can call, text, or email to schedule an appointment. These tools shift responsibility for scheduling an appointment from the applicant to the staff, which makes the scheduling process easier for applicants.

Other digital tools allow applicants to request an appointment and select the days and times they prefer. Staff then follow up using email or texting to schedule the appointment at a convenient time.

One way to help ensure timely appointments is to offer applicants the opportunity to schedule their appointment online. These digital tools can be located in an app or on a website. Ideally they are linked to the information system so the appointment is automatically recorded on the clinic’s schedule. Online appointment scheduling can be made available to families after they complete an online screening or application that indicates they meet basic eligibility requirements. Coordination between state and local agencies is essential for maintaining the available appointment times offered to applicants.

How can applicants provide information in advance of a certification appointment?

Digital tools that are easy to access and allow applicants to provide information in advance of a certification appointment can simplify the enrollment process. These tools range from electronic forms that collect basic contact information (as described above) to online applications where families enter most of the demographic and basic health information needed for certification. Some online applications allow families to upload eligibility documents (such as income and residence documents) and to read and electronically sign required forms (such as rights and responsibilities).

Online forms and applications may be forwarded to a local agency or clinic automatically based on the applicant’s address, or a state agency staff member may review and forward them to an appropriate clinic. In either case, it is important to have clear policies for timely local follow-up and procedures for monitoring the status of requests or applications.

When feasible, transferring information from an online form or application into a WIC information system reduces redundant data collection for families, reduces data entry for WIC staff, promotes information accuracy, and speeds up the enrollment process.

Can families apply for WIC using a multi-program application?

Multi-program eligibility screeners and online applications are available in many states. These are often set up and operated by state human services agencies that administer SNAP and Medicaid. Some of these applications allow for documents to be uploaded and/or for forms to be signed electronically. While some of these screeners and applications contain information about WIC, families that may be eligible for WIC are often referred to a separate website for information about how to apply.

Some states include WIC in the multi-program application, allowing families to request that relevant information be shared with the WIC program to begin the enrollment process. A few states have integrated these multi-program applications with their WIC information system to use the data entered by the applicant to set up a WIC record.

To initiate WIC services earlier in pregnancy, are eligible prenatal applicants enrolled immediately, followed by a nutrition assessment within 60 days?

Federal WIC rules allow for income-eligible pregnant individuals to be enrolled as presumptively eligible immediately, with a nutrition assessment and determination of nutritional risk eligibility completed within 60 days. Some state agency policies make use of this option and include presumptive eligibility for prenatal applicants with nutrition assessment within 60 or, in a few cases 30, days.

A two-step process may make it easier to enroll pregnant individuals as soon as they contact WIC to apply. For example, when a parent of a child participating in WIC shares that she is pregnant during an appointment for her child, she could be enrolled right away (assuming the family is already income eligible) and begin to receive food benefits immediately. The nutrition assessment and risk determination could be scheduled one or two months later.

For a prenatal applicant who does not have a child on WIC, a two-step process may be less overwhelming than a single appointment. The first contact could focus on collecting demographic information, confirming income eligibility, making referrals for prenatal care or other support, assigning a food package, and providing education on WIC foods and how to shop for them. The second contact could focus on a nutrition assessment, nutrition and breastfeeding education, and addressing the participant’s questions about shopping or using WIC foods. If the second contact is scheduled after a prenatal health care appointment, measurements and blood test results may be available for use in the nutrition assessment.

If telephone or video appointments for certification remain allowable even after the COVID-19 waivers end, establishing presumptive eligibility remotely could enable pregnant individuals to begin receiving benefits when they first contact WIC for services, thereby maximizing access to nutritious foods during the pregnancy.

Is there an online tool to request, schedule, or reschedule an appointment?

Some digital tools allow a new applicant to request an enrollment appointment or a participant to initiate rescheduling of an existing appointment by entering contact information so that WIC staff can call, text, or email to schedule or change an appointment. Some of these tools ask for preferred days and times for appointments to increase the likelihood that the appointment is kept.

