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Toolkit: Increasing WIC Coverage Through Cross-Program Data Matching and Targeted Outreach

| By

Center on Budget and Policy Priorities and Benefits Data Trust

Overview

In recent years, more than 40 percent of eligible individuals have missed out on the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), despite the program’s well-documented dietary, health, and developmental benefits. Many of those missing out on WIC are enrolled in Medicaid or the Supplemental Nutrition Assistance Program (SNAP) which makes them automatically income-eligible, or “adjunctively eligible,” for WIC. This toolkit is designed to help state and local WIC agencies leverage data from Medicaid and SNAP to measure enrollment gaps and increase enrollment using tools to plan, launch, and/or strengthen data matching and targeted outreach to eligible families who are not receiving WIC benefits.

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How to use this toolkit and additional context

How to Use this Toolkit

Each of the nine topic areas in this toolkit includes background, practical planning tools, resources, and examples to guide users through the process of developing data-informed outreach. By briefly reviewing the planning tools in advance, you will be able to identify the colleagues you will need to involve in each step and determine how much time you will need to devote to each tool.

Completing this toolkit will help your team:

  • Set project goals for increasing WIC participation and enrolling a greater share of adjunctively eligible families;
  • Develop a comprehensive workplan for launching a data matching and targeted outreach initiative;
  • Plan an evaluation that measures progress toward goals and can guide improvements over time; and
  • Benefit from lessons learned in states that have matched Medicaid or SNAP data with WIC data to measure the enrollment gap and conduct targeted outreach.

While this toolkit will equip your team to implement data matching and targeted outreach to reach more families eligible for WIC, this particular outreach model is only one part of a broader strategy to connect underserved people to WIC. The model explained in this toolkit is effective at identifying eligible non-participants who are already enrolled in another program, such as Medicaid or SNAP; different types of outreach may be needed, however, to reach those who are not already connected to other benefits. Before embarking on this type of outreach, it is important to assess who is eligible for WIC but missing out. That assessment will help determine whether Medicaid and SNAP participants are a key group for outreach and which subsets of Medicaid and SNAP participants to focus on.

Context

This toolkit builds on growing interest from policymakers in ensuring that low-income families with young children receive the full package of supports for which they are eligible, which can reduce short-term hardship and put children on a healthier course for life. At the direction of Congress, the Department of Agriculture is developing state-level estimates of pregnant individuals, infants, and children under age 5 who are participating in Medicaid or SNAP but not WIC. States may wish to refine those estimates once they become available and use them to measure progress over time, identify underserved groups, or target outreach.

The toolkit is informed by recent state pilots conducted in Colorado, Massachusetts, Montana, and Virginia, where outreach strategies were tested through randomized control trials. In partnership with the Center on Budget and Policy Priorities (CBPP) and Benefits Data Trust (BDT), each of these states performed cross-program data matches between WIC and Medicaid, SNAP, and/or other means-tested programs and found large numbers of WIC-eligible non-participants. Evidence from the pilot evaluations indicates that targeted text outreach to adjunctively eligible families is a practical, sustainable strategy to improve WIC certification rates. BDT and CBPP used this information to develop a workshop series for seven additional states, during which the planning tools included in this toolkit were initially developed and then used by state WIC agencies.

  • Current Outreach
  • Setting Goals
  • Sharing Data
  • Data Sharing Agreement
  • Outreach Plan
  • Outreach Messaging
  • Streamlining Certification
  • Evaluation Plan
  • Action Plan

Understanding Current WIC Outreach

WIC agencies conduct many forms of outreach, but few are targeted directly to families known to be adjunctively eligible for WIC. A helpful starting place for state and local teams interested in launching new targeted outreach practices is to catalog how your WIC agencies currently conduct outreach. This information can help you assess how targeted outreach practices could fit into ongoing operations and consider where targeted outreach would require new processes.

Setting Goals for Targeted Outreach

Establishing clear goals from the outset can help shape an outreach initiative and guide decision points throughout the design process. Those goals also provide a framework for determining how to use the results of data matching and assess the effectiveness of a new outreach campaign.

