Assessing Your WIC Certification Practices

While WIC programs operate under a set of federal rules and policies, state and local WIC agencies have considerable flexibility to determine how they certify new applicants and ongoing participants. This toolkit, while not a comprehensive list of all practices used to certify participants, provides questions for agencies to consider, examples, and suggested resources for exploring ways to make certification easier for families and WIC staff. The toolkit has seven topic areas, each with a set of questions, approaches, and examples. Because some approaches and examples are appropriate for multiple topics, they appear under more than one topic area. New examples are welcome and will be added as they become available.
  • Facilitating Enrollment
  • Scheduling Appointments
  • Documenting Eligibility
  • Simplifying Certification
  • Phone/Video Appointments
  • Coordinating Services
  • Targeting Outreach

Facilitating Enrollment

Digital tools can make it easier for families to express interest in WIC and get certified for WIC. They can also make the process easier for WIC staff.

Digital tools like smartphone apps, mobile-friendly online portals, and text messaging can make it easier for families to express interest in WIC, schedule an enrollment appointment, or provide information necessary for certification. Outreach messages that include a link to an online tool allow recipients to take immediate action to enroll in WIC. Digital tools that enable WIC staff to move the certification forward make the process easier for applicants. Digital tools that are linked to WIC information systems make the process easier for staff.

Clear procedures for timely WIC staff follow-up and monitoring of the status of requests or applications are essential to providing strong customer service and effectively enrolling families in WIC. To develop more user-friendly tools, WIC agencies can apply the principles of human-centered design, such as including the future users of a tool at every step of design: understanding who users are, identifying what problems are being addressed, brainstorming and modelling solutions, and testing the new tool during development and before implementation.

Click question for ideas and examples

More on this topic

Modernizing and Streamlining WIC Eligibility Determination and Enrollment Processes, Center on Budget and Policy Priorities, January 6, 2017.

Streamlining and Modernizing WIC Enrollment – With Current Rules and Funding, WIC Agencies Can Simplify Certification Practices to Reach More Eligible Families, Center on Budget and Policy Priorities, Updated December 17, 2020.

The federal rule on presumptive eligibility for prenatal applicants is at 7 C.F.R. § 246.7 (e)(1)(v).

Have an example to share? Please send a brief description of a process or project along with an email address to contact for more information using this contact form.

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.

Examples:

  • Oregon WIC connects applicants to the USDA Food and Nutrition Service WIC Pre-screening tool. Its website also includes an online “WIC Interest Form” for applicants to submit demographic information and a request for a WIC clinic in their area to contact them. Interest forms for five local agencies are also available on the state’s website. Forms are routed to the appropriate local agency for follow-up. More information
  • Central New York has a collaborative of local agencies that developed a WIC outreach website with a screening and referral tool. The tool screens potential applicants for eligibility and collects demographic information from those that may be eligible. A referral is then sent via email to the local agency closest to their home address for follow-up. More information

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.

Examples:

  • New Hampshire WIC’s digital pre-application allows applicants to submit demographic information online and request that a WIC clinic in their area contact them to schedule an enrollment appointment. The request is routed to the clinic for follow-up. Data entered in the pre-application is automatically transferred into the state’s WIC information system. More information
  • Texas WIC's website at TexasWIC.org includes information about program benefits, eligibility requirements, and how to prepare for an enrollment appointment, with videos of interactions between participants and WIC staff along with participant testimonials about their WIC appointments. The website has both an online form for applicants who want to have a local agency contact them to schedule an appointment and a search function for applicants who want to locate the nearest WIC site and call for an appointment. More information
  • California's PHFE WIC has an online form to collect eligibility and contact information from applicants, including an option for the applicant to opt in to receive text messages from WIC. Staff exchange interactive text messages with the applicant to schedule an appointment. PHFE WIC also advertises texting “APPLY” to the local agency’s short code phone number. When an applicant sends the text, they receive an automated response that a representative from WIC will contact them within 1-4 days to complete their application by phone. During regular business hours, follow-up for both types of applications normally occurs within an hour of receiving it. More information
  • Massachusetts WIC’s website has a form that allows applicants to submit contact information, the best times to be contacted, and their preferred language. The information from the forms is incorporated into the WIC information system and the application is assigned to a local agency to follow up with the applicant within two business days. More information  
  • Arizona’s Maricopa County WIC’s website allows applicants to indicate which weekdays work best for them and whether they prefer morning or afternoon appointments. Clinic staff follow up by text, email, or phone to offer enrollment appointments that fit with these preferences. More information
  • Michigan’s WIC Connect app allows applicants to self-screen and, if they appear to be eligible, to schedule an enrollment appointment at a clinic near their home address. Ongoing participants can use the app to request an appointment, which is then scheduled by WIC staff. More information

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.

