WIC Coordination With Medicaid and SNAP

Collaboration between the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Medicaid, and the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) is an important way to give eligible low-income families with children access to a range of health, nutrition, and supportive services they need to become and stay healthy.^[1] By enrolling a greater share of Medicaid and SNAP participants in WIC, states can support healthier pregnancies, improve birth outcomes, and improve child health and cognitive development for low-income families, potentially reducing striking racial disparities.By enrolling a greater share of Medicaid and SNAP participants in WIC, states can support healthier pregnancies, improve birth outcomes, and improve child health and cognitive development for low-income families, potentially reducing striking racial disparities.

This report draws on information the Center on Budget and Policy Priorities (CBPP) collected during the summer of 2021 to describe various ways that state WIC agencies are collaborating with their state’s Medicaid and SNAP programs.

WIC provides nutritious foods, nutrition education, breastfeeding support, and referrals to health care and social services to low-income pregnant and postpartum people, infants, and children under age 5. A large body of research demonstrates that WIC improves participants’ health, developmental, and nutrition outcomes.^[2] Yet the share of eligible families who participate in WIC has declined over the last decade, and the reach of this critical program appears to have declined further during the COVID-19 pandemic.^[3]

WIC works alongside Medicaid and SNAP to help families weather financial distress, improve health and wellness, and boost economic prospects. To simplify eligibility determinations, a WIC applicant who already receives Medicaid or SNAP is automatically considered income-eligible, or adjunctively eligible, for WIC.^[4] Medicaid and SNAP enrollees can benefit from WIC’s nutritious foods and services, but many do not participate.^[5]

Interest in cross-program collaboration has grown in recent years. More state WIC programs not only collaborate with Medicaid and SNAP, but have entered into written cross-program agreements, which sometimes allow for sharing data that can be used for targeted outreach and streamlined enrollment. This report is the first state-by-state compilation of cross-program collaboration efforts involving WIC, Medicaid, and SNAP. CBPP recently collected information from states on coordination between WIC and Medicaid and/or SNAP.^[6] Responses from 46 of the 50 WIC geographic state agencies^[7] showed:

• At least 26 WIC state agencies periodically meet with Medicaid and/or SNAP officials.
• At least 27 WIC state agencies have a written agreement on coordination or data sharing with Medicaid or SNAP and six more are developing one.
• At least 22 WIC state agencies periodically (anywhere from daily to annually) receive data on Medicaid and/or SNAP enrollees and six more are establishing data sharing.

In a separate, earlier effort to further explore the possibilities of strengthening cross-program enrollment, CBPP and Benefits Data Trust (BDT) partnered with Colorado, Massachusetts, Montana, and Virginia to conduct pilots during 2018 and 2019 to measure how many people were adjunctively eligible for WIC but not enrolled, and to test whether outreach in the form of a series of text messages could help increase these families’ WIC enrollment. These pilots demonstrated that by matching data across programs to identify families enrolled in Medicaid or SNAP but not WIC, and conducting outreach to them, states can increase WIC enrollment, especially for Medicaid participants, which may improve health and developmental outcomes.^[8]

CBPP and BDT subsequently conducted a workshop series for seven additional states that developed workplans to launch or expand data matching and targeted text-based outreach. More recently, Share Our Strength’s No Kid Hungry campaign has provided grants administered by the American Public Human Services Association (APHSA) to several states to better connect SNAP participants with nutrition supports, including WIC. The projects include data matching and analysis across agencies as well as targeted outreach to families likely to be eligible.^[9]

Examples in this report of how WIC agencies are collaborating with their state’s Medicaid and SNAP programs can help states that are interested in launching or expanding such collaboration identify other states undertaking similar work and confer with them or draw on the lessons they learned. The state-by-state information compiled in this report can also serve as a baseline going forward, as cross-agency collaboration is likely to become more prevalent and extensive over time.^[10]

Assessing the Extent of WIC Coordination With Medicaid and SNAP

Cross-program coordination can take many forms. One common approach is for WIC staff to meet periodically with Medicaid and/or SNAP officials. In addition to facilitating outreach, such collaboration fosters better coordination of services and supports for families participating in more than one program.