  • Planning Tool 2: Developing Useful Goals

    This goal-setting exercise is designed to help your team collaborate to formulate goals that drive action and help you focus on achieving measurable results. The exercise will be most effective if completed as a group activity, whether virtually or in person, to generate a wealth of ideas.

    The downloadable template included here can be uploaded to a shared drive, allowing teams to collaborate simultaneously in a remote environment. Alternatively, teams that meet in person can replicate this exercise on a physical whiteboard with sticky notes. Review the template to ensure you understand the process and then use whichever approach works best for your team.

    Download planning tool (5 pages)

Sharing Data

Sharing data from Medicaid, SNAP, and other programs that confer adjunctive eligibility with WIC allows agencies to measure cross enrollment, enables targeted WIC outreach, and facilitates streamlined enrollment. The U.S. Department of Agriculture (USDA) is developing a state-by-state measure of cross enrollment and a growing number of state WIC agencies have successfully executed memoranda of understanding and data sharing agreements, demonstrating that this type of data sharing can be conducted securely in a way that protects families’ privacy while improving access to essential benefits and services. When conducting legal reviews, compliance overseers in these states have consistently found that existing program rules permit both sharing data and the use of data matching results for targeted WIC outreach.

Read more about relevant federal rules

Relevant federal rules include:

  • SNAP applicant and participant data may be disclosed for purposes of administration of other federal assistance programs and federally assisted state programs providing assistance on a means-tested basis. (7 USC § 2020(e)(8); 7 CFR § 272.1(c)(1))
  • Medicaid applicant and participant data may be disclosed for purposes directly connected with administration of the Medicaid state plan. (42 USC § 1396a(a)(7)(A); 42 CFR § 431.300 et seq.)
  • Disclosure of protected health information by a Medicaid program is allowable where authorized by statute. (45 CFR § 164.512(k)(6)(i))
  • Federal law requires Medicaid state plans to include coordination with and referral to the state’s WIC program. (42 USC § 1396a(a)(11)(c); § 1396a(a)(53); 42 CFR § 441.61(c); 42 CFR § 431.635)

Drafting a Data Sharing Agreement

States generally enter into a formal data sharing agreement (DSA) to document how programs will collaborate, how data will be shared, and how data will be used. Considering in advance how shared data will be used and how the impact of those uses will be evaluated allows you to craft a strong, secure, and flexible DSA.

Executing DSAs can take significant time, so it is beneficial to discuss these considerations early in the process of planning your data matching initiative. While agency configurations vary across states, means-tested programs are commonly administered by multiple agencies; in most cases, WIC is administered by a different agency than Medicaid or SNAP. This can lengthen the process of obtaining necessary approvals from legal and compliance oversight authorities.

  • Planning Tool 5: Sample Data Sharing Agreement

    This tool is a customizable shell of a data sharing agreement (DSA) modeled on an actual DSA that was used for a pilot in Virginia. You should plan to review this document with the data stakeholders you identified in Planning Tool 4. There are two samples to choose from:

    • Option A: One-way data sharing from another benefit program to WIC, where WIC will perform the match and conduct outreach.
    • Option B: Two-way data sharing where WIC will share data with another benefit agency to conduct the match and a third party (such as a texting vendor) will conduct outreach.

    These samples are meant to help you understand the common components of a DSA by providing plain-language explanations for the various sections and directions for how to incorporate the information your team compiled in the previous two planning tools into your DSA. However, it is important to note that your circumstances may differ from these two examples. Your team may need to further customize your DSA depending on factors such as the number of different agencies and third-party entities you need to include, in what direction(s) the data will be shared among them, which entity will perform the data match, and which entity will conduct outreach.

Developing a Targeted Outreach Plan

The list generated through a data match can be used for several different types of outreach, including mail, phone, and text. Considering key questions — including which methods of outreach will be used, how frequently outreach will be conducted, and which metrics to monitor — before launching a new outreach initiative or modifying an existing initiative can help your team develop a plan that is well suited to the families you are trying to enroll, as well as your staff.