Examples:

  • Oklahoma WIC’s online application collects demographic, eligibility, and health/nutrition information used for certification. It includes a HIPAA compliant upload function for required documents and signatures. State WIC staff send applications to a clinic near the applicant’s home address for staff to contact the applicant and schedule an appointment to complete the certification. More information
  • West Virginia WIC has an online screening and application process that collects demographic and health information from applicants. State WIC staff review the applications to determine if the applicant already has a record in the WIC information system before forwarding the application to a local agency for follow-up. When no record exists, the data from the application can be used to automatically populate a new record in the WIC information system. More information
  • Minnesota WIC’s online application makes it easier to apply for WIC benefits. The link “Apply for WIC” is located on the top of the Minnesota IC homepage and the “Am I Eligible for WIC?” page. Applicants can fill out eligibility information and upload documents. Applications are automatically routed to a local agency for follow-up. More information
  • Iowa’s Polk and Dallas County WIC has “one-stop” online options for families to apply for WIC, request an appointment, and/or upload documents. More information

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.

Examples:

  • Colorado’s PEAK system is a multi-program screening tool that assists a family with determining what public programs they may be eligible for, including WIC. Families can then set up a secure PEAK account to enter application information that is shared with programs they are eligible to receive. Electronic WIC referrals from PEAK are routed by zip code to the local WIC agency “in boxes” within the WIC Referral System — a secure, online database. Designated local agency staff access the referrals and follow up with the applicants. More information

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.

Examples:

  • For the federal rule on presumptive eligibility for prenatal applicants, see 7 C.F.R. § 246.7 (e)(1)(v).
  • Kansas WIC’s certification policies include presumptive eligibility for prenatal applicants. More information

Scheduling Appointments

WIC participants typically have several appointments each year. Offering alternatives to calling a WIC clinic to schedule or reschedule an appointment can make it easier for parents who lack daytime flexibility to make calls and increases the likelihood that appointments will be kept.

It is common for WIC participants to have four appointments each year: a certification appointment, a nutrition education appointment, a mid-certification appointment with a health and nutrition assessment, and another nutrition education appointment. Families in which different members have different certification periods might have even more appointments. Prior to COVID-19, these appointments were primarily conducted in person, though many WIC agencies offer online nutrition education that participants can complete at any time, eliminating two appointments.

While some agencies have implemented walk-in or “same day scheduling” practices, most WIC sites operate with schedules that have defined appointment types and time periods. Appointments for new applicants may be scheduled within a week or two, but for participants who are due to be recertified or need mid-certification health checks or nutrition education, appointments are often scheduled two or three months in advance. While most WIC staff work with applicants and participants to find appointments that fit their work or school schedule, changes in people’s circumstances can require rescheduling or follow-up for a missed appointment, and high no-show rates are a chronic concern. Offering applicants and participants more flexibility to request, schedule, and reschedule their appointments using WIC apps, web portals, or other digital tools can reduce staff time spent on scheduling and increase the likelihood that appointments will be kept.

Appointment reminders via phone call, text messaging, and email are essential for helping families remember their appointments. Reminders that include information about the WIC site location, what will happen during the appointment, and what documents to bring are helpful, especially for new applicants. Email or two-way text message reminders allow the participant to confirm their appointment or request a change, which can often be handled without a phone call.

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More on this topic

The federal rules regarding exemptions from appearing in person for a WIC certification appointment are in 7 C.F.R. § 246.7(o).

Have an example to share? Please send a brief description of a process or project along with an email address to contact for more information using this contact form.

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.

