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Research from MedStar Georgetown’s Division of Community Pediatrics and MedStar Health Research Institute sheds light on how to boost enrollment in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), a critical government program to relieve food insecurity for low-income families.
Food insecurity—inability to or uncertainty about being able to afford enough food—is a significant problem for families in Washington, DC. According to The Capital Area Food Bank, one-third of greater Washington, D.C. residents experienced food insecurity in 2021.
The Food Bank found that DC-area households with children were twice as likely to be food insecure as those without children, and nearly 66% of families of color with children faced hunger in 2021.
Chronic childhood hunger is associated with delayed development, an increased risk of chronic conditions such as asthma and anemia, and mental health concerns such as anxiety and aggression. Pediatricians have the privilege and opportunity to care for our communities’ youngest members even before they reach school age. During this delicate time, we can have the most significant impact on their health and development if we can connect them with resources and programs to relieve food insecurity.
Though help is available for pregnant women and young children through the federal Supplemental Nutrition Program for Women, Infants, and Children (WIC) program, nearly half of the people eligible for WIC aren’t enrolled in the program—only 56.9% of eligible households were participating in WIC in 2018.
A new study from MedStar Georgetown’s Division of Communtiy Pediatrics and MedStar Health Research Institute SBSM found that proactively identifying eligible families, increasing awareness, and making enrollment easier could help connect more families with nutritious food.
By analyzing data from states with the highest (Vermont, California, Minnesota, Maryland, Massachusetts) and lowest (Montana, Utah, District of Columbia, New Hampshire, New Mexico) WIC coverage rates—as well as reviewing available literature and research and lessons learned from our work to improve maternal and infant health through the D.C. Safe Babies Safe Moms initiative—our researchers created a list of recommendations to help improve WIC coverage in D.C. and the U.S.
Recommended strategies to improve WIC enrollment.
Reviewing state-level WIC practices and procedures revealed several areas for improvement. To be most effective, strategies should be tailored to each community—these broad, data-driven approaches are an excellent first step toward increasing access.
Streamline and proactively identify eligibility.
States that make it easy for low-income residents to know when they are eligible for social programs see improved enrollment rates.
For instance, federal regulations state that those enrolled in the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), or Medicaid are automatically income-eligible for WIC.
Through the “adjunctive eligibility” process, applicants can apply for WIC using documentation from other assistance programs to prove their income, making it easier to apply. The five states with the highest WIC coverage have used adjunctive eligibility for years, and some states with the lowest coverage rates have recently adopted the practice.
Adjunctive eligibility data can also help identify people eligible for WIC but not enrolled. Vermont, for example, produces a monthly list of people who are enrolled in Medicaid but not WIC, and state staff contacts them proactively to offer an enrollment appointment.
In Virginia, studies found that enrolling all adjunctively eligible families would slash the WIC coverage gap from 58% of non-enrolled individuals to 18%.
Data-sharing agreements will be necessary, and because the information is stored in various software products, state agencies must confront compatibility challenges between technological systems. This powerful strategy can significantly decrease enrollment barriers and proactively reach many parents who could benefit from WIC services.
Increase awareness of WIC programming.
The more people understand what WIC offers, the more they are likely to participate. According to U.S. Department of Agriculture interviews with a sample of WIC participants, 61% of first-time enrollees with other children said they were unaware of the program.
Pediatricians frequently visit with patients and families from birth to age 5—the coverage window for WIC. This makes doctors an incredibly impactful resource for educating patients, particularly those enrolled in Medicaid, about the benefits of WIC and other social programs.
Many U.S. health clinics use a WIC referral form, though a forthcoming study from our research team shows many D.C. providers do not feel prepared to make WIC referrals or discuss program benefits.
Provider education is a critical component of expanding access. All five states with the highest WIC enrollments use sophisticated websites with easy-to-navigate resources and referral forms for physicians. Provider websites are less user-friendly in lower-coverage states.
Other means to increase knowledge about WIC programs include community outreach, partnerships, and social media. Many state agencies have built strong partnerships with early childhood intervention programs such as Head Start, including co-locating their services, sharing their data, and more.
Modernize WIC benefits with a smartphone app.
