WIC Module II

1. Eligibility criteria for WIC per NC WIC Program Manual Categorical Eligibility (Must belong to one of the following)
o Pregnant- proof not required
o Postpartum Breastfeeding Women up to one year postpartum- a
woman is considered breastfeeding if she feeds breastmilk at
least once every 24 hours on average, or expresses with the
intention to breastfeed at least once every 24 hours.
A non-birth mother may receive WIC up to infants first birthday
if she is the adoptive mother, or living in same household as
infant receiving her breastmilk. She has to meet all WIC
requirements of residency, income and nutrition risk.
o Postpartum Non-Breastfeeding Women up to 6 months
postpartum- a woman who has been pregnant within the past 6
months is categorically eligible regardless of the length or
outcome (stillbirth, miscarriage, spontaneous/elective abortion)
o Infants- birth to 12 months of age
o Children- 12 months to 5th birthday
Residential Eligibility- Must reside in the state of NC.
Income Eligibility- Must provide documentation of adjunctive eligibility
or a gross household income at or below 185% of the current federal
poverty income guidelines.
Nutrition Risk Eligibility- Must be at nutrition risk as determined by a
competent authority using NCs nutrition risk criteria.
2. Obtain and view videos on WIC certification at the site
Crossroads Training Videos: Complete Certification
This video went through the entire process of adding and certifying a
participant. It is important to make sure to search the new participants name
in the system first to make sure they are not receiving benefits already
elsewhere.
Add participants name, address, phone number, birthdate, gender, preferred
method of contact- click add, save
Add additional family members if necessary
Family demographic screen: hover over moms name for unique participant
number, clinic assigned
Select proof of ID
Parent guardian one section- is parent or guardian also a participant
Parent guardian two- click checkbox- add parent guardian if you chose
Make sure you ask what the relationship is between the child
and the adult present.
Select proof of residence
Select photo registration option
Review and save
Family Assessment Screen: applies to all family members, completed by
support staff, answer all questions listed (NC policy)- save

Participant demographic screen- completed for every family member

individually- verify date of birth
Ask ethnicity then race
Create in CNDS- Link from CNDS button- do this for all family members
participant id will be changed to CNDS ID
Family Income screen: enter # of family members, expected # of infants
Adjunctive eligibility- Medicaid, SNAP, Pana- automatically verifies
entire family if mother is eligible
Certification signature screen
Anthropometrics/ Lab screen
Growth grids
Health Information
Eco-Social
Dietary
Assigned Risk Factors
Care Plan Detail
Care Plan Summary
Maintain Goals
3. Review 2009 food packages. Discuss changes.
The Institute of Medicines report entitled WIC Food Packages: Time for
Change, was the catalyst for the improvements in WIC food packages. In
2009 an interim rule aligned WIC with the Dietary Guidelines for Americans
and infant feeding practices from the American Academy of Pediatrics. In
December of that year the amount of cash value vouchers used to purchase
fresh fruits and vegetables increased from $8.00 to $10.00 for pregnant,
postpartum, and partially breast feeding women. The United States
Department of Agriculture finalized changes to the WIC food packages
February 28, 2014. The changes included:
- 30% increase in dollar amount for childrens fruit and vegetable purchases
- Expanded whole grain options for purchase
- Provide yogurt as partial milk substitute for children and women
- Allows parents of older children to purchase fresh fruits and vegetables
instead of jarred if they prefer
- Gives states and local WIC agencies more flexibility to meet the nutritional
and cultural needs of WIC participants.
Recent changes in the WIC food packages are a contributing factor to the
decline in obesity rates among low-income preschoolers reports the Centers
for Disease Control and Prevention.
USDA. USDA Finalizes Changes to the WIC Program, Expanding Access to
Healthy Fruits and Vegetables, Whole Grains, and Low-Fat Dairy for Women,
Infants, and Children. Web site.
http://www.fns.usda.gov/pressrelease/2014/003114. Accessed March 19,
2015. Published February 28, 2014.