Examples:

  • Arizona’s Maricopa County WIC website has a form that allows applicants to send an online appointment request and indicate which weekdays work best for them and whether they prefer morning or afternoon appointments. Clinic staff follow up by text, email, or phone to offer enrollment appointments that fit with these preferences. More information
  • California's PHFE WIC uses interactive texting to communicate with participants who miss appointments to facilitate rescheduling. Outgoing text messages offer a selection of available appointment days; participants can request their preferred date by replying with a single-digit response. An automated text response asks if they prefer a morning or afternoon appointment on that date. Staff schedule the appointment and text the confirmed date and time. Participants can also schedule a weekend appointment by texting an advertised keyword for the preferred appointment day. Staff monitor incoming texts and confirm the appointment date and time via text. More information
  • Michigan’s WIC Connect app allows applicants to self-screen and, if they appear to be eligible, to schedule an enrollment appointment at a clinic near their home address. Ongoing participants can use the app to request an appointment, which is then scheduled by WIC staff. See WIC Connect Screenshots and FAQs.
  • New Jersey’s WIC Participant Portal shows participants their next appointment and allows them to update information or upload documents for the upcoming appointment. More information

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.

Examples:

  • Kansas’s Shawnee County WIC implemented next-day scheduling to improve participant attendance at appointments and staff satisfaction. The county also added new opportunities for drop-in appointments. See the section “Scheduling Approaches” on page 6 of https://www.cbpp.org/wicstreamlining.
  • For information about WIC “education choice,” see

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.

Examples:

  • The federal rules regarding exemptions from appearing in person for a WIC certification appointment are contained in 7 C.F.R. § 246.7(o).
  • California’s Community Medical Centers WIC conducted a pilot to offer video recertification appointments for parents whose children met the exception criteria for physical presence. WIC staff assisted the parents in using a videoconferencing platform called Healthie and in obtaining and submitting documents before appointments, including measurements and blood test results from health care visits. Parents could also bring their children to the WIC office for measurements when it was convenient for them. More information
  • Vermont WIC implemented phone appointments for mid-certification assessments during 2019 and for certification during 2020. It found that participants were much more likely to keep phone appointments than in-person appointments. Local agencies coordinated with health care providers for measurements and offered providers options to send data to WIC by fax, email, or phone. Participants could also share measurements from electronic health records or have children weighed and measured at drop-in visits to the WIC site. More information

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.

Examples:

  • California’s San Diego State University Foundation WIC tested different approaches for helping new applicants keep their appointments and complete the certification process. It found that two-way text messaging providing information about the appointment in the reminder was popular with participants and had a broad reach. When given the text option, participants strongly preferred it over phone communication. Their appointment reminder text message now allows participants to confirm or cancel their appointment. More information
  • California’s Watts Healthcare Corporation WIC redesigned its text message reminders to increase appointment attendance. More information
  • Florida WIC’s App shows future appointments along with the clinic location and phone number where the appointment is scheduled. More information

Documenting Eligibility

Reducing the number of documents applicants must bring to certification appointments and reviewing documentation in advance can increase the likelihood that eligible families successfully enroll in WIC.

While federal law and program rules are the foundation of WIC eligibility requirements, state WIC agencies set policies and procedures for documenting eligibility, and local agencies/clinics implement these in varying ways within the context of staffing patterns and facilities. As a result, WIC agencies employ a wide range of options for documenting identity, residence, and income eligibility.

During the COVID-19 pandemic, agencies expanded their use of technology to collect documents because they were conducting certifications remotely under waivers approved by the USDA Food and Nutrition Service. These changes make certification easier for both participants and staff, and many of them can be continued without waivers. By checking for adjunctive eligibility or viewing documents submitted by applicants in advance of the certification appointment, and by allowing a single document to meet multiple eligibility requirements, WIC staff can reduce the length of the appointment and the number of documents that applicants must bring with them.

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More on this topic

Supporting WIC Enrollment – Using technology to improve the certification experience for participants and WIC agencies, Nava Public Benefit Corporation on behalf of the National WIC Association, October 20, 2020.

Have an example to share? Please send a brief description of a process or project along with an email address to contact for more information using this contact form.

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.

Examples:

  • Oklahoma WIC updated its eligibility policies to incorporate electronic documents. More information
  • California’s TrueCare healthcare agency gives WIC staff access to medical records of participants that receive both their health care and WIC services from the agency. The medical record is a source of eligibility documentation and can also be a source of data for nutrition assessment. More information
  • Idaho’s Central District Health Department WIC staff log on to a Medicaid portal to check for adjunctive eligibility. Staff collect Medicaid numbers for new WIC applicants to check eligibility when their initial certification appointments are scheduled, and use the Medicaid number in the WIC record to check again prior to recertification appointments. More information
  • California WIC’s information system has an interface that contains data on Medicaid, SNAP, and TANF participation. Staff can check for participation in those programs during certification appointments or when conducting eligibility screening for applicants prior to scheduling an appointment. More information
  • North Carolina WIC’s policies allow documentation of participation in Medicaid to satisfy WIC income, residence, and identification requirements. More information
  • Colorado WIC implemented webinar training to promote policies allowing electronic documents. All local agencies were required to participate in the webinar, which included sharing practices in a local agency that had fully adopted the policies. More information
  • California’s San Diego State University Foundation WIC realized that having a policy allowing applicants to show electronic documents wasn’t helpful if they didn’t know about it. They implemented text messaging in advance of certification appointments to help families understand what information they needed to bring and make clear that they could show an electronic document or a photo of a document on their phone. More information

