Connecticut WIC:The Big Picture

Presentation to the MAPOC(Medical Assistance Program Oversight Council)

Marjorie Chambers, Interim State WIC DirectorKim Boulette, WIC Vendor Specialist

Hartford, Legislative Office Building, Room 1ENovember 8, 2013 @ 9:30 am

www.ct.gov/dph/wic

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State of Connecticut Department of Public HealthCommissioner Dr. Jewel MullenSection Chief Renee D. Coleman-Mitchell,Community Health & Prevention Section (CHAPS)

Special Supplemental Nutrition Programfor Women, Infants & Children (WIC)

Interim State Director Marjorie Chambers

12 Local Agencies:Full-time Offices &

Satellite Clinics

WIC Authorized Vendors:Grocery Retailers,

Pharmacies & Farmers

> 54,000 Participants

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Founded: Child Nutrition Act, 1974 WIC is a discretionary – NOT an entitlement – program

Mission: to safeguard the health of low-income pregnant, postpartum and breastfeeding women, and infants and children up to age 5, who are at nutritional risk.

Services: WIC provides . . . nutritional assessment & education; breastfeeding promotion and support; referrals to health care and social services; and checks for specific nutritious foods to supplement diets.

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Who is eligible? Categorical eligibility: pregnant, postpartum and

breastfeeding women, and infants and children up to age 5 (5th birthday).

Income eligibility: WIC & Medicaid/HUSKY A have the same income

eligibility requirements. Since 1989 WIC recognizes adjunctive eligibility, making

HUSKY A clients automatically income-eligible for WIC. Residency requirement Nutritional risk: applicants must be found to be at

nutritional risk

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http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Eligibility/Downloads/2013-Federal-Poverty-level-charts.pdf

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Who do we Serve? In Connecticut:

roughly ½ of WIC clients are children;

¼ are women; ¼ are infants.

By race & ethnicity: approx. ½ are Hispanic; roughly ¼ are white*; and, ¼ are black or

African American*.* Non-Hispanic.

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Pregnant Women10.7%

Breastfeeding Women5.0%

PostpartumWomen(not BF)5.5%

Breastfeeding Infants7.3%

Non-Breastfeeding In-fants

18.0%

Total CHILDREN= 53.5%

CT WIC Participation by CategoryFederal Fiscal Year (FFY) 2013

(n = 54,231)

Total WOMEN= 21.2%

Total INFANTS = 25.2%

Over 1/3 of all infants born in Connecticut are enrolled in WIC at some point during

their first year of life.

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Where are our Programs?

12 Local Agencies, covering all 169 towns across the state: 23 full-time offices; 35 part-time satellite sites.

Nearly 1/3 of WIC clients are from our 3 largest cities: Bridgeport , New Haven & Hartford

Over ½ are from the 8 largest: Bridgeport, New Haven, Hartford,

Stamford, Waterbury, Norwalk, Danbury and New Britain

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Bridgep

ort

Bristol

/ New B

ritain

Danbu

ry

East Hart

ford

Norwich

/ New Lon

don

Hartford

Meriden

/ Middle

town

New H

aven

Stamford / N

orwalk

Torrin

gton

Wate

rbury

/ Nau

gatuck

Wind

ham / P

utnam

0

2,000

4,000

6,000

8,000

10,000

6,759

4,743

2,428

4,420

3,841

6,496

3,713

8,620

4,574

1,171

5,304

2,162

WIC Participation by Local AgencyAverage Monthly Participation

(FFY 2013)

# of

Par

ticip

ants

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Program Infrastructure:Local Agency Operations

CT WIC contracts 12 local agencies to operate: WIC offices are located in:

6 local health departments / districts; 6 hospital-based programs; 5 community health centers; and, 5 CAP (Community Action Partner) agencies

164 FTEs at the local agencies: 12 Program Coordinators; 107 Nutrition staff; and, 45 Clerical / Administrative staff.

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How many Participate? On average, over 54,000

women, infants & children participate

Down from high of > 60,000 in 2009 . . . Lower birth rate

Births to Connecticut residents decreased by 12.5% between 2000 (43,075) & 2010 (37,713)

Fewer young people Out migration

Economy improving slowly

. . . but still 2% higher than before the 2008 recession.