These tools make it easier for applicants and participants to schedule appointments since they can make the request online at any time rather than having to call during times when the WIC clinic is open. For WIC agencies, these tools can reduce the number of incoming phone calls for appointments, and they provide a way to monitor requests and responses. WIC staff benefit from being able to respond to requests during times when they are not involved in other activities.

One way to help ensure timely appointments for new applicants, and to respond to changes from participants, is to offer them the opportunity to schedule or change their own appointment online. Scheduling tools can be made available through in an app or participant portal. Ideally, the tools would be linked to the WIC information system so the type of appointment offered is appropriate for the applicant’s or participant’s needs and the appointment is automatically recorded on the clinic’s schedule.

For scheduling tools used statewide, coordination between state and local agencies is essential for operating an online appointment scheduling tool.

Is there flexibility to accommodate participants with variable schedules or for rescheduling?

A missed appointment is a missed opportunity to enroll a new family or provide continuity of service to a participating family. It can also affect staff productivity and lead to over-booked schedules when appointments are rescheduled. WIC agencies use a variety of scheduling practices to accommodate participant schedules, including offering appointments during lunch hours, the early morning, or the early evening. Some agencies offer flexible scheduling options, such as same-day or next-day appointments, for participants who do not want to make an appointment several weeks or months in advance.

Offering “education choice” with in-person options as well as nutrition education modules online or in print for participants to complete independently gives busy families flexibility to take part in nutrition education when it is convenient for them.

When scheduling appointments for families with multiple participants, staff should consider the different services needed for each family member, along with the family’s work, school, or child care schedules. Aligning certification periods of family members whenever possible is important for minimizing the frequency of appointments as well as the need for eligibility documents.

Do infants and children need to be present for appointments?

Allowing parents to attend appointments without their children can make it easier for them to schedule and keep appointments. Federal WIC regulations permit an exception from physical presence at certification for infants or children receiving ongoing health care (after the initial certification), for infants or children with working parents (with a limit on how much time can elapse between in-person appointments), and for newborn infants under 8 weeks old. For adults, exemptions from the physical presence requirement are limited to individuals with disabilities.

Offering phone or video appointments for certification when a physical presence exemption applies, or for infant/child mid-certification health and nutrition assessments, is another tool for accommodating parents. When infants/children are not present, it is important to collaborate with health care providers to obtain measurements and blood test results for assessment. Some agencies also allow “drop-in” visits for parents to bring the infant/child to the WIC site for measurements and blood tests whenever it is convenient, before or after the appointment.

What options are available for appointment reminders?

Appointment reminders are critical to help prevent “no shows” or to allow participants to reschedule in advance of the appointment. They are especially important for new applicants and for participants with appointments scheduled weeks or months ahead. Agencies use a variety of ways to remind participants of upcoming appointments. Auto-dialer tools that call with a voice message have been in use for many years. Newer tools that send text message or email reminders are growing in both popularity and functionality. Messages can be tailored to include links to helpful information such as directions to the WIC site or items to bring to the appointment. Two-way text messaging capability is especially helpful for encouraging participants to confirm their appointment or, if needed, to cancel it and reschedule.

WIC apps, participant portals, and other digital tools that allow a participant to look up their appointment at any time offer another way for them to remember their appointments, especially if the tool is linked to an automated calendar.

What documents are used to determine identity, income, and residence eligibility?

While bringing paper documents to an appointment for staff to review is a longstanding practice, viewing documents electronically in advance of an appointment or relying on electronic documents during an appointment can simplify WIC certification. Participants can send electronic documents to WIC in advance of the appointment or can show electronic records, such as pay statements or utility bills or photos of such documents, to staff on their phones during the appointment. In some cases, participants or staff can access an electronic record, such as a medical record, using a clinic computer or tablet during the appointment.

Applicants who are participating in Medicaid, the Supplemental Nutrition Assistance Program (SNAP), or the Temporary Assistance for Needy Families cash assistance program (TANF) meet WIC’s income requirements under the “adjunctive eligibility” policy. WIC agencies use a variety of ways to check for an applicant’s participation in these programs without requiring paper documentation. WIC agencies use online portals, automated phone systems, or a feature integrated into the WIC information system to quickly check for adjunctive eligibility either before or during the certification appointment.