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.

Examples:

  • Maryland’s Greater Baden Medical Center WIC implemented an off-the-shelf technology called Intake Q, which includes a secure way for families to send demographic information and eligibility documents in advance of their certification appointments. Staff use Intake Q to send email reminders about upcoming appointments and encourage participants to send documents prior to visiting the clinic. More information
  • New Jersey WIC’s participant portal allows new applicants or ongoing participants to securely upload documents. To use the portal, the applicant or participant must create an account. More information
  • Oklahoma WIC’s online application collects demographic, eligibility, and health/nutrition information used for certification. It includes a HIPAA compliant upload function for required documents and signatures. State WIC staff send applications to a clinic near the applicant’s home address for staff to contact the applicant and schedule an appointment to complete the certification. More information

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.

Examples:

  • Arizona’s Maricopa County WIC greatly reduced the number of temporary certifications by promoting the use of electronic documents with staff and participants. More information

Simplifying Certification

By combining certification streamlining practices discussed in this toolkit, and retaining the simplifications adapted under COVID-19 waivers where possible, WIC agencies can shorten certification appointments and make them easier for applicants and staff.

WIC participants generally have several appointments each year. Certification appointments – during which a family is enrolled in WIC or their certification is renewed – are usually the longest appointments, especially for new applicants or families with multiple participants. The certification process typically has several steps, with some centered around eligibility, some focused on nutrition assessment and counseling, and others explaining how to participate in WIC, such as how to use a WIC benefit card and shop for WIC foods. The process sometimes seems burdensome to participants and cumbersome to WIC staff, especially when parents have infants and/or toddlers with them.

Many WIC agencies have been exploring ways to streamline the certification appointment to make it shorter and simpler for both participants and staff by combining the approaches described in other portions of this toolkit. Clinics returning to in-person appointments following the pandemic have an opportunity to rethink their processes, practices, and clinic flow to make certification appointments a more efficient and positive experience for WIC families.

Digital tools that enable families to provide information and submit documents in advance of the certification appointment, or that enable staff to obtain needed information, allow completion of some steps in the eligibility determination process before the appointment. Some practices that agencies implemented to simplify the process and conduct remote or modified appointments under COVID-19 waivers can be continued or adapted after the waivers end. Also, offering remote appointments when regular program rules permit could make it easier for families to keep appointments and participate in WIC longer.

Click question for ideas and examples

More on this topic

The federal rule on state-administered programs that may confer adjunctive income eligibility is at 7 C.F.R. § 246.7(d)(2)(vi)(B).

The federal rules regarding exemptions from appearing in person for a WIC certification appointment are in 7 C.F.R. § 246.7(o).

The federal rule on presumptive eligibility for prenatal applicants is at 7 C.F.R. § 246.7 (e)(1)(v).

Have an example to share? Please send a brief description of a process or project along with an email address to contact for more information using this contact form.

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.

Examples:

  • Idaho’s Central District Health Department WIC staff log on to a Medicaid portal to check for adjunctive eligibility. Staff collect Medicaid numbers for new WIC applicants to check eligibility when their initial certification appointments are scheduled, and use the Medicaid number in the WIC record to check again prior to recertification appointments. More information
  • Oregon’s Woodburn Salud Clinic WIC staff check adjunctive eligibility before meeting with the applicant, which slightly reduces the time a client must spend in the clinic. Two sites check adjunctive eligibility after the client has checked in for her appointment, but prior to seeing the certifier. The other sites have staff check in the morning to determine who on the schedule for the day is adjunctively eligible. See the section “Checking for Adjunctive Eligibility” on page 9 of https://www.cbpp.org/wicstreamlining.
  • Minnesota WIC’s policies allow documentation obtained by phone or online of receipt of Medicaid to satisfy income, residence, and identification requirements. More information  
  • The federal rule on state-administered programs that may confer adjunctive income eligibility is at 7 C.F.R. § 246.7(d)(2)(vi)(B).