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2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

to da

te45,000

50,000

55,000

60,000

65,000

48,87449,252

51,328 51,72052,130 52,059

51,443

53,205

56,238

60,148

58,108

56,081

56,584

54,232

WIC Participation by Federal Fiscal Year *Average Monthly Participation *

(14-year average = 53,672)

* Federal Fiscal Year (FFY) = Oct 1 to Sept 30)* Numbers are rounded.

# of

Par

ticip

ants

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Financial Management Unit Ensure fiscal integrity, accountability and

compliance with USDA rules & regulations: Manage USDA Food & Nutrition Services / Administration funds; Oversee and administer the budget, disbursements & rebates; Monitor monthly local agency and state office expenditures; Submit monthly financial reports to the USDA.

Federal funding formula (not an entitlement!)

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What does it Cost?

Food Expenditures*: $50,318,871 Food Grant: $33,692,594 Rebates: $16,626,277 Food = 80% of total budget

Nutrition Services &Administrative Costs*: $12,586,059 Local Agency Contracts: $ 9,736,243 (77.4% of NSA) State WIC Office: $ 2,849,816 (22.6% of NSA) NSA = 20% of total budget

* Preliminary FFY 2013 figures.

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Nutrition Services

USDA-approved Annual State Plan

Participant eligibility & program support: Oversee applicant eligibility, certification and nutritional risk

assessment

Technical assistance, training & continuing education: Quarterly statewide meetings, monthly coordinators meeting,

special training opportunities Program planning, monitoring & evaluation

Cont . . .

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Technical assistance, training (cont . . . ) Procure, develop and review educational materials Oversee WIC breastfeeding promotion & support activities

Baby-Friendly Hospital Initiative (BFHI): global program launched by WHO & UNICEF in 1991

Breastfeeding Peer Counseling (USDA grant)

Monitor local agency compliance with state & federal regulations (administration, civil rights, food package prescription, management, outreach) Oversee development of local agency work plans, monitor

progress and evaluate achievement of outcome objectives Provide feedback on local agency reports and other deliverables Manage implementation of state policies & procedures, and the

interpretation of federal guidance and policies, budget, staffing

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WIC Outcome Objectives(FFY 2013)

1st Trimester Enrollment Increase to 50% the rate of

first trimester enrollment of pregnant women.

Statewide average: 53.7% Range: 44.0% to 70.4%

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Maternal Weight Gain (MWG)

At least 70% of pregnant women who participate in WIC for a minimum of 6 months gain appropriate weight. Statewide average: 73.0%

Range: 48.6% to 86.6%

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Low Birth Weight (LBW)

The incidence of LBW among infants whose mothers were on WIC for at least 6 months during pregnancy does not exceed 6% (does not exclude preterm and multiple births).

Statewide average: 6.4% Range: 3.1% to 9.0%

A few comparisons (2010 data): US – all births, general pop: 8.2% CT – all births, general pop: 8.0%

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Breastfeeding (BF)

At least 65% of infants enrolled in WIC Program have mothers who initiate breastfeeding. Statewide average: 75.9%

Range: 66.7% to 90.7%

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Anemia in Children (2 – 4 yrs)

The prevalence of anemia among children enrolled in WIC for at least one year does not exceed 7.5%. Statewide average: 8.3% Range: 4.2% to 12.3%

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Overweight in Children (2 – 4 yrs)

The prevalence of over-weight* among children enrolled in WIC for at least one year does not exceed 10%. Statewide average: 12.5% Range: 9.4% to 15.8%

* BMI ≥ 85th percentile to < 95th percentile

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Obesity in Children (2 – 4 yrs)

The prevalence of obesity * among children enrolled in WIC for at least one year does not exceed 15%. Statewide average: 13.1%

Range: 7.3% to 18.3%

* BMI ≥ 95th percentile

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Food Resources isresponsible for:

128 ounces WIC-approved fluid juice OR 2 cans (11.5-12 oz) juice concentrate 1 Half gallon milk: 2% OR 1% OR Skim 1 pkg up to 16oz/1lb each approved cheese6