4. Observation of client from income eligibility screening to food instrument

issuance.
Observation of client from income eligibility on March 31 st. A mother, 2 weekold daughter, and infants father were present for the screening. The family
lives with the childs grandmother, who is the only one in the household with
an income. NC Tracks was used to verify the mother was on Medicaid. The
WIC nutrition assistant also used a pay stub from the grandmother. The
family receives SNAP which automatically qualifies them for WIC.
After the income is ascertained, the amount is located on a scale to
determine if the family is eligible.
The mother provided a form from the hospital given to her at the time of her
childs birth entitled Mothers Verification of Facts. This form is utilized by
WIC as a birth certificate. The drivers license of the mother was used for
photo identification, and to verify the correct address, and birthdate were
listed.
The nutrition assistant asks questions to prepare the nutritionist for the first
meeting including: does the family have a working stove and refrigerator, and
if anyone in the household smokes in the house, and if the mother consumes
alcohol. She also asks the mother general questions concerning
breastfeeding and formula she uses. She then takes a weight and height for
both the mother and the baby and sends the mother to the lab at the health
department for a hemoglobin test. After all information is recorded into
Crossroads, the assistant gives the mother a WIC folder that will hold her
coupons and she is told to bring it to every meeting. The mother signs her
name electronically and is transferred to the WIC nutritionist.
At this time the nutritionist reviews information entered into Crossroads and
asks further questions. I performed this interview with the mother. I first
inquired about the gestational age of the baby, what type of delivery she had
and any current or previous medical problems.
We then discussed how, what and when she fed her baby. This mother was
using an elemental formula due to reflux. We reviewed how to feed the child
by keeping her upright, not laying her down right after feeding, making sure
the nipple size was appropriate and producing a flow that was too fast for the
baby to swallow. We walked through how she burps the child and the
duration she does this procedure. The frequency and amount of formula
provided at each feeding was recorded. After reviewing any questions the
mother had concerning the feeding of the infant, I asked the mother about
her diet history.
The mother was 327 pounds and morbidly obese. She had delivered two
weeks early due to preeclampsia. When I attempted to discuss her diet, she

would not make eye contact and seemed to be self-conscious of her weight
problem. I felt as if she didnt want to talk about it in front of her husband.
Several nutrition education topics were briefly mentioned and the family was
asked if they had any questions. They were asked if they wanted to
exchange 1 gallon of milk for 1 pound of cheese. A follow-up appointment
was made and food coupons were issued.
5. Review eligibility for referral programs:

EFNEP- Expanded Food and Nutrition Education

Program:
EFNEPs targeted audience is limited resource families with young children
(under the age of 19) living in the household and who are eligible for public
assistance. EFNEP serves individuals and families who are expecting a child
(pregnant) or who provide non-custodial care for children on a regular basis
(grandparent or non-custodial parent) as long as these individuals meet the
income guidelines and are responsible for the planning, shopping, and preparing
of food for the children in their care. EFNEP also serves limited resource, schoolage children (5-19 years of age).
http://newhanover.ces.ncsu.edu/efnep-2/

School Lunch Program-

Head Startb) Age eligibility requirements.

(1) For Early Head Start, except when the child is transitioning to Head Start, a child
must be an infant or a toddler younger than three years old. A pregnant woman may
be any age.
(2) For Head Start, a child must:
(i) be at least three years old; or,
(ii) turn three years old by the date used to determine eligibility for public school in the
community in which the Head Start program is located; and,
(iii) not be older than compulsory school age.
(3) For Migrant or Seasonal Head Start, a child must be younger than compulsory school
age by the date used to determine public school eligibility for the community in which
the program is located.
(c) Income eligibility requirements.
(1) A pregnant woman or a child is eligible, if:
(i) the familys income is equal to or below the poverty line; or,
(ii) the family is eligible or, in the absence of child care, would be potentially eligible for
public assistance.
(2) If the familys income is above the poverty line, a program may enroll a pregnant
woman or a child who would benefit from services. These participants can only make
up to 10 percent of a programs enrollment in accordance with (d).
(d) Additional allowances for programs.
(1) A program may enroll an additional 35 percent of participants whose families are
neither income nor categorically eligible and whose family incomes are below 130
percent of the poverty line, if the program:
(i) establishes and implements outreach, and enrollment policies and procedures to
ensure it is meeting the needs of income or categorically eligible pregnant women,
children, and children with disabilities, before serving ineligible pregnant women or
children; and,
(ii) establishes criteria that ensures eligible pregnant women and children are served
first.
(2) If a program chooses to enroll participants, who are neither income nor categorically
eligible, and whose family incomes are between 100 and 130 percent of the poverty
line, it must be able to report to the Head Start Regional Program Office:
(i) how it is meeting the needs of low-income families or families potentially eligible for
public assistance, homeless children, and children in foster care, and include local
demographic data on these populations;