Several state WIC agencies accept documentation of participation in Medicaid, SNAP, or TANF to document both income and residence if that program checks residence within the state as part of its eligibility process. Participation in these programs is also used to document identification in some states, which maximizes the benefit of checking for adjunctive eligibility. Use of one source, whether adjunctive eligibility or another form of documentation, to determine multiple eligibility requirements makes the process easier for both participants and staff.

Initiating new methods for documenting eligibility or making practices adopted under COVID-19 waivers permanent requires training, monitoring and reinforcement to support staff in integrating these approaches into ongoing, daily operations. New methods also require assisting new applicants with using technology to document eligibility and promoting new options to ongoing participants.

What options are available for participants to send or sign documents electronically?

Some local agencies begin the eligibility process before the certification appointment by checking for adjunctive eligibility or viewing documents submitted by applicants. This practice reduces the length of the appointment and may reduce the number of documents that applicants must bring with them.

WIC agencies have implemented a variety of mechanisms for participants to submit documents electronically before appointments. The most common approach is for the participant to send a photo or screenshot of a document via email or text message. Some agencies have set up document uploading capability as part of an online application or within their WIC portals, while others offer stand-alone tools for uploading documents.

New digital tools and services have been put in place for participants to sign required certification documents. Using these methods, participants can read a form such as “WIC Rights and Responsibilities” and then sign and submit it electronically to WIC.

All methods used for electronic documents must ensure data security and privacy since many documents contain confidential or personal information. Clear policies for the tools, for processes used to collect the documents, and for storage or deletion after they are used to determine eligibility are important.

What options are in place for participants who are certified for 30 days (temporary certification) when documents are not available?

By maximizing the use of electronic documents and adjunctive eligibility, agencies can reduce the number of applicants with incomplete documentation. When documentation is missing, however, most state agencies permit a 30-day certification to give the participant the opportunity to provide additional eligibility documents. Flexible options for submitting the documents without having to return to the clinic are important to help ensure participants with temporary certifications become fully certified.

Some state and local agencies monitor the number of temporary certifications as well as the number of these that become full certifications. If a large number of participants are certified for 30 days, this may indicate a need for staff training on maximizing the use of electronic documents. A high rate of temporary certifications that do not become full certifications may warrant more follow-up assistance to ensure that eligible and interested families are able to submit the documentation necessary to continue receiving benefits.

Is adjunctive eligibility checked prior to the certification appointment?

Applicants who participate in Medicaid, the Supplemental Nutrition Assistance Program (SNAP), or Temporary Assistance for Needy Families cash assistance (TANF) meet WIC’s income requirements under the “adjunctive eligibility” policy and do not need to provide additional documentation of their income. If adjunctive eligibility is checked prior to the appointment, communications to remind the family of the appointment can be tailored to let them know what (if any) documents they need to bring. Families that have been found adjunctively eligible can be told that they do not need to bring income documentation, which will save them time. This approach can also shorten the certification appointment for both participants and staff.

Several state WIC agencies accept documentation of participation in Medicaid, SNAP, or TANF to document both income and residence; some also use it to document identity, which maximizes the benefit of checking for adjunctive eligibility. When one source — whether adjunctive eligibility or another form of documentation — can be used to document multiple eligibility requirements in advance, the appointment reminders can be even more tailored and the appointment completed more quickly.

To further reduce the share of applicants that must provide income documentation, states can identify state-administered programs to confer adjunctive income eligibility as permitted in federal program rules. Programs that have income eligibility limits at or below WIC’s and that routinely require documentation of income can be used for this purpose.

What methods are available to submit documents without bringing them to the clinic?

During the COVID-19 pandemic, WIC agencies have set up various methods for applicants or participants to submit documents or photos of documents electronically, including email, text message, participant portals, document uploading tools, and WIC mobile apps. Accepting documents electronically before, during, or after a certification appointment was permitted under program rules prior to the pandemic and will remain allowable once COVID-related waivers expire. For families to fully benefit, however, these options must be clearly explained. If applicants understand them before the certification appointment, they will not spend time unnecessarily getting a document printed or travelling to a WIC clinic.

