WIC has a proven and applauded record of public health success, but only 51% of eligible individuals are connected with WIC services. Structural barriers, including the real and perceived value of the WIC food package and the smaller value of the WIC benefit for children, and access hurdles impact both initial and ongoing participation decisions. Increases in caseload for the majority of states during the COVID-19 pandemic demonstrated the importance of more flexible and responsive WIC services. As USDA evaluates new opportunities to advance nutrition security and build a healthier next generation, it is crucial to invest in a more modern and accessible WIC participant experience by enhancing outreach and certification processes, integrating further with healthcare providers, and creating an equitable shopping experience.
Ad-to-Enrollment: Outreach and Streamlining Certifications
Eligible WIC participants expect an enrollment process that is aligned with other federal programs and industry practices in comparable healthcare settings. When resources allow, state agencies have increasingly driven innovations to develop web-based platforms and tools that simplify the certification experience and streamline enrollment in WIC services. WIC must adopt an ad-to-enrollment mindset that provides a cohesive vision combining 21st-century outreach efforts with a 21st-century certification process.
In 2016, the National WIC Association launched the National Recruitment and Retention Campaign, bringing together approximately two-thirds of State WIC Agencies to coordinate national strategic marketing efforts to reach eligible individuals across digital marketing platforms (e.g., online, social media, and mobile, including use of strategic influencers) as well as print advertorial, point-of-care literature, etc. These regularly updated strategies and tools direct prospective WIC clients to a web-based clinic locator tool that provides contact information for their community WIC provider. Informed by the perspectives of both participants and eligible-but-not-participating individuals, the Campaign developed unified WIC branding that created consistent and identifiable logos and identity across state lines. Some state agencies have fully adopted that branding while others cobrand with their own WIC logos and the national brand. For WIC to have meaningful recognition and marketing success, committing to one national brand to build greater awareness of the benefits of participation and the range of services provided at WIC clinics is crucial. Amazon is Amazon, not Amazon Delivery, or Delivery A, or A Buy and Receive, etc. Brand – and by extension product – success depends upon universal recognition to build awareness, trust, motivation, and engagement.
WIC providers are exploring innovations that streamline the certification process and allow for most of the appointments to be frontloaded or conducted virtually. A local agency in Iowa implemented a website that combines a local clinic locator tool with an online application, appointment scheduler, and document uploader. Other states have implemented participant portals, similar to patient portals in healthcare settings, that coordinate certification-related information with health data, benefits balance, and other relevant information. These digital and web-based tools reduce the burden on the applicant, minimizing time spent on the phone or in a clinic. However, WIC providers are increasingly relying on digital tools that are not fully integrated with state-based Management Information Systems, with interoperability being essential to maintain efficiency and reduce back-end work by WIC clinic staff. Other providers are limited in establishing these platforms by limited technology funding or glacial procurement and approval processes in parent agencies. Ensuring that every local agency has the capacity and authority to implement these straightforward digital tools is a necessary step in streamlining certifications across the country.
"In a world where technology use is only increasing, it is imperative that the WIC program can keep up with busy families," says Lexie Stoneking of Iowa’s Broadlawns WIC Program. "Our website has allowed our agency to literally meet families where they are at. Families can now apply for the program and access our services with a simple click of a button, reducing barriers and prioritizing care for our families."
Another approach to streamlining certifications would involve proactive outreach by USDA and other federal partners, integrating WIC referrals and applications into other program processes. Four out of every five WIC participants are also enrolled in either Medicaid or the Supplemental Nutrition Assistance Program (SNAP), and intentional, robust efforts in these sister programs can direct eligible individuals to WIC at the moment of a qualifying event (e.g., pregnancy, birth of a child, etc.). State WIC Agencies have increasingly partnered with their Medicaid and SNAP agencies to cross-promote programs, refer to WIC, and explore unified program applications. States are also building new partnerships with Head Start, recognizing that partnerships can streamline health assessments across the two programs while reaching a target population of three- to four-year-old children. For tribal populations, partnerships with Indian Health Service, Urban Indian Health Programs, and other tribal health offices can similarly identify eligible families and direct new participants to WIC. To ensure families receive their full benefits of support, referral practices require the integrated commitment of all agencies to the referral process.
