It is well established that the United States has poor maternal health outcomes as compared to other industrialized nations and that there are significant disparities in maternal morbidity and mortality rates for non-Hispanic Black women relative to non-Hispanic White women. These poor outcomes are particularly pronounced in the Medicaid program, which which finances more than four in ten (41%) births finances more than four in ten (41%) births in the United States. While multifaceted policy approaches are needed at the federal, state and local levels to address these challenges fully, there are proven programs that can be better leveraged today to begin to reverse this troubling trend. A highly beneficial, though underutilized, resource for improving maternal and child health outcomes is the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). WIC provides eligible participants with healthy food, nutritional education, referrals and other resources to positively influence lifetime nutrition and healthy behaviors. Access to WIC is linked to improved maternal and child health outcomes and is shown to reduce healthcare costs.
While Medicaid enrollees generally meet income eligibility requirements for WIC, most WIC-eligible Medicaid enrollees do not participate in WIC. To maximize the positive impact of WIC, it is important to understand how these gaps can be closed and identify ways to conduct targeted outreach to improve coverage rates.
Initially piloted in 1972, WIC is a public health nutrition program within the United States Department of Agriculture (USDA) that provides nutrition education, healthy foods, breastfeeding support, and healthcare referrals for income-eligible people who are pregnant or postpartum, infants and children up to age five. In FY22, WIC served roughly 6.3 million participants nationwide each month, including about 39% of all infants in the United States.
Federal costs for WIC were $5.7 billion in FY22. Research suggests that every one dollar invested in WIC yields $2.48 in cost saving for medical, educational and productivity. Other studies suggest that for every dollar spent on pregnant WIC participants, there is a $1.77 to $3.13 reduction in Medicaid spending during the first two months post-delivery. WIC participation has a marked impact on reducing healthcare costs, especially for the Medicaid population, and efforts to maximize participation in WIC for Medicaid enrollees are vital to controlling costs and improving outcomes.
A WIC-eligible person must be pregnant or breastfeeding, or an infant or child under five years of age, meet income guidelines and residency requirements, and meet nutritional risk criteria. Applicants covered under Medicaid who receive Supplemental Nutrition Assistance Program (SNAP) benefits or monthly Temporary Assistance for Needy Families (TANF) cash assistance payments are automatically considered income-eligible for WIC through a policy called “adjunctive eligibility."
The USDA reported that in the average month in 2022, WIC served only 53.5% of eligible individuals nationally. The coverage rate was significantly lower in the District of Columbia (46.7%) and Virginia (49.6%), while it was significantly higher in Maryland (58.3%).
With only approximately half of eligible individuals receiving WIC benefits nationwide, the program is an underutilized resource, and steps must be taken at all levels to increase enrollment. Given that Medicaid enrollees and SNAP recipients meeting other WIC criteria are automatically eligible for WIC based on income, focusing initial efforts on increasing uptake by these populations should yield results. Recommendations to accomplish this aim include the following:
- Improved data matching efforts among SNAP, WIC, state Medicaid agencies and state health information exchange platforms (e.g., Maryland’s Chesapeake Regional Information System for our Patients (CRISP)) to identify coverage gaps and facilitate targeted outreach.
- Bolstered communication and educational efforts that “meet beneficiaries where they are” and ensure that beneficiaries are aware of the benefits they are eligible for and receive appropriate assistance with applying for those benefits through their local WIC agency.
- Leveraging of community-based organizations and community health workers in awareness efforts and referral processes. These groups operate within a community to address local needs and improve the well-being of residents, can help educate Medicaid enrollees about the program and their eligibility and assist individuals with applying for the benefit.
- Easy-to-navigate WIC agency websites and apps that are accessible in multiple languages and include user-friendly interfaces that can be accessed from both computers and smartphones.
To address and improve maternal health outcomes nationwide and within CareFirst’s service area, a comprehensive approach including multiple parties is critical. The WIC program’s improved health outcomes for participants and cost savings for the healthcare system overall mean efforts to increase uptake among eligible individuals should be prioritized. CareFirst remains committed to advancing health equity and stands ready to support efforts that ensure individuals have access to all the programs for which they are eligible.