(Photo by Andrea Piacquadio from Pexels)
Even though the Affordable Care Act survived another challenge at the Supreme Court earlier this year, America’s social safety net remains under constant threat.
Medicaid, SNAP, and cash assistance programs are perennial targets of various state legislature’s chopping blocks. At the same time, enrollments in WIC, the Special Supplemental Nutrition Program for Women, Children, and Infants, continue to decline. And the lack of support for it could affect pregnancies, birth outcomes, and child development for low-income families in the Philadelphia region and beyond.
A report from Benefits Data Trust released earlier this year in partnership with the Center on Budget and Policy Priorities found that states could lower health disparities and increase WIC enrollments by using data-sharing and other technologies to promote the program to eligible Medicaid and SNAP participants.
Through four pilot projects in Colorado, Massachusetts, Montana, and Virginia, BDT created a framework for using other social safety net programs to broaden WIC coverage. States could now reach more low-income women and families while also addressing the racial inequities prevalent in these areas.
In Philadelphia, where the pandemic wreaked havoc on the region’s WIC programs, such as North Inc., a provider since 1979, additional support from the state would be beneficial. But according to Dr. Linda Kilby, the organization’s director, instead of giving women and children in need continuity throughout COVID-19, officials decided to create chaos.
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“We learned [April 1] that we will no longer be the providers of the WIC program in Philadelphia County,” Kilby said. “There are three areas that are basically run by African American women. Shenango Valley which is on the Western side. South — Mercer, Venango, and Forest Counties, little counties, but they’re very important, they’re run by minorities, and North.”
“And all of these have not been given … they were not awarded to continue [to provide WIC],” she said.
America incorporated WIC into its social safety net in 1974 for low-income and at-risk pregnant and postpartum women and their children, hoping to bolster their nutritional health. Throughout its first 20 years, Congress underfunded the program, forcing people in need to go on waiting lists and organizations to apportion what few resources they had by priority.
But in 1997, legislators threw their support into the program, and enrollments increased up to and through the Great Recession.
For the past 10 years, participation has declined, from 9 million in 2010 to under 6.5 million in 2019. According to CBPP, the share of eligible persons participating in WIC is known as the “coverage rate,” and in a survey, the organization found that misinformation plays a significant role in the falling coverage rate. Many families that qualify for WIC believe they are ineligible for various reasons — because they have a working adult in the house, a child over the age of one, or that only Medicaid participants can receive it.
The survey also found that some families don’t value WIC services such as breastfeeding support and nutritional education, while the amount of paperwork required can turn people off the program. Finding WIC-approved foods and stores also affects a person’s decision to join the program.
Jessica Maneely, a policy manager at BDT and one of the authors of the report, says that stigma plays an essential role in keeping families away from WIC. She told Generocity that enrolling could feel like an impersonal process because, for example, participants have to come for an office visit and have their height measured and weight taken.
“It’s a very clinical process to enroll in WIC because they very much see it as a public health program and an intervention to where food is medicine,” Maneely said.
The upside is, research shows the program improves long-term outcomes for women and children. WIC participants have healthier babies who are more likely to be immunized, score higher on assessments of mental development and have lower incidences of obesity, among other things. Such things are important for not only low-income families but Black and Latinx women who have higher risks for pregnancy-related health issues, including preterm birth, low birth weight, and possible death of the mother or child.
To address declining enrollments, Maneely and BDT initiated four pilot programs in Colorado, Massachusetts, Montana, and Virginia, attempting to match data from Medicaid, SNAP, and WIC to bring participants from the first two programs into the third.
Not only did the program achieve its goals by assisting more families, but it also streamlined complicated, often siloed administrative processes too.
For example, BDT identified over 100,000 persons using Medicaid, SNAP, and other social safety net programs who were not on WIC in the Virginia pilot program.
According to Maneely, while not all of those people were brought over to WIC, the data match put program officials on the road to almost doubling enrollments and closing the coverage gap. “We know a whole lot of information about them that could be used to better target and better serve those families,” Maneely said.
Once they achieved their data-matching goals, BDT used that information to conduct outreach in various ways, including text messaging, multi-benefit online applications, health-provider referrals, and more.
The WIC Outreach pilot results were mixed; some audiences were more likely to enroll after getting texts than others, depending on the audience. For example, texting was beneficial, especially for Medicaid-only participants in Virginia. On the other hand, Colorado, Montana, or Virginia-based SNAP-only participants did not enroll at higher rates.
Overall, the program was a success. And as BDT’s CEO Trooper Sanders told Generocity, it will help increase WIC enrollments.
“Using data matching across programs, such as WIC, is an effective strategy to help policymakers identify participation gaps and take concrete steps to improve access and enrollment,” Sanders said. “By increasing access to WIC, states can improve maternal and child health, which is critical to reducing racial disparities in health and education outcomes.”
But in Philadelphia, for organizations like North Inc., enrolling families in WIC continues to be a challenge during the COVID-19 pandemic.
When social distancing went into effect and closed everything down, that meant using drop-boxes and the postal service to give people their benefits. Pennsylvania is one of only a few states that use benefits cards that can’t be reloaded electronically. As Kilby told Generocity, serving clients became difficult, as new moms understandably didn’t want to go outside.
“I just closed the [office] that’s on Chelten Ave. in the Germantown section because the caseloads had gone down so far that I could not afford to keep the space,” Kilby said.
Kilby, a nutrition professional with a master’s in health administration and a doctorate in public health, has been with North Inc. since the beginning. Her first concern is always the women and children that come into her office, and she said she worries about those without SNAP benefits or access to unemployment, especially as the WIC caseloads continue to fall.
Come this October, Kilby has to worry whether her families will still receive the same level of care that North Inc. has given them for the past 30 years.
Last year, the Bureau of Women, Infants, and Children, housed within the Pennsylvania Department of Health, had each of the county WIC offices rebid for their contracts. North Inc., which has served the area for decades, lost a $30 million, five-year contract to Temple University, a new provider in the space.
In addition, included in the WIC organizations that lost their contracts were all of Pennsylvania’s minority-run programs. “There’s no rhyme or reason to this,” Kilby said. “It’s like someone is trying to just dismantle the WIC program in Pennsylvania.”
For now, Kilby perseveres, caring for her families and hoping to bring attention to her cause. BDT continues as well, with their recent report being the second of three that hopes to bring attention to the need for increasing enrollments in WIC.
“Whether people are on benefits or off benefits, the really important thing is that they have access to everything that they’re going to need to be a healthy, happy human living in the world, thriving,” Maneely said.
“Let’s meet people’s needs, totally, wherever they’re at in the world, in their circumstance. And if we can align on that, then maybe we can get somewhere,” she said.-30-
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