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.

Examples:

  • New Hampshire WIC’s digital preapplication allows applicants to submit demographic information online and request that a WIC clinic in their area contact them to schedule an enrollment appointment. The request is routed to the clinic for follow-up. Data entered in the pre-application is automatically transferred in the state’s information system. More information
  • New Jersey WIC’s participant portal allows new applicants or ongoing participants to securely upload documents. To use the portal, the applicant or participant must create an account. More information
  • Maryland’s Greater Baden Medical Center WIC implemented an off-the-shelf technology called Intake Q, which includes a secure way for families to send demographic information and eligibility documents in advance of their certification appointments. Staff use Intake Q to send email reminders about upcoming appointments and encourage participants to send documents prior to visiting the clinic. When participants use the tool, their certification appointments are several minutes shorter. More information
  • Iowa’s Polk and Dallas County WIC has “one-stop” online options for families to apply for WIC, request an appointment, and/or upload documents. More information

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.

Examples:

  • California’s WIC Wise management information system creates a pending certification record with demographic and eligibility data entered prior to the appointment. An interface between WIC Wise and the state’s system that contains records for clients enrolled in Medicaid and SNAP is used to check for adjunctive eligibility when the pending record is created. More information

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.

Examples:

  • Wisconsin’s Public Health Madison and Dane County WIC changed the clinic flow for certification appointments by adding equipment for taking measurements and blood tests into the offices of competent professional authorities (CPAs). Participants stay in the CPA’s office for the appointment rather than moving through multiple clinic areas. In addition to shortening appointment times, the redesign had a positive impact on staff scheduling and intake capacity. More information
  • Texas WIC's website at TexasWIC.org includes information about program benefits, eligibility requirements, and how to prepare for an enrollment appointment, with  videos showing what takes place during a certification appointment along with participant testimonials about their WIC appointments. The website has both an online form for applicants who want to have a local agency contact them to schedule an appointment and a search function for applicants who want to locate the nearest WIC site and call for an appointment. More information
  • For discussions of how participants’ experience of appointments affects their perception of WIC, see:

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.

Examples:

  • Federal rules regarding exemptions from appearing in person for a WIC certification appointment are in 7 C.F.R. § 246.7(o).
  • California’s Community Medical Centers WIC conducted a pilot to offer video recertification appointments for parents whose children met the exception criteria for physical presence. WIC staff assisted the parents in using a videoconferencing platform called Healthie and in obtaining and submitting documents before appointments, including measurements and blood test results from health care visits. Parents could also bring their children to the WIC office for measurements when it was convenient for them. More information
  • Missouri WIC’scertification policies include criteria for exemption from the physical presence requirement during certification appointments. More information
  • Vermont WIC implemented phone appointments for mid-certification assessments during 2019 and for certification during 2020. It found that participants were much more likely to keep phone appointments than in-person appointments. Local agencies coordinated with health care providers for measurements and offered providers options to send data to WIC by fax, email, or phone. Participants could also share measurements from electronic health records or have children weighed and measured at drop-in visits to the WIC site. More information

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.

Examples:

  • For the federal rule on presumptive eligibility for prenatal applicants, see 7 C.F.R. § 246.7 (e)(1)(v).
  • Kansas WIC’s certification policies include presumptive eligibility for prenatal applicants. More information

Phone/Video Appointments

Phone and video appointments were used before the COVID-19 pandemic and routinely offered during it. WIC agencies can apply lessons learned to make phone or video appointments available on an ongoing basis as an option for participants, when appropriate and allowable.

WIC participants generally have several appointments each year. Under federal program rules, applicants are required to appear in person for certification appointments – during which a family is enrolled in WIC or their certification is renewed – unless a specific exemption applies. Prior to the COVID-19 pandemic, participants also were generally expected to appear in person for a mid-certification appointment with a health and nutrition assessment.

A limited number of WIC agencies offered certification or mid-certification appointments by telephone or videoconferencing prior to the pandemic, but during the pandemic, nearly all conducted appointments by phone or (to a lesser extent) video. Remote and modified appointments helped keep both participants and staff safe while maintaining families’ access to WIC services and food benefits. USDA waivers of the requirements that applicants be physically present during certification appointments and that measurements and blood test results be used for nutritional risk assessments made it possible to certify participants by phone or video. WIC agencies can apply the lessons learned from conducting certification and providing services remotely to continue to make phone or video appointments available on an ongoing basis as an option for participants, when appropriate and allowable.

