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Connecticut WIC: The Big Picture

Connecticut WIC: The Big Picture. Presentation to the MAPOC (Medical Assistance Program Oversight Council) Marjorie Chambers, Interim State WIC Director Kim Boulette, WIC Vendor Specialist Hartford, Legislative Office Building, Room 1E November 8, 2013 @ 9:30 am www.ct.gov/dph/wic.

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Connecticut WIC: The Big Picture

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  1. Connecticut WIC:The Big Picture Presentation to the MAPOC (Medical Assistance Program Oversight Council) Marjorie Chambers, Interim State WIC Director Kim Boulette, WIC Vendor Specialist Hartford, Legislative Office Building, Room 1E November 8, 2013 @ 9:30 am www.ct.gov/dph/wic

  2. State of Connecticut Department of Public Health Commissioner Dr. Jewel Mullen Section Chief Renee D. Coleman-Mitchell, Community Health & Prevention Section (CHAPS) Special Supplemental Nutrition Program for Women, Infants & Children (WIC) Interim State Director Marjorie Chambers WIC Authorized Vendors: Grocery Retailers, Pharmacies & Farmers 12 Local Agencies: Full-time Offices & Satellite Clinics > 54,000 Participants

  3. 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.

  4. 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

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

  6. 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.

  7. Over 1/3 of all infants born in Connecticut are enrolled in WIC at some point during their first year of life.

  8. 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

  9. 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.

  10. 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.

  11. 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!)

  12. What does it Cost? * Preliminary FFY 2013 figures. • 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

  13. 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 . . .

  14. 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

  15. 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%

  16. 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%

  17. 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%

  18. 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%

  19. 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%

  20. 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

  21. 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

  22. Food Resources isresponsible for: 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

  23. Where can participants get WIC Foods? Farmers = 40 Large Vendors = 179 Pharmacies = 157 • 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. Medium Vendors = 59 Small Vendors = 213 Total Vendors = 648

  24. 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 million CT will meet 2020 mandate by implementing by 2016.

  25. 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 . . . .

  26. 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

  27. 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.

  28. 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.”

  29. What are some of theBenefits 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

  30. A collaborative effort . . . Family Health, Immunization, Oral Health, Vital Records... DoAG - Connecticut Food Policy Council USDA / SNAP USDA Farmers’ Market Nutrition Program WIC Vendor Advisory Council CT Head Start State Collaboration Office BF Peer Counseling CT Chapter Integrated Eligibility, HUSKY A . . . with Hartford Hosp + Yale-New Haven Hosp; plus 3 WIC clinics

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