Online appointment requests and online applications allow new applicants to submit demographic and contact information for use in scheduling an enrollment appointment and setting up a WIC record for the family. Some of these tools also include functionality for uploading documents. In some instances they are used to collect information and documents for recertifications as well as new applications.

When applicants/participants send information or eligibility documentation prior to the certification appointment, WIC staff can review it and alert the family about any missing documents before they arrive for the appointment.

Having methods for submitting documents without a trip to the WIC site following a certification appointment is important when a document is missing and the certification is incomplete or a participant is temporarily certified. After exploring all options for the participant to provide the document in paper or electronic form during the appointment, staff can advise them to send the document through one of the available methods as soon as possible to complete the certification. Follow-up reminders can also tell participants how to send the documents without coming back to the WIC site. These steps are important for retaining participants who find it difficult or inconvenient to return to WIC within 30 days of their certification appointment.

How can information collected prior to the certification appointment be recorded and saved?

Many WIC management information systems allow for eligibility information collected before the certification appointment to be entered into a pending record. Entering eligibility information into the WIC system in advance speeds up the appointment. In some states, information entered into online WIC request forms and applications is automatically transferred into the WIC system, which reduces the burden on staff.

When the information cannot be entered into the WIC system in advance, some local agencies retain it in a separate file and enter it in the WIC system record during the certification appointment. This is less efficient but can still shorten the time needed to complete the certification since staff do not need to ask for information that has already been provided.

Since many documents contain confidential or personal information, all methods used for electronic documents must ensure data security and privacy. Clear policies are needed for the processes used to collect and store the documents before and after they are used to determine eligibility.

How else can WIC agencies make the certification appointment more comfortable for participants?

In designing the certification process, WIC agencies and clinics consider factors such as federal and state policies, management information system design, clinic facilities, and staffing patterns. The process steps and clinic flow can significantly affect both the time needed to complete a certification appointment and participants’ experience with WIC, including how well they understand the process and their attitude toward WIC appointments and services.

There are two general approaches to how participants flow through the clinic. Either they move between rooms for various steps (such as checking documents and measuring heights and weights), sometimes returning to a waiting area between steps, or they remain in one room while staff rotate into the room to provide the services. Reducing the number of times a participant needs to move between different areas of the clinic can make certification easier, especially for parents with young children.

Giving participants a roadmap of the process at the start of the appointment and throughout helps them understand what will happen during their appointment and reduces anxiety, especially for families that are new to WIC. Also, participants can best use their time with WIC staff if they know when they can ask about nutrition, shopping for WIC foods, or other topics.

Do infants and children need to be present for appointments?

Federal WIC regulations permit exemptions from the physical presence requirement for infants and children under certain conditions, and many state agencies incorporate exemptions into their certification policies. Depending on state agency policy, exemptions may include infants under 8 weeks of age, infants or children who were present at the initial certification and receive ongoing health care, or infants and children under the care of working parents or caretakers whose working status presents a barrier to bringing them to the WIC appointment. When appropriate, using these exemptions can help parents keep their certification appointments, enroll their newborns, and keep their children on the program.

For infants or children exempted from being present during the certification, having measurements or (when needed) blood test results from a health care visit facilitates a more complete nutrition assessment and individualized nutrition education. WIC agencies get this information in a variety of ways. These include viewing electronic health records (accessible by WIC staff in some cases or on a parent’s phone); receiving it from health care provider offices by fax, phone call, or other means; and viewing crib cards or records from child health visits provided by parents. When clinic schedules permit, allowing parents to drop in with their children to have them measured when it is convenient can help ensure the information is available for nutrition assessment and education.

To initiate WIC services earlier in pregnancy, are eligible prenatal applicants enrolled immediately, followed by a nutrition assessment within 60 days?

Federal WIC rules allow for income-eligible pregnant individuals to be enrolled as presumptively eligible immediately, with a nutrition assessment and determination of nutritional risk eligibility completed within 60 days. Some state agency policies make use of this option and include presumptive eligibility for prenatal applicants with nutrition assessment within 60 or, in a few cases 30, days.

