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Introduction

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal grant program to states to provide food and nutrition education benefits and referral services to pregnant and postpartum women, infants, and young children who meet income eligibility criteria or who are enrolled in other federal public assistance programs (adjunct eligibility) and who are considered nutritionally at risk. Each year the United States Department of Agriculture (USDA) estimates the number of people who are eligible for WIC and the number of people who are expected to participate in the program if it is fully funded. These estimates serve as a basis for making budget requests for the program for the upcoming year. The WIC budget for fiscal year (FY) 2000 was just over $4 billion, and 7.2 million people participated in the program. Since WIC is not an entitlement program—that is, eligible people can be enrolled in the program only to the extent that funds are appropriated—underestimating the number of people eligible and likely to participate in WIC may result in a shortfall of funds to serve them. But overestimating the number of people eligible and likely to participate in WIC may result in other important programs not receiving sufficient appropriations.

The USDA estimates of the number of participants have come under critical scrutiny in part because the number of infants and postpartum women who actually enrolled in the program has exceeded the number estimated to be eligible by as much as 20 to 30 percent in recent years. These high “coverage rates” have led some members of Congress to con-



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Estimating Eligibility and Participation for the WIC Program: Phase I Report 1 Introduction The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal grant program to states to provide food and nutrition education benefits and referral services to pregnant and postpartum women, infants, and young children who meet income eligibility criteria or who are enrolled in other federal public assistance programs (adjunct eligibility) and who are considered nutritionally at risk. Each year the United States Department of Agriculture (USDA) estimates the number of people who are eligible for WIC and the number of people who are expected to participate in the program if it is fully funded. These estimates serve as a basis for making budget requests for the program for the upcoming year. The WIC budget for fiscal year (FY) 2000 was just over $4 billion, and 7.2 million people participated in the program. Since WIC is not an entitlement program—that is, eligible people can be enrolled in the program only to the extent that funds are appropriated—underestimating the number of people eligible and likely to participate in WIC may result in a shortfall of funds to serve them. But overestimating the number of people eligible and likely to participate in WIC may result in other important programs not receiving sufficient appropriations. The USDA estimates of the number of participants have come under critical scrutiny in part because the number of infants and postpartum women who actually enrolled in the program has exceeded the number estimated to be eligible by as much as 20 to 30 percent in recent years. These high “coverage rates” have led some members of Congress to con-

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Estimating Eligibility and Participation for the WIC Program: Phase I Report clude that some participants are truly ineligible, and that funding could be reduced somewhat and still meet the needs of truly eligible people who would participate under full funding (see U.S. House of Representatives, 1998). In contrast, some advocates and state WIC agencies believe that the estimates of the number of eligible persons are too low and that there are additional people who are eligible and want to participate. PANEL CHARGE AND APPROACH In response to these concerns, the Food and Nutrition Service (FNS) of the USDA asked the Committee on National Statistics of the National Research Council to convene a panel of experts to review the methods used to estimate the national number of people eligible for WIC and the assumptions underlying estimates of the national number of people likely to participate if enough funds are allocated to serve all who wish to participate, that is, if the program is fully funded. The panel is charged with reviewing data and methods for estimating income eligibility, adjunctive eligibility from participation in other public assistance programs, nutritional risk, and for estimating participation if the program is fully funded. The panel was also asked to consider alternative methods and data for making these estimations. The study includes two phases. In the first phase, the panel was asked to provide preliminary feedback to FNS by reviewing the current methodology for making eligibility and participation estimates and the relevant literature on these estimations, assessing the methodology, and potentially recommending improvements to the methodology. The first phase began when the panel was formed in November 2000. Since its formation the panel has hosted two meetings, the first of which discussed the panel’s charge, the WIC program, and methods for estimating WIC eligibility and participation, and the second of which was a workshop to examine components of the estimation methodology in more detail, and to learn more about how the WIC program operates in states. Agendas for both of these meetings are included in Appendix B. In preparation for the panel’s work, FNS contracted with Mathematica Policy Research Inc. to prepare a report that reviewed the estimation methodology and identified several data and methodological issues (U.S. Department of Agriculture, 1999a). This overview report, the presentations and background information presented at the panel meetings, and the deliberations of the panel in closed sessions were all considered in the development of this Phase I report.

