National WIC Association

Aligning Policies and Procedures for Systems-Level Innovations

Referrals are one of the cornerstones of the WIC program, yet communication between WIC and health, early learning, and social service providers relies largely on the WIC participant to follow through with referral information and communicate their referral experience or outcome back to WIC staff. Through policy initiatives, state WIC programs can create standardized workflow systems for WIC staff when a participant’s health, developmental, or social need is identified. Key to the success of these workflows will be the establishment of ongoing, two-way communication between WIC and the referral organizations to ensure continuity of care. The placement of patient guides - individuals paid by health care systems to help patients with health and social needs to navigate service systems - in WIC would assure a warm hand-off for WIC participants when WIC staff identify an issue that is outside of their scope of practice or requires more intensive case management.

Automated data sharing systems similar to those currently in use by health systems to track Emergency Room visits within and outside of their own health networks could help support continuity of care. Existing technologies, such as Data Bridge, facilitate the automatic extraction and communication of designated risk codes from one organization to another. For example, a WIC risk code, indicating failure to thrive, would automatically initiate a data transfer to the WIC participant’s primary care provider, thus spurring follow-up by a case manager. Likewise, a hospital or OB-GYN office could send an automated notification to WIC staff if a woman were diagnosed with gestational diabetes after her initial WIC visit or has certain complications with labor and delivery. This would lead to more tailored prenatal or postpartum WIC services. Innovative pilot studies to test standardized workflows, automated data sharing, and connection of patient navigators to WIC are a promising area for future research.

Clinical health care systems use the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) and Current Procedural Terminology (CPT) codes to document diagnoses, and encounter type, and level of complexity. WIC has a series of numerical risk codes created by USDA that are unique to the program. WIC is a public health nutrition program, and therefore does not provide diagnoses nor bill Medicaid for services, it may seem unnecessary to connect WIC codes to medical coding systems. However, in order to facilitate communication and continuity of care between WIC and health care providers, particularly through automated data sharing procedures, a crosswalk between WIC and ICD and CPT codes would be beneficial.

Transportation is a commonly cited barrier to attending WIC appointments. Non-emergency medical transportation (NEMT) is a benefit for Medicaid participants who need to get to and from medical services, but have no means of transportation. Federal law requires states to ensure that eligible, qualified Medicaid beneficiaries are afforded this benefit. As the vast majority of WIC participants are also Medicaid patients, expanding NEMT to include rides to WIC could lessen the transportation barrier. Research is needed to determine whether this could be implemented in all states and territories given the varied implementation of NEMT. In addition, WIC services need to be mapped to correspond to existing Medicaid billing codes in order to determine which WIC appointment types (e.g., certification, follow-up with registered dietitian, group class, etc.) align with Medicaid services. Finally, if NEMT were to include WIC appointments as qualified medical visits, evaluation of WIC participant uptake and the impact on Accountable Care Organization service costs would prove valuable.