A two-step process may make it easier to enroll pregnant individuals as soon as they contact WIC to apply. For example, when a parent of a child participating in WIC shares that she is pregnant during an appointment for her child, she could be enrolled right away (assuming the family is already income eligible) and begin to receive food benefits immediately. The nutrition assessment and risk determination could be scheduled one or two months later.

For a prenatal applicant who does not have a child on WIC, a two-step process may be less overwhelming than a single appointment. The first contact could focus on collecting demographic information, confirming income eligibility, making referrals for prenatal care or other support, assigning a food package, and providing education on WIC foods and how to shop for them. The second contact could focus on a nutrition assessment, nutrition and breastfeeding education, and addressing the participant’s questions about shopping or using WIC foods. If the second contact is scheduled after a prenatal health care appointment, measurements and blood test results may be available for use in the nutrition assessment.

If telephone or video appointments for certification remain allowable even after the COVID-19 waivers end, establishing presumptive eligibility remotely could enable pregnant individuals to begin receiving benefits when they first contact WIC for services, thereby maximizing access to nutritious foods during the pregnancy.

When is a phone or video appointment an option?

Federal WIC regulations permit states to allow exemptions from physical presence at certification for infants or children receiving ongoing health care (after the initial certification), for infants or children with working parents (with a limit on how much time can elapse between in-person appointments) and for newborn infants under 8 weeks old. For adult participants, exemptions from the physical presence requirement are limited to individuals with disabilities. Many state agencies offer these exemptions and WIC clinics might use them under special circumstances, but using them routinely and offering phone or video appointments to participants who qualify could make appointments less burdensome.

When a participant is eligible for an exemption, some parents or participants may prefer to complete the certification appointment by videoconference or phone. This option may be especially convenient for individuals who are working or attending school, or when transportation barriers make it difficult to reach a WIC site. However, for video or phone appointments to allow for certifications:

• Applicants will need to provide required information or documents to WIC before or during the appointment, including the information or documents needed to determine eligibility, as well as measurements and (if needed) blood test results.
• Both the applicants and the WIC agency must have reliable phone or internet service. Applicants also need to be able to access, read, and sign required forms.

Nutrition education appointments and mid-certification appointments for a health and nutrition assessment, along with nutrition education, provide other opportunities to offer phone or video appointments. The USDA WIC Nutrition Education Guidance allows for a variety of methods, including phone and video. To facilitate assessment of growth patterns during mid-certification appointments, parents can be asked to make available measurements from their infant’s or child’s health care provider or supply the measurements through other means.

How can measurements and blood test results be obtained for infants or children who do not have to be present?

For infants or children who do not have to be present during the certification, having measurements or (when needed) blood test results from a health care visit facilitates a more complete nutrition assessment and individualized nutrition education. WIC agencies can obtain this information through a variety of ways, including:

• Viewing hospital crib cards or child health visit records that parents provide.
• Viewing electronic health records on a parent’s phone (such records also are accessible by WIC staff in some cases).
• Receiving the information from health care provider offices by fax, phone, electronic transmission, or other means, with a parent’s permission.
• Allowing parents to drop in with their children to have them measured, when clinic schedules permit and it is convenient for the family.

How can agencies help families prepare for a video or phone appointment?

Individuals who choose a video or phone appointment need clear instructions about what information and documents are needed and how to provide these to WIC. Providing the instructions several days prior to the appointment gives them the opportunity to gather and send information in advance. Participants in video appointments may be able to show documents during the appointment; those participating in phone appointments will need to send them electronically or by U.S. mail, or drop them at a WIC site.

For video appointments , participants may need instructions for joining, including how to download an app or tool and what links and passwords to use. Helping them prepare for a future video appointment, either while they are at the WIC site or when the appointment is scheduled, can increase the likelihood of a successful appointment. Even with assistance, some participants may not be comfortable using videoconferencing or may not have the technology or bandwidth to support a video appointment. It is important to offer appointment options that will work best for them, whether remote or in person.

During the pandemic, most WIC staff conducted appointments by phone; many also used videoconferencing to provide services. Some WIC staff are more comfortable with phone appointments than video, while others prefer in-person interactions with participants. To build staff comfort with phone and video appointments, it is essential that WIC staff be trained in the new options and determine how to integrate them into existing business processes.