  • Planning Tool 6: Planning for Outreach

    This tool discusses considerations for planning or modifying a targeted outreach initiative, drawing on lessons learned from targeted outreach pilots and ongoing projects in other states. It provides a template for states to document initial steps of planning for outreach. The early sections of the tool can be used for any kind of outreach initiative (mail, phone, or text); the later sections focus on considerations for teams interested in launching a texting campaign.

    Download planning tool (8 pages)

Developing Targeted Outreach Messaging

The framing of an outreach message can directly affect whether it is read and understood, and whether the recipient takes the action requested of them or engages at all. Best practices from behavioral science — a field that draws on empirical research from psychology, neuroscience, marketing, and economics — can help you develop messages that improve participant engagement.

  • Planning Tool 7: Developing Messaging

    This exercise is designed to help teams plan the content of their outreach messaging. It will help you answer key questions like: How will the team decide on outreach messages? What will messages say? Will participants be consulted? Which principles from behavioral science will the messaging reflect?

    Download planning tool (5 pages)

  • Planning Tool 8: Developing an Engagement Plan

    Now that you’ve thought through the content for your outreach messages, this planning tool will help your team develop an actionable engagement plan that maps out the wording of messages and their order and frequency. The template in the tool is based on flow charts previously used in states where BDT and CBPP worked with WIC teams to launch targeted text outreach and can be customized to your outreach plan. Review this sample call-back script and FAQ, which show the kind of information that might be useful to provide to staff who will be calling outreach recipients.

    Download planning tool (4 pages)

Certification Streamlining Considerations

When outreach is targeted to individuals or households that are enrolled in Medicaid, SNAP, or TANF cash assistance, protocols for scheduling and conducting certification appointments can be simplified for those who respond. These applicants are adjunctively income-eligible for WIC, which eliminates the need for them to provide documentation of their income. Several state WIC agencies accept documentation of participation in these programs as proof of residency in addition to income; some states also permit it as documentation of identity.

When an individual responds to the targeted outreach “call to action,” the follow-up by the state or local staff can be modified if there is a way for the staff to identify that the applicant is part of the adjunctively eligible WIC outreach group. This could be accomplished by having the applicant complete an appointment request form set up for the outreach group or by routing the responses to local agencies in a way that identifies them as coming from the outreach group. When staff follow up with these applicants, they can tailor the communication about what will be needed to enroll in WIC. The certification process can also be tailored to omit checking income and, when applicable, other eligibility documentation. This streamlines and simplifies application and enrollment.

  • Planning Tool 9: Streamlining Certification

    This tool will help states explore how scheduling and conducting certification appointments can be simplified for adjunctively eligible outreach recipients, including ways that communications and eligibility determinations can be tailored, as well as what protocols and training will be needed for local staff.

    Download planning tool (3 pages)

Developing an Evaluation Plan

An evaluation of the results of your data matching and outreach initiative can take many forms. Even if you do not have the resources for an extensive evaluation, by planning ahead you can measure the impact of your initiative and monitor progress over time. Developing an evaluation plan up front can ensure you collect the right data — in a useful format — to track progress towards project goals and measure outcomes. Identifying key metrics early will allow you to ensure that the data sharing agreement includes all necessary data elements. Determining who will collect the necessary data and how it will be monitored can help ensure that staff are appropriately trained.

This information can then be used to monitor the project during implementation and make changes if needed to increase effectiveness. For example, if outreach is not yielding the expected responses, you might choose to tweak messaging or add another phase of communication. The information can also be used for general reporting purposes and to help scale outreach models. Evaluations can vary in their complexity; even the simplest designs can yield valuable insights.

  • Planning Tool 11: Managing Data

    This tool is designed to help you develop a plan to manage the data needed to evaluate your program, including a review of data storage considerations, and space to plan your evaluation timeline and specify deliverables. The examples provided will prepare you to analyze your data and share your findings.

    Download planning tool (5 pages)

Action Plan: Implementing and Sustaining Targeted Outreach

The resources in this section are designed to assist your team in turning the planning tools and activities completed in this toolkit into an action plan for implementing your targeted outreach initiative. These materials can serve as a planning guide to carry the project forward.

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