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More on this topic

WIC Nutrition Services Standards, U.S. Department of Agriculture, August 2013.

TeleWIC: Keeping Up with the Times, California WIC Association, 2018.

The federal rules regarding exemptions from appearing in person for a WIC certification appointment are in 7 C.F.R. § 246.7(o).

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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.

Examples:

  • The federal rules regarding exemptions from appearing in person for a WIC certification appointment are in 7 C.F.R. § 246.7(o).
  • California’s Community Medical Centers WIC conducted a pilot to offer video recertification appointments for parents whose children met the exception criteria for physical presence. WIC staff assisted the parents in using a videoconferencing platform called Healthie and in obtaining and submitting documents before appointments, including measurements and blood test results from health care visits. Parents could also bring their children to the WIC office for measurements when it was convenient for them. More information
  • Minnesota WIC piloted the use of video recertification appointments in the Fillmore County WIC program for children eligible for an exemption from the physical presence requirement. A videoconferencing platform called Vidyo already used by another state program was available to Minnesota WIC to use at no cost. The pilot demonstrated that certification can be conducted using video appointments, which provide a flexible option for families that lack transportation or during inclement weather. More information
  • WIC Nutrition Education Guidance published by the USDA Food and Nutrition Service contains the following guidelines. “The WIC nutrition educator may use multiple delivery media during nutrition education contacts/intervention. Although face-to-face personalized contact is considered the optimal medium for providing nutrition education, new technology such as computer-based educational programs, may allow WIC nutrition education to meet the needs of participants through a variety of delivery media while still providing an effective nutrition education contact/intervention.” Additionally, the guidance states that “The elements of effective nutrition education can also be applied via telephone.” See https://wicworks.fns.usda.gov/wicworks/Learning_Center/ntredguidance.pdf. Research has shown that online and in-person nutrition education can have similar effects on knowledge and behavior. See https://thewichub.org/online-and-in-person-nutrition-education-improves-breakfast-knowledge-attitudes-and-behaviors-a-randomized-trial-of-participants-in-the-special-supplemental-nutrition-program-for-women-infants-an/.

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.

Examples:

  • Vermont WIC implemented phone appointments for mid-certification assessments during 2019 and for certification during 2020. It found that participants were much more likely to keep phone appointments than in-person appointments. Local agencies coordinated with health care providers for measurements and offered providers options to send data to WIC by fax, email, or phone. Participants could also share measurements from electronic health records or have children weighed and measured at drop-in visits to the WIC site. More information

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.

Examples:

  • California’s Community Medical Centers WIC and Minnesota’s Fillmore County WIC conducted pilots using videoconferencing for recertification appointments for children. Lessons learned by both agencies included: 1) participants need help setting up the videoconferencing application and using it effectively for their appointments; 2) staff need to help families obtain and upload documents before appointments; and 3) it takes time for new approaches such as videoconferencing to be adopted and accepted by WIC participants and staff. More information on California and Minnesota.
  • WIC Value Enhanced Nutrition Assessment (VENA) Guidance includes a section on staff training and competencies for nutrition assessment and suggestions for providing WIC services remotely. More information
  • A staff training webinar recording and related materials on Techniques for Phone and Video Education in WIC are available on Minnesota WIC’s website at https://www.health.state.mn.us/people/wic/localagency/training/pcs/skills/webinars/20192020.html#sept2019 .

Coordinating Services

Coordinating with health care providers and other community-based organizations that serve families that are likely eligible for WIC is an important way of conducting outreach and providing services.

Coordination may take many forms, from sharing information to making referrals to co-locating or integrating services with other programs or service providers. WIC participants often report transportation barriers and difficulty taking time off work as challenges to keeping WIC appointments and continuing to participate in the program. Providing WIC services in places where applicants already spend time, like prenatal or pediatric health care settings or Head Start centers, or during maternal and child health home visits, can facilitate WIC enrollment and ongoing participation. Collaboration with other services and programs is an important way of reaching eligible families and giving them access to the range of health, nutrition, and supportive services they need to become and stay healthy.