How can WIC coordinate with health care providers and community organizations to conduct WIC outreach and make referrals to WIC?

Many families that are eligible for WIC may need help understanding the services it offers and how to enroll. Providers and employees working in health care settings and community organizations may also be uninformed about WIC and unprepared to make referrals or help families apply.

At the state level, ongoing coordination with other state programs, medical associations, and consortia of community-based organizations can provide an effective mechanism for sharing up-to-date information about WIC services and referral processes. Including information about WIC in communications to members of associations and community-based groups can reach a broad audience.

At the local level, offering training to explain WIC services, referral processes, and ways to assist with WIC applications provides an opportunity to educate and motivate people who work with WIC-eligible families to actively connect them to WIC. Establishing an ongoing relationship with providers or their employees, setting up an easy-to-use referral process, and giving them a point of contact for questions and assistance can increase the likelihood of referrals.

Identifying and training “WIC assistors” in settings where WIC-eligible families go for health care or other services can help families overcome barriers to applying for WIC. Assistors could be employees of a community organization that helps connect families to services for which they are eligible. Alternatively, WIC could contract with a community organization to hire or pay a portion of salaries for employees to do this work. In either scenario, WIC agencies would provide training to arm assistors with accurate information and would establish a WIC liaison as their point of contact for questions or feedback and to help troubleshoot enrollment challenges that families encounter.

How can WIC co-locate in settings where eligible families go for services?

Serving participants in places they frequent for other reasons can make WIC enrollment more convenient and help retain families in the program. It also facilitates coordination of care between WIC and health care providers or other service providers. Depending on the number of families coming to the facility and the amount of space available, co-location models could range from offering WIC services at specific times to maintaining WIC staff in the location full-time.

Co-location with health care can have benefits beyond making WIC more readily available. Co-location fosters positive relationships between WIC staff and providers, who might then refer patients and advocate for WIC more actively. In some cases, a nutrition assessment conducted by dietitians or nutritionists employed by the health care facility can be used for WIC certification, or nutrition counseling they provide can meet WIC nutrition education requirements. This would eliminate duplication of effort and shorten the time needed to complete the WIC certification. Also, WIC staff located in health care settings might have access to measurements, blood test results, and other information from health care visits to use for a nutrition assessment and education. There may also be opportunities for registered dietitians and lactation consultants employed by WIC to provide services billable to Medicaid or health insurance.

WIC often operates independently even when co-located with other services. New models of co-location that focus on integrating services rather than just situating program staff in the same place would allow for more coordinated services and less duplication.

In instances where out-stationing WIC staff is not feasible, the combination of an electronic referral (including the data needed for certification) and a video-conferencing connection from the health care provider’s office to WIC would incorporate WIC services into health care appointments. For the applicant, this “virtual co-location” would address barriers of time and transportation and might lead them to enroll earlier in pregnancy and enroll older children.

Co-location requires time and attention to coordinate with the host organization and can make staff scheduling more challenging. However, the benefits of reaching more WIC families and building relationships with health care providers or other programs can make the effort worthwhile.

How can WIC work with Head Start to enroll and serve participating children?

Children enrolled in Head Start fall in the age range WIC serves and generally are income-eligible for WIC. Because children begin to drop off of WIC after their first birthday and participation declines more steeply as they approach age 5, collaboration with Head Start can be an effective strategy to reach and retain older children in WIC.

Some WIC agencies work with Head Start to offer WIC enrollment when families register their children for Head Start. Alternatively, Head Start could obtain parents’ consent to share contact information with WIC to facilitate outreach. Offering periodic training to Head Start employees on WIC services and how to refer families to WIC (along with providing a WIC point-of-contact) can also build a fruitful connection.

In addition, offering nutrition education as part of Head Start parent events can provide required education for children enrolled in WIC and save parents time, as the events can meet two requirements simultaneously. It can also be an opportunity to help families of children not enrolled to apply.

How can WIC be integrated into programs for families with young children to serve participants where they are?

