By: Elisabeth Wright Burak, Sonya Schwartz, Zoë Neuberger, Jennifer Sullivan, Lauren Hall

[Editor’s note: CBPP and CCF hosted a webinar to discuss this resource. Please find the webinar recording here and a copy of the presentation slides here).]

Child health leaders are no strangers to the benefits of the Special Supplemental Nutrition Program for Women, Infants and Children, known as WIC. For 50 years, WIC has offered food, nutrition and breastfeeding support, and provided connections to health care and social services to low-income pregnant and postpartum people, infants and children under age 5. A robust body of research documents WIC’s cost-effective role in improved birth outcomes, as well as improvement in participants’ nutrition, health, and development.

National and state Medicaid policymakers have a role to play in ensuring WIC reaches all families who may benefit. Only 37 percent of WIC-eligible individuals who are enrolled in Medicaid participate in WIC and a meager 14 percent of pregnant women enrolled in Medicaid participate in WIC. Connecting more Medicaid enrollees to WIC is a promising approach to addressing health-related social needs for pregnant and postpartum people, infants, and young children and potentially reducing glaring racial disparities in maternal and child health outcomes.

As the predominant payor of maternal health care, Medicaid is an important place to focus on improved WIC connections. State Medicaid agencies and state WIC agencies can partner to connect more Medicaid enrollees with the WIC benefits they are qualified to receive.

CCF was pleased to partner with the Center on Budget and Policy Priorities (CBPP) on a new resource to help state Medicaid policy leaders do just that, State Medicaid Agencies Can Partner With WIC Agencies to Improve the Health of Pregnant and Postpartum People, Infants, and Young Children. After outlining the many ways WIC can support Medicaid’s goals, we outline possible approaches with state examples.

To enroll as many people who qualify for WIC as possible, states ideally would take advantage of every opportunity to connect Medicaid applicants and enrollees with WIC, as illustrated below.

The report details several key recommendations state Medicaid and WIC programs can use to increase WIC enrollment.

• Sharing Medicaid enrollment data with WIC agencies to identify eligible families who are not enrolled in WIC, conduct targeted outreach to them, and simplify their enrollment. When someone who is pregnant or postpartum applies for Medicaid, or when a caregiver applies for Medicaid for a child under 5, they can be automatically referred to WIC. States can also match Medicaid enrollee data with WIC data to conduct targeted WIC outreach directly to eligible Medicaid families who are not enrolled. States can also strengthen the referral process by developing a standardized and streamlined referral mechanism that health care providers can use. For example, when someone applies for SNAP, Medicaid, and/or TANF in New Mexico they are automatically evaluated for WIC categorical eligibility, and referral information is sent to the WIC eligibility system, where it is linked to family records. Between May 2022 and October 2023, this process resulted in an 18 percent increase in New Mexico’s WIC caseload.
• Supporting a community-based health workforce that can strengthen connections to WIC. Community health workers, doulas, home visitors and case managers can conduct screenings for food insecurity, refer individuals to programs like WIC, and provide enrollment assistance and support in using WIC benefits, which can be financed by Medicaid. For example, Illinois’ model Medicaid managed care contract requires MCOs to refer all pregnant enrollees to WIC and provide another referral to WIC during the third trimester. After childbirth, the state requires MCOs to provide and document referrals to WIC.
• Working with health care providers and Medicaid MCOs to include WIC enrollment as a strategy to improve quality and address health-related social needs (HRSNs). Medicaid can require MCOs to report on meeting WIC-related quality goals, enrollment goals, or both, and states can reward MCOs that improve. State agencies can also require MCOs to screen for and track HRSNs and make referrals to WIC and then reward enrollment in WIC. For example, Pennsylvania’s Medicaid MCOs are eligible for bonus payments based on meeting the 75th or 90th percentile benchmark for quality metrics for prenatal care visits, postpartum care visits, and well-child visits in the first 15 months of life (metrics associated with WIC participation). Among the 12 states CCF researchers recently reviewed on MCOs and maternal health, none of the external quality review reports explicitly referred to WIC in their performance improvement plans or quality improvement efforts. This is clearly a ripe opportunity for state Medicaid agencies.

To help bring these strategies to life, CBPP is partnering with organizations in Colorado, Ohio, Illinois, Louisiana, New York, and Pennsylvania to identify and promote policies to increase WIC take-up among eligible Medicaid enrollees. But any state can take these steps to ensure more young families access needed nutrition and health support.

WIC is a proven resource that can help Medicaid do its job better. Policymakers can do more to leverage these programs in their efforts to improve maternal and infant health.