One historical barrier to WIC enrollment has been stigma. Participants were issued paper vouchers to redeem at stores. Focus groups with WIC participants found that barriers to enrollment and retention include confusion in finding program-eligible products in the store, check-out challenges, and stigma.
As a result of federal requirements, 48 states and Washington, DC, now issue WIC participants an Electronic Benefits Transfer (EBT) card to use as a debit card at participating grocery stores, eliminating embarrassment. Both remaining states are in the process of implementing EBT cards
The next step in modernizing how WIC participants get their benefits is evolving the EBT card into a smartphone app. Tap-to-pay technology can improve retention and utilization by including functionality such as:
- Access to WIC information
- Checking benefits status
- Directions to the nearest WIC office or store
- Healthy recipes
- Identifying WIC-eligible items in the store
- Nutrition information, and more.
The top five coverage states use some smartphone applications, making it easy for families to access program benefits.
Optimize technology for remote accessibility.
During the pandemic, WIC services like appointments, certification, and benefits issuance were authorized through waivers from the U.S. Department of Agriculture. In a recent report, almost all state agencies said adopting remote procedures improved safety, accessibility, and convenience for WIC participants.
Continuing with remote options after the pandemic would reduce barriers to accessing benefits such as scheduling, childcare, and transportation. More digital enhancements that have shown a positive impact include:
- A centralized online portal for WIC-related information
- Online pre-application forms
- Text messages to remind participants of telehealth appointments
- Bidirectional communication (like text and email), which is offered in the five highest-enrolled states
Enhancing communications, awareness, and enrollment can improve WIC engagement, but forming strategic health partnerships will keep the positive change in motion long term.
Building partnerships with pediatricians and beyond.
In partnership with the D.C. Chapter of the American Academy of Pediatrics (AAP) and DC WIC, MedStar Health Research Institute is working to help pediatricians in Washington, D.C., become change agents for low-income patients. In May 2022, we present the DC AAP’s spring symposium. “Building Pediatrician Capacity to Address Food Insecurity.”
This event was met with great enthusiasm as we brought together pediatricians and representatives from impactful government and private sector agencies to discuss how pediatricians can help more women and children avoid food insecurity by enrolling in WIC.
Among the exciting results of this symposium was the development of tailored resources that give providers quick access to everything they need to help low-income families in Washington, D.C., make full use of available nutrition assistance programs.
In September, President Biden convened the first White House Conference on Hunger, Nutrition, and Health in more than 50 years and announced more than $8 billion in new funding.
Among the exciting projects funded during the Conference was modeled on our collaboration with the AAP and the non-profit anti-hunger No Kid Hungry. They committed to offering training to all 67,000 AAP pediatrician members on screening for food insecurity, referring patients to federal and community food resources, and improving referral loop between providers and WIC. Our program for DC-area pediatricians will serve as a framework for this national program, as each locality customizes outreach based on its particular resources and needs.
How we are contributing now.
MedStar Health is already leading the way in integrating health care and community resources with our D.C. Safe Babies Safe Moms program (SBSM). A partnership between MedStar Health, Community of Hope, and Mamatoto Village, the program addresses disparities in maternal and infant care with evidence-based healthcare and proven community support services that put the family at the center of their care.
SBSM breaks down organizational silos to create smooth transitions for families in the healthcare continuum and expands the model of care with mental health and care coordination and the capacity to screen and address social determinants of health.
SBSM demonstrates that the hard work of developing actionable community partnerships can help push back against inequities. Examples include clinical collaborations with Georgetown University Law Center’s Health Justice Alliance, Healthy Homes, and DC WIC.
As a part of the next phase in the research project with DC WIC and DC AAP, MedStar Health is developing a scalable model for closed-loop referrals from healthcare providers to WIC agencies. This innovative work is uncommon because it is resource-intense and requires multi-sector collaboration. Still, it is an important example of how integrating services streamlines enrollment, delivery, and implementation to provide our communities the best possible support and outcomes.
By optimizing enrollments, spreading awareness, using technology, and adopting remote-friendly policies—among other initiatives—providers, particularly pediatricians, can break down barriers and bring the benefits of healthy nutrition to more eligible families.