Some WIC agencies, such as local health departments or community clinics, incorporate WIC certification into prenatal care or child health visits. Employees are trained to provide both health care and WIC services, with labor costs shared between programs. Applying this model to other scenarios, such as home visiting programs, can make WIC services available to participants in locations outside of WIC clinics. This approach can reduce barriers for families with transportation challenges and parents of newborns. Successful implementation requires adequate training and monitoring of staff on WIC certification and nutrition services requirements, as well as appropriate equipment and access to the WIC information system.

How does WIC work with Medicaid, SNAP, and TANF to conduct outreach to families that are adjunctively eligible for WIC?

Collaboration between WIC and Medicaid, SNAP, and TANF occurs at both the local and state level. Local WIC agencies periodically meet with employees of the other programs to educate them about WIC’s eligibility requirements and services and how to make a referral to WIC. Some WIC local agencies send staff to Medicaid/SNAP offices to conduct direct outreach and help clients apply for WIC. Other local agencies have agreements with the programs to receive contact information of clients who may be eligible for WIC to facilitate targeted outreach to them.

At the state level, representatives from WIC and the other programs periodically share program updates or work together to disseminate program information to WIC-eligible clients. A growing number of WIC state agencies have data-sharing agreements with Medicaid or SNAP to periodically receive files with information about clients enrolled in the other program who are adjunctively eligible for WIC. These files are matched with files of WIC participants to identify WIC-eligible individuals who are not enrolled. The state or local agencies follow up with these individuals to offer an enrollment appointment. A written agreement or memorandum of understanding describing how these programs will be coordinated and how to make referrals across programs can be beneficial for both state and local WIC agencies.

How do Medicaid, SNAP, and TANF make referrals to WIC?

Application processes for Medicaid, SNAP, and TANF vary across states, with some primarily online and others by phone or in person. In all scenarios, there are opportunities to make referrals to WIC and provide information about how to apply.

One way to facilitate referrals from other programs to WIC is to incorporate the use of online tools for families to request a WIC appointment or initiate an application. Links can then be included in referral materials provided to WIC-eligible families. WIC agencies can provide recommended language for the other programs to use in these communications to ensure it is accurate and engaging.

Digital tools that allow these other programs or health care or social service providers to provide WIC with information about a potentially eligible family (such as contact information, measurements, or blood test results), with the family’s consent, could be a “game changer” for increasing referrals to WIC.

Other mechanisms to connect families applying for Medicaid or SNAP with WIC include online multi-program eligibility screeners and applications to facilitate enrollment of families in all programs they are eligible to receive. These are often set up and operated by state human services agencies that administer Medicaid and SNAP. While some of these screeners and applications contain information about WIC, families that may be eligible are often referred to a separate website for information about how to apply. Some states allow families to request that their relevant information be shared with WIC to begin the enrollment process. A few states have integrated these multi-program applications with their WIC information system to use the data entered by the applicant to set up a WIC record, which facilitates outreach and reduces data entry for WIC staff.

How can community organizations and health care providers be engaged to help families they serve enroll in WIC?

Many families that are eligible for WIC are not aware they qualify, do not understand the services it offers, or do not know how to apply. Identifying and training “WIC assistors” in settings where WIC-eligible families go for health care or other services can help families overcome these barriers. These assistors could be employees of a community organization that helps connect families to services for which they are eligible. Alternatively, WIC could contract with a community organization to hire or pay a portion of salaries for employees to do this work. In either scenario, WIC agencies would provide training to arm assistors with accurate information and establish a WIC liaison as their point of contact for questions or feedback and to help troubleshoot enrollment challenges that families encounter.

Another way WIC can provide outreach and generate referrals for WIC-eligible patients is to train providers and employees working in health care settings on WIC services and referral processes. Establishing an ongoing relationship with providers or their employees, setting up a referral process that is easy for them to use, and giving them a point of contact for questions and assistance can increase the likelihood of referrals.

In some communities, outreach and application assistance is provided through 211 services. (211 is the telephone number assigned by the Federal Communications Commission for providing quick and easy access to information about health and human services in local areas.) WIC agencies or clinics can develop relationships with their local 211 service to train call staff to screen callers for program eligibility and provide agency-specific referral information. The 211 staff could also enter information on an online referral or appointment request form to initiate a WIC application on behalf of the caller, especially for those lacking computer or smartphone access.