(ii) outreach and enrollment policies and procedures that ensure it is meeting the needs
of income eligible or categorically eligible children or pregnant women, before serving
over-income children or pregnant women;
(iii) efforts, including outreach, to be fully enrolled with income eligible or categorically
eligible pregnant women or children;
(iv) policies, procedures, and selection criteria it uses to serve eligible children;
(v) its current enrollment and its enrollment for the previous year;
(vi) the number of pregnant women and children served, disaggregated by whether
they are either income or categorically eligible or meet the over-income requirements
of paragraph (c)(2) of this section; and,
(vii) the eligibility criteria category of each child on the programs waiting list.
(e) Additional Allowances for Indian tribes.
(1) Notwithstanding paragraph (c)(2) of this section, a tribal Head Start or Early Head
Start program may fill more than10 percent of its enrollment with participants whose
family incomes exceed the low-income guidelines or who are not categorically eligible,
if:
(i) the program has served all pregnant women or children who wish to be enrolled from
Indian and non-Indian families living on the reservation who either meet low-income
guidelines or who are categorically eligible;
(ii) the program has served all pregnant women or children who wish to be enrolled
from income-eligible or categorically-eligible Indian families native to the reservation,
but living in non-res. areas the tribe has approved as part of its service area;
(iii) the tribe has resources within its grant or from other non-federal sources, without
using additional funds from HHS intended to expand Early Head Start or Head Start
services, to enroll pregnant women or children whose family incomes exceed lowincome guidelines or who are not categorically eligible; and,
(iv) at least 51 percent of the programs participants are either income or categorically
eligible.
(2) If another Early Head Start or Head Start program does not serve a non-reservation
area, the program must serve all income-eligible and categorically-eligible Indian and
non-Indian pregnant women or children who wish to enroll before serving over-income
pregnant women or children.
(3) A program that meets the conditions of this paragraph must annually set criteria
that are approved by the policy council and the tribal council for selecting over-income
pregnant women or children who would benefit from Early Head Start or Head Start
services.
(f) Categorical eligibility requirements.
(1) A family is categorically eligible for Head Start, if:
(i) the child is homeless, as defined in 1305.2; or,
(ii) the child is in foster care, as defined in 1305.2.
(2) If a program determines a child is categorically eligible under (1)(i) in this
paragraph, it must allow the child to attend a Head Start program, without
immunization and other medical records, proof of residency, birth certificates, or other
documents. The program must give the family reasonable time to present these
documents.
(g) Migrant or Seasonal eligibility requirements.
A child is eligible for Migrant or Seasonal Head Start, if:
(1) the family meets an income eligibility requirement in paragraph (c); or
(2) the family meets a categorical requirement in paragraph (f); and
(3) the familys income comes primarily from agricultural work.