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USDA has entered into a memorandum of understanding with HHS to improve coordination and service delivery among WIC, the Child and Adult Care Food Program, Head Start, and the Child Care and Development Fund Program. See USDA and HHS, “Memorandum of Understanding,” October 2017.

USDA and HHS also developed a resource explaining ten ways WIC and Head Start programs can collaborate. See USDA and HHS, “Enhancing Patient-Centered Services Between the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and Head Start Programs,” October 2019.

USDA and HHS also partnered to encourage WIC and maternal and child health home visiting programs to collaborate, as explained in USDA and HHS, “Collaboration between Women, Infants, and Children (WIC) and Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) Programs Encouraged at the State and Local Levels,” January 8, 2021.

The U.S. Department of Agriculture’s WIC Nutrition Services Standards (August, 2013) includes standards for Program Coordination and Participant Referrals.

Have an example to share? Please send a brief description of a process or project along with an email address to contact for more information using this contact form.

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.

Examples:

  • Virginia’s Richmond City WIC conducted a project to increase the number of WIC-eligible individuals referred to the program by training over 400 health care providers and employees in community-based organizations on WIC services and benefits. WIC liaisons were assigned to follow up monthly with those that took part in the training. More information
  • New York WIC contracted with a nonprofit anti-hunger organization to identify families potentially eligible for WIC and help them navigate the enrollment process. Ten WIC Help Specialists, who worked at community-based organizations, conducted outreach, eligibility screening, and applicant assistance across 20 counties. More information

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.

Examples:

  • Oklahoma’s Variety Care WIC established a satellite walk-in WIC clinic in the agency’s newborn screening and women’s health office. WIC staff members worked at the satellite clinic one day per week, enrolling women and infants who were receiving health care at the location. Variety Care WIC coordinated with the health care clinic to ensure staff access to necessary WIC enrollment information, including anthropometric measurements, documentation of residence, and adjunct eligibility. More information
  • California’s TrueCare WIC co-locates a full-time WIC Coordinator in TrueCare’s Health Center. An office was set up for the WIC Coordinator positioned between Pediatrics and Woman’s Health (OB) Services. The WIC Coordinator works with the health center staff to enroll and recertify patients during their health care appointments. Information from nutrition and infant feeding assessments, along with counseling provided by Health Center dietitians and lactation specialists, is used to complete the certification, saving time and preventing duplication. More information

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.

Examples:

  • Oklahoma WIC worked with Head Start to increase collaboration and referrals between the programs. One of the largest Oklahoma WIC agencies, the Tulsa City-County Health Department, and the Tulsa Community Action Project (which administers Head Start), established a memorandum of understanding outlining a strategic partnership to cross-promote programs and share data. More information
  • Connecticut WIC implemented a “WIC And Head Start Better Together Collaboration Project” using USDA WIC Special Project grant funds. The project established a formal partnership between Connecticut’s WIC and Head Start Program to increase participation and retention in both programs for the overall health and welfare of families. Project outcomes included improvements in cross-referrals, information sharing, and coordination between the programs. More information
  • Colorado’s San Juan Basin Public Health WIC partnered with the local Head Start program to increase access to, and education about, healthy foods among Head Start students and families. The project included teacher training and implementation of a nutrition education curriculum as well as the creation of a school garden and farm stand. The project strengthened the relationship between the programs and generated opportunities for future collaboration to make WIC services available at Head Start centers. More information

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.

Examples:

  • Iowa’s Webster County Public Health integrated WIC certification into its home visiting program. Home visiting nurses are also trained, WIC-competent professional authorities who complete post-partum and infant certifications during home visits. More information
  • Iowa WIC built on the experience with Webster County’s home visiting model to plan and implement a statewide campaign to improve WIC access by encouraging and supporting local WIC agencies in conducting certification appointments outside of WIC sites. Collaboration between WIC agencies and community organizations and health care providers strengthened existing relationships and contributed to success in serving participants at alternate locations. More information

Targeting Outreach

Targeted outreach to adjunctively eligible families and a streamlined certification process could result in more of these families getting enrolled in WIC.

Individuals and families enrolled in Medicaid, the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps), or Temporary Assistance for Needy Families (TANF) cash assistance are adjunctively income-eligible for WIC. While all such individuals who are in the categories served by WIC (pregnant, breastfeeding, or postpartum individuals, infants, and young children) could benefit from the program’s nutritious foods and nutrition services, many do not participate in WIC. Targeted outreach to inform these families that they are eligible for WIC and explain how to apply, coupled with a streamlined enrollment processes, can reduce this gap by enrolling more of these families in WIC. Other ways to target outreach and facilitate enrollment for WIC-eligible families include engaging community organizations and health care providers by training them on WIC services and offering user-friendly referral tools, as well as making WIC application assistance available in community or health care settings.

