To reduce child hunger, make WIC easier to access

As a pediatrician, I worry not only about whether my patients will get sick, but also about whether they have access to the food they need to stay healthy. Over the past 18 months, the pandemic and economic downturn have led to record high levels of child hunger. Almost one in every three families in the U.S. has been unable to afford enough food to feed their children, and many of these families have turned to food banks and government benefit programs for support.

The Special Supplemental Nutrition Program for Women, Infants, and Children — better known as WIC — is one such government program intended to help these families. WIC provides nutrition assistance for pregnant and postpartum individuals and children ages 5 and under living in poverty.

WIC has proven health benefits for participating children, and healthier children are better able to learn, grow, play and contribute to their communities. So I was both surprised and concerned when I learned that despite skyrocketing rates of child hunger, several of my patients’ families had chosen to drop out of WIC during the pandemic. When I asked them why, I found out that in Pennsylvania, individuals who receive WIC are required to travel to their local office every three months, often using multiple forms of public transportation and risking exposure to the coronavirus, just to reload their benefit cards.

WIC families receive benefits on an electronic benefits transfer (EBT) card, and during the pandemic, most states allowed WIC benefits to be reloaded onto these cards remotely, recognizing the risks posed by travel and in-person contact. But nine states (Arkansas, Louisiana, Missouri, New Mexico, Ohio, Pennsylvania, Texas, Utah and Wyoming) required WIC-eligible families to either mail in their card or present it to their local WIC office in-person to have their benefits reloaded.

To see whether this requirement for in-person visits may have limited access to WIC when it was needed most, I partnered with a team of researchers to conduct a study comparing WIC participation before and after the pandemic across states with either in-person or remote reloading.

We found that on average, states requiring in-person or mail-in reloading (“offline EBT” states) experienced a 9.3 percent relative decline in participation during the pandemic. This was driven both by increased participation in states with remote reloading and decreased participation in states that required in-person reloading. Because of this policy, about 160,000 fewer beneficiaries received WIC benefits during the first nine months of the pandemic in offline EBT states. 

Even prior to the pandemic, in 2018, only 57 percent of the approximately 11.9 million caregivers and children who were eligible for WIC benefits actually enrolled in the program — meaning more than 5.2 million eligible individuals were not receiving WIC. One reason for this low participation rate is that families have always faced many administrative burdens when accessing and using the program, including the requirement for in-person visits for WIC enrollment and recertification, the stigma and inconvenience associated with using WIC paper vouchers (prior to the recent transition to EBT cards), and limited access to WIC vendors and to WIC-approved products in stores.

Our study suggests that during the pandemic, some of these administrative burdens may have become insurmountable barriers. While participation in other government programs, like Medicaid and SNAP, surged by more than 10 percent nationally during the pandemic, WIC participation only increased by 2 percent. 

The pandemic is far from over, and child hunger remains a critical threat to children’s health and wellbeing. Federal and state policymakers must, therefore, act now to reduce the administrative barriers that are keeping eligible families from accessing WIC benefits. 

Here are four ways they can do so:

• First, the nine offline EBT states should immediately work towards implementing systems where benefits can be reloaded remotely. In the meantime, they should require participants to reload their EBT cards less frequently;
• Second, the U.S. Department of Agriculture (USDA) should make permanent COVID-19 flexibilities that permit remote benefits certification. By allowing families to complete their initial WIC enrollment and certification through a “teleWIC” video or phone visit, states have made it easier for families with limited transportation access to receive these benefits, and many WIC-eligible families prefer these remote appointments to traditional in-person visits;
• Third, federal and state policymakers should incentivize improved data sharing across all programs serving children living in poverty and their caregivers. For example, identifying families enrolled in SNAP or Medicaid and providing targeted outreach to encourage them to enroll in WIC may lead to improved participation. In addition, improved data sharing between WIC offices and pediatric primary care providers could eliminate the need for families to visit a WIC office in-person for iron deficiency anemia screening when a provider has already conducted this screening and;
• Fourth, building on the recent success of the SNAP online purchasing pilot and a state-level WIC online ordering pilot, the USDA should allow WIC beneficiaries to purchase approved food and beverage products online. This would make it easier for families to redeem the full value of their WIC benefits, particularly in settings where they have limited access to local WIC vendors or WIC-approved products are sold out at these vendors.     

We must ensure that eligible caregivers, infants, and children have access to the health and developmental benefits that come with WIC participation. We already have the tools we need; now we must apply them.

Aditi Vasan, MD, MSHP, is an associate fellow at the Leonard Davis Institute of Health Economics, an instructor of Pediatrics at the University of Pennsylvania, and a pediatrician and health services researcher at PolicyLab at Children’s Hospital of Philadelphia.