COVID-19 necessitated WIC changes that reduced barriers to the program. Let’s keep them.
LOUISA SHOLAR: Imagine you’re a single, new mother who was just laid off from your job. You struggle with reading English, but you were put in contact with a WIC agency in your state. You have to gather different kinds of documents in order to register for the program, commit to quarterly check-ins and nutrition classes (all in-person), and follow a specific list of foods you can purchase. Then the COVID-19 pandemic hits: you aren’t supposed to travel anywhere, supermarket shelves become much more bare and you need to learn what this program can help you with and how to navigate it.
You wouldn’t be alone in feeling discouraged even before COVID-19 hit. Individuals on WIC, the nation’s third-largest food and nutrition assistance program for mothers and their infants, can struggle with participation barriers every day. WIC enrollment and participation is constrained by learning costs associated with enrollment and program requirement components, compliance costs via restrictive eligible food lists, language barriers, and transportation hurdles for in-person meetings; and psychological costs regarding the stigma of program use and psychological stress in shopping environments.
COVID-19 adjustments
The COVID-19 pandemic necessitated changes to WIC’s program operations that were executed via the Families First Coronavirus Response Act (passed March 18, 2020), which vested the USDA with the authority to approve waivers for states for SNAP and WIC programs. These waivers made adjustments like:
allowing participants to receive WIC benefits remotely without coming into a WIC clinic,
allowing participants to enroll and re-enroll in WIC remotely (including the ability to defer certain health paperwork requirements typically necessary to determine nutritional risk),
allowing WIC purchases to be made without the presence of a cashier, facilitating the use of online ordering and curbside pickup options,
allowing WIC agencies to make appropriate substitutions for unavailable WIC food package items and allowing state agencies to change approved-foods lists as needed,
and many more.
After a series of extensions, the waivers have ultimately been set to expire 30 days after the end of the nationally declared public health emergency (PHE), which is currently in place until January 2022. However, we should keep and expand adjustments that reduce administrative burdens to make the program permanently accessible and nimble, not just during disaster circumstances.
Why disaster-proof WIC?
A primary reason for keeping pandemic adjustments and further disaster-proofing WIC is because we know adjustments have already increased participation and eased benefit redemption by lowering administrative burdens. During the first year of the pandemic, WIC participation increased by 2.1%, after trending downward since 2011. Furthermore, in a study on COVID adjustments to the program, WIC participants reported satisfaction with remote appointments and a reduction in the compliance costs of accessing and maintaining benefits. Keeping the adjustments permanent and finding ways to expand them can continue that progress.
Access to WIC is also a justice and equity issue, as historically marginalized groups are likely to be eligible for WIC as they experience poorer health outcomes and accumulate less wealth. The eligibility requirements to enroll in the program consist of income thresholds (meeting between 100 and 185% of the federal poverty guidelines), and display of nutritional risk. We know that Black and brown women in the U.S. are more likely to live in poverty, which can also correspond to increased risk during disasters, and that women of color, especially Black women, face persistent health inequities. In 2018, WIC coverage rates were highest for Hispanic (63%) and non-Hispanic Black and races other than White (59%) eligible individuals, and lowest for non-Hispanic White eligible individuals (49%).
It is common for the number of eligible individuals to be higher than those enrolled; for example, in 2018, just 56.9% of eligible individuals and 44.2 percent of eligible children participated in WIC. In context of the economic effects of the pandemic especially, it is estimated that the number of people eligible to receive benefits has increased.
Finally, disaster-proofing WIC will make program continuance easier when disasters occur by standardizing and streamlining service delivery -- this will help administrators anticipate how to navigate future environmental- or human-related disasters/emergencies.
The lessons are ours for the taking.
Those who are accessing WIC already struggle with administrative burdens relating to how much they have to learn in order to participate, the requirements they must follow, and the psychological costs they often bear relating to stigma and the stress of securing the right resources for themselves and their children. Making COVID-era adjustments permanent will help reduce those barriers as well as transition the WIC program to an anticipatory approach that truly reflects priorities of resilience and recovery. Given what we know about WIC enrollments and experiences over the pandemic, these adjustments exemplify how program accessibility will significantly benefit recipients. We should go forward with those changes, not backwards.
What would disaster-proofing look like?
Disaster-proofing WIC and keeping pandemic adjustments permanent means recognizing a likely increase in future disaster scenarios as well as the need to reduce burdens for participants under “normal” circumstances. There are a few areas of burden that could be addressed via an permanent extension of COVID-era adjustments plus additional remedies:
In-person requirements: One of the largest burdens is requiring prospective participants and current participants to travel to enroll, load cards and attend nutrition courses. As during the pandemic and during other natural disasters, travel can become even more challenging or impossible. Retaining changes necessitated by the pandemic and going further to reduce transportation costs can be accomplished by the following (address compliance costs):
Use of EBT-style cards that can be checked online
Online shopping options
Virtual nutrition education courses
Making WIC offices/clinics mobile
Food list adjustments: Another challenge for participants is meeting the strict requirements for eligible food lists, even under non-disaster scenarios. Such challenges can be amplified during disaster circumstances as food supply and distribution are disrupted. Addresses: learning costs, compliance costs, psychological costs
Make lists of acceptable food lists more flexible-- continue with waivers that allow substitutes to be used for items
Address supply: promote a messaging and campaign strategy to ensure retailers are encouraged to stock WIC-compliant items and incorporate that consideration into relief/distribution efforts in immediate, on-the-ground disaster response
Louisa Sholar is a Master of Public Policy candidate at the McCourt School of Public Policy at Georgetown. Originally from Mooresville, North Carolina, she is a graduate of Elon University and an alum of the Lead for North Carolina (LFNC) public service program.