A growing number of WIC state agencies have a written agreement with Medicaid or SNAP (such as a data-sharing agreement or memorandum of understanding). A written agreement describing how these programs will coordinate and how to make referrals across programs can benefit both state and local WIC agencies.^[11] It may also allow data exchanges and describe the information that will be shared and how often. This allows state WIC agencies to periodically receive files with information about participants in the other program who are eligible for WIC. These files can then be matched with files of WIC enrollees to assess how many WIC-eligible individuals are not enrolled, and state or local WIC agencies can contact those individuals to offer to enroll them.

Though not the focus of this report, collaboration between WIC and Medicaid and/or SNAP also occurs at the local 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.

During July and August of 2021, the Center on Budget and Policy Priorities collected information from states on coordination between WIC and Medicaid and/or SNAP. In our survey, 46 of the 50 WIC state agencies located in geographic states responded to questions regarding coordination with Medicaid and SNAP programs in their states:^[12]

• Are there periodic (at least annual) meetings between state-level WIC representatives and representatives from Medicaid and/or SNAP programs?
• What information about applying for WIC does Medicaid provide to enrollees who may be WIC-eligible?
• What information about applying for WIC does SNAP provide to enrollees who may be WIC-eligible?
• Is there a state-level data-sharing agreement or memorandum of understanding between WIC and Medicaid and/or SNAP?
• Does Medicaid and/or SNAP share data on enrollees with WIC to identify enrollment gaps?
• If Medicaid and/or SNAP data are shared with WIC, does the agreement allow for the data to be used for targeted outreach?
• If Medicaid and/or SNAP data are shared with WIC, how often are they shared?

Their responses show that nearly every WIC state agency collaborates with the Medicaid and/or SNAP programs in their state in some way; nearly two-thirds have or are developing written agreements with another program; and more than half either currently receive enrollee data from Medicaid, SNAP, or both or are in the process of setting up procedures to receive such data.

Responses from WIC state agencies are summarized below, along with examples of ways WIC works with Medicaid and SNAP to coordinate, establish agreements, and use shared data. Table 1 shows each state’s response to each question.

Cross-Program Collaboration

WIC is usually administered by a different state agency than the agency that administers Medicaid and SNAP, while Medicaid and SNAP are sometimes administered by the same agency, but not always. Thus, coordination often must occur not only across programs, but across agencies. Regular cross-program meetings provide an opportunity to share information, develop referral processes, identify cross-enrollment opportunities, and coordinate outreach and service delivery.

Twenty-six of the 46 WIC state agencies that responded reported that they periodically meet with representatives of Medicaid and/or SNAP. In addition, many state agencies indicated that Medicaid and/or SNAP provide their enrollees with information about WIC, ranging from general program information, such as the WIC website or a toll-free WIC phone number, to a link to an online application. WIC state agencies that coordinate with other programs can recommend language for them to use in their communications with enrollees to ensure it is accurate and engaging.

Application processes for Medicaid and SNAP vary across states, with some emphasizing online service more than others. 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 online tools into the WIC certification process for families. These tools range from electronic forms that collect basic contact information or allow an applicant to request a certification appointment to online applications where families enter most of the demographic and basic health information needed for certification, upload eligibility documents, and read and electronically sign required forms.^[13] Links to online tools can then be included in the referral materials that Medicaid or SNAP provides to WIC-eligible families.

A few WIC state agencies indicated that they provide the other programs with a link to such an online tool to include in their outreach messages.^[14] This approach helps eligible families initiate enrollment in WIC without having to make a phone call or navigate a website to find information about how to enroll. By offering a unique link, WIC state agencies can also monitor whether Medicaid or SNAP enrollees are initiating WIC enrollment.