ϭϭͬ.ϴͬ .ϭϯ

ϭϮͬ.ϳ ͬ.ϭϯ

^ŵŝƚŚ͕ :ĂŶĞ 123456 050 1234567 050-123456

Food check distribution & management (>220,000 checks issued per month)

Approval of prescribed foods for nutritional content, cost, statewide availability - Food List

Oversee multi-state infant formula and infant food rebate contracts

Distribution site for Farmers’ Market Nutrition Program $15 check booklets (DoAG)

Process special formula orders for CSHCN, inventory and delivery to LAs

Anticipated collaboration between WIC and DSS on special formula issuance to decrease multiple distributions

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Where can participants get WIC Foods?

Checks are issued for foods, formula, fruits & vegetables (year round - $5 & $6)

Food stores accept all types of WIC checks

Pharmacies only accept checks for infant formula

Farmers at Farmers’ Markets only accept fruit & vegetable checks.

Large vendors, 179

Medium vendors, 59

Small vendors, 213

Pharmacies, 157

Farmers, 40

Total Vendors = 648

Large Vendors = 179

Medium Vendors

= 59

Farmers = 40

Pharmacies = 157

Small Vendors

= 213

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Vendor Management is responsible for: Vendor applications, training, monitoring,

selection and authorization Vendors need to meet minimum inventory

requirements at all times to meet the needs of participants

Fraud prevention & compliance (unannounced onsite monitoring, undercover compliance investigations)

Process reimbursements of checks rejected by our bank Administrative reviews (hearings) for non-compliant vendors

EBT is coming! $8.5 millionCT will meet 2020 mandateby implementing by 2016.

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Data Quality & Integrity(Information Technology & Epidemiology)

Purchase, distribute and maintain all computer-related equipment for state office, local agency and satellite operations Training & technical assistance to local agency staff Onsite troubleshooting & Help Desk support New MIS & EBT (Electronic Benefits Transfer) systems Autodialer (Automated Appointment Reminder System)

Responsible for all daily operations of the Statewide WIC Information System (SWIS)

Cont . . . .

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SWIS, cont . . .

SWIS: a mainframe-based distributed data system; holds participant demographic, medical & nutrition risk-factor data, & check issuance / redemption information Master files are maintained on BEST mainframe in East Hartford Central Processing Unit is located at the State WIC Office (DPH) LAN servers are located at each local agency office; run on

independent networks with nightly data uploads to state office Daily exchange of check transaction data with the bank Work with state nutrition staff & epidemiologist to design data

queries to meet reporting needs

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Our new MIS system will be web-based, utilize modern technology, and provide real-time data.

New EBT capability will allow for the elimination of paper checks, signifi-cantly enhancing data analysis capabilities: fraud-prevention efforts; check-use reports; and, budget planning, among

many other uses.

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Coordinate with state & local staff to:strengthen data analysis & reporting capabilities

(participation, client demographics, check issuance & redemption, risk factors, referrals, outcomes, ad hoc reports); and,

ensure data reports meet all programmatic, fiscal and regulatory requirements.

Newly executed MOU with DSS on data sharing . . . “To increase food security for the Medicaid population by

increasing referrals and co-enrollment of low-income [women, infants & children] . . . in order to deliver timely health and nutrition services and improve birth outcomes.”

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What are some of the Benefits of WIC Participation? WIC participation improves pregnancy outcomes

(fewer preterm births, LBW deliveries and infant deaths) Reduces hospitalization and Medicaid costs Helps ensure a child’s developmental readiness to

enter kindergarten Increase food security for low-income families Contributes food dollars to local economies Increases local availability and access to

fruits, vegetables and other healthy foods, of benefit to all Connecticut residents

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A collaborative effort . . .

Family Health, Immunization,Oral Health, Vital Records...

USDA Farmers’ Market Nutrition Program

DoAG - ConnecticutFood Policy Council

WIC VendorAdvisory Council

CT Head StartState Collaboration Office CT Chapter

Integrated Eligibility, HUSKY A . . .

USDA / SNAP

with Hartford Hosp + Yale-New Haven Hosp;

plus 3 WIC clinics

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