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Estimating Eligibility and Participation for the WIC Program: Phase I Report Phase II of the study will examine in greater detail the methods used to estimate eligibility and participation and consider alternative potential improvements in these methods. Other topics the panel did not have time to consider in much detail during the first phase will also be examined, including: the use of the Survey of Income and Program Participation to estimate income eligibility, methods for estimating the number of pregnant and postpartum women, and assumptions used to estimate the number of eligible people from the U.S. territories. A final report of the panel will be issued at the end of the second phase of the study. The remainder of this chapter provides background on the WIC program. Chapter 2 discusses WIC eligibility regulations and the difficulty of matching estimation methods and data to fit these regulations. Chapter 3 briefly reviews the current FNS methods for estimating eligibility and participation. Chapter 4 focuses on six different components of the method for estimating the number of people eligible for WIC. Methods for estimating the number of full-funding participants are discussed in Chapter 5. Finally, Chapter 6 discusses issues the panel will consider in the second phase of the study. WIC PROGRAM BACKGROUND WIC began in 1972 as a pilot program and has grown rapidly as the number of people served per month has increased from 205 thousand in FY1974 when it became a permanent program, to 3.6 million in FY1988, to 7.2 million in FY2000. The program provides three types of benefits to those who are eligible: food instruments, usually in the form of vouchers or checks, that can be exchanged for specific types of food from participating retail grocers; nutrition education; and referrals to health care and to other social services. In order to receive WIC benefits, an applicant must be categorically eligible, income eligible, and nutritionally at risk. There are five categories of eligibility: pregnant women, women who are not breastfeeding and are less than 6-months postpartum, women who are breastfeeding and are less than 1 year postpartum, infants (age 0 to 1 year); and children age 1 through 4 years. The contents of food packages differ for each eligibility category; for example, the food package for a non-breastfed infant includes infant formula, while the food package for a child includes milk, juice, cereal, and eggs. To be income eligible, an applicant’s income must be at or below 185 percent of the U.S. poverty income guidelines. In addition, those who are

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Estimating Eligibility and Participation for the WIC Program: Phase I Report enrolled in the federal Medicaid, Food Stamp, or Temporary Assistance for Needy Families (TANF) programs are also adjunctively eligible for WIC even if their income exceeds 185 percent of poverty. Applicants must also be determined to be at nutritional risk on the basis of an assessment conducted by a competent professional authority at the WIC site. To be certified as nutritionally at risk, an applicant must meet at least one of the nutritional risk criteria. These risk criteria fall under five broad categories: anthropometric risk (e.g., underweight, obesity); biochemical risk (e.g., low hematocrit); medical risk (e.g., diabetes mellitus); dietary risk (e.g., inappropriate dietary patterns); and predisposing factors (e.g., homelessness). In order to be certified to receive WIC benefits, a person must fit into one of the five categories of eligibility; must have income at or below 185 percent of poverty or be adjunctively eligible for WIC through enrollment in Medicaid, TANF or the Food Stamp Program; and be assessed as nutritionally at risk. The length of certification for WIC depends on the category of eligibility. Pregnant women can be certified from the time they become pregnant through 6 weeks postpartum. Postpartum women are certified for up to 6 months if they are not breastfeeding and up to a year if they breastfeed for more than 6 months. Infants are certified for 6 months or for 1 year—most often for an entire year. Children are usually certified every 6 months. The federal government gives grants to states and Indian tribal organizations to provide the food, nutrition education, and health and social service referrals, and to administer the program. State food grant allocations are based on the amount the state received in the previous year and the estimated number of eligible persons for that state. States then fund local agencies who actually provide the services to participants.1 If local agencies do not have enough funding to serve all eligible persons who want to participate, they place participants on a prioritized waiting list. Priority is based on the type of nutritional risk and the eligibility category (see U.S. Department of Agriculture, 2001, for information on the WIC priority system). The last year a state had to implement a priority waiting list was 1999. In cases in which states have had shortages of funds to serve all who wanted to participate, supplemental funding was usually obtained from the federal government. 1   States can provide their own funding for the program. In FY 2001, 12 states contributed a total of $44.5 million of their own funds.