Food Stamps
Income

All households must meet an income test to receive benefits. Income limits vary
by household size. You *may* be eligible for Food and Nutrition Services if your
total income falls below the appropriate gross income limits for your household
size. Please be aware that the eligibility workers at your local county Department
of Social Services determine which income limit applies to your household and
have many other factors to consider in determining if you are eligible.
"Household" size refers to the number in the household who may be eligible for
FNS. Individuals who receive SSI, WFFA, or the household contains an aged or
disabled individual may have different eligibility requirements.
Household Composition
Individuals residing together, but purchasing and preparing their meals
separately, may participate in FNS as a separate household. Some individuals
must participate in FNS as one household even though they purchase and prepare
their meals separately.
Individuals who must participate in FNS as one household are:

Individuals living together who purchase/prepare their food together or will do

so upon receipt of food assistance

Spouses living together or individuals representing themselves as husband

and wife to the community

Individuals under 22 living with a parent

Individuals under 18 under the parental control of an adult living in the home;
or

Two unmarried adults living in the same home who are parents of a mutual
child

Citizenship/Immigration Status
Each member of the FNS household must be a U. S. Citizen or an immigrant
admitted to the United States under a specific immigration status. Citizens
and eligible immigrants must also meet all other FNS eligibility requirements
to receive assistance.
You can choose not to apply for yourself or members of your household and
are not required to answer questions about Social Security Numbers (SSNs)
and citizenship/immigration information for those you choose not to apply
for. For each individual that you are applying for you must provide
information about SSNs and citizenship/immigration status. Providing a SSN
is required by the Food and Nutrition Act for applicants seeking benefits. We
will not share SSNs with INS. We will only use the SSNs you give us to do
computer matches and check what you told us with State and Federal
Agencies. You must be a United States (U.S.) citizen or an eligible alien and
also meet other Food and Nutrition Services rules to get Food and Nutrition
Services benefits. We will only contact USCIS to check the immigration status
on the household members who give us their immigrant documents. If an
applicant does not provide this information, they will be ineligible for benefits.

Household members must provide their financial information because it is

needed to determine eligibility for individuals who are applying. Eligible
household members who apply will be able to get benefits even though some
people in the household are not applying for benefits. The amount of
benefits will depend on the number of people requesting benefits.
Resources
Some households may be subject to a resource test. For households subject to
the resource test the household may have $2,250 in countable resources, such as
bank accounts and money in certain retirement accounts. Households may have
$3,250 if at least one person is age 60 or older or disabled. Certain resources are
not counted, such as homes, buildings, and land. The resources of people who
receive Supplemental Security Income (SSI), Work First payments or services, or
households that are Categorically Eligible are not countable.

Work First

Medicaid
Medicaid serves low-income parents, children, seniors, and people with disabilities. There
are different types of coverage for people with different needs. Income and resource
limits for each of these groups vary:
Aged, Blind and Disabled
Infants, Children and Families
Long-Term Care
Medicare Recipients
To be eligible for Medicaid, you must also:
Be a U.S. citizen or provide proof of eligible immigration status. Individuals only
applying for emergency services are not required to provide documentation of
immigration status.
Live in North Carolina, and provide proof of residency.

Have a Social Security number or have applied for one.

You are automatically eligible for Medicaid if you receive any of the following benefits:
Supplemental Security Income (SSI)
Work First Family Assistance
State/County Special Assistance for the Aged or Disabled (Adult Care Home
Assistance)
Special Assistance to the Blind
To receive Medicaid, you do not have to go through a physical or other type of exam.
However, if you are applying because you are disabled, a medical exam may be required.
If you are applying for Medicaid because you are pregnant, proof of pregnancy is required.

Child Service Coordination

Child Service Coordination serves children with a developmental delay, a disability, a
chronic illness, or an emotional or social disorder. Children and their families get
preventive and specialized support services. The program is family-centered and familydriven.
Our Child Service Coordinators develop a service plan for your child and family based on
your familys strengths, needs and concerns. They then work with other health and social
service providers to monitor your childs development.
The coordinator strengthens your interactions with your child and helps your family to be
self-sufficient. You can receive information about available programs and services,
assistance with application forms, and/or help to locate appropriate resources.
Your coordinator with follow up with you at least every three months. However, the
frequency is actually based on your familys ability and need. Children from birth to age
three who meet one of the Risk Indicators and children from birth to five who meet one of
the Diagnosed Conditions are eligible. There are no income eligibility requirements for
this Program.

Baby Love
Maternal Support Services are available to Medicaid-eligible pregnant women during and
after pregnancy (60-day postpartum period) for the purpose of promoting a healthy
pregnancy and positive birth outcomes.