Integrating WIC with Healthcare
WIC’s critical role in addressing nutrition security at the earliest stages of development necessitates greater coordination with healthcare providers, especially as the healthcare system mobilizes to address systemic racial disparities in maternal and infant health. Clearer channels of two-way communication are essential to promoting efficiency within WIC services while providing patients with holistic and comprehensive care.
WIC providers are required to establish nutrition risk before certifying an individual for WIC services. Although WIC’s required health assessments are currently being waived during the COVID-19 pandemic, a post-pandemic service delivery model will continue WIC’s public health efforts by reinstating regular health assessments, including iron screenings and anthropometric measurements. This health information is useful for evaluating proper development and identifying health risks, including iron-deficiency anemia. As WIC providers may be in more constant contact with an individual than their physician, exchanging relevant health information ensures that all relevant metrics are included in the patient’s health records, reducing duplicative tests across providers and ensuring that medical professionals have access to all data points measured at any clinic location. Despite the clear public health imperative for building stronger communication links, navigating complex national computer networks requires a comprehensive, well-funded approach. USDA and the Department of Health and Human Services (HHS) should collaborate at the national level to create data exchanges or interoperable systems that electronically communicate relevant health information between WIC clinics and healthcare providers.
Some WIC clinics may be collocated in a hospital or other healthcare setting, streamlining access to electronic health records and promoting greater coordination. While any approach to healthcare coordination must be inclusive of standalone WIC clinics outside of healthcare settings, USDA could strategically plan new efforts that leverage the WIC workforce to address a broader range of clinical needs. WIC’s professional workforce, including Registered Dietitians (RDs) and International Board Certified Lactation Consultants (IBCLCs), are often trained to provide additional services that could be billed to Medicaid, including medical nutrition therapy and diabetes management. A select number of local WIC providers are already partnering with Medicaid to coordinate services across programs. USDA should partner with HHS to promote, evaluate, and encourage innovative payment models that efficiently utilize WIC staff to address the holistic needs of patients.
Finally, WIC can be a partner in pushing for more equitable care in maternal health, recognizing the historic legacy of abuses and systemic barriers to access for women of color, especially Black and Indigenous women. WIC should partner with healthcare providers to ensure that all maternity care workers have conducted anti-racism and bias trainings.
Creating an Equitable Shopping Experience
WIC’s role in enhancing access to healthy foods has a proven impact on increasing broader consumer access to nutritious options, including fruits and vegetables, but WIC shoppers are too often limited in their options to redeem benefits. Although the nationwide transition to EBT/eWIC has modernized the WIC transaction, the COVID-19 pandemic exposed a significant disparity as WIC shoppers were one of the only groups who could not utilize online shopping and home delivery options. WIC must commit to a modern and equitable shopping experience that stays current with comparable federal programs like SNAP and industry practices utilized by the general shopping public.
USDA is currently leading several initiatives to advance online transactions, home delivery, and self-checkout options in stores, but ongoing urgency is needed to push forward solutions in a timely and thoughtful manner. Smaller, independent stores may need additional assistance to scale up options for WIC shoppers and ensure ongoing participant access, particularly in rural and tribal communities. USDA must also double down on investing in new, modern technologies, staying abreast of cutting-edge developments such as mobile payments.
To further an equitable shopping experience, WIC shoppers need to have the ability to shop in a variety of avenues, including farmers markets. Additional funding is needed to support local farmers and producers through the Farmers Market Nutrition Program. The WIC transaction at the farmers market must be modernized to allow for families to redeem both their WIC Cash Value Benefit (CVB) and their WIC Farmers Market Nutrition Program vouchers. Supporting these technological efforts at a national level would relieve the burden of small farmers markets to invest in technology, support local agriculture, and ensure WIC families have the opportunity to shop locally.