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Matching Data Across Benefit Programs Can Increase WIC Enrollment – Greater WIC Participation Can Boost Health and Developmental Outcomes for Low-Income Pregnant Individuals and Young Children, Benefits Data Trust and the Center on Budget and Policy Priorities, April 27, 2021.

Targeted Text Message Outreach Can Increase WIC Enrollment, Pilots Show, Benefits Data Trust and the Center on Budget and Policy Priorities, June 10, 2021.

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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.

 

Examples:

  • North Carolina’s Piedmont Health Services WIC serves two counties and partners with both local Medicaid/SNAP offices to reach more potential WIC participants. WIC staff are on site in one of the local Medicaid/SNAP offices weekly to talk with clients about WIC, provide informal nutrition assessments, and help set up WIC appointments. In addition, WIC staff regularly engage with the local Medicaid/SNAP staff ― meeting at least quarterly. See the section “Co-location and Offsite Enrollment,” page 21 at https://www.cbpp.org/wicstreamlining.  
  • Oregon WIC agencies are working to establish collaborations with Medicaid coordinated care organizations (CCO). One agency developed a memorandum of understanding with a CCO: when the CCO newly enrolls pregnant women into Medicaid, it obtains their permission to send their name to the WIC clinic so the clinic can reach out to them. More information
  • WIC agencies in Colorado, Massachusetts, Montana, and Virginia worked with their state’s Medicaid and/or SNAP programs to pilot data matching to identify WIC-eligible individuals enrolled in the other programs but not in WIC. These states established or modified data-sharing agreements providing WIC with data, including contact information, for WIC-eligible individuals. Through cross-program data matches, the states identified large numbers of eligible individuals who were not enrolled; they then used different outreach and enrollment strategies to help them enroll in WIC. For a report describing the data matching pilots and key findings, see www.cbpp.org/wicpilotreport.
  • For an example of a data-sharing agreement that can enable the type of targeted outreach piloted in these states, see https://thewichub.org/data-sharing-agreement-for-data-matching-and-outreach/.

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.

Examples:

  • New Hampshire WIC’s digital pre-application allows applicants to submit demographic information online and ask a WIC clinic in their area to contact them to schedule an enrollment appointment. Other programs and community partners refer families to the pre-application. The request is routed to the clinic for follow-up. Data entered in the pre-application is automatically transferred in the state’s information system. More information
  • Massachusetts WIC’s website has a form that allows applicants to submit contact information, the best times to be contacted, and their preferred language. The information from the form is incorporated into the WIC information system and the application is assigned to a local agency to follow up with the applicant within two business days. More information
  • Arizona’s Maricopa County WIC website has a form that allows applicants to send an online appointment request and indicate which weekdays work best for them and whether they prefer morning or afternoon appointments. Clinic staff follow up by text, email, or phone to offer enrollment appointments that fit with these preferences. More information
  • Colorado WIC’s PEAK is an online service Coloradans can use to screen, and in some cases apply, for medical, food, cash, and child care assistance programs — including WIC. Electronic referrals from PEAK are routed by zip code to local WIC agency “inboxes” within the WIC Referral System (WRS). Designated local agency staff access the WRS and manage the referrals. Local agencies are responsible for contacting referred individuals within 10 days from the date of submission. More information

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.

Examples

  • New York WIC contracted with a nonprofit anti-hunger organization to identify families potentially eligible for WIC and help them navigate the enrollment process. Ten WIC help specialists working at community-based organizations conducted outreach, eligibility screening, and applicant assistance across 20 counties. More information
  • Virginia’s Richmond City WIC conducted a project to increase the number of WIC-eligible individuals referred to the program by training over 400 health care providers and employees in community-based organizations on WIC services and benefits. WIC liaisons were assigned to follow up monthly with those that took part in the training. More information
  • Oregon WIC and four other public health programs have a joint contract with 211info, the state information and referral call center, to provide information and referrals to any caller searching for services related to pregnancy, food assistance, and nutrition assistance. Information and referral specialists can screen individuals who call or text 211info for eligibility and provide information about the closest WIC clinic and other services. More information