Including WIC in an online eligibility screener or multi-program application is another way to connect families applying for Medicaid or SNAP with WIC. These are usually set up and operated by state agencies that administer Medicaid and SNAP. Some of these screeners and applications contain information about WIC, but families who may be eligible are often referred to a separate website for information about how to apply. Other multi-program applications allow families to request that their relevant information be shared with WIC to initiate the enrollment process.^[15]

Agreements Between WIC and Medicaid and/or SNAP

A written agreement describing how WIC, Medicaid, and/or SNAP will coordinate, how to make referrals across programs, how data will be shared, and how it will be used, can be beneficial for state and local WIC agencies.^[16] Federal law allows Medicaid and SNAP to share enrollee data with WIC, and states have demonstrated that data can be shared securely, protecting families’ privacy while improving their access to essential benefits and services.^[17]

Twenty-seven WIC state agencies reported that they have a data-sharing agreement or memorandum of understanding with Medicaid or SNAP; an additional six reported that they are in the process of establishing an agreement. (See Figure 1.)

Developing a written agreement that includes data sharing involves staff from multiple programs with expertise in areas including program policy, legal, data security, and technology. Thinking through in advance how shared data will be used, and how the impact of those uses will be evaluated, helps states craft strong, secure, and flexible data-sharing agreements.^[18] Consulting with states that have a data-sharing agreement in place or with national organizations with relevant experience can help states anticipate key issues and overcome challenges that arise.

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Data Sharing Between WIC, Medicaid, and SNAP

Sharing data from Medicaid and SNAP with WIC allows state agencies to measure cross enrollment in the aggregate to assess the extent to which eligible families are missing out on WIC benefits. It also allows for direct outreach to families who are eligible for WIC but not enrolled. If these families enroll in WIC, the certification process can be streamlined because WIC already has information documenting adjunctive eligibility.^[19]

Twenty-two WIC state agencies report that they or their local agencies periodically receive data on program enrollees from Medicaid and/or SNAP. The frequency of data sharing ranges from daily to annually. An additional six WIC state agencies are in the process of establishing procedures for receiving data from Medicaid and/or SNAP. (See Figure 2.)

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State and local agencies use Medicaid and SNAP enrollee data for a variety of purposes, including documenting adjunctive eligibility. Most states have an automated telephone- or web-based system that allows them to check whether a WIC applicant is adjunctively eligible.^[20] States with such automated systems do not necessarily have a written agreement in place.

State and local agencies also use Medicaid and SNAP enrollee data to match Medicaid or SNAP data with WIC enrollee data to understand the enrollment overlap and gap between programs. Measuring the aggregate enrollment gap allows states to measure progress over time in reaching more adjunctively eligible families. Analyzing which groups are more likely to be missing out on WIC allows states to develop more effective referrals and tailor outreach to underserved groups.

Once the data have been matched, the results can also be used to conduct targeted WIC outreach directly to eligible families who are not enrolled. Most states that use Medicaid and SNAP data this way have a written agreement in place that establishes the parameters for sharing and using data.

Twenty state agencies indicated that they or their local agencies are allowed to use the Medicaid and SNAP enrollee data for targeted WIC outreach.^[21] Five additional state agencies are setting up agreements and procedures to use data from one or both of these programs for WIC outreach.

In some states, letters with information about WIC and how to apply are sent to families who are eligible for WIC but not enrolled through mass mailings. Other states provide lists with names and contact information for WIC-eligible families to their local agencies to contact by phone. Targeted outreach using text messaging has been successful in reaching and enrolling adjunctively eligible families in WIC.^[22] Regardless of the method, procedures for timely outreach and follow-up with respondents, and a mechanism for monitoring the results, are important for successful outreach.

Conclusion

By collaborating with Medicaid and SNAP, state WIC programs can strengthen referrals, measure the extent to which WIC reaches adjunctively eligible families, conduct outreach to enroll more eligible families, and monitor progress over time. By working across agencies to ensure that low-income families with young children receive the full package of supports for which they are eligible, administrators of each program can help prevent short-term hardship and put children on a healthier course for life.